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Back to School: A Q&A with Pediatrician O. Douglas Wilson, MD


By Scott LaFee   |   September 01, 2017

​It’s back to school time, though for some children, it’s really going to school for the first time. Whatever the case, there are invariably questions, aside from why was summer so short or long (depending on who’s asking). We asked O. Douglas Wilson, MD, pediatrician at UC San Diego Health, to answer some of the most common queries, from how much sleep children need to do well in school to the weighty topic of backpacks.

Question: How much sleep should my child be getting during the school year?

O. Douglas Wilson

Answer: This is one of the most frequent concerns for parents as the children need to wake early to attend their early morning classes and knowing how late to stay up doing homework while also sustaining their extracurricular activities. The American Academy of Sleep Medicine recommends the following healthy sleep hours:

  • Infants, 4 to 12 months: 12 to 16 hours including naps
  • Toddlers, 1 to 2 years: 11 to 14 hours including naps
  • Preschoolers, 3 to 5 years: 10 to 13 hours including naps
  • Grade schoolers, 6 to 12 years: 9 to 12 hours
  • Teens, 13 to 18 years: 8 to 10 hours

This is somewhat surprising for many parents that so much sleep is needed, but proper sleep hygiene is very important for students to do well in school and to stay healthy overall. With teens it becomes even more difficult with the amount of homework needed after school and with the many who are involved in extracurricular activities, such as sports.

It’s also important to maintain a regular rhythmic sleep-wake cycle to avoid adversely affecting the circadian rhythm, which can be caused by staying up late and sleeping late on the weekends. This may result in early weekday lethargy and lack of concentration and fatigue. Further, there should be no screen time for about one hour before bedtime and no screen time while in bed.

Q: What is the best way to prevent and treat a lice infestation?

A: Head lice infestation, or Pediculosis capitis for the Latin term, is somewhat common after returning to the classrooms. Though this is a rather disgusting finding for parents, it is not due to uncleanliness or poor parenting. The transmission of head lice requires close contact with the heads of persons with live lice. It can be transmitted by wearing an infested person’s hat or scarf or using that person’s comb or brush. The lice cannot fly or jump, but they crawl quite rapidly, so close contact is to be avoided if there is a history of head lice in the classroom. Having overnights with a person with head lice can be a problem as contact with pillows and bedclothes can transmit the lice.

Short hair is less conducive to acquiring head lice, so girls with long hair are at a disadvantage. If there is a history of head lice in the classroom, doing nightly head checks can be done to look for evidence of live lice or unhatched nits. Adult lice lay their eggs at the base of the hair shaft so any nit shells over one-quarter-inch from the base of the hair shaft have hatched and are just shells. 

If head lice are seen or are suspected, the best option is to call your primary care provider’s office; this can often be handled without being seen. If you are unsure if there are lice, your child can be seen so your provider can check. There are several options for therapy, so it is best to get the options you’re your primary care provider’s office. You will be given advice for removing nits and will be told that it is best if everyone in the family receives treatment as well. Do not worry about the persistence of nits far out on the hair shaft as these are empty shells that are not infective. The American Academy of Pediatrics is encouraging schools to abandon their “no nits policy,” if it exists. Your child should be allowed to return to school after the first therapy. 

Q: When should a child stay home from school for health reasons?

A: This, of course, depends on what the health condition is. Usually, parents want to know when a child with an infectious disease can return to school. This is quite variable depending upon the disease entity.  The best source of information is your child’s health care provider. I will comment on some of the more common entities.

  • Documented Streptococcal Throat infection: 24 hours after the first antibiotic dose and no fever.
  • Whooping Cough (Pertussis) documented by nasal swab: 5 days after beginning treatment or, if not treated, 3 weeks after the onset of the illness.
  • Chickenpox (Varicella): After all the blisters are crusted. This is usually day 6 or 7 of the rash
  • Pink Eye (Bacterial Conjunctivitis): 24 hours after beginning antibiotic eye drops and no fever.
  • Ear Infections: After 24 hours of no fever and no significant ear pain.
  • Diarrhea and Vomiting: 48 hours after there are no further symptoms and there is no fever.
  • Influenza: 24 hours after fever resolution without using anti-fever medications. 
  • Hand-Foot Mouth Disease: 24 hours after the fever is gone and all the blisters have dried up.
  • Croup: 3 days after the disease onset and free of fever and with normal breathing.
  • Colds and Coughs: This depends on what is causing the symptoms. Most are due to viruses and return to school can occur when there is no fever for 24 hours and the child is comfortable.
  • Head Lice: After the treatment regimen has been instituted. We advise that children can return without all of the nits removed.
back to school chalkboard

The most important comment I can make here is that there are vaccines that can prevent many of these childhood illnesses and we strongly advise that all children be fully immunized for age before entry into school settings. 

Q: Is there a rule of thumb for how heavy a child’s backpack should be?

A: The back pack should not be heavier than 10 percent of your child’s weight. For instance, a 50-pound child should not carry a backpack weighing more than five pounds. Also, it is imperative that all of the shoulder straps be over the shoulders and it should be held up high on the back and not hanging down below the waist. Otherwise the child is at risk for serious back pain.

Q: What is the best approach for a child overwhelmed by their new school environment?

A: The first days of school can be scary and your child may be especially anxious about attending a school that is new to them. The response to this anxiety is dependent on the age of the child and on their prior experiences in school. There are several approaches you can take to ease this anxiety regardless of the age of the child.

Prior to the beginning of the first day, visit the school: Driving to the new school or walking with your child to the school so that they will know where it is and how they will get there. Also, if there are friends that the child has made who will attend the school, get together with them so your child knows that there will be someone he or she knows there. Also, walk around school grounds looking at the playground and the fun things about that. Let your child know where the bathrooms are and even let them look in the windows to see what the classrooms are like. 

If you can obtain the name of the teacher and, if it is provided, arrange to visit with the teacher to get an idea of what the day’s routines will be: This will help your child to be prepared for the first day rather than worrying about the mystery of what will occur.

Prepare your child at home: Talk in specific terms about what will happen at school. For the younger ages, playing school at home is helpful. Make sure your child knows ahead of time how he or she will get to school including what time he or she will go to bed at night and when he or she will be required to get up in the morning. Discuss what your child will be doing during the day and what you will be doing while he or she is at school. Make sure that your child knows ahead of time how he or she will get lunch. Also, let your child know what will happen when the school day ends and what will happen when he or she arrives at home.

If your child persistently resists going to school or cries daily and is not adjusting to the school routine after the first several days, make an appointment with your child’s care provider to discuss other approaches.

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