Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health service clinic for information on clinics.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the recommended immunizations, the RSV medication often raises questions.

Hospitalist Laura Romano, D.O., explains the key facts about RSV and the medication that prevents it.

What is RSV?

Respiratory syncytial virus, or RSV, is a highly contagious virus that causes upper and lower respiratory symptoms in people of all ages. Symptoms range from a stuffy nose to difficulty breathing. While most cases are mild, severe infections can cause bacterial pneumonia or require hospitalization for oxygen therapy and intravenous fluids. Premature infants and babies with underlying heart or lung conditions face the highest risk.

Can RSV be prevented?

Yes! Pregnant women can receive an RSV vaccine to protect their babies, or infants can receive a preventive immunization during the winter. Some children qualify for more than one immunization so ask your pediatrician if your child needs a second dose. Thanks to maternal vaccines and infant immunizations, hospitals - including Cook Children’s - are seeing a drop in RSV hospitalizations.

What would you like families to know about RSV and its immunization?

RSV while mild for many can be fatal for some. RSV can affect everyone from young babies to our grandparents and can be fatal in both cases.

RSV is mild for most people but it can be fatal for some. RSV affects individuals of all ages - from infants to older adults - and can be deadly for high-risk populations across both groups.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the recommended shots, the pertussis vaccine often raises questions.

Hospitalist Laura Romano, D.O., explains the key facts about pertussis (whooping cough) and the vaccine that prevents it.

What is pertussis?

Pertussis, a highly contagious bacterial infection, causes a severe, long-lasting cough which can sometimes end in a "whooping" sound when a child breathes in. The illness is also known as whooping cough or the “100-day cough.”

In older children and adults, pertussis typically causes only a low-grade fever and a prolonged cough. However, the disease can be fatal in infants. In babies, pertussis can cause difficulty breathing, apnea (when a baby stops breathing) due to coughing and respiratory failure. The infection can be fatal even when treated with antibiotics.

How can the disease be prevented?

Pertussis is very contagious. Vaccinating newborns is the best way to protect them. New parents, grandparents, or aunts and uncles should also receive a Tdap vaccine before welcoming a new baby home.

What would you like families to know about Pertussis or its vaccine?

As a medical community, we have watched pertussis vaccination rates steadily decline in recent years, leading to outbreaks in states like Kentucky. In that outbreak, three babies died from respiratory failure. Pertussis has proven to be fatal to at-risk infants and unvaccinated children.

RELATED STORIES:
Cook Children's Back to School Checklist
What Families Should Know About Hepatitis B
Back-to-School Breakdown: Preparing for Class with the MMR Vaccine
What Families Should Know about Human papillomavirus (HPV)

Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health service clinic for information on clinics.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the recommended shots, the Human papillomavirus (HPV) vaccine often raises questions.

Hospitalist Laura Romano, D.O., explains the key facts about HPV and the vaccine that prevents it.

What is HPV?

HPV is a viral infection that causes flesh-colored warts on certain mucous membranes, most commonly affecting the mouth, throat and genitals.

HPV infections can lead to cervical cancer in women, as well as head-and-neck and anal cancers in both men and women

Most people with HPV have no symptoms and don't realize they carry the virus, yet they can still pass it to others.

How can the disease be prevented?

Vaccinating older children and teenagers can provide lifelong protection against HPV and helps prevent several types of cancer as well.

What would you like families to know about the virus or the vaccine?

Vaccinating boys and girls offers lifelong protection against a virus that can cause warts but also against deadly cancers. The vaccine protects your child now and helps safeguard their future partners down the road.

Last year, for the first time, the United Kingdom announced zero deaths from cervical cancer among women under age 30. Australia and New Zealand have seen similar results alongside increased vaccination rates.

Other countries have also reported declines in cervical cancer among women, as well as head and neck cancer among men.

RELATED STORIES:
Cook Children's Back to School Checklist
What Families Should Know About Hepatitis B
Back-to-School Breakdown: Preparing for Class with the MMR Vaccine

As summer winds down and school begins, families face the challenge of shifting back to structured routines. In the first episode of For Kids' Sake, a new

Q: What's at the top of the back-to-school checklist for families?

Dr. Arnaout: Sleep. During the summer, schedules often disappear. Bedtimes get later and routines become more relaxed. Before school starts, it's important to help kids get back on track because sleep affects attention span, mood, decision-making and learning.

The best approach is to start a few weeks before school begins. Move bedtime earlier by 10 to 15 minutes every few days and gradually adjust wake-up times. Small changes can make the transition much easier.

Q: How much sleep do school-aged children need?

Dr. Arnaout: Most school-aged children need about nine to 12 hours of sleep each night, depending on their age and individual needs. A typical 10-year-old should be getting somewhere between nine and 11 hours.

If caregivers are unsure whether their child is getting enough sleep, it's always a good conversation to have with their pediatrician.

Q: What is something parents often overlook during back-to-school season?

Dr. Arnaout: Emotional readiness.

During the summer, many families relax routines. There may be more screen time, more snacking and less structure overall. Going back to school requires kids to adjust to schedules and responsibilities.

A few weeks before school starts, begin reintroducing routines such as regular meals, consistent bedtimes, and limits on screen time. That gradual transition can make a big difference.

Q: School vaccines can feel overwhelming. What should parents know?

Dr. Arnaout: There are several recommended immunizations for school-aged children, and your pediatrician can help you understand what's appropriate for your child.

One vaccine I remind parents about every year is the flu vaccine. The flu spreads easily in schools. While a flu shot may not prevent every case of flu, it's very effective at reducing the risk of serious illness, hospitalization and death.

We typically begin receiving flu vaccines in our offices around the end of August, and I generally recommend getting vaccinated in September or October.

Q: How can parents help children who are nervous about going back to school?

Dr. Arnaout: First, don't dismiss their worries. It's easy to say, "You'll be fine," but it can be more helpful to ask, "What's your biggest concern?" Let them talk about what they're feeling.

One of my favorite strategies is doing a practice run. Visit the school if possible. Walk the halls, find the classroom, visit the cafeteria, locate the bathrooms and meet the teacher. When kids know what to expect, school feels much less intimidating.

An anxious child often benefits greatly from preparation and planning.

Q: What are some signs that a child may be experiencing anxiety about school?

Dr. Arnaout: Anxiety doesn't always look obvious. Some children become quieter. Others may have trouble sleeping. They may complain of stomachaches or headaches.

These symptoms are real. Stress can affect the digestive system and lead to physical discomfort. If you're seeing more tummy aches, headaches, difficulty sleeping or changes in behavior as school approaches, anxiety may be part of what's going on.

The good news is that these feelings are normal. Most people experience stress and worry at times, and parents can help by offering support and preparation.

Q: What emotional skills help children succeed during the school year?

Dr. Arnaout: For younger children, skills like empathy, patience, listening and following directions are incredibly important.

Simple games can help build these skills. Games like Simon Says or Red Light, Green Light teach children to listen carefully, pay attention and follow instructions.

Reducing screen time before school starts is also helpful. Screens can affect attention and behavior. Instead, encourage activities like coloring, drawing, reading or creating stories. These activities help children practice focusing and creativity.

For older children, emotional readiness often involves organization and routine. Helping them clean their rooms, organize school supplies, set up study spaces or use planners can help them feel more prepared and confident.

Q: Is it okay for children to have a desk in their bedroom?

Dr. Arnaout: It depends on the home and the space available. In our house, we've found that our children are less distracted when they have a quiet area to work. The key is maintaining boundaries. Homework happens at the desk, but the bed remains for sleep. Once homework is done, we leave the room and move on to other activities.

Q: How should families think about germs and illnesses when school starts?

Dr. Arnaout: Young children have developing immune systems, and part of growing up involves being exposed to new germs. Schools bring children together, and illnesses are inevitable.

That's why vaccines are important. It's also why good hygiene habits matter. Teach children proper handwashing and how to use hand sanitizer appropriately. Those simple habits can go a long way.

Q: What should parents keep on hand during cold and flu season?

Dr. Arnaout: A few basics can make life easier:

• Tissues
• Hand sanitizer
• Acetaminophen (Tylenol)
• Ibuprofen
• Antihistamines
• A good thermometer
• Your pediatrician's phone number

Remember that pediatric offices often have nurses available to answer questions after hours. Illnesses rarely happen at convenient times, so it's helpful to have a plan before you need it.

Q: In our "Asking for a Friend" segment, a listener asks: Is it okay if my child eats the same lunch every day?

Dr. Arnaout: Yes. Many children are creatures of habit and prefer familiar foods. Try to offer variety at other meals and on weekends, but don't stress if your child chooses the same lunch repeatedly. There are bigger things for parents to worry about.

Q: What's the biggest sleep mistake parents make?

Dr. Arnaout: Screens in the bedroom. Many parents believe children need a television, tablet, or other screen to fall asleep, but screens interfere with sleep quality. The light from screens signals the brain that it's daytime and can affect melatonin production.

Make the bedroom as dark as possible. Avoid screens before bedtime. Instead, read books, tell stories or listen to calming activities that promote sleep.

Q: What's one of the best ways to reduce first-day-of-school stress?

Dr. Arnaout: Do a practice run. Visit the school if possible. If that's not an option, look at pictures of the school, the classroom or the teacher online. Familiarity helps children feel more comfortable and confident.

Q: What about parents who are nervous on the first day?

Dr. Arnaout: Parents experience first-day jitters too. When my children started school, I was nervous because they were no longer under my constant watch. One thing that helped was walking through the day's schedule.

I'd remind them, "You're going to have lunch, then recess, then class, and then I'll be there to pick you up."

Parents can do the same for themselves. Focus on how you'll spend your day and keep yourself occupied rather than dwelling on the separation.

Q: What's one health habit that pays off all year long?

Dr. Arnaout: Handwashing. Teaching children how to wash their hands properly and regularly is one of the most effective ways to reduce illness throughout the year.

Final Thoughts?

Dr. Arnaout: If you care enough about your child to listen to a podcast about getting ready for school, you're already doing a great job.

Give yourself some grace. Let go of the guilt.

You've got this.

Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health service clinic for information on clinics.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Raising a child brings up endless questions, especially when it comes to their health and well-being. As back-to-school season approaches, immunizations may be top of mind for families, and searching for clear, honest answers about what goes into their child's body and why. With so much conflicting information online, sorting facts from fear can feel overwhelming. Cook Children’s Health Care System helps parents and caregivers cut through the noise with trusted guidance from medical experts who are parents themselves.

Among the required school shots, the Hepatitis B vaccine often raises the most questions, especially when it comes to why infants and young kids need protection so early.

Hospitalist Laura Romano, D.O., explains the key facts about hepatitis B and the vaccine that prevents it.

What is Hepatitis B?

Hepatitis B is a serious liver disease that is caused by the hepatitis B virus (HBV).

In adults, hepatitis B is usually spread through blood or intimate contact. In young children, however, the virus usually spreads through contact with infected bodily fluids. Transmission most commonly occurs during labor and delivery, but it can also happen through everyday activities, such as sharing a toothbrush or being bitten by a person who has the virus.

People infected with hepatitis B can spread the virus even if they show no symptoms. In fact, children often remain asymptomatic for years while still being contagious. This is especially concerning because infants and young children are more likely than adults to develop chronic, lifelong liver conditions, including permanent liver damage, cirrhosis (severe scarring), and liver cancer.

Treatment options for chronic hepatitis B are limited and focus primarily on halting the progression of liver damage rather than curing the virus itself. For severe cases where the liver has sustained significant damage, a liver transplant may ultimately be necessary.

How can the disease be prevented?

The most effective way to prevent hepatitis B is through vaccination. The vaccine is highly protective, offering about 95% effectiveness in preventing both acute and chronic infections. Since its routine inclusion in infant immunization schedules, rates of hepatitis B cases and associated liver cancer have steadily declined.

What would you like families to know about the hepatitis B vaccine and HBV?

• Hepatitis B is often misunderstood as a disease that only affects people engaging in high-risk or illegal behaviors. Anyone can contract the virus through everyday actions such as sharing a razor or toothbrush with someone who has the infection, even if that person shows no symptoms.
• Prenatal screening and maternal immunity testing alone are not enough to protect all children from hepatitis B. History has shown that targeting only 'high-risk' infants leaves gaps, leading to ongoing infections in both mothers and children that universal vaccination prevents.
• While some countries delay hepatitis B vaccination until children are older, their social and health care infrastructure differs significantly. Longer parental leave in those countries means children spend less time in daycare, where early exposure can occur. Also, universal health care access allows these countries to detect acute infections quickly and manage chronic cases more effectively.

Related Stories:

• Mindful Monday Medicine: Back to School Checklist

• Prioritizing Firearm Safety and Youth Well-being in Fort Worth

• Heat Safety for Kids: Hydration, Heat Illness Signs and Sun Protection Tips

Resources and tips for finding immunizations for children:

Navigating vaccines can feel overwhelming. Talk to your pediatrician.

