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Back to School Health
Published on 23 August 2017 by Dr Fionnuala Barton, GP, updated on 23 August 2017
Ten top tips for a healthy return to school
Over the Summer months children enjoy freedom from school and homework, and many of the normal daily routines. It is a time when holidays are often taken and rules are often relaxed when it comes to sleep, activities and nutrition. Returning to school can involve a big adjustment. Children and adolescents often benefit from some help transitioning. Here are some tips to consider:
1) Make sure your kids are “up-to-date” on all their immunisations. If they are starting school for the first time they should have already had their pre-school vaccinations: 4-in-1 booster to protect against diphtheria, tetanus, polio, whooping cough and their MMR against measles, mumps and rubella. The next routine vaccination is the HPV vaccine for girls in year 8. Between 13-18 they should also receive their 3-in-1 teen “booster” against diptheria, tetanus and polio and a Meningitis ACWY vaccination.
2) Hearing and Vision – these are both screened routinely in all children (including those in Private and Home Educated settings) by School Nurses. This normally happens in Reception. Symptoms of hearing problems to watch out for include: inattentiveness, change in concentration, mispronouncing words, talking loudly or listening to things at loud volume and change in progress at school. Symptoms of underlying visual problems can include: headaches, change in performance at school, behavioural change, sitting closer to TV or losing interest in reading. If you have any concerns see your GP or School Nurse for more information.
3) Teeth – tooth decay is the most common chronic condition of childhood and accounts for many missed school days. Tooth extractions are the most common reason for a child to have a general anaesthetic. This is all entirely preventable. Children should brush teeth twice daily (under supervision up to the age of 7) with a pea-sized blob of fluorinated toothpaste (1000 ppm); they should spit not swallow and NOT RINSE after brushing. Avoid decay by cutting out excessive sugar in the diet (juices, fizzy drinks, sweets) and attending a dentist at least 1 per year for check ups so they can intervene early.
4) Nutrition – this is important all the time, not just in term time. But if rules are more relaxed in the holidays now is the time to re-instate the rules and boundaries and encourage long-term healthy eating habits. Aim to have three meals per day of an appropriate “fist-sized” portion size for your child. Avoid processed foods that contain lots of hidden sugar and salt such as sugary breakfast cereals and squash. These can encourage a “sweet tooth” and dependence on sweet sugary foods that can have detrimental effects in the long term. Encourage wholegrain versions of starchy foods such as bread and pasta as soon as possible to prevent difficult-to-break habits. Children should drink approximately 6-8 x 250ml glasses of water per day. Ideally this should be plain water rather than squash or juice. Avoid habitual or “reward” snacks such as sweets or crisps at break-time and instead encourage eating at meal-times or offer a healthy savoury snack or piece of fruit. Aim for 5 (or more) portions of different vegetables and fruit per day but remember fruit contains lots of sugar. Children should eat at the table and try to eat as a family as often as possible to provide role-models. Discourage “pudding” with every meal which can lead to bad habit formation. Encourage your children and teens to enjoy food by involving them in shopping for and preparing meals. Change4Life have some great starter resources www.nhs.uk/change4life.co.uk and “me size meals” advice. If you worry that your child is a “Fussy Eater” speak to your School Nurse for advice such as offering very small portions and giving seconds when requested; encouraging all good eating behaviour and ignoring bad behaviour. Try never to offer an alternative if the initial meal is refused.
5) Physical Activity – this goes hand in hand with nutrition and is crucially important to maintain good health and function. Children should be taking part in “vigorous” physical activity for AT LEAST 1 hour per day. So, try to develop strategies to enjoy physical activity together as a whole family: be a positive role model. Walk or cycle to school and encourage your children to play actively. Minimise “screen time” and passive TV time.
