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October 2, 2006
With the kids back in school, now’s a good time to make sure they’re up to speed with immunizations, physicals, and other “maintenance.” Whether you are a healthcare professional, a teacher, or a parent, the beginning of the school year means life is going to be busier than usual. Doctors’ offices can expect more patients, whether it be for routine checkups or to tend to the first flu outbreak. For today’s students, there are the usual topics to address: lice, pink eye, dental health, and vision. But, pediatricians and general practitioners are faced with new challenges. “Immunizations are becoming a frequent topic of discussion because it is becoming clear that we are not aware of exactly how long these immunizations are lasting,” says Norman Lavin, MD, a pediatrician and an endocrinologist at Encino-Tarzana Regional Medical Center in Los Angeles. “The issue is not the initial immunization but rather when or if we should be reimmunizing. The American Academy of Pediatrics [AAP] is constantly revisiting the topic, but it is becoming apparent that immunizations for whooping cough, chicken pox, and the mumps are not lasting as long as we originally thought they would.” While the AAP has a recommended schedule of when children should be immunized against a particular disease, it is important that children be seen at their regularly scheduled doctor’s visits to be sure that their immunizations are current, explains Lavin. Another hot topic in children’s health circles is childhood obesity and nutrition. It is no secret that school districts across the country are under close scrutiny to improve the food options available to school-aged children. “Good nutrition and exercise are key to good health throughout the school year,” says Lavin. Although genetics is a component of obesity, 40% to 50% of good health lies in lifestyle choices, he adds. Good nutrition and daily physical exercise can reduce the likelihood of obesity, but the benefits are more far-reaching than the waistline. Good eating habits can stave off fatigue and headaches as well as improving ocular and dental health, according to healthcare professionals. Other topics of interest include shoe-fitting techniques, proper alignment of the computer screen to alleviate computer vision syndrome, the basics of good oral hygiene, and the ins and outs of purchasing a backpack. First Stop: The Pediatrician A child who has a good diet and is involved in regular daily exercise is more likely to be healthy throughout the school year than a child who has a poor diet and little or no exercise, he says. Therefore, it is also a good idea for healthcare providers to have some information and guidelines on hand to give parents, says Lavin. “Providing guidelines about the food pyramid, recommended daily exercise, and food portions will assist parents in helping their children make good food and lifestyle choices,” he says. Lavin believes soda—and even fruit juices—should be eliminated from a child’s diet. According to the AAP, “Each 12-ounce soft drink contains approximately 10 teaspoons of sugar and 150 calories. Drinking just one can of soda a day increases a child’s risk of obesity by 60%.” Lavin says emphasis should be placed on more fruits and vegetables and less on snack foods. As for other recommended checkups, Lavin says, “the first dentist visit should occur around age 2 or 3 unless there is some other issue requiring an earlier visit. Eye exams are generally conducted in the pediatrician’s or general practitioner’s office, but that should not deter a parent from taking his [or her] child to see an optometrist or ophthalmologist sooner if they want to.” In addition to a balanced diet, daily exercise, and regular checkups, Lavin says another important way to reduce illnesses and the spread of germs is through frequent hand washing. “The main reason infections spread is through the lack of hand washing or improper hand washing. When hand washing is not an option, using a hand sanitizer is fine,” he says. Eye Health Throughout the course of the school year, children may suffer from several common eye ailments. Many children have awakened only to find they cannot open their eyes. Although there are approximately 20 different kinds of conjunctivitis (also called pink eye), there are three which are the most common, explains Anshel. Environmental conjunctivitis is characterized by red, itchy, watery eyes, which are treated by relaxing the eyes and applying a cold compress. Redness and low tearing are symptoms of viral conjunctivitis, which is considered contagious. This form of conjunctivitis generally runs its course without treatment. In the case of bacterial conjunctivitis, symptoms include a goopy discharge from the eyes, which may glue the eyes shut. Treatment includes antibiotics and a hot compress for comfort; it will usually be resolved in approximately one week. Bacterial conjunctivitis, like the viral form, is highly contagious and can be spread from one eye to another. “It is important to wash your hands if you touch your eyes to preclude you from spreading it to the other eye or to others,” says Anshel. Although conjunctivitis has been lurking in classrooms for decades, another ocular irritation is becoming more common as computers become more prevalent in the classroom and at home: computer vision syndrome (CVS). According to the 2001 census, nearly 54 million children work at a computer each day either at home or school. Symptoms of CVS can include: tired, sore eyes due to eyestrain; periodic blurred near vision; occasional blurred distance vision; headaches; dry eye; slowness in changing the focus of the eyes; red, burning eyes; contact lens discomfort; changes in color perception; and glare sensitivity. Most of these symptoms are generally caused from simple ergonomics and misplaced lighting, says Anshel. “Our eyes naturally see best at a 40º angle, yet most schools and offices have the computer screen in the straight ahead position, which can increase the likelihood of CVS. Our focusing is more accurate at a lower level and ideally the computer screen should be 7 inches below eye level and should be at least 20 inches to 26 inches away,” says Anshel. “Extraneous light, or glare, is the greatest source of eyestrain for computer users,” says Anshel in a Johnson & Johnson vision care press release. Other issues that can contribute to eyestrain include staring at the computer screen for extended periods of time, which can cause dry eye, and improper workstation setup. Although there are no limitations to the amount of time a child should spend on the computer at a given time, Anshel says 30 minutes to one hour is really no big deal, but beyond that is when eyestrain, dry eye, and CVS can become