• Schedule an appointment through Cook Children's.
• Find your nearest Texas Department of State Health Service Clinic.
• Call 211 for help.
• Call Tarrant County Public Health at 817-248-6299 to make an appointment or to find a walk-in clinic.
• Check with your local school district for vaccine events.

Just weeks before students return to the classroom, the Texas Department of State Health Services (DSHS) issued a health alert following four reported cases of measles in July. According to DSHS, all four cases occurred within a single family after a family member traveled out of state.

With back-to-school season underway, pediatricians at Cook Children’s Health Care System are sharing key information about how measles moves through communities and how families can protect their children.

Measles is highly contagious. One infected person can potentially infect 12 to 18 unvaccinated individuals. The virus spreads through infectious respiratory droplets and airborne transmission (from coughing or sneezing), where tiny droplets can remain suspended in the air.

Cook Children’s experts say the best way to prevent getting and spreading the virus is to get the measles, mumps and rubella (MMR) vaccine.

The MMR vaccine is required by most school districts and Cook Children’s understands that navigating conflicting information about vaccines can feel overwhelming. Mary Suzanne Whitworth, M.D., medical director of Cook Children’s Infectious Diseases, explains the key facts about the measles and the MMR vaccine.

What is measles

Measles is a viral infection caused by the rubeola virus, which is not the same as rubella. The virus is very small, which makes it more contagious. It can remain in the air of a room for up to two hours after an infected patient leaves. Measles symptoms typically appear seven to 14 days after infection.

Symptoms include:

• Rash
• Fever, sometimes over 104º Fahrenheit or 40 º Celsius
• Runny nose
• Cough
• Red, watery eyes
• Sore throat
• Tiredness

Complications can include ear infections, diarrhea, pneumonia and, in rare cases, brain damage or death.

How can measles be prevented?

Vaccination is the most effective way to prevent measles. The first dose of the MMR vaccine is typically given to children on their first birthday (12 months old), followed by a booster at age 4. Talk to your pediatrician about questions and concerns. Children traveling outside the United States may be able eligible to receive the vaccine before their first birthday.

Because measles remains airborne for up to two hours, if 10 unvaccinated children are in a room with one infected child, nine of them will likely contract the virus.

In addition to getting vaccinated, the spread of measles can be mitigated by proper hygiene. This includes:

• Handwashing
• Covering your mouth and nose when you cough or sneeze
• Avoid sharing drinks or eating utensils
• Disinfect frequently touched surfaces

What would you like families to know about measles and the MMR vaccine?

Measles was declared eliminated from the United States in 2000. However, measles immunization rates have declined in recent years due to missed checkups during the pandemic, parental concerns and vaccine misinformation.

Measles also remains common in many parts of the world. Most recent U.S. cases stemmed from unvaccinated travelers returning from abroad. This drop in vaccination coverage makes communities vulnerable to disease resurgence.

Related Stories

• Mindful Monday Medicine: Back-to-School Checklist

• Top 10 Questions Parents Ask About Vaccines

• Measles Mythbusting with Laura Romano, D.O.

Wellness

• Schedule a Check-up: The American Academy of Pediatrics (AAP) recommends annual checkups from age 3 through adolescence. Schedule early to secure an appointment before the school year starts.
• Mental Health: Have open and honest conversations with children about their concerns. Speak with the pediatrician on tools to help with anxiety.
  • Parenting & Back-to-School: Emotional Safety Starts at Home
  • Raising Joy Podcast: Back to School Anxiety
• Oral health: Children should visit the dentist every six months. Make sure kids brush twice a day for two minutes and floss daily. Make an appointment.
• Update child vaccinations: Navigating vaccines can feel overwhelming. Talk to your pediatrician. The Texas Department of State Health Services requires certain immunizations before children can attend school.
  • To schedule an appointment, visit Cook Children's website or your county's health department website.
  • If a child is not of school age but attends daycare, other requirements may apply.

  • College students are required to receive the meningococcal vaccination.

    

• Sport physicals: The annual UIL pre-participation physical evaluation form applies to middle school and high school students. Sports physicals give doctors the opportunity to check for a variety of concerns, from vision issues and asthma to a lingering sprain or even a serious heart condition.

Healthy Routines

• Sleep: Sleep fuels a child's memory and concentration. Without consistent rest, children struggle to focus in class and retain what they learn, impacting their academic performance.
• Key elements for building a bedtime routine:
  • Establish a consistent schedule by going to bed at the same time each night.
  • Limit screen time at least one hour before bedtime.
  • Keep bedrooms quiet, cool and dark.
  • Create a calming routine, such as reading together.
• Transportation safety:
  • E-Bike and E-Scooter safety: Always wear a helmet.
  • Driving: Drive slowly through school zones and watch for pedestrians.
  • Car Safety: Ensure your child is in the correct car seat or booster for their age and size.
• Nutritious meals: Plan balanced breakfasts and lunches to keep energy levels stable throughout the day.
• Screen time: According to the American Academy of Child and Adolescent Psychiatry, children ages 8 to 18 in the United States spent an average of 7.5 hours a day using screens in 2025. Set clear daily limits for non-academic screen use.

Make a Plan

• Virtual care: If school district offers it, sign up for the Cook Children’s School-Based Virtual Health Program.
• Allergy action plan: Provide updated emergency allergy plans and medications to the school nurse.
• Medication management plan: Submit required doctor authorization forms for any daily or emergency medications needed during school hours.

Whether you’re a younger kid starting kindergarten or a teenager starting high school, going back to school can create a lot of feelings. We asked Kia Carter, M.D., co-medical director of Inpatient and Consultation Liaison Psychiatric Services and Kristen Pyrc, M.D., medical director of Psychiatry Outpatient Services and the Partial Hospitalization Program at Cook Children’s Medical Center – Fort Worth, about how they talk to their own children when it is time to go back to school. They approached the subject from different perspectives because their children are different ages. Their back to school tips for parents cover all the bases, and we are thankful for their expertise and personal experiences as mothers!

Dr. Pyrc’s Back to School Tips for Young Kids:

• Little kids want to be big so badly, so parents should play up just how big they are going to be at their new school and all the fun things they can do when they get there.
• Read the book The Invisible String together, and remind your kiddo that you are always connected even when you’re not together.
• Tag in an older sibling or friend if you can! They can give the best advice and pep talks!
• If they are scared (which is totally normal), ask them what makes them worried. It may be the expected things like “Will I get lost? What if no one likes me?” or it could be something totally off the wall that an adult would never think of like “Who’s going to pet the dog when I’m at school?”
• Make drop-off short and sweet. Elementary school teachers are masters of distraction and comfort. I would give a quick hug and let the teacher work their magic.
• Kids look to us to know how to respond in new situations. Even if your mind is racing with worry, it’s important to put on a brave, reassuring face to set them up for success. You got this!

Dr. Carter’s Back to School Tips for Older Kids/Teenagers Addressing Anxiety:

• I encourage all teens to attend the school’s scheduled pickup/orientation as this is a way to decrease anxiety as they are able to see the school, walk their schedule and even see old friends which will help with those first day jitters when navigating such a big school. Also, you may see your old friends at these events which will help with that anxiety about reintegrating with old friends.
• Encourage teens, especially those new to a school, to join a club/afterschool organization to just get involved – this is an easy way to make new friends, provides outside engagement and even creates new hobbies/activities to keep kids busy. They may actually end up loving it. High schools have so many clubs, so most kids can find at least one extracurricular activity.
• Most middle/high school kids don’t want parents to be involved in drop off/make a big deal like we do in elementary school. As parents, we can support our teens differently like the night before or morning of – sitting down for a back to school dinner, eating first day of school breakfast with your teen a couple of minutes early, or reviewing their schedule with them the night before. This just provides some time to connect with your child in a space that is focused on something casual, while also providing the opportunity to talk about any first day anxieties and provide reassurance.
• Mostly teens worry about who they will walk the halls with, or who they will sit at lunch with, and so I would encourage teens when this is a worry – if your child has friends in their class, maybe try asking their friends if they can walk to the next class or walk to lunch together. Another tip is to try looking for familiar faces when walking the halls, or at lunch, because most likely other kids are also feeling the same way and don’t want to sit or eat alone.

When people hear that I’m a pediatrician they often ask if my own children are vaccinated and I always answer with a resounding yes! The next question I’m asked is why I chose to get my kids vaccinated. Here are just a few of my reasons why:

1. Vaccines are safe!

• Millions and millions of vaccines are administered every year with minimal side effects.
• The most common side effects are a low-grade fever, some redness around the vaccine site and maybe some muscle aches.
• Every vaccine went through the same process to ensure they are safe. Side effects and potential reactions are reviewed by multiple agencies including the Centers for Disease Control and Prevention and the Food and Drug Administration.

2. Vaccines are effective!

• Across the world, diseases like smallpox have all but been eradicated because of vaccines!

3. Vaccines save lives!

• Vaccines prevent diseases and illnesses that have serious consequences, even in otherwise healthy children.
• Vaccines prevent diseases that can lead to hospitalizations, pneumonia, potential hearing loss, potential loss of an arm or a leg, brain damage and even death.

4. Vaccines do not cause autism.

• Science and research has proven again and again that there is absolutely no link between vaccines and autism.

5. Vaccines are recommended by my kids’ own pediatrician.

• Vaccines are also recommended by the American Academy of Pediatrics, the American Academy of Family Physicians, the CDC and others.

6. Vaccines help keep my community safe.

• Vaccines protect more than just kids. They protect your child’s grandparents, their classmates, your neighbors, and the community at large.
• Vaccines can help prevent your child from spreading illnesses to at-risk individuals such as your parents who have diabetes, your child’s classmate who is undergoing chemotherapy for cancer, your neighbor who just received a kidney transplant or the cashier in the grocery store who has an autoimmune condition.
• We rely on everyone to get their vaccines to keep the community safe!

7. I want my kids to give their grandparents a big hug at Thanksgiving!

• My father has multiple medical conditions including rheumatoid arthritis and Type 1 Diabetes. We get our vaccines so every time we see him, my kids can run and give their Pap the BIGGEST hug in the world without worrying about giving him the flu!

If you have any questions or concerns about vaccines, please reach out to your pediatrician or primary care provider. We would love to talk to you more and answer all of your questions and concerns! 

As students gear up for summer break, it’s not too early to get a physical or the immunizations they’ll need before school starts again in August.

Incoming kindergarteners and seventh graders are due for routine vaccinations. Junior high and high school students need a physical before they can participate in athletics or marching band.

Cook Children’s neighborhood health centers and pediatric offices can help your family check these items off your to-do list. Make an appointment early in the summer, come in for the required shots or a physical examination, and beat the back-to-school rush.

Amy Medalie, RN, MSN, CPNP advises parents not to postpone scheduling those visits. She wants children and teens to stay on track for their vaccines – or get caught up if they’ve fallen behind.

“This is a topic we talk about all day,” said Medalie, a nurse practitioner at Cook Children’s Neighborhood Health Center Richland Hills. “I tell parents that vaccinations are our best defense at helping prevent illnesses.”

Vaccines to protect against certain contagious diseases – including measles, polio and chickenpox – are safe and effective at stopping the spread. The boosters required in Texas for kindergarten and for seventh grade can usually be administered in one visit to your pediatrician or neighborhood health center.

Before the final school bells ring this May, here’s a quick look at a few key points.

Immunizations

The 2024-2025 Texas Minimum State Vaccine Requirements chart lists in English and Spanish the number of doses that students need. If an incoming kindergartener has missed out on vaccines normally given at age 4, these additional vaccines are due now:

• MMR (measles, mumps and rubella)
• DTaP (diphtheria, tetanus and pertussis)
•  IPV (inactivated poliovirus)
•  Varicella (chickenpox)

And between the ages of 11-12 years, these additional vaccines are due:

• MCV4 (meningitis)
• Tdap (tetanus, diphtheria and pertussis)

How do vaccines work? If someone who’s been vaccinated comes into contact with that infectious disease, their immune system has already been primed to respond, Medalie said.

“Vaccines teach our bodies to recognize a certain bacteria or virus. If a person is exposed to those bacteria or virus, the immune system is already prepared to fight off infection,” she said.

Sites across Cook Children’s offer a Comfort Menu of items that help patients relax and feel less of a pinch when the needle goes in. Children can request cold spray or a buzzy tool on their skin for comfort and distraction. 

Medalie and her colleagues are happy to answer any questions to provide families with accurate information and reassurance about vaccines.

Sports Physicals

Early summer is also an ideal time to come to Cook Children’s for the physical exam UIL requires before participation in school athletics and activities such as cheerleading and marching band. The form contains two parts:

1. Medical history – a list of yes/no questions about headaches, dizziness, chest pain, seizures, allergies and more. This portion must be filled out every year by the student and parent or guardian.
2. Physical exam – performed by a health care professional to check the student’s lungs, joints, vision, weight, heart rate, blood pressure and more. UIL requires the physical exam before the 7th, 9th and 11^th grades. Some school districts require it annually.

