Last year, the Florida State legislature attempted to gag pediatricians from discussing gun safety with families. That law, referred to as the docs n’ Glocks Law, was overturned by a Federal Judge this past September after strong rallying by the American Academy of Pediatrics and the Brady Center to Prevent Gun Violence.

Judge Marcia Cooke’s ruling was a huge victory for gun safety education and for pediatricians. Her ruling validated what pediatricians in Florida, and every other state in our Nation, have been attempting to explain for a very long time: this issue isn’t about gun ownership but about gun safety.

The recent  tragic death of a Texas 8th grader, Jaime Gonzalez, is a grim and very real reminder of how serious events can become when any type of gun is involved.  According to reports, police could not discern that the gun was a pellet gun and the events unfolded in a way that forced them to act so that the school student body and staff would be safe. That’s their job. Playing Monday morning quarterback isn’t going to change the event. However, we can prevent future events by recognizing that we need to do better in providing gun safety educations in our schools, for parents in their homes and for pediatricians in their offices.

For some reason, gun safety education is one of those topics that everyone agrees is important, including pediatricians, yet no one takes enough time to truly do justice to when they have a family, or group of students, in front of them. With kids still bringing guns to school, we have to stop assuming that someone else is providing that important talk and step up.

Parents need to have the talk with their kids, whether they own a gun or not.

Schools need to have gun safety education in their health and safety courses and in their Open Circle times.

And, pediatricians need to fit it into their busy office visits.

We should be having it at home with our kids.

Communities and schools can think outside the box and post information and links to resource on websites and in newsletters. Drama classes could organize skits. Art classes could make posters. Both of these avenues have been very successful with other hard to discuss topics such as drug and alcohol use and abuse and high tech issues.

As long as you do more today than you did yesterday, the students in your community will more safe tomorrow and the likelihood of another school gun incident will go dramatically down.

This is a New Year’s Resolution we can do something about – and we owe it to the Jaime Gonzalez’s family to do just that.

Today’s school backpacks are an amazing amalgam of fashion and function – with sometimes a dash of technology as many seem to come either prewired for ear phones or with a special place for them.

As our kids move through elementary school and beyond, the look of this bag becomes as important as what is inside – and perhaps even more so. Today’s backpacks remind me of Hermione Granger’s purse – they all seem to hold an endless array of stuff. The thing is that pile of necessary stuff packs on the pounds setting the state for a lifetime of back woes…unless we change the equation starting today!

Backpack’s are one of the leading causes of injury to children with more than 7000 children injured last year due to overloaded backpacks according to the U.S. Consumer Product Safety Commission. Back experts recommend that backpacks weigh no more than 10-15% of a child’s weight but many kids carry at least 20% of their weight. The type of injuries caused by backpacks are more varied than you may realize. The most typical injuries are shoulder and back strain from improper backpack use and overloading. Shoulders and backs are not the only part of the body at risk from backpacks, however. Many children each year actually injure their feet, toes and legs from tripping over heavy backpacks put on the ground to give their owner’s backs a break. Head trauma and lacerations have also been reported from children using their backpacks as impromptu balls. Backpacks indeed put the entire body at risk.

Helping our children not only choose a proper backpack but wear it correctly will dramatically reduce a child’s chance of injury. Leading orthopedic experts agree that most back and shoulder pain in children is avoidable by simply wearing the backpacks correctly and resisting the temptation to sling the back from one shoulder. Additionally, the straps should hold the bag close to the body fairly snugly. Spreading the contents throughout all the compartments will help distribute the weight more evenly in the bag but in the end it’s the overall weight that matters.

Just like with clothes, backpacks are actually sized. Just like we would never have our children wear adult sized shoes, we need to be careful they are not hauling adult size backpacks. In addition to the weight of the actual pack, a fully loaded backpack may end up weighing more than your child!

True outdoor stores such as LL Bean and Eastern Mountain Sports, as well as popular retain stores, have backpack lines designed just for children and teens but similar lines. So, before you pull out your wallet and head for the cash register, check the tag of the backpack to make sure it’s designed for your child’s age.

What features of a backpack should you look for beyond the age specifications on the tag?