an issue. Computer users blink at a rate that is three times slower than normal. Frequent breaks and the use of over-the-counter eye drops can help with dry eye, says Anshel, but “it is important to see your eye care provider so he can troubleshoot the cause of your dry eye. Although it could be CVS, an eye care professional can check for myopia or—if the patient uses contact lenses—if he [or she] is wearing the appropriate type of lens.” Like Lavin, Anshel says good nutrition is key. “A child’s diet should include fruits and vegetables with reduced amounts of junk food and less sugar to promote good eye health,” he says. Oral Hygiene “Childhood obesity is a direct cause of dental decay and sodas are the biggest tooth eaters,” he says. To help healthcare providers educate their patients on good oral hygiene and eating habits, Zurn offers the following tips: • Children should visit a dentist every six months. • Children should not brush without parental assistance until they are at least 8 years old. The child should brush at least twice per day with the optimum time being after every meal or snack. • Once teeth have begun to come together, daily flossing should begin. • Any after-school snack should be eaten while the child is sitting. He or she should finish it entirely with no grazing. When a person finishes eating, the saliva in the mouth is stimulated to begin a “cleaning process.” If a person is constantly grazing, the saliva does not have the ability to adequately keep the mouth clean, leading to plaque formation and decay, says Zurn. • Most juices are loaded with sugar and should be avoided; the same goes for sports drinks. Children should only drink water, milk, and 100% juice. • Snack choices should include veggies, cheeses, and fruits, except for raisins, which can stick to tooth enamel. Sticky, sugary snacks promote tooth decay. To maintain good dental health, Zurn recommends several options. Sealants are a great choice for the right patient. “Someone who is able to sit still while a sealant is being placed and already has good oral hygiene habits is a good candidate for a sealant. Parents too often think that placing a sealant will prevent their children from getting cavities, which is not true,” he says. A patient who brushes after meals, flosses twice per day, and has good nutrition is a better candidate for sealants because, without proper tooth care, cavities can form between the teeth, leading to tooth decay and possible cavities. Another option is using fluoridated water. “Many parents believe that those mouthwash rinses prevent cavities, but if it does not contain fluoride, it is doing nothing to prevent the buildup of plaque,” says Zurn. If brushing your teeth after a meal or a snack is not an option, Zurn recommends rinsing out the mouth with water. For those children who participate in sports, including football, basketball, and baseball, a mouth guard is recommended to protect teeth from injury. “A mouth guard bought at your local drugstore is fine, but if a child is fitted for a mouth guard by a dentist, he [or she] should be seen at the start of the school year to be sure that the guard is still the correct size and is still intact,” says Zurn. Protecting the Spine Parents often underestimate the importance of getting the right backpack. The wrong backpack can cause coldlike symptoms, asthma, headaches, chronic fatigue, and sleep problems, says Cox. To alleviate these concerns, it is important to follow manufacturer’s guidelines on using the backpack and to evenly distribute the weight of the bag between the shoulders and hips. Cox offers these tips for purchasing a good backpack: • Be aware of the manufacturer’s pound limit on the backpack and do not exceed it. • When wearing the backpack, the child’s head should be above the shoulders, with the ear hole lined up with the shoulder. • The child should have a strap on each shoulder and use the waist strap to help hold the weight against the back and reduce the pull in the spine. • The backpack’s weight should be distributed between the shoulder and hips. “If the child is wearing the backpack correctly, within the pound limit of the bag, then he [or she] can wear it for extended periods of time. If the child is not using the bag correctly, or hanging it from one shoulder, after 15 to 20 minutes of wear, problems can begin to occur,” says Cox. In his practice, Cox has noticed that a number of his pediatric patients take medications to alleviate the symptoms associated with wearing a backpack incorrectly. “Medication will not treat the book bag, only the symptoms caused by its improper usage. Parents should bring their child to a chiropractor to be sure they are fitted for the bag correctly and the parent should invest in a good quality bag, such as an Airpack or a rolling bag that the child can pull behind him [or her],” he says. Although the spine is resilient, any damage done cannot be corrected. Cox says the improper use of a backpack can cause the loss of the curve in the neck, a condition that will not correct itself and will only be further compounded by improper use of a backpack, explains Cox. If parents invest in a quality bag, they are more likely to have healthy children throughout the year, he adds. Shoe-Buying Tips Anderson and the American Podiatry Medical Association offer the following shoe-buying tips: • Children should shop for shoes with their parents. It is best to shop at the end of the day because that is when the foot is at its largest. • Try on all shoes; do not assume that a specific size is the same across brands. Avoid heels, flip-flops, and slide-on shoes; they are not appropriate for outdoor play and can cause a sprained or twisted ankle. Also avoid shoes that need a break-in period. • The child should wear socks or tights when trying on shoes and be sure that there is a thumb’s width of space at the end of the toe box; always buy for the larger foot. • To determine whether the shoe truly makes the grade, try this three-step test: look for a stiff heel by pressing down on both sides of the heel—it should not collapse; check toe flexibility by bending the shoe—it should bend with the toes, not in the middle. The shoe should be rigid in the middle—it should not twist in the middle. • Most importantly, children should not wear hand-me-down shoes. Also, the shoe should be comfortable and, if it is a closed toe, the child should wear socks or tights to reduce fungus growth, says Cox. In summary, with proper preparation, attention to diet, and hygiene awareness, your child has an excellent chance of remaining healthy throughout the school year. — Kim M. Norton is a freelance writer/journalist.
The American Optometric Association The American Podiatric Medical Association
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