The provider checks one of three options on the form: cleared for participation, cleared after completing additional evaluation or rehabilitation, or not cleared due to concerns.

Medale said the physical exams can identify issues such as irregular heartbeat, vision problems, spine curvature or uncontrolled asthma. A referral might be needed for follow-up testing, such as an electrocardiogram (EKG) if a possible heart rhythm disorder is noticed.

Sports physicals give also teens the chance to ask questions or report any problems that might impact their ability to practice or compete safely. Medalie urges her patients to speak up if something feels off … shortness of breath or a lingering sprain for instance.

“Be honest with yourself and your parents about how you’re feeling, so that you’re not just pushing through something that can contribute to reinjury,” she said.

As a mom, Medalie has seen in her own teens the endurance it takes for marching bands and drill teams to perform in the Texas heat. Connecting with student athletes for physicals early in the summer gives her the chance to remind them to stay hydrated, avoid excessive caffeine, and don’t skip meals.

We’ve all bought the desired backpack or lunch box, purchased the needed clothes and shoes, and reviewed class schedules and lists with a fine-toothed comb. As parents and caregivers, so much detail and organization goes into getting things ready for going back to school. 

Every one of my girls has a different priority - how many classes do they have with a friend, if they made it into the class they hoped for, if they got the teacher they wanted, and do they get to do the activity this year that they really want to do. 

All of our priorities collide and we forget the most important priority is who we are in the midst of all of these things. As we prepare our kids for returning to school, it can be easy to get caught up in the supplies, schedules and activities. However, preparing our kids for the character traits they will need throughout the year and their lives is also important. 

If I focus on just the year in front of me, I can get a little overwhelmed with the extras and forget that my kids’ integrity matters most. Their character, in terms of their kindness, gratitude, honesty, and making good choices, will carry them further than any other detail of the year.

Kindness

Kindness is not the easiest way all the time. It takes work and fortitude. Choosing kindness is intentional and as an adult, I need reminders and help to choose kindness when others are not. 

Our kids need even more help with this. They need ideas and help processing exactly what kindness looks like when they really don’t feel kind toward someone. 

Sharing with someone who never shares, helping the person that doesn’t help you, responding softly when others use their words to hurt – all of these things and more are hard but effective in the long game of life. 

This is not something that comes naturally. It is important to remind our kids that we don’t know everyone’s story or even all of their story.

We want to be people and raise people that leave a positive mark on others’ lives. So, while we aren’t wanting to kill anyone with kindness, we can be certain that kindness will overshadow meanness every time. 

Gratitude 

I have said, “Name 10 things you are thankful for!” about a million times in my parenting journey. The minute their world is falling apart and nothing is going their way, I am giving them a speech about everything that is good. 

I found years ago, though, that having my kids list the things that they are grateful for made a bigger difference than my lecture. 

Just like kindness, gratitude is also not always easy. Some days I can barely come up with three things for my list when the reality is that I truly have a thousand things a day to be grateful for. Again, our kids need help.  It has been researched and studied for decades, but what we know is true is that gratitude changes our perspective and ultimately the atmosphere around us. 

You put a bunch of ungrateful kids in a classroom together and you have a classroom full of complainers that cannot be happy. You add one grateful kid into the mix and they can change the group. Help your kiddos be the grateful kids. 

One way I often see parents help their kids practice this is through highs and lows at the end of the day or as one of my friends calls it “roses and thorns.” Have your kids name their top three good things and the top three hard things of each day. 

I also recommend having your kids say three things (or 10) they are grateful for on the way to school before the day starts. This helps set the tone for the day.

Honesty 

Honesty can come with some weight. If you don’t choose the honest way, then your words become meaningless to those around you. To be a person of your word comes with consequences, but it also builds you into a trustworthy person.

I find that honesty can be difficult for kids because they are more fearful of the consequences of their honesty than they are of lying.

This is often because they can’t see how lies pile up and that they will have to lie to keep their first lie intact. It’s our job as parents to help them make the hard choice to tell the truth even if there is a short-term consequence. 

Years ago, one of my precious daughters drew on her teacher’s couch and then lied about it saying she didn’t do it. While she wasn’t the only one, she was one of the artists. She had to write a note apologizing for not telling the truth, look her teacher in the eyes and tell her she lied and then I joined her for a lunch hour to try all the options for cleaning ballpoint pen off of a faux leather white couch. She still remembers this! 

Good choices 

As my kids head out of the car every day, I say, “Be kind. Make good choices.” I was reading another mom’s encouragement the other day: “You (and everyone you know) are just one decision from falling off a cliff.” It is the truth. One bad choice can change the course of a whole day, week, month, year or even someone’s life. 

My husband always says that he wants our kids to know how to think. Being able to stop and think through your next move and decision is incredibly important. This is also something all of our kids need help with. 

As parents and caregivers, we want to provide a safe space to think through decisions. We want our kids to learn how to stop and think before impulsively moving into a choice. 

If we can remind them and help them to be mindful, we can help them establish their moral compass that will last them a lifetime. Good choices account for yourself, for others, and for the future. 

As you blaze into this next school year, try to remember that your kids character matters the most in the long game. It doesn’t mean that we don’t focus on the schedules, activities and supplies, but we prioritize their character and the attention it needs and deserves. Also, don’t forget, we are all in this together! 

The Jane Justin School, under the Child Study Center at Cook Children's, is a private school that provides special education to children. This year, 86 students are enrolled.

Early Monday morning, students hugged their parents, took photos in front of the school and met their teachers. Friends reunited with hugs and talked about their summers.

“The friendships are strong here,” said Tracie Mann, Ph.D., Headmaster at Jane Justin School. “A lot of them do things after school together and get together over the summer. Everybody is really excited for the first day.”

“I'm ready to get back to lessons and play with my friends – and not go outside because it's way too hot," student Wyatt Merchant said. 

Students in the Purple Room class are between 7 to 9 years old. They gathered around to color a large “back to school” sheet together.

“We're such a small community of people and we're so welcoming and so warm,“ Dr. Mann said. “I think it makes it easier for children to come in every year and kind of make that transition.”

Summertime is the best time of year (in my opinion!). Schedules can sometimes be looser, we can be outside more and it’s great to have a break from schoolwork! It is common to be more relaxed with the bedtime routine.

As a parent myself, I am happy to let a strict bedtime for the school year fade away. However, a late bedtime and waking up late can end up being troublesome during this time of year when we know we have to return to a more regular schedule.

It isn’t “bad” for kids to go to bed late and awaken late, as long as they are getting the total number of hours of sleep recommended for their age. I have met a few kids that go to bed late but also wake up early so they are tired in the daytime, which can impact their behavior.

Our middle school kids are programmed to go to bed late and awaken late -- this change to the clock inside your brain is part of the pubertal process. Therefore, it can be hard to fight the return to an early morning wake-up in August.

How should you do it? Here is one method. Once a person has been going to bed late for a longer period of time, the brain becomes accustomed to that. So simply getting in bed early won’t mean that a person gets to sleep early.

It’s best to continue with the late bedtime, but get up a bit earlier (like 1 hour earlier) than usual. It’s hard to do but using sunlight exposure (sun to the face) and encouraging breakfast can help. Then kids will be naturally tired earlier the following evening since they arose earlier that morning. Some parents use melatonin (dose of 1-3 mg) given 1 hour earlier than the late bedtime to help with falling asleep as well.

Watching caffeine intake, aiming for calm play in the hours before bedtime and keeping lighting low can also help with resetting bedtime. Screen use (TV, phones, computer monitors, and video game consoles) should stop around 1 hour before the desired bedtime as well.

Remember that bright artificial light (from screens) can trick your brain into thinking it is daytime. Try not to allow afternoon naps, so kids build up their sleepiness- aiming for a reasonable bedtime.

Sometimes writing down the plan for bedtime/waketime change can help. Kids can be an ally here so involve them in the process.

Good luck with the new school year!

A new school year is just around the corner and it’s time for incoming kindergarteners and seventh-graders to get caught up on their routine immunizations.

Vaccines to protect against certain contagious diseases – including measles, polio and chickenpox – are required for students in Texas. Your child or teen might need a few boosters depending on their grade and whether they’re behind on their shot schedule.

Cook Children’s wants parents to know that vaccines for school are safe and proven tools to prevent diseases from spreading through the classroom and beyond.

“These vaccines have been around for a long time. There's nothing new to these vaccines, and they're as safe as they've ever been,” said Erin Bridgewater, M.D. at Cook Children’s Pediatrics in Celina.

The 2023-2024 Texas Minimum State Vaccine Requirements lists the number of doses that students need. If an incoming kindergartener has missed out on vaccines normally given at age 4, these additional vaccines are due now:

• MMR (measles, mumps and rubella)
• DTaP (diphtheria, tetanus and pertussis)
•  IPV (inactivated poliovirus)
•  Varicella (chickenpox)

And between the ages of 11-12 years, these additional vaccines are due:

• MCV4 (meningitis)
• Tdap (tetanus, diphtheria and pertussis)

About 7% of seventh-graders statewide either submitted exemptions or were delinquent in their meningitis and Tdap vaccines in the 2022-2023 school year. The concern is that a decline in the vaccination rate makes the general population more vulnerable to a disease catching hold.

“These illnesses are still very much present and could possibly cause serious illness in our children, especially if we don't continue to vaccinate and keep that high level of herd immunity that keeps these things from spreading,” Dr. Bridgewater said.

For example, a pediatric patient in June 2023 was diagnosed with the first confirmed measles case in Texas since 2019. And in New York in 2022 an adult was diagnosed with the first case of polio identified in the United States in nearly a decade.

Making an Appointment

If your child or teen needs an up-to-date shot record before school starts in August, it’s best not to put it off. Schedule your child's appointment earlier in the summer to get what you need for the school year. A spike in appointments and rush for vaccinations and school physicals can cause delays at Cook Children’s pediatrics offices. You can make an appointment at any Cook Children’s neighborhood clinics or pediatric office, including the site in Celina, which opened in April.

Dr. Bridgewater understands that it’s easy to lose track of checkups and shots -- especially for families in transition, like the influx of residents moving into the fast-growing area around Celina and Cook Children’s Medical Center - Prosper.

“A lot of parents meant to come in,” she said. “Things got busy and so they just kind of forgot. We certainly want to help people in those situations.”

The boosters required for kindergarten and for seventh grade can usually be administered in one visit to the clinic or office.  If the patient needs a checkup, it’s an appointment with the doctor. If the patient needs vaccinations only, it’s an appointment with the nurse.

How do vaccines work? The needle injects a portion of a pathogen into the body so that the immune system learns to recognize the virus or bacteria, Dr. Bridgewater said. Vaccines don’t cause infection.

“It's kind of like we're giving their immune system a snapshot of the most important piece of the puzzle so that if their immune system sees that piece again, they already know how to respond,” Dr. Bridgewater said.

She explains to her patients that it’s better to get one preventive poke than to catch a disease that might put them in the hospital. She welcomes any questions they or their parents want to ask so that they can feel confident and informed. Dr. Bridgewater wants to dispel any myths and misinformation that might be a stumbling block.

Dr. Bridgewater believes in vaccines not just as a pediatrician, but as a mom. She points out that her own two kids in recent years got the shots they needed for school.

“I want other parents to have the same reassurance that I have,” she said. “If they've heard anything at all that makes them concerned, I really encourage them to reach out and ask those questions instead of living in fear and then maybe avoiding something that could truly be lifesaving for their children.”

Before they can pump weights in the school gym or march with the band this summer, teens in Texas need to complete a form that aims to catch any underlying health concerns.

The annual UIL pre-participation physical evaluation form applies to junior high and high school student athletes and marching band members for the 2023-2024 school year. The form has two parts:

1.      Medical history – a list of yes/no questions about headaches, dizziness, chest pain, seizures, allergies and more. This portion must be filled out every year by the student and parent or guardian.

2.      Physical exam – performed by a physician to check the student’s lungs, joints, vision, weight, heart rate, blood pressure and more. UIL requires the physical exam before the 7th, 9th and 11^th grades. Some districts, including Fort Worth Independent School District (FWISD), require it annually.

Doctors at Cook Children’s say the physical exams are an important safeguard for student athletes. Sports physicals give doctors the chance to check for a variety of concerns – everything from poor eyesight and asthma to a lingering sprain or even a serious heart condition.  

“The goal of a sports participation physical is to review each child’s health history, to perform a thorough exam, and to identify health issues that could predispose the participant to a high risk of having symptoms or an injury while playing sports,” said Ann Natterer, M.D. at Cook Children’s Pediatrics Cityview in Fort Worth.

Why go to your regular pediatrician for this exam?

Dr. Natterer points out several advantages, including patient privacy and getting up-to-date with routine care, such as vaccinations.

“The pediatrician knows the child the best, has access to past medical history, and is also in a better position to facilitate any follow-up evaluations that may be necessary,” she said.

The pediatrician sees the big picture during a sports physical, said Wuroh Timbo, M.D. at Cook Children’s Pediatrics Lake Forest in McKinney. Your teen’s doctor has the files to track changes over time in weight, heart rate, medications and other parts of health history. Your teen’s doctor also knows about any previous illnesses, such as rheumatic fever, which can cause heart valve damage.

