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.”

One panda sticker and four green smiley faces. Pretty much sums up my son’s first week at kindergarten. I’m not sure why his teacher used a panda sticker the first day, maybe it’s because he was actually a bear to deal with, but I’m refusing to believe that’s the case. His response to mommy’s enthusiastic questioning about his first day was summed up with a profound, “I’ll explain later.”

Quick update: Dropping him off the first day went pretty much as expected. He was happy to go in, excited even. No tears were shed from either him or me (Mrs. Doc Smitty might’ve gotten a “little” misty-eyed.).

So, why am I getting emotional as I reflect back on his first week of school?

He’s still our little boy, but something is different. He still cried at breakfast yesterday because his 3 year-old little brother wouldn’t share his “talking Diesel 10” toy with him. He still ran through the house to give me and mommy kisses every time the Aggies scored a touchdown last night (which was a lot - whoop!).

But, I noticed this morning as he stood by his mommy to say goodbye; he instantly seemed inches taller, his vocabulary grown up, his mannerisms more mature.

How did that happen in just five days?

I think what hit me the hardest today is that I no longer know about what he does with his days, at least not in the way I could before. Just last week, I could get home from work and get a full run down from his mommy of everything funny he said and everything else he did. Now, those quirky puns and silly rhymes are shared with his classmates and his teacher who aren’t able to file them away to share with his dad. I don’t know what he did at recess except that he reports, “Of course, I played with the girls.” And I’m not even sure who (or even what) that means.

Today, it feels heavy, as if those 5 days will quickly turn into 13 years before I know it. Then I’ll have to deal with the fact that there will be days where I have no idea what he is up to. I may have to rely on infrequent phone calls and even less frequent visits to get a picture of what his life is like.

For now, I’ll cling to every word I can get out of him about his day.

For now, I’ll try to cherish every moment I still have with him.

For now, I will learn to trust those green smiley faces (and count the days to our first teacher conference).

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

The screaming-leg-hanger-on-er

I know there are parents who are terrified of how their child will do on their first day of school. They are picturing their children crying and hanging on to a leg shouting, “Mommy! Don’t leave me here!” My heart goes out to those families because that must be really difficult. It seems painful for the child and is probably the most painful on mom or dad who is attempting to pry themselves away. Then, they have to spend the whole day worrying if their child is OK or building a need for therapy from their mounting sense of abandonment.

Here are some tips:

1. This behavior might be demonstrating some separation anxiety Talk through the drop-off period and the day with your child until you are both sick of talking about it. One of the best methods for combatting anxiety is to be prepared.
2. If possible, send the parent who is less likely to cause this reaction early on. Sometimes it’s mom and sometimes it’s dad. If your child can make an easy break with one, but not the other, let that parent try to help during those early days until the child sees that school isn’t such a terrible place.
3. Make a quick break. Trying to coerce children to say they love you and give you 1,000 kisses only makes things worse. A quick goodbye and we’ll see you soon should suffice.

A quick note of support: Ultimately, you may do everything right and this may still happen to you. Try to remember that their behavior at this extremely stressful moment does not define your ability as a parent. Teachers are used to seeing this. Most of them probably see it every single year in a child or two.

The quiet, but compliant child

I would bet that many kids fall into this category. They aren’t exactly sure what to think about school. They are a little annoyed about their first day of school outfit and a little more annoyed about the fact that they had to take pictures wearing it, holding a sign that says “First Day of School.” (What’s Instagram mom?) They are not openly upset about you leaving them, but they may seem a little anxious.

Here are some tips:

1. They might appreciate it if you walk them into class the first few days and see what they have been up to for a minute or two.
2. Let them know what they are feeling is normal. “It’s OK to be afraid. But every day you go, it will get easier.”
3. This is another instance where a quick, clean break is good. After the child is settled in, say goodbye and leave. No need to make every drop off day sappy … just treat it like it is no big deal.

The “see you later, dad; or not. Whatever it’s cool” child

My child might fall into the previous category, but I have a pretty strong feeling he will fit here. He seems really excited about school and I hope that is actually the case on the day of. I plan to give him lots of latitude to change his mind that day because with 5 year olds, you never know what to expect.

For this child, these tips are more for mom and dad:

1. Keep it together yourself, if you can. Your big boy or girl is growing up and independent. That is actually the goal of parenting. No one wants their college age child to be holding onto their leg at the dorm so you can check that off your parenting accomplishment list.
2. Don’t take it personally. They still love you (for now) and still want you around (occasionally).

There are many more first day of school personalities that your child could show, these are just a sampling. The best advice I can give from hearing back to school stories for years is to be flexible. Come back next week to see if I can follow my own advice. I’ll try not to cry the first day he asks me to stay in the truck while he walks in …

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.