• wide shoulder straps with one for each shoulder so the bag’s weight can distribute evenly over the child’s back and not place too much strain on any one shoulder joint.
• Padded backs and waist straps to help distribute the load in the bag more evenly.
• Wheels: while many kids refuse wheeled backpacks these are the best way to avoid strain on the back. However, these are only a good option if your child’s school is on one floor.

Keep in mind that part of the issue is the amount of material our kids need to trek to and from home each day as well as to each class. The school day doesn’t seen to allow kids to return to their lockers easily so many end up lugging a heavily load all day long…and on one shoulder!

Keep in mind that while most backpack injuries are weight and use related, some are due to tripping over packs put on the ground. A few kids a year do break toes and sprain ankles and wrists from tripping over heavy backpacks put on the ground to give their wearer a much needed break. The solution for this is for kids to not only pay more attention to where they are walking but for kids to pay more attention to where they leave their backpacks…at least until we collectively fix the weight problem.

So, as you embark on back-to-school shopping, add backpack fitting to the list and have kids try a few on for size and comfort. In the end, your child will find a backpack that provides the fashion statement they desire with the safety and fit features you know they need.

(Originally published 2008; updated 8/22/2011)

Looking for some homework helpers for the new school year? Here’s a list in progress of sites that have helped my kids over the years.

Ask For Kids

Great search engine for kids of all ages.

Ben’s Guide To US Government For Kids

Huge assortment of topics and web sites for fun and learning.

Fact Monster from Information Please

True fun with learning for teens and tweens.

FirstGov for Kids

Government Sponsored Web sites on oodles of topics. You name it, you’ll find it here.

High School Ace

Homework helper for High School students.

Homework Spot

Great site for older elementary school and middle school students.

KidSpace

Online Library for Elementary School and Middle School students from The Internet Public Library.

Teenspace

Online Library for Teens from Internet Public Library.

Kid Info

Has sections for younger elementary school kids and older kids on every topic their school covers.

National Geographic for Kids

Everything adults love about National Geographic done kid-style! Covers many nature and social studies topics.

Reading Rainbow

Targets ages 4-8. Has games, family activities and ideas to help your young child learn to love reading.

Refdesk.com

Online reference desk for kids of all ages.

Time For Kids

Great for older elementary school and  middle school students. Covers world news appropriate for kids in a way they can understand.

Yahooligans – web guide for kids

My family has a tradition of getting all our back-to-school shopping completed just before our big end of the summer vacation. Lunch boxes used to be big ticket back to school items but since my girls are tweens now, as Hilary Duff once sang, “that’s so yesterday”. Plus on most school days we’re lucky if their lunches make it from the frig to their backpacks!

If only the choice of what to have for lunch these days were as easy as whether to brown bag it or have a fancy lunch box. With the confusing food pyramid and ever changing food guidelines coupled with school days that barely allow for time to eat lunch, it is truly a challenge to get kids a proper lunch.

Let me give you a preview of what’s about to come: don’t view nutrition as one meal but view it as a group of meals that balance out together and function like a bank; lunch may very well be the new breakfast, meaning our kids most important energy meal.

Some Thoughts To Ponder

As my kids have gotten older, I’ve realized that helping my kids eat healthy is a balance between offering healthy foods, giving them control of some of their meals, and helping them learn to incorporate the less healthy foods with the healthy foods. Concerning lunch specifically:

1. Given how much of their day is decided by others, especially at school, I give my kids total control over what they have for lunch among the foods we have at home.
2. I’ve started to realize that lunch is not just a meal in a day but a meal that has to get my kids through the entire day including learning and after school activities. It is perhaps their most important energy meal when viewed this way.
3. Fruits and veggies are crucial to their overall growth but don’t always get that energy jolt needed to learn.  So, I tend reserve fruits and veggies for dinner and after-school snacks and add more carbohydrates like pretzels and granola bars for lunch and in-school snacks.  The energy they provide lasts longer for my girls.
4. It occurred to me that getting through a school day is like a mini marathon for my kids but involving both body and mind.  Just like with a marathon, hydration becomes as crucial as energy. So, I’ve put more emphasis on what they drink during the day and how much.
5. When my kids have a sugary snack occurring at school, we don’t pack a snack that day or pack veggie sticks but leave lunch untouched. Lunch needs to happen as planned to learn well.