“And I think also just having an already established rapport with the families,” Dr. Timbo said. “It’s way easier to communicate with someone you already know. You’re going to get better information and give better information when there’s already a previously established relationship.”

Dr. Timbo recommends that parents make the appointment for their teen’s sports physical as early as possible. Getting the physical exam done early in the summer beats the rush that typically happens just before football workouts and band practice start. In other words … don’t put it off. It’s better to find out in May rather than in August if a student athlete needs vision correction, an inhaler or physical therapy, for instance.

What to Expect

It takes about 15 minutes, Dr. Timbo said, to go through a sports physical. Blank spaces on the UIL form allow the doctor to make note of any abnormalities with the patient’s eyes, ears, throat, lymph nodes, pulse, lungs, abdomen, back, feet and joints.

A sports exam gives patients the chance to ask questions or report any problems that impact their athletic ability. Knee pain and heel pain are the two most common complaints that Dr. Timbo hears. Sometimes the athletes tell him they’ve noticed shortness of breath or frequent headaches.

“Whether it’s something like exercise-induced asthma that we hadn’t caught before, or it’s an injury that re-aggravates every time they do a certain movement, we want to know, and we want to come up with a treatment plan to address it,” he said.

After the exam, the doctor checks one of three options on the UIL form: cleared for participation, cleared after completing additional evaluation or rehabilitation, or not cleared due to concerns. A referral might be needed for further tests with a specialist.

FWISD Director of Athletics Lisa Langston, Ph.D. said a physician’s clearance offers some assurance that the students can safely practice and compete in sports activities. Thanks to the required physical exams, she said, conditions such as cardiac issues and hernias have been detected through the years.  

“The students understand it’s all about their health and wellbeing. We’re not just doing lip service,” Dr. Langston said.

Dr. Timbo urges his patients to listen to their bodies. Speak up if something feels off. Understand that the annual sports physical is geared to pick up on any medical condition that might hinder their performance. Some underlying conditions could even be life-threatening, such as heart rhythm disorders that might lead to sudden cardiac arrest. 

“All doctors want their patients to be active,” he said. “Athletics is good for the body, good for the heart and teaches great life lessons on the ability to work in teams, resiliency and concentration. But we as physicians want to make sure that they’re safe to participate in these activities.”

As we settle into a new school year, many parents and caregivers may find themselves unsettled about the need for increased security measures in our schools. Given recent gun violence events in Texas and across our nation, school administrators have placed safety at the forefront of their concerns. With this concern, however, also comes heightened and unwanted stress, worry, and anxiety for parents, caregivers, students, and teachers. Recognizing and addressing these emotions can be fundamental in helping our children develop a sense of peace and reassurance for a successful school year.

Before adults begin having conversations with children, it is important for them to process their own thoughts and emotions around the given topic. This is best practice for any conversation, not just those involving difficult topics like school tragedies. 

When caregivers take time to process and discuss their own feelings, it better equips them to manage personal expressions and reactions as well as model desired behaviors for their children. As a parent or caregiver, this small step can have a big impact on the outcome of a child’s thoughts, expressions, and approaches to processing difficult situations. 

Limiting exposure to information in the news and media is another key component of curbing anxiety and stress. We live in a digital age where, inevitably, we are inclined to receive information through various platforms and outlets. Generally, the primary adults in a child’s life are the first line of defense for what a child hears, sees, and does. 

By limiting exposure to harsh content in the news and media, you are helping safeguard and filter information that may or may not have negative implications for your child. If and when your child does have exposure to undesirable items in the media, discuss what was seen or heard, talk through questions and concerns, and validate these feelings. Repeat this process, consistently following up with your child, until a felt sense of safety is established. These actions will show children that their concerns are important and they matter.

Finally, share with your children the importance of "trusting their gut" and speaking up when something doesn’t feel or seem right. Express to them: "If you see something, say something." Teachers, administrators, and school personnel cannot physically have eyes everywhere at all times. Students see and hear things among their peers that school personnel may never know about. 

Encourage your child to speak up if they feel uneasy or have a concern. Oftentimes, students are afraid of the negative social attention this could bring, but their instincts and initiatives to act on something that doesn’t "seem right" could be very impactful in preventing a crisis situation or even saving a life.

All of these suggestions can and will look differently depending on the age of your child.  So it’s important to take a developmentally appropriate approach when talking with your kids.  Also, these conversations can be time-consuming and prompt further discussion.  Allow plenty of time for such discussions with your child so they don't feel rushed or dismissed.

It is a good sign if your child is expressive and requests more of your time. This means you are fostering and holding a space for them to come to you with big issues and big feelings, and that is something well worth your while. These are small investments that can make a huge difference now and in the future.

Reminders to help facilitate conversations with our kids: 

• Recognize: Name the emotion, talk about it, and deal with it.
• Reflect:  Think about and work through your own feelings around a given topic. Then develop a plan for a discussion with your child.
• Review:  Be a buffer and filter the content your child may see or hear through media platforms.
• Respond & Reassure: Hold space for your child to share his or her thoughts and have a developmentally appropriate conversation by responding appropriately to his or her needs. Provide reassurance to foster a felt sense of safety and security.

Back to school can be a difficult time for kids, especially if they suffer from anxiety.

On this episode of Raising Joy, we’re talking to Laura Anne Burgos, LCSW. She is a licensed clinical social worker and therapist in the Gastroenterology Department at Cook Children’s Medical Center. Laura Anne explains how the mind/body connection can trigger physical pain such as stomachaches and headaches. She also helps us understand when to seek help from teachers, therapists and doctors.

In addition to her clinical work, Laura Anne is also a canine handler for the Sit..Stay..PLAY! program at Cook Children’s. We talk to her about the value Cook Children’s facility dog program provides to patients, families and staff.

Raising Joy is part of Cook Children’s Health Care System’s Joy Campaign, a communications initiative aimed at preventing youth suicides. For more information about the Joy Campaign, visit cookchildrens.org/joy.

New episodes of the Raising Joy podcast will be available each Tuesday. It is currently available on all major streaming platforms including Apple, Spotify and Google Podcasts.

Nutrition experts at Cook Children’s want parents to know that lunch in the school cafeteria presents unique challenges and opportunities for students to form healthy eating habits.

First, the challenges …. Foods that some kids don’t like or won’t try. Too little time to eat.  Vending machines. And famished kids and teens who skip lunch and go home so hungry they eat meal-sized snacks after school.

And the opportunities …. Appropriate portion size. Attractive options. Nourishment helps students concentrate in the classroom, power through PE, and hit their growth milestones.  

As the 2022-2023 academic year gets underway with new lunch routines, families are encouraged to have ongoing conversations with their children about what they’re eating or not eating. Best practices will incorporate vegetables, lean proteins and whole grains in every meal. Getting your child’s input on preferences can help make the most out of their lunch period.

“Look at the menu ahead of time and make a plan so that they’re being mindful about eating veggies and other healthful foods,” said Kathryn Wheeler, D.O. at Cook Children’s Pediatrics Clearfork. “Preparation will help empower the kids to make good choices.”

Lunch Line Options

The Journal of the Academy of Nutrition and Dietetics reported that youth between 2-18 years old get almost half of their daily calories from added sugars and solid fats in sodas, fruit drinks, desserts, pizza and whole milk. The National School Lunch Program sets limits on sodium, saturated fat and calories. Five components are included in school-served lunches:

1. Fruits (fresh, frozen, dried or canned in light syrup or juice)
2. Vegetables including dark green, red/orange, beans or peas (fresh, frozen or canned)
3. Grains  
4. Meat or meat alternatives such as beans
5. Low-fat milk

Registered dietitian Lauren Williams works in the Risk Evaluation to Achieve Cardiovascular Health (REACH) program, which serves children and teens with high cholesterol, lipids disorders, diabetes and obesity at the Cook Children’s Endocrine Clinic. Williams sometimes hears complaints about school lunch from her patients.

“They might only eat the fruit because they don't really like the main entree, or they might only eat the main entree because the vegetables are overcooked or unappealing,” she said. ‘They might only like one or two components out of the five that are served. And if they don’t supplement with something from home, they may be left hungry.”

Another concern is inadequate time to eat lunch, which forces children to eat so quickly that they don’t respond to the fullness cues sent from the stomach to the brain. In a hurry, they overeat.

“What they're being inherently taught by having 10 minutes to eat is ‘I have to eat this quickly because if I don't eat right now, I don't eat,’” Williams said. This may also lead to the habit of eating quickly at other meals. Or if their lunch break happens at 10:45 am, they might be hungry and overindulge in snacks later in the afternoon.   

Williams recommends that parents talk to their children about what they ate at school. Bonus points if this is a conversation had around the dinner table since family dinners are another important part of healthy eating. If they’re not liking what the cafeteria serves, then bring a lunch from home.

Packed Lunches

Consider making sandwiches, wraps, pasta or salads. Include a protein (such as turkey or ham, cheese, Greek yogurt, beans or nuts); a starch (beans or whole-grain bread or tortillas); and fruit and vegetables for fiber (carrots, celery sticks, bell peppers, apple slices).  Williams also suggests a side of hummus or a dip to keep things fun and entice kids to eat more vegetables.

“It doesn't have to be fancy,” she said. “It just has to fill their tummy with some nutrition to get them through the day.”

More back-to-school advice from the dietitian:

• Rely on familiar favorite foods. “If you know that your 8-year-old is perfectly fine with having carrots most days with lunch, then that's OK,” Williams said.
• Ask your child about anything that might make them apprehensive in the cafeteria environment, especially on a new campus. Normalize the discussion of their lunch routine. “Don't be too hard on your kids if they don't choose the broccoli or green beans. Find out why.”
• Keep a handy stash of nutritious foods for after-school snacks. Her top picks include peanut butter crackers, non-fat yogurt, cut-up veggies and low-fat cheese sticks. Keep in mind that snacks should bridge the gap until dinner and not be meal-sized portions.

“You can't always guarantee that a child is going to choose fruit over a cupcake or cookie, but having it there and accessible makes it a whole lot more likely,” she said.

At annual check-ups with her patients, Dr. Wheeler talks with children and families about the benefits that come from consuming the right foods. She emphasizes the role that nutrition can play in preventing diseases down the road, one small step at a time, such as eating less processed foods and more fresh produce.  

“We know that all those good habits they have in childhood lay the foundation for a healthy lifestyle as they grow up,” she said. “Parents can be such great models.”

On the evening before the first day of school the multiple to do’s on a list have almost been checked off and completed: 

• Hair cuts 
• School supplies 
• School clothes and other necessities 
• Adjustment of bedtimes to make the early morning wake time doable 
• Meet the Teacher 

While I’m almost certain I’ve forgotten to add something to that list, a sense of angst, excitement, worry, uncertainty and joy all in one rush my mind. While it’s common for parents of kids that will begin school for the first time to feel these emotions intensely for the first time, it's not uncommon for parents of kids returning to school to feel these very same feelings once again.  

The world we are raising children in now seems very different from the not too distant past when we were school aged children ourselves. The last few years have proved to be anything but easy when it comes to parenting and raising children. While these complex situations have led to many difficulties and internal struggles; the resilience and innate perseverance of our own children is what reassures us that this will all be okay. 

While there are varied life circumstances and difficulties that parents may be facing, we must remember that a “first day” offers a new beginning and opportunity to help us through these complex situations in our lives. May we use this new beginning as an opportunity to form partnerships with teachers, school administrators and those who are a part of our child’s village to help them thrive. 

The emotions come rushing back after I’ve given myself a pep talk about the many worries that are usually put at ease when my children are on summer break. Will they be safe? A very loaded question because now they will leave my attentive side and learn to navigate their time away without me. Have I taught them enough about being kind? Will other children be kind to them?  

My worries ease some with knowing that although there are many factors beyond my control I have done my best to prepare them for these “first days” and beyond.

To all parents feeling all the feels on the evening before the “first day of school”  know that you are not alone. Continue to inspire kindness and connect with your village to help your children thrive. For they are our future and how we shape that future is dependent on us.

To all teachers and educators thank you for what you do every day for students and their families. Your willingness to remain in this profession has gone underappreciated for quite some time but we are so very thankful for what you do every day.

Lastly to ALL kids returning to school this year may this be a healthy, safe and successful school year for you!

 – Dr. Soria-Olmos

By Ashley Pagenkopf, MS, CCLS, Child Life Specialist at Cook Children's

I truly cannot believe that the summer is over. The summer months typically provide respite and regrouping for families. That is true for our family, but it is about this time that I start feeling ready to begin the new routine and move through the awkward first weeks of school.  One of my kiddos will have major surgery the second week of school and another kiddo starts middle school this year so my mom heart is extra anxious!

Summer months typically provide some respite at the hospital too. We see less illness and historically a fewer number of patients. I don’t think that any of us would say that this summer felt restful, though. While there is less illness in the summer, the number of traumas tends to increase, and we see a great deal of tragedy over the summer months.  This summer has been no exception. 