6) Constipation and Soiling – these can often be a result of a diet that is insufficient of fibre and fluid so ensure your child is drinking 6-8 glasses of water per day, eating plenty of fibre and exercising frequently. Encourage a regular toileting routine e.g before school or after every meal. Try to reduce fear about toilets, listen to why your child is frightened and reassure. Consider using a step to support your child’s feet when on the toilet or having bubbles to blow in the bathroom which can help with pushing. Talk to your child about “poo”, make it non-taboo. Soiling often occurs at times of change to routine and anxiety so watch out for this on return to school.
7) Bed wetting – is very common with 1 in 7 children aged 5 affected. Most will settle by early teens. The following tips can help: reassure your child and try not to get cross; do not restrict fluid intake! – on the contrary, encourage 6-8 glasses of water per day to increase bladder capacity and prevent co-existent constipation; encourage regular toileting during the day – even consider a reminder system; give children time to empty bladder fully in a “comfortable” environment; talk to them about any fears they may have e.g. going to the loo at school; make “last drink” 1 hour before bed and encourage child to “double void” – once before getting in to bed and again before settling after any bedtime reading; avoid tea, coffee, hot chocolate, fizzy drinks or juice as these can irritate the bladder. Praise dry nights or nights when they have used the toilet themselves at night. If these are not enough, then consider talking to your GP. www.eric.org.uk is a helpful resource.
8) Growing up, Behaviour issues and Body Changes – be open with your children from an early age about relationships, puberty and the changes that they may notice. Answer their questions simply and with honesty. Consider introducing the correct names for sexual body parts so they are familiar and less daunted. Supporting a child in this area encourages positive self-esteem, healthy attitudes to their body and the ability to form safe friendships and relationships. Behaviour change is common when there is a change of routine such as start of new year at school. To help navigate this tricky time try to be consistent with your strategy of managing poor behaviour. Maintain your boundaries as these encourage your child to feel secure. Have confidence in what you say and do. Reward good behaviour and ignore the bad. Have reasonable expectations (they will not be perfect 100% of the time, were you?). Consider setting aside quality time with your child to build positive trusting relationships full of love and laughter as that way they know they can come to you when they need. Also try to imagine yourself in your child’s position as this can help to understand their behaviour.
9) Anxiety and Depression – sadly 1 in 6 young people admit to struggling with symptoms of anxiety and depression, and there are probably many more struggling silently. Unrecognised and untreated, this can lead to suicide. To spot symptoms look for persistent frightened, nervous or panicky behaviour, low mood, poor sleep and appetite, poor concentration and loss of interest in things or withdrawal from friends and activities. Often anxiety can cause irritability and tiredness but also physical symptoms such as dry mouth, palpitations, trembling, feeling faint or stomach cramps and diarrhoea. If you are concerned about your child speak to your GP and School Nurse or Teacher early to access support. If there is bullying as a cause intervene early as studies show that bullying at school has strong links to anxiety and depression in adulthood. Encourage your child to talk about their day and really listen. Encourage your child to explore www.youngminds.org.uk or Kooth.com online resources.
10) Sleep – it is nice to let your kids stay up a bit later in Summer, especially on holiday. But it is important to remember that children still require more sleep than adults. These are some guidelines from the National Sleep Foundation: AGE 3-5 10-13hrs per night AGE 6-13 9-11hrs per night AGE 14+ 8-10 hrs per night
It can take up to 6 weeks to settle back into a healthy sleep routine once it has been disturbed so it is important to try and stick to a positive and consistent bedtime routine as much as possible during the holidays. To help your children fall to sleep easier consider these tips:
- Encourage a warm bath or shower before bed – this warms the body and triggers the brain to induce a sleepy state
- turn the lights down a few hrs before bedtime and turn off/put away any devices that have a bright screen as this stimulates the brain
- avoid caffeine-containing drinks (incl hot chocolate) in the evening
- give your child or teen time to share their experiences and worries of the day and try to listen carefully. They will learn that they can feel safe and trust to talk to you with any future worries
- read together once already in bed.
Hopefully, your child will transition easily back to school in the coming weeks and these tips with be superfluous. If not, then consider some of the advice I have gathered here and don’t hesitate to come and see us here for advice if required. Just call 0800 852 1234.