Kids and Food: The Big Picture

These concepts that have helped me, can work for your kids, too. In addition, you have to remember that kids have simple tastes hence why kids menus have the same 5 foods on them regardless of the restaurant! And, unlike us parents, kids can truly eat the same meal every day without getting bored. I swear my youngest daughter will one day become a ham or waffle!

As I mentioned earlier, considering lunch in the big picture of your child’s overall nutrition is really helpful.  The government’s new food pyramid (www.mypyramid.gov) gives a great visual description of what kids should eat during the day but it can be overwhelming. I know my kids don’t come anywhere close to what the pyramid suggests for a given day but their nutrition is fine if I take into account what they eat over the course of a few days.  So, if one day has more carbohydrates or fewer fruits, I help them make-up for it the next day. If one day has an extra treat built in, we skip dessert.

Your Kids Food Bank

Give and take, and balance. Those are the ultimate ingredients to success. Each meal has its own role in a child’s day. Breakfast jump starts our bodies after a long sleep. Dinner helps us refuel after the afternoon of physical and mental work and gives us fuel to keep our bodies going while we sleep. Lunch, on the other hand, has to catch us up from the morning and get us through the afternoon until dinner. A lot is being asked of our kids through the day, and lunch has to meet all those needs, including physical growth.  In many ways, breakfast and lunch need to be a bit more carbohydrate slanted and snacks and dinner more balanced with fruits and vegetables.

Lunch is tricky because of not only how brief it is in most schools but because of how important it is. Kids have to make up from energy lost from the morning and store energy for the afternoon, and eat it in about 10 minutes. Pre-cut fruits and vegetables and even prepackaged items such as the new 100 calorie packs are very useful for both purposes. The 100 calorie packs also visually teach portion control which is very useful for prepubertal and early pubertal kids who are primed to gain weight entering puberty. Using these items may not seem healthy to you but it’s what the kids like to eat and what they see their friends eating.

Sandwiches tend to be the best way to get grains and proteins done all at once and are easy to eat quickly. Kids tend to not like the taste of the real grainy breads so try the grain or wheat breads that look like white.   My kids can’t tell the difference.

Finally, for hydration with lunch, my choice is water. Kids don’t get enough during the school day and while I understand that school nutritionists view lunch as a way of getting calcium into our kids we can do that at home. What our kids need is water and more of it during school.

My kids hate buying lunch at school but I know many kids who love school lunches. The problem is school lunches are not always as balanced as they should be. On days your child buys lunch, plan dinners higher in proteins, fruits and vegetables and less in fats and carbohydrates to balance out the day better. Be sure you ask your kids specifically what they had for lunch if they buy to help you plan meals better.

Finally, no school year would be complete without the birthday treats and special events but that extra sugar load need not derail our child’s nutrition train. You can plan a healthier lunch the day of the treat or the next day to balance out the extra treat. Or, just skip dessert with dinner that night. I’m a believer that our kids can have a daily treat once a day but if it happens at school, then it doesn’t happen after school. This is how our kids learn to incorporate the sweets into a normal diet without adding pounds.

Making Deposits and Withdrawals

Clearly lunch will provide the most benefit if the remainder of your child’s meals are healthy.  Kids need breakfast  and skipping it is akin to trying to start a car without gas.  At the end of a day, kids need a healthy dinner, preferably with the entire family as studies demonstrate huge value to kids for the family meal and time together around the table. It fuels their souls! This may not be logistically possible if parents work late or kids need to eat earlier, but have a consistent time all of you are around the table. Perhaps breakfast works better for your family or dessert.

In addition to healthy eating, regular exercise has to be a priority. After sitting in school all day, kids need to burn off steam and have some unstructured time.  You don’t need a gym or organized sport. Just playing outside and regular walks together as a family can go a long way to staying fit. When I was a kid, my dad and I would go for a walk after dinner. Exercise and family time all wrapped into one – and calorie free!