What is the well-known saying? We need a vacation from our vacation. I can’t imagine that I’m the only one feeling that at the close of this summer. Just like the beginning of a new year, we can all appreciate the reset that a new school year can bring. But we can’t ignore the intense emotions, anxiety and stress that a new school year inevitably brings to kids and families.

The weeks before and the first few weeks of school, the emergency room experiences an uptick in the number of kids coming in for behavioral health needs. There are so many stressors to starting something new, and post-pandemic we are needing more than ever to be aware of this and address it in every environment a child encounters – home, school and healthcare.

The Association of Child Life Professionals recently began an initiative nationwide addressing emotional safety within the healthcare environment. Emotional safety is defined by the ACLP as “an intentional, interdisciplinary practice to promote resiliency, healing and trust for pediatric patients and their families during medical experiences.”

This means that when a child walks through the doors of the hospital, we are all working together to be trustworthy adults that help a child recover more quickly from difficult experiences and help them work towards emotional, physical, and spiritual healing. While child life specialists promote and advocate for emotional safety, it is the job of the entire multidisciplinary team to provide this high level of care to patients and families.

When I look at this definition of emotional safety, I am reminded as a parent that this is what I want for my kids within my own home. I want my children to be able to recover quickly and withstand the storms of life. I want them to trust themselves, peers that are trustworthy, and adults that are trustworthy. I deeply desire for my girls to experience a balanced, healed life physically, emotionally and spiritually.

I don’t know about you, but as a mom, I am certain that I am not always promoting emotional safety within my home. I always desire it, but I know that I can often get in the way of my children feeling emotionally safe. In my exhaustion and selfishness, I can forget to really take the time to process the difficult emotions and validate my girls’ feelings. I often want them to just get over the hard without ever acknowledging how hard it may be. (And just in case you aren’t aware, things have been HARD over the last couple of years – especially for our kids.)

I have three girls that often cry in response to hard things. Even I cry often in response to hard things, but I can still find myself being annoyed at their tears. When in reality, the expression of our emotions often leads to healing and tears are needed.

I have also found that my kids need me at this time in their life to be their cheerleader and their advocate. My kids count on me to fight for them and to help them feel safe in all situations. Even my oldest, who is learning to advocate for herself, needs me to be there to help her when her school world or friend world is crumbling around her. 

As a child life specialist, emotional safety is extremely important to me in the healthcare environment. It is a right of every human to feel safe in every way while they are receiving healthcare services.

As a parent, it is also my responsibility to provide an emotionally safe home. This provides the framework for my girls to know what emotional safety is. When our children can understand what emotional safety is, they will be able to advocate for it not only in their healthcare experiences but also at school and at their jobs.

As we begin another new school year, I want to challenge you as parents and grandparents to consider this definition of emotional safety. Consider how you can promote resiliency among your kids and grandkids. Take some time to be with your kids in the next few days and weeks.  Allow them to really express their emotions to you (tears and all), validate their emotions and cheer them on towards the next right thing. Our kids need us to model in our homes what an emotionally safe environment should look like so that they can truly expect that level of safety in their all encounters.

For Lisa Elliott, Ph.D., back to school means a full schedule of therapy sessions that all have a common topic – bullying. Dr. Elliott has been a psychologist at Cook Children’s for 28 years and says bullying now starts as early as Kindergarten.

“We see it moving down in years considerably,” Dr. Elliott said. “Parents need to understand, given our culture, that most children will engage in bully behavior because it is being modeled for them through programs on TV, news media and reports, online exposure and adult actors, sports figures and political figures.”

The pandemic has only made the bullying issue even worse.

“COVID, isolation and increased use of social media have definitely impacted bullying – the number of bully incidents have significantly increased, and the severity has also,” Dr. Elliott said.

Since children spend a large amount of their time at school, teachers have the opportunity to demonstrate inclusion and empathy toward others.

“The reality is that teachers are critical role players, and their kindness matters,” Dr. Elliott said.

Types of Bullying

Four types of bullying exist – physical, verbal, social and cyberbullying.

Physical bullying accounts for less than 1/3 of bullying incidents and more boys engage in this type. 

Verbal bullying is the most common form affecting an individual’s self-esteem and feelings for years, leaving scars that last a lifetime. This includes spreading mean rumors, making accusations that are not true, gossip, lies, spreading embarrassing private truths, name-calling, taunting, belittling and cruel criticism.

Girls have the highest engagement in social bullying – a difficult-to-detect form of bullying including ignoring, isolating, excluding or shunning. It is the most potent kind, especially in the middle school and high school years.

As soon as children have cell phones, cyberbullying comes into play.

“Cyberbullying is 24/7 and has a rapid transmission. It reaches the world in an instant,” Dr. Elliott said.

Five years ago, cyberbullying in schools was addressed with the enforcement of David’s Law in Texas which requires schools to notify the parent of an alleged victim of bullying within three business days of a report, rather than waiting for the findings of an investigation. The school also must adopt policies allowing students to anonymously report incidents of bullying and may expel or place a student in a disciplinary alternative education program.

Signs and Symptoms of Being Bullied:

• Does not want to go to school/skips school/gets into trouble at school
• Grades suffer
• Stops talking about peers and school activities
• Loses interest in activities
• Physical manifestations (sleep disturbances, withdrawal and wanting to be alone, complaints of pain or illnesses, appears tearful, displays victim body language such as keeping head down, hunching shoulders and avoiding eye contact)
• Emotional manifestations (appears sad, angry or irritable, withdraws and acts timid, becomes overly moody or anxious, exhibits aggressive behavior)
•  Social/behavioral manifestations (withdraws socially, changes friends, engages in self-mutilation, threatens violence to self and others, talks of running away or suicide, suddenly stops using the computer or other mobile devices)

Signs and Symptoms of Being the Bully:

• Suddenly stops using the computer/device or turns off the screen when someone comes near
• Appears secretive about what they are doing on the computer/device
• Appears nervous when using a computer/device
• Spends an excessive amount of time on the computer/device

“If your child is bullying others, react calmly and don’t blame yourself because there are so many influences in a child’s life. I commend parents who recognize their child could be a bully,” Dr. Elliott said.

Equip Your Child with a Foolproof Tool

When talking to children about peers, the growth mindset of appreciating and valuing differences of opinion should be addressed. Tell your child how to help a classmate who is being bullied such as spending time with them and encouraging them at school and outside of school, helping them get away from the negative situation and telling an adult. 

After researching various strategies to deal with bullies, Dr. Elliott created a response tool that has proven to stop the bully from coming back for more harassment.

“If you show pain, hurt, fear or anger it feeds the bully,” Dr. Elliott said. "Ignoring the bully still gives them the idea they are successful in hurting the victim which fuels the fire and motivates them to keep bullying. The fewer words you say, the better – use words such as ‘OK’ and ‘whatever’ before walking away.”

This strategy acknowledges the bully while at the same time showing him that the tactics are not effective.

“I’ve never had a child or teenager tell me that it doesn’t work,” Dr. Elliott said.

Proactive Tips for Every Parent

Modeling empathy needs to be at the forefront when raising children. Focusing on others’ needs and feelings will contribute to a child’s overall happiness.

• Openly talk about bullying all the time
• Ask questions like “Has bullying ever happened to you? How did it make you feel?”
• Role play and ask “How do you think this would make you feel?”
• Teach empathy and kindness – have child open doors for people, get involved in a service project

“Kids are naturally born with kindness and empathy,” Dr. Elliott said. "What changes over time is what gets modeled for them and what they see.”

When it comes to life-threatening food allergies at school, teachers make all the difference. 

“It is about prevention,” said Ankita Singh, D.O., pediatrician at Cook Children’s Pediatrics Walsh Ranch. “Teachers need to be involved from the beginning and incorporate the food-related safety precautions just like it is part of the normal school day.”

As a mom of two kids with life-threatening food allergies, I know that the school experience largely depends on the understanding and empathy of those involved. Kindness goes a long way.

One in 13 children has severe food allergies (about two per classroom), and 75% of these cases occur in children with no prior family diagnosis. Chances are most children will know someone with food allergies and could save a life.

A food allergy reaction can cause symptoms that range from mild to life-threatening. In the United States, food allergy is the leading cause of anaphylaxis outside the hospital setting. Anaphylaxis is a serious, life-threatening allergic reaction that typically affects more than one part of the body at the same time and may include hives, wheezing, high heart rate, rapid swelling and trouble breathing. People who have previously experienced only mild symptoms may suddenly experience a life-threatening reaction.

Clear Communication is Key

Parents need to be very clear from the beginning with everyone at the school – teachers, nurses, administrators and other parents. They should discuss the food allergy action plan with the school nurse, informing them what foods the child should avoid and what to do in case the food was eaten, or they have been in contact with it.

“For lunches and birthday parties in the child’s classroom, the school should tell the parents not to include the allergens to avoid cross-contamination and the risk of severe allergic reactions,” Dr. Singh said. “Make sure the child is aware of what to do if there is exposure at school. Run through the scenario at home so all aspects are covered the best you can without being there.”

The nurse should also receive two epinephrine autoinjectors – the first-line treatment for anaphylaxis which works to reverse the life-threatening symptoms. A delay in using epinephrine is common in severe food allergic reaction deaths.

“Parents need to be vigilant about checking the epinephrine autoinjectors for expiration dates as well as dosage,” Dr. Singh said. “There are different doses for weight and age as children get older.”

If epinephrine is used, the child must be monitored at the emergency department as they could still have a rebound reaction.

Empowering Kids to be Kind

About one-third of children with food allergies report being bullied because of their allergies. The reported bullying ranges from verbal teasing or criticism to more obvious acts such as an allergen being waved in their face or intentionally putting it in their food. Therefore teachers leading by example can show what it means to put others before yourself. This can change the trajectory for children with food allergies.

“The best way to go about it is education such as a doctor talking to the students about food allergies or a fun presentation led by the teacher empowering the children to protect their classmates with the allergies,” Dr. Singh said. “If kids understand why food allergies happen, it can decrease bullying.”

Tips from Food Allergy Research & Education to prevent food allergy bullying:

• Encourage open communication – be sure children understand what bullying is and what to do if they are bullied. Emphasize reporting bullying to a trusted adult.
• Teach children the skills they need to stand up to bullies – saying “stop” or “leave me alone” with confidence, using humor and walking away.
• Recognize the signs of bullying – these can include torn clothing or damaged books, unexplained reactions or injuries, avoiding school, physical complaints, consistent nightmares, lower grades and loss of interest in school, social isolation and behavior changes.
• If your child is being bullied, be calm and assure him that you’re going to help – don’t encourage retaliation or confront the bully yourself. Talk to the appropriate personnel at your child’s school.
• Encourage teachers, administrators, the school nurse or counselors to offer educational programs about food allergies and bullying
• Set up a buddy system – encourage children who are bullied to stay with a group of trusted friends in high-risk situations, such as at the lunchroom or while walking home from school.

Food allergy parents have a lot to handle and may seem overprotective at times. But if they get it wrong, they don’t get to hit the reset button.

We, the physicians at Cook Children’s Health Care System, are directly connected to the district or school either as concerned parents or as pediatricians who care for the children we mutually share with your district/school.

We are writing to you to express our concerns about the Delta Variant of COVID-19 and to recommend that our school district implement safety protocols beyond those that have been in place this summer to address this exigent threat. The rapid increases in COVID-19 cases, hospitalizations and deaths locally and throughout the US in recent weeks are alarming and require an appropriate response. Indeed, we are seeing rising COVID-19 cases in our practices.

Please find below the Cook Children’s 10-Point Guide for Safely Reopening Schools crafted by Marc Mazade, M.D., Medical Director of Infection Control and Prevention at Cook Children’s Medical Center.

We stress key recommendations to mitigate the spread of this infectious new variant of the COVID-19 virus with the start of this school year:

• Strongly encourage universal masking for students and staff in accordance with CDC and American Academy of Pediatrics recommendations.
• Minimize contacts for each student to the greatest degree possible.
• Encourage and support all opportunities for eligible children to receive COVID-19 vaccination.

The Cook Children’s Promise states: “Knowing that every child’s life is sacred, it is the Promise of Cook Children’s to improve the health of every child through the prevention and treatment of illness, disease and injury.” Please help us honor the health and sanctity of our children’s lives through your sincere attention to these recommendations. We would welcome the opportunity to collaborate with the district/school in promoting the health and safety of our community during this new and troubling phase of the pandemic. We will gladly provide additional data if it would be helpful, and we are available to answer any questions that arise.

We appreciate your time and look forward to further conversation on this important topic.

With respect and care,

Cook Children's Physicians

Whichever decision or situation you choose for your student, the start of this school year will be like no other. I thought I would review a few recommendations the CDC (Center for Disease Control) has made that will help you and your family get ready for the start of the new school year.

