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Feb 22, 2006
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Off-to-School Health Special

Whether he's in daycare, preschool, or beyond, here's what to know to protect your child and keep him well this year

By Marguerite Lamb

Now's the time to...
Ease your child into her new sleep schedule.

"Kids can't just jump from a nine-thirty bedtime to eight o'clock," says Jodi Mindell, Ph.D., associate director of the Sleep Center at the Children's Hospital of Philadelphia. To make the transition:
  • Move bedtime and wake time up by 15 minutes starting two to three weeks before the first day of the new routine. Every few days, make them another 15 minutes earlier.
  • Declare a ban on screen time for the hour before bed; cut out caffeine a few hours earlier. These changes will help her fall asleep faster.
Getting there
School-bus accidents actually are surprisingly rare. When they do happen, they're often in the first two months of the school year, when kids are anxious or excited, and less likely to be cautious when getting on or off the bus. All the more reason to teach your child these tips now:
  • Stand way back from the street at the bus stop.
  • Wait until the bus stops completely and the driver has opened the door before approaching the bus.
  • Use the handrail when getting on and off.
  • Cross in front of the bus, instead of behind it. Take ten big steps away from the bus after getting off, and be sure the driver waves you across before crossing in front.
  • Don't stop to pick up stuff dropped near, under, or in front of the bus until the coast is clear.
Fact: Riding the bus is 12 times safer than walking, biking, or riding in a car to school

Better school lunches
Sandwich upgrade
Switching to whole-wheat bread isn't the only way to make your kid's lunch pack a healthier punch. Rethinking what you put between those slices can also add nutrients — and variety. Kid-tested suggestions from dietitian Bridget Swinney, the author of Baby Bites:

Old standby: Peanut butter and jelly
Upgrade: Almond, cashew, or sunflower-seed butter instead of peanut. All three provide significantly more iron and magnesium. Almond and sunflower butters also offer almost three times the vitamin E; almond provides calcium, too.

Old standby: Turkey or ham
Upgrade: Lean roast beef. It's nutritionally denser than turkey or ham, providing the same amount of protein but a lot more iron, zinc, and vitamin B12 — for about the same or only slightly more fat and calories.

Old standby: Bologna
Upgrade: Turkey or meatless bologna. Turkey has about half the fat, with just as much protein. Better still: Meatless (which is made from wheat and soy but tastes surprisingly good) has zero fat and cholesterol, and about twice the protein of regular.

Old standby: Cream cheese and jelly
Upgrade: Low-fat cream cheese with fruit spread. You'll cut four grams of fat per ounce of cheese. Fruit spreads (like Polaner All Fruit or Smucker's Simply Fruit) have about 20 percent fewer calories and about a third less sugar than jellies and jams.

Field trip tip! A double brown bag with a frozen water bottle or juice box inside works just as well as an insulated sack or lunch box to keep foods fresh — and you don't have to worry about it getting left behind. The drink will thaw in time for lunch.

Not-so-unusual ailments
Unpack that bag
Homework really can be a pain in the neck. Experts say a backpack should weigh no more than 15 percent of a child's body weight, but most kids carry more.

The result: "We're seeing more children with neck, shoulder, and back problems," says Karen Jacobs, a spokesperson for the American Occupational Therapy Association.

To ease the strain, have your child:
  • Pack the heaviest items closest to the back of the pack
  • Use the right-size bag (one that sits below the shoulder blades and extends no lower than the waist), with well-padded shoulder straps
  • Wear the bag snug against his back
  • Hand-carry a book or two if his backpack weighs a ton
  • Empty out nonessentials daily
Louse-y luck?
You may have heard that lice are gaining resistance to the shampoos that worked when we were kids. It's true, but for now Nix and Rid are still the best first line of defense, says Barbara Frankowski, M.D., chair of the American Academy of Pediatrics Council on School Health.
If you get the dreaded call from daycare or school, use a shampoo treatment and let your child return to class the next day. You may have to repeat the process a week later to kill newly hatched lice. If your child still has live lice after that second dose, she may have a resistant strain. Her doctor can help you weigh the risks of using a prescription shampoo that's stronger — but also harsher — than an over-the-counter.

Curious about insecticide-free alternatives? While meticulous combing without a shampoo works for some, it's not easy to pull off. Coating the hair in Cetaphil soap is your best bet for suffocating lice (it works better than home remedies like petroleum jelly, vinegar, and mayo). Visit to learn how to do it.

Get moving!
Ten minutes of exercise may not sound like much, but that's all it takes to boost attention and focus in schoolkids, according to a recent study at East Carolina University, in Greenville, North Carolina. (Bonus: These mini-workouts add up to about 70 miles of movement a year!) If your child's school doesn't offer regular P.E., talk to the teacher about a daily ten-minute "get the wiggles out" session. For some creative ideas for schoolkids of all ages, click on "Energizers" at

A guide to illness
Too sick for school?
"Mom, I don't feel good." Now what? Should you let your child stay home? Call the doctor? We asked Steven P. Shelov, M.D., coeditor of The American Academy of Pediatrics Guide to Your Child's Symptoms:

Sick child
Skip school: If your child's temperature is 100 degrees Fahrenheit or higher. A fever usually signals a contagious infection.
Call the doc: If he seems unusually lethargic, has a severe headache, is hallucinating or delirious, or still looks ill after the fever breaks.

Skip school: If his cough is persistent, severe, brings up mucus, or is accompanied by a fever.
Call the doc: If your child starts to have noisy, rapid, or difficult breathing, or you notice a blue tinge to his lips or fingernails.

Runny nose
Skip school: If he has other cold or flu symptoms. A drippy nose alone is no reason to skip school; just be sure he has plenty of tissues!
Call the doc: If your child is having difficulty breathing, is unusually sleepy or lethargic, or has a fever over 101 Fahrenheit.

Sore throat
Skip school: If the pain seems moderate to severe and isn't relieved by taking a drink
Call the doc: If there's also has a fever, spots on the throat, a severe headache, rash, swollen glands, red or painful joints, nausea, or trouble breathing.

Skip school: If the pain seems sharp or is concentrated in a specific area of the stomach, or is accompanied by fever, vomiting, or diarrhea
Call the doc: If it's severe and lasts longer than two hours, is accompanied by severe vomiting, or there's blood in vomit, stool, or urine.

Skip school: As long as your child is still having loose bowel movements
Call the doc: If it lasts past 48 hours, or if your child has a fever, is vomiting, there's blood in his stool, or you suspect dehydration

Skip school: If your child has thrown up within the past few hours, or has a fever or no appetite.
Call the doc: If your child also has a fever or diarrhea that lasts more than 12 hours, or shows signs of dehydration

Skip school: If your child also has a fever (this usually means an ear infection)
Call the doc: If your child has a fever, discharge from or swelling around the ear, headache, dizziness, or hearing loss

Skip school: Until it's diagnosed
Call the doc: No matter what. Many rashes are contagious; any skin eruptions should be seen and diagnosed by your pediatrician.

As somebody working in the schools, if there is anyway to get child care please keep sick and contagious kids home. My friends who sub say the first year you're sick just about every couple of weeks until you build up some immunity. I'm not looking forward to that part of the new job.


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