What about weekends? Most weight experts and programs advocate a 5:2 plan for staying on track and this can work for families, too. You stay on track Monday through Friday with healthy eating and exercise but loosen the reins on weekends.  This is when most families eat out or order pizza. There is nothing wrong with indulging once in a while if the remainder of your week is healthy with food and exercise. If our kids learn this now, they’ll have it well ingrained by the time they are on their own.  But, even on weekends, lunch is still the pivot meal. You can’t skip it just because you are having a bit dinner that night. Eat lighter but still eat lunch.  It is that important.

Lunch: the new breakfast

So, breakfast, watch out, there’s a new meal in town, that may very well be more important than you are.

Here’s to a wonderful school year with new horizons and healthy choices…and perhaps even time for our kids to eat their lunch.

(Originally posted August 2007; Updated September 2011)

It seems the fashion industry doesn’t realize we still have a good half the summer to go! Everywhere I go there are reminders that another school year is around the corner. Although we’d all rather block this from our brains, it’s actually not such a bad idea to at least get into a quasi-back to school state of mind. Doing so will help you and your kids considerably once that first day of school does arrive.

Since the last school year ended, we’ve been on a diametrically opposite schedule from what we live when school is in the mix in just about every way:

• Sleep: Sleep tends to be more free in the summer with later bed times, wake up times and no set schedule.
• Nutrition: Fruits and veggies may be more abundant but people also indulge on more ice cream and treats at barbeques they don’t often eat at other times of year.
• Exercise: Many kids are either not in camp, in “indoor” camps or in sports camps that focus on just one sport and not overall fitness, so kids are actually less active in the summer than in the past.
• Activities and Hobbies: Most kids put on hold the activities they pursue rigorously over the school year – music, art, even some sports.
• Reading: Many schools have reading expectations for the summer so most kids do read each summer.
• Technology: For most kids, especially tweens and teens, they’ve had much more use of technology over the summer than in the school year and likely without the oversight that you’d normally have over the school year.

Making small tweaks now in all these areas will help ground our kids and give them the energy they need to stay on top of school and the increased demands they’ll feel.  To nudge your kids back to tip, top school shape, try these ideas out:

• Sleep: You can change your kids’ biological clocks from summer to school  by moving them to an earlier bedtime and having them wake up with an alarm for at least 3-5 days before the first day of school. The more time their bodies have to adjust to the new time, the better they will feel when they have to do it every day – and the easier it will be.
• Nutrition: In addition to needing three meals a day, kids eat healthier when they help make meals. Try that out this month and then continue it in the school year.
• Exercise: Growing kids need daily exercise, even if they play team sports. And, kids who play sports need a break once in a while or they risk overuse injuries. The goal is 30 minutes of moving a day. If you can get that in for your kids, they’ll feel great and their bodies will benefit.
• Activities and Hobbies: The best rule of thumb is to slide into the school year and see what the work load is like before adding too many new activities, especially if activities are already in place from last year. And, to remind your child it isn’t the end of the world to try something new and drop it if they don’t like the activity or it’s too much for their schedule.
• Technology: Whatever your usual technology plan is for the school year, now is the time to regroup on that and revisit expectations that make sense once homework kicks in. I’ll have more on this soon so stay tuned!

If you enjoy today while being realistic about tomorrow, tomorrow can be enjoyed much more, even if it is the first day of school!

Preparing for a new school year is always challenging, and always catches even the most organized of parents off guard. In the blink of an eye, summer is over and we’re in school mode again – just like that!

Before you panic, keep in mind that you don’t need to organize the entire school year right now.  To help you get organized, just think

“BACK TO SCHOOL”!

Breakfast of Champions!
Activities
Cell Phone Rules
Kid Time
Texting & Sexting, and the Internet
Oh my aching back!
Sleep
Come To Dinner
Health Check
Outdoor Time
Organization & School Work
Lunch Plan

Breakfast of Champions!
Breakfast is the most important meal of the day. Not having it is like attempting to drive your car on fumes for miles and miles. Breakfast doesn’t have to be huge or complicated…it just has to occur!