For parents who have a child starting school in person, it’s normal to have some anxiety about the entire process, staying informed and connected may reduce these feelings and can give you a way to express concerns that you have regarding practices at your child’s school.

Consider the following if your child is set to start in-person learning and or will eventually be transitioning from virtual at-home learning to in-person learning:

Get organized and stay informed: Make sure you are aware of the safety guidelines that your school will be taking when students are back in the classroom.

Will face coverings be required for ALL children? If so ensure you have taken the last few weeks of summer to have child practice wearing their face covering or mask and encourage minimizing touching the face while putting the mask on or taking it off. Other things to consider regarding masks/face coverings:

• Ensure the mask/face covering you choose fits snugly yet comfortably against the face, covers the nose and mouth completely, and if its design is “re-usable” ensure the material allows washing and drying without damage to shape or build of the mask.
• Once you have found the type/style of mask your child is comfortable in ensure you have several available as backups.
• Tips on practice for wearing a mask (gathered from several different expert pediatricians)
• Have the child wear the mask/face covering during times likes watching a movie or playing a game. Allow them to take breaks but also praise them when they have successfully worn the mask or covering for a significant amount of time.
• For younger children needing help with wearing a mask use a favorite stuffed animal to demonstrate proper mask wearing, or find pictures of children or their favorite cartoons wearing masks.
• Modeling is very important. As a family model wearing masks/face coverings, children learn by example and this is one of the best ways to teach a child the importance of wearing a mask.
• Get in the habit of checking in with your child each morning for signs of illness. If there is ANY concern at all take the child’s temperature (if the child has a temperature of 100.4F or higher even without any other symptoms the child should NOT go to school).
• Thereafter monitor for any other symptoms: ensure your child does NOT have sore throat, cough, diarrhea/vomiting, headache or body aches.

Even if symptoms seem mild they should be recognized and taken into account in order to avoid potential spread of any infectious illness. This will remain important as the cooler weather and fall season are typical for other respiratory illnesses to arise such as influenza.

• If your child is sick and develops symptoms of COVID make sure you are aware of where you child can be tested. Also make sure you know who the school’s point of contact is for reporting illness. Find out what options for instruction/learning will be available for the child if quarantine is required. Make sure you are familiar with the school’s plan of communicating with families when a positive case or exposure to COVID-19 have occurred.
• Ensure your child is up to date on ALL recommended vaccines including the flu vaccine when it becomes available this year. We do not know how these two respiratory illness will affect severity of illness if a child or adult is co-infected.
• Review and practice proper hand washing techniques with your child at home and ensure they are aware of the options available at school for hand hygiene.
• Adjust daily before and after school routines to include the following if you had not been doing them already: remember to pack hand sanitizer and extra face coverings/masks. Have children change out of school clothes into clean set of clothes and wash hands as soon as they return home.
• Make sure the school has up to date contact information including emergency contacts as well as individuals authorized to pick up your child. If the list includes anyone who is considered high risk for developing severe illness for COVID-19 consider choosing an alternate person.
• Plan for potential school closures or quarantine periods. Consider if you will be able to take time off work should the child require quarantine at home. If the parent is unable to work from home or take time off work it is important to identify an adult who would be able to supervise the child during this time.

Stay alert: We know these times of significant change and decreased social interactions can contribute to stress and anxiety in children as well as adults.

Talk to your child about what to expect regarding how school will look different from before. For example desks may be set far apart for distancing purposes, teachers and staff will likely be using masks/face coverings and in some instances eye protection or googles, lunch time may occur at staggered times in smaller groups. Sports and other outside activities may involve different precautions than before. Be alert to changes in your child’s behavior that may indicate they are struggling with stress, anxiety or depression.

These include excessive crying or irritation, excessive worry or sadness, change in eating habits or sleep habits or difficulties concentrating among other changes in their typical behavior.

Remember there has already been a lot of stress with handling the many unknowns and issues the COVID pandemic has brought, it is important for children and adults to take breaks when necessary, get plenty of sleep, exercise and eat well and stay socially connected during this time.

As the fall semester approaches we know how hard it has been for parents and families to decide the mode of learning for their children. Some school districts have opted for a hybrid model in which the school year will start with ALL students in the remote/virtual setting gradually transitioning and providing opportunities in-person instruction.

Whichever decision or situation you choose for your student, the start of this school year will be like no other. I thought I would review a few recommendations the CDC (Center for Disease Control) has made that will help you and your family get ready for the start of the new school year.

 For those in virtual at-home instruction:

• Talk to your child about how school is going (even if they are home and involved in virtual learning), ask them about their day and about how they are feeling regarding this form of learning. It’s normal for children who are extroverts to struggle with the lack of in-person interaction while natural introverts may be more comfortable in this setting. Regardless of the situation it’s important to find out how they feel and work through the things they are struggling with.
• If you do identify behavior changes which worry you that your child may be experiencing difficulties reach out to your pediatrician to discuss these. Also find out if school has set up a plan to provide counseling or other support services during periods of virtual learning.
• Be a role model: Practice self-care. If your job or other responsibilities have you worried about how you will handle supporting your child’s learning during virtual at-home learning time seek out resources to help you find that balance (there are webinars out there currently covering this very topic).
• Consider the following to get prepared for Virtual or At-home learning:
• Get organized: Make sure you are aware of any registration deadlines, including submitting preference forms that your school districts may need. These forms will help how staff will need to prepare for when they will be offering in-person learning as well as ongoing virtual learning options.
• Review your families schedule and identify times for learning or instruction if your school has not provided a schedule for the student. Also don’t forget to schedule “recess” times in which the child can spend doing activities outside. Make sure to include breaks, waking/bedtimes, and unstructured “free time.”
• Attempt to schedule family oriented physical activity as your schedule allows (such as walks in the evening, water activities outside)
• A family calendar if you don’t use one yet may help keep everyone organized especially if you are keeping track of multiple assignments and deadlines for more than one child.
• Find a space in your home that is free of distractions and noise and designate this area as the area for learning. Avoid choosing rooms or areas that have easy access to toys or distractions such as TVs. Make sure the area is well lit and has access to electrical outlets for access to charging devices if necessary.
• Identify activities that will allow your child to remain socially engaged with peers or family virtually and if in person ensure you know the proper precautions that should still be taken.
• Stay informed: The information coming from school districts is immense. Make sure you are reading any communications that your school is putting out. Consider attending any virtual meetings which are discussing the preparations the school has made for the start of school year. Keep up with the constant changes that occur as new guidelines are made for school districts to consider.

Consider the following and ask questions regarding the following to ensure you are well prepared:

• Will your student be expected to be logged in at certain times of the day for live video instruction? Will the access to recorded lessons?
• How will attendance be taken each day?
• Will the school offer any sort of physical activity opportunities? If not remember it’s important to come up with your own to include in your kid’s daily routine.
• If your student participates in the school’s meal program, does your school plan to make meals available while students are learning online, if so how will you be able to access these?
• If your child has an IEP (Individual Education Program) or 504 Plan or receives other support services (PT,OT, Speech) from your school, how will your school provide these during the virtual at-home learning period?
• If you anticipate any technological barriers (we all experience these at some point), does your school offer support such as allowing students to borrow a laptop? Will they help with internet connectivity if this is an issue? Make sure you know how to access the school’s IT department for questions or issues.

Remember there has already been a lot of stress with handling the many unknowns and issues the COVID pandemic has brought, it is important for children and adults to take breaks when necessary, get plenty of sleep, exercise and eat well and stay socially connected during this time.

Related Content:

• Regreso a la escuela durante la pandemia de COVID: Planificación para el aprendizaje en persona
• Regreso a la escuela durante la pandemia de COVID-19: Planificación para el aprendizaje virtual

For parents who have a child starting school in person, it’s normal to have some anxiety about the entire process, staying informed and connected may reduce these feelings and can give you a way to express concerns that you have regarding practices at your child’s school.

Consider the following if your child is set to start in-person learning and or will eventually be transitioning from virtual at-home learning to in-person learning:

Get organized and stay informed: Make sure you are aware of the safety guidelines that your school will be taking when students are back in the classroom.

Will face coverings be required for ALL children? If so ensure you have taken the last few weeks of summer to have child practice wearing their face covering or mask and encourage minimizing touching the face while putting the mask on or taking it off. Other things to consider regarding masks/face coverings:

• Ensure the mask/face covering you choose fits snugly yet comfortably against the face, covers the nose and mouth completely, and if its design is “re-usable” ensure the material allows washing and drying without damage to shape or build of the mask.
• Once you have found the type/style of mask your child is comfortable in ensure you have several available as backups.
• Tips on practice for wearing a mask (gathered from several different expert pediatricians)
• Have the child wear the mask/face covering during times likes watching a movie or playing a game. Allow them to take breaks but also praise them when they have successfully worn the mask or covering for a significant amount of time.
• For younger children needing help with wearing a mask use a favorite stuffed animal to demonstrate proper mask wearing, or find pictures of children or their favorite cartoons wearing masks.
• Modeling is very important. As a family model wearing masks/face coverings, children learn by example and this is one of the best ways to teach a child the importance of wearing a mask.
• Get in the habit of checking in with your child each morning for signs of illness. If there is ANY concern at all take the child’s temperature (if the child has a temperature of 100.4F or higher even without any other symptoms the child should NOT go to school).
• Thereafter monitor for any other symptoms: ensure your child does NOT have sore throat, cough, diarrhea/vomiting, headache or body aches.

Even if symptoms seem mild they should be recognized and taken into account in order to avoid potential spread of any infectious illness. This will remain important as the cooler weather and fall season are typical for other respiratory illnesses to arise such as influenza.

• If your child is sick and develops symptoms of COVID make sure you are aware of where you child can be tested. Also make sure you know who the school’s point of contact is for reporting illness. Find out what options for instruction/learning will be available for the child if quarantine is required. Make sure you are familiar with the school’s plan of communicating with families when a positive case or exposure to COVID-19 have occurred.
• Ensure your child is up to date on ALL recommended vaccines including the flu vaccine when it becomes available this year. We do not know how these two respiratory illness will affect severity of illness if a child or adult is co-infected.
• Review and practice proper hand washing techniques with your child at home and ensure they are aware of the options available at school for hand hygiene.
• Adjust daily before and after school routines to include the following if you had not been doing them already: remember to pack hand sanitizer and extra face coverings/masks. Have children change out of school clothes into clean set of clothes and wash hands as soon as they return home.
• Make sure the school has up to date contact information including emergency contacts as well as individuals authorized to pick up your child. If the list includes anyone who is considered high risk for developing severe illness for COVID-19 consider choosing an alternate person.
• Plan for potential school closures or quarantine periods. Consider if you will be able to take time off work should the child require quarantine at home. If the parent is unable to work from home or take time off work it is important to identify an adult who would be able to supervise the child during this time.

Stay alert: We know these times of significant change and decreased social interactions can contribute to stress and anxiety in children as well as adults.

Talk to your child about what to expect regarding how school will look different from before. For example desks may be set far apart for distancing purposes, teachers and staff will likely be using masks/face coverings and in some instances eye protection or googles, lunch time may occur at staggered times in smaller groups. Sports and other outside activities may involve different precautions than before. Be alert to changes in your child’s behavior that may indicate they are struggling with stress, anxiety or depression.

These include excessive crying or irritation, excessive worry or sadness, change in eating habits or sleep habits or difficulties concentrating among other changes in their typical behavior.

Remember there has already been a lot of stress with handling the many unknowns and issues the COVID pandemic has brought, it is important for children and adults to take breaks when necessary, get plenty of sleep, exercise and eat well and stay socially connected during this time.

Related Content:

• Returning to School During the COVID-19 Pandemic: Virtual Learning
• Regreso a la escuela durante la pandemia de COVID: Planificación para el aprendizaje en persona
• Regreso a la escuela durante la pandemia de COVID-19: Planificación para el aprendizaje virtual

As the fall semester approaches we know how hard it has been for parents and families to decide the mode of learning for their children. Some school districts have opted for a hybrid model in which the school year will start with ALL students in the remote/virtual setting gradually transitioning and providing opportunities in-person instruction.

Whichever decision or situation you choose for your student, the start of this school year will be like no other. I thought I would review a few recommendations the CDC (Center for Disease Control) has made that will help you and your family get ready for the start of the new school year.