Ok,so everyone who knows me already knew that I wasn't actually advocating home schooling in the traditional kinder-twelfth grade manner. I believe that parents should school their kids however they feel they works best for their family and their child. I know families who have chosen to home school some of their children while putting the others in public and/or private schools.  They chose what they thought was best based on their individual child and I applaud that.

One thing I would stress is to make sure you don't do anything out of social pressure. People who hang out with people who home school will get tremendous pressure to home school, but some parents simply aren't made in the mold of the home school teacher (especially me). People who hang out with people who do private school will insist that you can't get a good education anywhere else, and that's simply not true. So, weigh your options carefully and make a decision and go with it. Ok, soap box rant over...

However, it's important to remember that educating your child does not start with your decision of where they start kindergarten and it doesn't end when you make the decision and send them off to their first day of school.

You may have seen the following study or heard glimpses of it before, but I don't believe that there is a more powerful study regarding child development so I am going to go over it again:

Observing kids in a preschool, 2 researchers from the University of Kansas, Dr. Todd Risley and Dr. Betty Hart, noticed a difference in the development of vocabulary between the professors' kids and other children in the preschool.  They tried several strategies to get the other children talking, but nothing that they did at the day care enabled them to catch up to the professors' kids in increasing their vocabulary. Interestingly, they were able to get the children talking more, but not with a broader vocabulary. They realized that something must be happening before age 4 that was causing the difference between the two group.  So, they decided to do a study.

They enrolled children in the study by calling people out of the birth announcements in the Kansas City newspaper and then they "began recording what the people were saying to each other, to the child, (and) to each other in the child's presence." Once a month an observer would go to the home and audibly record, as well as make observations about what was going on in the home while they were there.  They followed the children from 9 months to 36 months.

There were 2 big discoveries:

1. The children who had bigger vocabularies had families who talked A LOT. There wasn't a lot of fancy teaching going on or flash cards, just talking. The difference was striking: 2100 words per hour in the professional families vs 600 words per hour in lower socioeconomic settings. This resulted in a 50 percent higher vocabulary and a higher IQ for those children at age 3.

2. Children who had bigger vocabularies had parents who used more "rich language" and not all "business talk." There is a certain amount of instruction that needs to happen with a toddler: "Sit down," "Eat your carrots," “Get your finger out of your nose” and "Don't hit your brother" are common phrases around our house. But it's not those words that lead to language development. The better phrases incorporate phrases like "what if," "shouldn't you" and "remember." These phrases came naturally as the number of words spoken increased because you get past the necessary business talk and into the rich language as your speech quantity increases.

The amazing things about the study is that they were looking to compare socioeconomic groups, but what they found is that if they stripped everything down the only remaining factor in predicting success in vocabulary was the quantity of words spoken and had nothing to do with the child's background.

There are so many interesting aspects of this study and you can read more about it here in an interview with Dr. Risley:

Where Vocabulary Growth Comes From 

Here's how you can use this research to start your child "home-schooling" early.

1. Talk to your baby/toddler.  It seems weird and awkward because early on you get nothing back, but they are soaking up every syllable into a construct in their brain that will likely come spilling back at you at some point when they are ready. Get in front of them and let them see you form the words with your mouth.  Use "parentease." Parentease is that higher pitched, sing-songy style of talking that anyone else listening would make fun of you for, but babies do understand and hear it better.

2. Talk with rich language. Explain things to them. Describe things. I've told this before, but my wife and I like to call our speech with our kids "narrating their world." When we can, everything they touch gets a noun label.  Then we will move on to adding an adjective or a verb when time allows and when they are becoming more developmentally advanced.

Here's an example of how that goes in our house:

"Hannah did you find a ball?"

"Ooohhh, look at that red ball.  And here's a blue ball too, Hannah."

"Hannah, are you going to throw that ball?  Yeahhh, you threw it."

We use our children's names all the time. In fact, we had to reconsider our list of baby names after our first because we realized what sounds cute once doesn’t always sound so cute the thousandth time you say it. It gets their attention in a way that isn't threatening in the way that, "Hey you, listen to me!!  (Sweet transition) Is that a red ball?" is.

3. Pretend they say stuff. It's OK. Using the above example, the first time Hannah said anything that even remotely sounded like ball, we got so excited. "That's right Hannah, it is a ball." I'm pretty sure she didn't even know what happened, but all the smiling and excitement was positive reinforcement and she was trying to say ball over and over again. Now, it's her favorite word.

Language development is such a critical component to the overall success of your child. There is nothing else that you can do that has a bigger impact on their future, so get to talking and talking and talking.

About the author

Justin Smith, M.D., is a Cook Children's pediatrician in Lewisville . He attended University of Texas, Southwestern Medical School and did his pediatric training at Baylor College of Medicine. He joins Cook Children's after practicing in his hometown of Abilene for four years. He has a particular interest in development, behavior and care for children struggling with obesity. In his spare time, he enjoys playing with his 3 young children, exercising, reading and writing about parenting and pediatric health issues.