Activities
Don’t overload the plate! Try to balance sports and nonsports.  If  your child wants to drop a sport or musical instrument for another, don’t get caught up on age or how many years have been invested. All isn’t lost…this is childhood and variety is the name of the game, not specialization.

Cell Phone Rules
With cell phones common and ubiquitous, we need to be involved with how our kids use them. Check in with your kids to be sure they are using features appropriately and not using features such as the web that has zero filter and ability to control from a cell phone right now.

Kid Time
Kids who work hard need to play hard! Make sure your kids have time each week of nothing scheduled for 100% down time.

Texting & Sexting, and the Internet
Do you talk with your kids about social networking, sexting and computer use? Dr. Gwenn’s new book CyberSafe has all the information you need to get you on the same page with your kids and perhaps even a step ahead.  More information coming soon!

Oh my aching back!
Backpacks are true health hazards for our kids. Be sure they are the proper size and that your kids are wearing them properly. For more information, click here:

Sleep
Kids in school need at least 10 hours of sleep. Start tweaking that schedule now to get into the sleep/wake cycle your child will have for the new school year, and try to keep to it on weekends.

Come To Dinner!
Studies show that family dinners not only help boost our kids self-esteems but may be the best antidrug around.

Health Check
Even if your school doesn’t require an annual physical, this is the best way to be sure that all the needs or your child are addressed entering a school year including medications, immunizations, issues lingering from the prior year, including emotional issues.

Outdoor Time
Studies show that spending time outside not only is a stress buster but an excellent way to increase daily exercise for kids.

Organization & School Work
Help your kids have a homework routine. If homework seems excessively long or stressful, call the school and ask for guidance.

Lunch and School Day Snack Plan
Helping kids plan for their school day meals and snacks helps them understand how to make healthy decisions. The more involved you are, the more informed they will be.

All kids have butterflies out of the gate even if they don’t show it. The more organized and in control you are, the more at ease they will be as the year slides into full swing.

(Originally posted August 2009; Updated August 2011)

You know one of these days it will happen. On the day when you least expect it (and often when it is least convenient) the school nurse will call in form you that your child has “flu like symptoms with a fever” and needs to be picked up. Now what?

The 2009-2010 school year game plan was simple enough: avoid the wide spread school closings that occurred at the end of the 2008-2009 school year when H1N1 first came into our lives. This certainly appeared to be a challenge with  2 influenza strains to contend with, an intensity of flu season predicted to be quite strong, and 55 million students and 7 million staff in 130,000 public and private schools, according to the CDC, to keep healthy.

Reassuringly, the CDC had learned a great deal about H1N1 since it first arrived on the scene, and recognized that we can manage the upcoming flu season as we always have but use last year’s aggressive plan if the situation ends up becoming much more intense in any way from anticipated.  To this end, the CDC  prepared two tiers of guidelines for schools and health professionals to follow which will come into play as the 2009-2010 school year progress and as the flu season develops with enough details to know which guidelines  make the most sense to follow:  http://www.cdc.gov/h1n1flu/schools/schoolguidance.htm

The highlights for the expected flu season include:

1. Keep sick people home until fever free for 24 hours.
2. Separate sick students and staff from healthy if someone becomes sick at school.
3. Wash hands, cough into your elbows, blow noses into tissue!
4. Clean, clean, clean all public areas frequently.
5. High risk folks need early treatment with anti-viral medications.
6. “Selective school dismissals” only.

If the flu season becomes a whopper, the CDC suggests that

1. Screening of influenza virus should start.
2. High risk folks should consider staying home until the situation is more under control.
3. Contacts of people stay home for 5 days.
4. Schools need a plan for this: homework to kids, separate kids while at school more.
5. People with the flu stay home for 7 days.
6. School dismissals become considered in consultation with local CDC chapters.

Your pediatrician is the best person to help you decide what family members are “high risk” so you can be prepared to know that ahead of time. Keep in mind, though, that all kids are considered “high risk” in that they are the ones at most risk for becoming the sickest from either flu strand. So please immunize all your kids ages 6months to 18 years against both the H1N1 and seasonal flu. If you don’t, you may very well find it’s your child that ends up in the ER…or worse.