 For those in virtual at-home instruction:

• Talk to your child about how school is going (even if they are home and involved in virtual learning), ask them about their day and about how they are feeling regarding this form of learning. It’s normal for children who are extroverts to struggle with the lack of in-person interaction while natural introverts may be more comfortable in this setting. Regardless of the situation it’s important to find out how they feel and work through the things they are struggling with.
• If you do identify behavior changes which worry you that your child may be experiencing difficulties reach out to your pediatrician to discuss these. Also find out if school has set up a plan to provide counseling or other support services during periods of virtual learning.
• Be a role model: Practice self-care. If your job or other responsibilities have you worried about how you will handle supporting your child’s learning during virtual at-home learning time seek out resources to help you find that balance (there are webinars out there currently covering this very topic).
• Consider the following to get prepared for Virtual or At-home learning:
• Get organized: Make sure you are aware of any registration deadlines, including submitting preference forms that your school districts may need. These forms will help how staff will need to prepare for when they will be offering in-person learning as well as ongoing virtual learning options.
• Review your families schedule and identify times for learning or instruction if your school has not provided a schedule for the student. Also don’t forget to schedule “recess” times in which the child can spend doing activities outside. Make sure to include breaks, waking/bedtimes, and unstructured “free time.”
• Attempt to schedule family oriented physical activity as your schedule allows (such as walks in the evening, water activities outside)
• A family calendar if you don’t use one yet may help keep everyone organized especially if you are keeping track of multiple assignments and deadlines for more than one child.
• Find a space in your home that is free of distractions and noise and designate this area as the area for learning. Avoid choosing rooms or areas that have easy access to toys or distractions such as TVs. Make sure the area is well lit and has access to electrical outlets for access to charging devices if necessary.
• Identify activities that will allow your child to remain socially engaged with peers or family virtually and if in person ensure you know the proper precautions that should still be taken.
• Stay informed: The information coming from school districts is immense. Make sure you are reading any communications that your school is putting out. Consider attending any virtual meetings which are discussing the preparations the school has made for the start of school year. Keep up with the constant changes that occur as new guidelines are made for school districts to consider.

Consider the following and ask questions regarding the following to ensure you are well prepared:

• Will your student be expected to be logged in at certain times of the day for live video instruction? Will the access to recorded lessons?
• How will attendance be taken each day?
• Will the school offer any sort of physical activity opportunities? If not remember it’s important to come up with your own to include in your kid’s daily routine.
• If your student participates in the school’s meal program, does your school plan to make meals available while students are learning online, if so how will you be able to access these?
• If your child has an IEP (Individual Education Program) or 504 Plan or receives other support services (PT,OT, Speech) from your school, how will your school provide these during the virtual at-home learning period?
• If you anticipate any technological barriers (we all experience these at some point), does your school offer support such as allowing students to borrow a laptop? Will they help with internet connectivity if this is an issue? Make sure you know how to access the school’s IT department for questions or issues.

Remember there has already been a lot of stress with handling the many unknowns and issues the COVID pandemic has brought, it is important for children and adults to take breaks when necessary, get plenty of sleep, exercise and eat well and stay socially connected during this time.

Related Content:

• Returning to School During the COVID-19 Pandemic: In-person learning
• Regreso a la escuela durante la pandemia de COVID: Planificación para el aprendizaje en persona
• Regreso a la escuela durante la pandemia de COVID-19: Planificación para el aprendizaje virtual

Sleep, it’s important, right?!

Has your kid's new COVID-19 schedule got them going to bed after midnight and sleeping until noon?

Well it’s time NOW to start getting back into a normal sleep schedule for school, even if they are learning online.

So how much sleep does your child need? This is a good estimate, but teenagers can require up to 12 hours of sleep while they’re going through a growth spurt.

How much sleep does my child need?

• 3-6 year olds need 10-12 hours of sleep
• 7-12 year olds need 10-11 hours of sleep
• 13-18 year olds need 8-9 hours of sleep

If your child has a midnight or (gasp!) even later bedtime right now, start working on adjusting their bedtime slowly over the next few weeks. I propose the following schedule:

• Aug 1: 11:30 p.m.
• Aug 2: 11:15 p.m.
• Aug 3: 11 p.m.
• Aug 4: 10:45 p.m.
• Aug 5: 10:30 p.m.
• Aug 6: 10:15 p.m.
• Aug 7: 10 p.m.
• Aug 8: 9:45 p.m.
• Aug 9: 9:30 p.m.
• Aug 10: 9:15 p.m.
• Aug 11: 9:15 p.m.
• Aug 12: 9 p.m.*

*Early elementary children will likely need a 7 p.m. or 8 p.m. bedtime, adjust the 15-minute pattern above as needed.

Keep in mind that bedtime means lights out, no screen time. Charge your child’s phone in your room, you’d be shocked to find out the long text message conversations happening at 2 a.m.! No TV in the bedroom either. If your child is having trouble with the adjustment in bedtime, it is perfectly fine to give melatonin about 20-30 minutes before bedtime. One or 3 milligrams is appropriate for elementary age, up to 5 milligrams for teenagers. Don’t allow caffeine after noon either.

Best of luck transitioning to school this year! We’re all going to have to work nicely together to get through this, but we can and we will!

“What’s school going to look like in the fall?” “Should I send my child or keep them at home?”

These are the questions that every parent is probably already asking as school districts roll out their plans for re-opening school in the context of continued COVID-19 cases in our communities. Many schools may present the option for all in person, all online or some blended method. And parents will have to consider what works best for their children.

There have been many stressful decisions in regards to COVID, but this might be the most anxiety inducing one for parents so far. School districts realize how stressful this is for parents and are taking steps to protect their students and your kids.

 “We understand that some of our families are anxious about the new school year so we are implementing strict new cleaning protocols for every campus. That means that schools will be cleaned multiple times during the daytime hours rather than in the evening as has been the practice for many years,” said FWISD Superintendent Kent P. Scribner. “We are also making a significant investment in both Personal Protective Equipment--for both adults and children—as well as cleaning supplies for campuses and other FWISD facilities. The good health and safety of our students and employees remains our top priority.”

The Texas Education Agency released these guidelines for school reopening on July 7, 2020:

• Daily on campus learning will be available to all parents who choose that option for their children
• Parents may be asked to commit to remote instruction for a full grading period but will not have to commit until 2 weeks ahead
• Health and safety procedures should be in place for student and teacher safety

In normal times, making a decision about what your child will do for school in the middle of July would seem way too late, but this year it feels way too early.

Each parent will have to make their own decision but here are some things that it would help to consider:

Childcare and Other Resources

First and foremost, it’s important to consider that children attending school is an important part of allowing parents to work and function in society. Parent’s jobs help secure food, shelter and in many cases provide health care insurance that allow children to receive care when needed. Not all parents can work from home, stay productive and keep a job. In addition, many of our children receive their most nutritious and guaranteed meal during the school year through their school lunch. Schools provide many resources to our communities and children beyond education.

Medical

Healthy children, for the most part, are considered to be safe in the school environment. Children have been more or less spared from severe illness but, as with most illnesses, children with chronic medical conditions are at higher risk for severe illness. Parents of children with medical conditions may learn toward keeping their child in the online environment in order to protect them from exposure. In addition to the child, considerations must be made for other household members and extended family members with whom the child might have contact. If the child will have contact with family members who have weakened immune systems, they could bring the virus home despite not having significant symptoms.

School

Examining the policies and procedures of the school will be another important decision point for families. Is the school district taking the recommendations for safety seriously and attempting to implement them consistently? With kids involved, there will be a learning curve but districts should be considering policies in regards to social distancing, mask use and movement throughout schools at a minimum. The evidence suggests that most schools are taking the threat of COVID very seriously but each parent should make that assessment for themselves.

Educational

April and May taught us a lot about how capable our students were of learning in an online environment. While the school districts will be significantly more prepared for teaching online, there are certain kids for whom it was obvious that the online environment was not going to be the right choice for them. Children who receive services and support at school might have a more difficult time adjusting to life at home without that extra help. For others, they struggle to learn online and in-person teaching might be a better fit. In addition to the child’s learning needs, families must consider their ability to support their learner with their existing responsibilities. Teachers and school staff can help, but students at home will often require some, if not significant, guidance from someone in the home. This is especially true for younger students and those with special learning needs.

Social and Emotional Needs

Some kids have thrived in regards to their mental health with the online learning environment. Many children with anxiety in regards to school or formalized testing had significant improvement in their symptoms as they transitioned to at-home learning. Other students and families needed the structure and activity of school in order to maintain a sense of normalcy. The lack of contact with friends, teachers and other school staff affected them in very negative ways. Another consideration should be the child’s level of concern about COVID-19. Children with significant anxiety regarding the virus could anxiety, depression and other severe health and mental health issues.

Decisions regarding going back to school in the fall are complex. Each parent should consider how the effects of being at school or at home would affect their children and consider that as part of their decision.

For more information on this topic, read the recommendations of more than 50 Cook Children’s pediatricians, led by Medical Director of Infection Prevention, who worked to create guidelines for returning back to school. The AAP released similar guidelines that support opening of schools for in person instruction.

It’s likely the plans for each school will continue to change throughout the rest of the summer. Parents should consider the best option for their children and be prepared for disruptions to occur based on local case numbers.

For more on this topic:

• Cook Children's Physicians Create Guide to Help Kids Safely Return to School amid COVID-19 pandemic
• COVID-19 Planning Considerations: Guidance for School Re-entry (AAP)
• Young Athletes and COVID-19: 'When Can My Child Start Playing Sports Again?'
• TEA Issues Comprehensive Guidelines for a Safe Return to On-Campus Instruction for the 2020-21 School Year

Recently, Dr. Justin Smith talked about things to remember before your child heads back to school. He specifically mentioned you and your child’s anxiety as back to school approaches. It is true that pediatricians experience first-hand the anxiety that the transition back to school can create. Working in the emergency room as a child life specialist, offers a front row seat to the same pressures and stress. We often see a wave of kids struggling with anxiety and having a difficult time coping as they go back to school. As parents, we are often struggling too. Getting back in the swing of things and managing our kids’ emotions can feel overwhelming and often disheartening.

I want to challenge you, though, as parents and caregivers to enter into this time of transition with some tools in your back pocket ready to combat the stress and anxiety that back to school can bring. As a child life specialist, we are on the hospital side offering kids normalcy in the midst of a stressful situation. We are creating space for kids to learn to cope and develop tools that they can use throughout their lifetime – not just during hospitalization. As parents we need to create this same space in our homes. Here’s a few tips for creating space to cope during this transition. Remember that not every family and schedule can look the same. As you read, think of ideas that fit into these tips but also fit into your family’s culture.

1. Celebrate!!! Instead of back to school being a bummer, make it a celebration. Have traditions around the first day of school. We always have cinnamon rolls on special days so the first day of school is no different in our family. I usually write my girls a special note to commemorate the day and have a Dollar Store goody sitting at their spot for breakfast. I have all girls, so we have a tradition of getting nails done before school starts. School supply shopping day usually includes a lunch or dinner out to eat at a favorite place. You could go to their favorite restaurant or make a special date for a fun activity. These are just a few ways we celebrate, but there are LOTS of ways to celebrate a new school year, the end of the school year and all the things inbetween!
2. Create a routine. Often during the summer, our routine is gone or at best inconsistent. Going to school can provide the opportunity to revamp your routines and boundaries. In our home, there is no screen time before school, no matter how early you get up. There is an order to our mornings that include breakfast, getting dressed, brushing teeth, packing backpacks - all while music is playing in the background. My kids know what to expect each day when they wake up. We also have afternoon routines- a few minutes for a show when they get home, quiet/homework time before dinner and always set aside time for reading. While routines need to include the mundane things, it’s also good to include FUN in your routines. We have fun weekly routines and traditions. We get ice cream after school every Wednesday. We often have movie/pizza nights on Fridays or Saturdays. This year we will be adding a weekly job for our girls to accomplish also. Setting expectations and boundaries for kids sets them up for success. My kids know when to expect screen time, ice cream and family activities, and they can look forward to it without always asking for the next thing.
3. Be nosy! What does that mean? Well, you are the parent. You get to know ALL the things simply because you are the parent. Just because your kiddo is away from you for 7 hours a day or more, you still get to know what is happening in those hours. Ask your kids about their day with open-ended questions - stay away from yes or no questions. Get to know the people at school…your kids’ teachers, principal, even cafeteria workers. Take time to honor them so that they can know and respect you. Get to know your child’s friends and ask who they are eating with, playing with, etc.? Know the other parents in your kids’ class so when the stories don’t quite line up, you can get some more details. Know your kids’ teacher. While you want to be respectful of their time, it is important to address things that come up for your kids during the year. Don’t be afraid to ask questions to know more. Send the email to clear up confusion. Make the phone call when you see a red flag. The more you know, the more you can engage your child. Plan to eat lunch with your child regularly. That might be once a month, but your presence in that space matters…mostly to your child. Volunteer in your child’s classroom or at the school or offer to do things from home. This allows you to know what to ask and to advocate when and where there is a need. You don’t have to be an infamous “helicopter parent,” but being present (and a little nosy) creates space for your kids to trust you and know that you are with them and for them no matter what.
4. Focus on character. So often much of school feels centered around grades, testing, and measured successes. Often those are measured against other kids and expectations are high. While it is incredibly important for kids to master subjects and advance academically, their character will take them through all of life ~ all the challenges that they will face. And while math facts are super important, they won’t teach them how to be a good friend or show respect. I try to assess what character quality my kids need encouragement in and spend time fostering it. Whether it be self-control, patience, humility or the many others, we take time as a family to talk about these things. One thing I do for my kids is start a notebook at the beginning of the year that goes in their lunch box. I focus on character and encouragement in that notebook. I write a note or draw a picture each day that hopefully reminds and encourages them in that character trait. I also always let them know they are loved. I remind them at the beginning of each day, usually on the way to school, to choose others before themselves and treat others as they would like to be treated. We encourage trying over perfection, kindness over being right, and gratefulness when things aren’t going your way. The work will always be there, the vocabulary and math facts, but I don’t want my kids to get so lost in those facts that they forget about being human.

We want our kids to feel prepared and ready for this next year. Preparation alleviates some anxiety while creating space to teach them how to cope with the inevitable stress that comes with this transition. Celebrating, establishing routine, being present (aka a little nosy) and focusing on their character are all ways that you can help your children cope and combat the stress and anxiety of going back to school.

Believe it or not, summer’s almost over and the new school year will begin before you know it.

Are you ready? Or are you like a certain dad I know who usually waits until the last minute? Last year, this dad forgot:

• To book his child's physicals so he had to scramble to get checkups before flu shots.
• His daughter has some pretty significant fears about going into school the first day and he didn’t take the time to properly prepare her.
• To get his son's asthma inhalers refilled and the forms on file so that he could have it at school (until April when he was having a flare).

Don't be like me…here are 10 steps you can take to make sure you and your child are ready for back to school.

1. Vaccines - Make sure that your child is up to date on vaccines. As your kids get older, your school might prevent them from enrolling in classes or other benefits, which might make it difficult to get their classes scheduled, etc. Vaccines are routinely scheduled at 4 years old (measles, whooping cough and polio among others), 11-12 (whooping cough and meningitis) and 16 (meningitis). At Cook Children's, we also recommend the HPV vaccination starting at age 11.
2. Physicals - If your child plans to participate in a sport or marching band they may need a sports physical form to be completed by your child's doctor. This requirement is required by the UIL before junior high, ninth and eleventh grade but many schools ask for it each year. The marching band requirement is new so not as many parents are aware. I expect we'll be doing a lot of those in the first few weeks of August. Students who are attending private schools or participating in sports that aren’t governed by the UIL may have other physical exam requirements. Many of these kids are already out in the heat working hard preparing for their upcoming season, so I recommend getting these as soon as possible.
3. Forms - Don't be that parent who realized in April that their child doesn't have his inhaler or the form required to take it at school (ahem ... me). Here are some common medications your child might take which might need to be administered at school: inhalers/nebulizers for asthma, insulin, ADHD medications and pain reducers.
4. Sleep - Transitioning back to a sleep schedule that works for school might be the most difficult transition in prepping for back to school. The older your child, the more likely they are to be going to bed too late and sleeping in. Start making subtle changes in their bedtime over the next few weeks. Rolling bedtime back 30 minutes at a time can make the transition to early morning easier.
5. Screen time - Just like sleep, screen time can get away from us a bit over the summer (Fortnite! I’m looking at you). An immediate drop off in daily screen time can be a struggle so starting to make changes now can help your screen junkies detox a bit before they go back to school.
6. Your child’s back to school fear or anxiety - Many children deal with some fears about going back to school. These fears can be mild or they can be more severe, almost debilitating. Helping your child prepare for the transition by talking them through their day, setting up a play date with classmates ahead of time or taking a tour of the school can orient (or re-orient them) back to school in a way that can be helpful. If the anxiety is more severe, consider talking with your pediatrician or a play therapist in advance to help them and you prepare.
7. Your back to school fear or anxiety - Getting yourself prepared for back to school is almost as important as preparing your child. Some parents will kick their kids out the door and drive off to their gym class without a second thought. For others, the transition can be just as hard on the parent as the child. Begin now to prepare yourself for what it will feel like those first few days at drop off. Showing emotions with your child is certainly OK, but a prolonged, tearful drop off can make things harder on your child.
8. Supplies - Get your child ready for back to school by buying their school supplies in advance whenever possible. Whether you buy the prepared packet from school or enjoy the process of shopping for individual supplies doesn't matter, just make sure your child is well prepared with what they need to start the year off right. Buy some extra tissues or hand sanitizer to help the teacher out.
9. Set goals - My favorite part of a new school year is the fresh start that kids can get. Whether last year was amazing or a huge struggle, it's a great opportunity to help our kids realize that they can always work on something to make themselves better. Using last year as a guide, help them set some goals that focus both on their strengths and challenges.
10. Attend meet the teacher night - Sometimes these events occur before school and sometimes they occur a little after school starts. Use meet the teacher night strategically to help frame your child in a positive light. This can go a long way to helping your child accomplish their goals for the year.

Whether you're counting the hours until you can send the kids back or dreading the return of early mornings, hopefully, these tips will help you think through some of the things you need to consider. I know it did for me.

What topics did we miss?

Related To This Topic:

• Vaccines and Immunizations
• Immunization Schedule
• Common Questions About Immunizations
• Knowing Your Child's Medical History
• Sleep Center
• Your Kids Are Ready For School. But Are You?
• 5 Questions Every Parent Should Ask Their Child's Teacher
• 6 Ways You Can Help The Teacher Understand Your Child

You’re holding your child’s hand on your way to the first day of school. The squeeze on your hand is tighter than usual. Then suddenly your little one sees a friend, smiles, releases your grip and you watch them run to school together without a care in the world.

Everything is great.

But then you notice a tear in your eye. Suddenly, you realize your child isn’t the one nervous about going back to school. It’s you.

The back-to-school transition can be stressful for many parents, and the reasons are valid.

For example, knowing that your child struggles with change can increase your own feelings of tension.

You may worry that your child will struggle to fit in with peers and make friends.

Maybe your child had a bad experience at day care or a previous school year, leaving you both with lingering anxiety.

Some parents are concerned that schoolwork or a tight schedule may be too difficult for their child or that a teacher will not understand their child's unique needs. 

Maybe, you’ve waited until the last minute and just aren’t ready. The need to buy new clothes and school supplies may cause concerns about finances, and a steady stream of demands on your time can leave you feeling pressured and stressed.

Plus, there’s just the feeling that your young child is growing up too darn fast.

If you are stressed about your child's return to school, you may wonder if you should share your concerns. Sam McCage, clinic manager of Behavioral Health Services in Fort Worth and a licensed psychologist,  says that could be a mistake. Your child looks to you for signs that school is fun, exciting and safe and not something to fear, so it's important to discuss school in an upbeat and encouraging way.

"Recognize that children will sense your anxiety and their own will increase if you express your anxiety too much," McCage said. "If they ask about your concerns, tell them that you are excited for them and confident they will do well."

McCage reminds parents that "it's normal to feel anxiety about your child going back to school, but he says there are strategies to help you effectively manage your stress.

Here's how you can calm your concerns and enjoy this annual adventure with your child.:

• Visit the school and connect with your child's teacher and other school staff.
• Make arrangements for car pools, play dates and after-school care well in advance.
• Be patient and give the teachers time to develop a relationship with your child.
• Make sure you have realistic expectations about how your child should perform in school and extracurricular activities.
• Talk with other parents about how they handle their anxiety.
• Use humor to diffuse the stress.
• Schedule fun family activities with your children.

1. What system do you use for your classroom management?

This question is important because it lets you know the class norms along with what is expected of your child’s behavior.

2. How do you reinforce positive behavior?

This will give you an idea of the rewards and praises the teacher gives out in order to support a more positive learning environment.

3. What is your primary medium for communication?

It's important to know how your child’s teacher plans to get important information to you and vice versa. Maybe they send home letters or maybe they prefer to email. It's always a good idea to know what the teacher prefers to ensure communication is not hampered.

4. What are the top three things I can do at home to help my child succeed?

By finding out the answer to this question, you will know what new material is of great importance in your child’s new grade level. For example, Ownby lets her parents know that practicing multiplication facts was extremely important when she taught third graders. If they are practicing at home, they will be better prepared in the classroom.

5. What supplies do you run out of first?

This is helpful to know in case you would like to send in supplies to school with your child. Many supplies are used on a daily basis and tend to run out quickly.

Other ways to ensure your child gets the most out of the school year include setting high expectations and making sure they attend school on a regular basis (unless they are sick). Parents should also keep an open line of communication with their child's teacher and make sure they understand the parents' goals and expectations for the child. With these points in minds, parents can help make sure their students are being given the opportunities they need to succeed in the classroom.

1. Health. Often, new teachers don’t know about your child’s health history. Many kiddos have severe nut allergies and teachers need to be aware of those food allergies, as well as if your child needs special medication or an EpiPen® injection. You should let your teacher know if your child has asthma, is diabetic or has any other serious health condition.

2. Educational Diagnoses. Teachers may not know your child has been diagnosed with a learning difference, dyslexia or an attention deficit problem. This is an opportunity to let teachers know about a 504 plan or IEP for your child. This is also a great time to let your teacher know what your child’s learning style is such as whether they are an auditory, visual or kinetic learner. Sharing your child’s areas of strengths and weaknesses is also helpful.

3. Emotional and family. Inform your teacher of any emotional factors that may impact your child such as divorce, death, illness or a parent being stationed overseas. It’s helpful for teachers to know the emotional factors that are impacting your child’s life which may help your teacher to understand and communicate better with your child.

4. Don’t settle for orientation. Teachers are bombarded with information at meet and greets during orientation. It’s hard to keep everyone and everything straight. My advice is to set up a conference with your child’s teacher as early as possible. One teacher told me she found it really helpful when parents provided a list of bullet points that included helpful information about their child, including the health and educational diagnoses, the strengths and weaknesses of the child, how the student learns the best, what the student responds to best when giving direction or correction and some points about the student’s social and personality style. Go in and set up an appointment one on one, especially if your child has special needs or considerations.

5. Be a team player. Every teacher I have spoken with has told me what they appreciate more than anything is for the parent to ask the teacher, ‘how can we help you? What information do you want to know?’ Most teachers prefer that team approach.

6. Be honest with yourself about your child. This is sometimes the most difficult tip for parents, but it’s so important. Know your child’s strengths and weakness. One of our biggest problems in today’s society is not teaching accountability. Set that example. Make sure your child knows his or her responsibility. Teachers have a difficult enough job without always blaming them, the school or another child. Please make sure you know how your child contributed to a situation and then take appropriate action from there.

Of course every child is different, and special, which makes communication between you and your teacher so important in having a great school year.

About the author

Lisa Elliott is a licensed psychologist and clinic manager of Cook Children’s Behavioral Health, located at 3201 Teasley Lane, Ste. 202, Denton, TX 76210. To make an appointment, call 940-484-4311. Cook Children’s Psychology provides care focused on children’s behavior, from ages 3 years through 17.

“Last year during that first week of school, we saw more kids coming to the ED for playground falls, sports injuries and pedestrian accidents with kids walking or riding their bike to school,” said Denise Doherty, RN, director of the Emergency Department at Cook Children’s. “But with the new ED I think we’ll be better able to handle what comes our way.”

The new $14.2 million expanded ED provides larger exam rooms that are designed so families and caregivers can better share the space. The room layout allows for the family to be on one side of the room, but also provides plenty of space on the other side, so the caregiver can be more mindful of the patient.

Cook Children’s new Emergency Department, features:

• 10 intake rooms.
• A new CT (computed tomography) room with a CT scanner that is 5 times faster than the previous one.
• 76 general exam rooms (five that can be used for resuscitation), up from 56 rooms in the old ED.
• All rooms are private and without curtains.
• Radiology scanning will now be embedded within the ED and all initial imaging will occur at bedside.
• Two X-ray rooms.

“The new ED allows ultrasound technicians to bring their technology with them and the patients don’t have to leave the exam rooms,” Doherty said. “With the additional imaging capabilities and lab services in our ED rooms, patients won’t have to be moved around as much as in our previous ED. This will be helpful with the amount of sports and pedestrian injuries we see during that first week of school.”

Pedestrian safety

Kids walking or riding their bikes, scooters or skateboards can be dangerous when not done correctly. The next few weeks, while everyone is getting adjusted to kids going back to school, can prove especially hazardous. More children are hit by cars during September than any other month of the year, according to Safe Kids Worldwide.

Safe Kids recommend teaching your kids these safe behaviors:

• Look left, right and left again before crossing the street. Cross when the street is clear, and keep looking both ways while crossing.
• Walk, don’t run.
• Understand and obey traffic signals and signs.
• Walk facing traffic, on sidewalks or paths, so that you can see oncoming cars. If there are no sidewalks, walk as far to the left as possible.

Practice safe behaviors:

• Don’t allow a child under age 10 to cross streets alone as he may not be able to fully appreciate the speed of cars on the road.
• Require children to carry a flashlight at night, dawn and dusk. Add retro-reflective materials to children’s clothing so that a child can be seen by motorists, even in the dark.
• Don’t let kids play in driveways, unfenced yards, streets or parking lots. Drivers may not see or anticipate children playing.

Doherty reminds parents that bike helmets should be worn at all times for kids riding a bike to school. Bike helmets should sit on the top of the head with the chinstrap fastened, holding the helmet in place if the child is to shake his or her head or fall.