Arming yourself with the latest information today is what will give you peace of mind tomorrow. So, check back often for the latest information and as the flu season unfolds we’ll regroup and adjust as needed to keep ourselves and our kids as healthy as possible.

(Originally posted October 2009; Updated December 2009)

Dear Dr. Gwenn:

My question is regarding children’s illnesses. I am not a parent but I work with 60 elementary school children. I have completed a senior first aid course so I am capable of assessing and treating severe illness when it comes up but I’m not particularly comfortable what to do when a child complains of illness yet shows little if any symptoms.

Often these complaints have a social trigger (for example, the child is unsatisfied with some aspect of their play environment and is looking for a little attention and comfort, or is feeling a little homesick being away from home for 6-8 hours). That said, on several occasions a child who has no symptoms is found to be quite ill within a short time (30 minutes to a few hours).

I worry that I have sometimes pandered to the attention seeking methods of a child, while at other times I may have neglected to provide sufficient comfort, care and treatment to others in need but without noticeable symptoms. I am looking for some rough guidelines for when to accept a child’s diagnosis of “I’m not well” and when it is better to make my own judgment based on what I can observe. – Lindsay

Dear Lindsay:

Thank you for your question. This is a common dilemma for anyone who works with kids, teachers and parents alike! The real crux of your question is something we grapple with as pediatricians daily and can be a challenge to sort out at times.

Any one who works with children becomes part of the overall triage system when a child complains of feeling off or sick. We each play a role in that triage system. Triage is an art and a skill all at once. Triage is the medical term used to sort people according to how sick they are. It typically applies to any situation where a person has to make a decision about how sick someone is and the type of care someone needs. In an emergency room, for example, the triage nurse determines who gets seen first based on who is the sickest and most severely injured.

The same concept applies to a school setting as well. If a child complains of being sick, first the teacher must triage that child to whether the child is well enough to stay in the class room or sick enough to warrant a visit to the school nurse and perhaps a call to mom and dad. So, you are the child’s first moment of triage in the health care system. And, most of those moments will honestly amount to much to do about nothing.

As a member of that child’s triage team and a teacher and not a health care professional, your role is a bit different than the school nurse’s role. Where as the school nurse will be focused on the evaluation of illness, your role will be focused on wellness. Is the child off from baseline enough to be potentially sick?

As your letter illustrates, illnesses in children often evolve. If a child’s illness evolves during school, you’ll know that and can act accordingly. But, if a child’s illness evolves so slowly that during school there are no symptoms and the child seems otherwise fine, there is really not much more you can do. All you can do is triage that child’s symptoms as they are at that moment and not focus on the future.

So, when present with a moment of “I don’t feel well”, first be mindful of what that child’s normal baseline is.

Issues to consider include changes in the following areas:

• Energy level
• Ability to complete tasks normally
• Mood and social interactions with peers
• Visible signs of illness
• Overall appearance of the child

Consider these issues as you run through the following questions to quickly assess if the child is off enough from baseline to contact Mom and Dad during the school day:

How is the child’s activity level? A child who is playing normally is likely not very sick. That is always a reassuring sign. A child who complains of feeling sick but can play normally and attend to school work, does not need to leave school but can be evaluated further by his or her parents.

Does the child have a specific complaint or a vague complaint? Specific complaints may be more sickness driven but may not need immediate attention if the child is otherwise fine.

How is the child’s appetite that day? Sick kids or kids getting sick tend to have a loss of appetite, even if subtle.

Any similar illness in the classroom or home? Kids do share their germs! If other kids have similar complaints, then sickness is more likely the culprit.

Does the child have a history of this sort of complaint, and what was the outcome? The child’s parents are your best resource for this – some kids have a pattern they follow when they get sick but others do not.

Remember, your goal is to determine changes from baseline, not whether illness is present. If a child is off from baseline, and you have a school nurse, the school nurse can help you decide if the child is well enough to stay in school or if that child needs to go home. You should never feel you are operating in a vacuum especially if you are worried a child is becoming ill. Rely on your school nurse and rely on mom and dad…and rely on how the child appears!

Best,
Dr. Gwenn

(Originally posted September 2007; Updated December 2009)