Getting your patients ready for school

Recently, Contemporary Pediatrics®spoke with Nathaniel Beers, MD, MPA, FAAP, executive vice president of community and population health, and a general and developmental-behavioral pediatrician at Children’s National Hospital in Washington, DC, about what every pediatrician should be doing when it comes to readying their patients for a new school year.

Transcript (edited for clarity):

Contemporary Pediatrics
This time, we're going to be talking about getting students ready for the school year that's coming. And I know I'm preaching to the choir when I say this, but we enter into a new school year, 3 years after the start of the pandemic, there's been all kinds of reports of disruptive behavior in classrooms by educators, we're still obviously, going through a children's national mental health crisis. And both teachers and parents speak of concerns about children falling behind on math and reading and in other areas of academics. How does a pediatrician even begin to help families in tackling all these challenges?

Nathaniel Beers
Yeah, there's tons of challenges, as you've noted, that are facing the kids right now, as we think about what they need to do in order to be able to be successful and return to school. There are a couple of things that we as pediatricians can help keep in mind and help support parents and families and the kids themselves. First and foremost, is really remembering that almost all behavioral issues will get worse if a child is sleep deprived. So helping the family think about that now, not the day before school starts or the week before school starts. But really in the beginning of August, thinking about how do you create good sleep hygiene for that child? How do you start having them get up closer to the time that school will actually start and or whatever time they would have to get up in order to get to school in time, is really an important first step in helping to improve the sleep hygiene for kids. You know, it's not popular, but it's important to say right, reducing screen time, certainly before bedtime. And so we do recommend at least half an hour if not longer off of screens before kids are going to bed is an important part of helping them learn to relax and resettle their brains and create the space for them to be able to be successful. So there is that really important part of sleep hygiene, that is a part of getting ready for school and success of school. It's also important for kids to have goals, just like we have goals as adults. And so now is a great time to start having dialogue with patients or for parents to have it with children about what's your goal for this next school year. What does success look like for you in the school year, and so children of any age can really enter into that conversation. And the goals are going to look different for a 5 year old than it's going to look for an 18 year old but certainly it's a good time to encourage some self-reflection and create some space of, you know, let's work on that together. And let me help you as a parent support you in that process. And so making sure that we as pediatricians are encouraging kids and families to set goals for what they would like to see accomplished during the next school year.

The other piece is making sure that they are doing the work that they need to do around thinking through what their medical needs are going to be for the next school year. So there's certainly we're seeing many more kids with behavioral health diagnoses. So making sure that families have medications and refills so they don't fall off if they need medication as part of the regimen, if they're going to counseling and maybe it slipped a little bit during the summer because they were busy doing other things or traveling or camp or didn't see it as a priority, making sure that we're asking the question of the family of should we restart it, so that the child is ready to reenter school, and then recognizing that the start of school is a transition time. And so preparing kids for it, talking about it, thinking about it with them if they had a hard school year last year, thinking about what are the things that are going to make this year better, creating space to really allow that transition to be something that the child is prepared for and that it's not that we as parents announced on a Saturday or Sunday night? Here we are school starts tomorrow, are we all ready to go? Instead, really create the space for that child to have the appropriate time to transition into that school year is really important.

CP
Yeah, that all makes a lot of sense. I love that idea of goals even for young children to kind of sit with. That's really smart. What about the academic level concerns? Obviously, since the pandemic reading and math, you know, statewide levels have really fallen off. Is there anything that pediatricians can suggest to families in that way?

NB
I think trying to think about ways to create joy in learning, right, right, so a kid who's really into sports and really engaged in sports, how do we think about how to leverage that so that they're reading sports articles, or talking about sports statistics, or thinking about those mechanisms. And there's the great thing nowadays, with things that are online, there's all kinds of different things at different reading levels, to really encourage the reading, but also to think about how to leverage that for some math skills as well, you know, the same thing goes right for that kid who's into the arts, or is into drawing or painting, you know: How do you help create learning and reading and dialogue and discussion in those spaces? But also, how can you insert some math into those spaces? I have a child who really likes to cook. So how do you insert math into that cooking space? And also thinking about the reading, right, and they're learning different words, different languages, so it doesn't have to be that we're gonna drill and kill during the summer, right? And sort of have them do math facts and, you know, produce book reports or, you know, but how do you challenge them to find things that they're passionate about and leverage those things, to really create some opportunity to encourage the academic growth during the summer so that you don't see what we the educators referred to as sort of the summer slide, right, which is less academic instruction going on during the summer in that 8 to 10 week period. How do you make sure that you don't see slippage of the academic games that child made during the school year, and get them ready to really start, ready to be successful in the new school year.

CP

Yeah, like that connecting their hobbies and interest to their academics? Makes more sense. What about immunizations for children? Anything that pediatric health care providers need to know right now for the fall season? In terms of annual vaccinations, such as influenza, and possibly an annual COVID vaccination, or particular vaccinations that are perhaps recommended, but not required? What is your take on all that?

NB
Yeah, we saw during this last year, some really great catch-up on childhood vaccines. It doesn't mean we're done, and we can rest on our laurels as pediatricians. It does mean that we need to continue to make sure that children are getting their required childhood vaccines, as well as those recommended vaccines, you know, we're certainly still seeing some more vaccine hesitancy than we saw pre pandemic. And so making sure that we're using every visit as an opportunity to talk with families about vaccine readiness, so that we're not missing opportunities to catch that child up with the family who may have been a little more reluctant at one point.

We [also] want to make sure that as the flu vaccine becomes available in the coming weeks, that we start right away with getting kids vaccinated for flu, particularly those who are at high risk for flu, at least from data coming out of Australia, which suggests that there may be increased pediatric impact of the flu strains that they saw in Australia this current winter, since they're in their winter season now. And so thinking about how do we prepare ourselves in the pediatric community to ensure that we actually are ready for those vaccines for those viruses.

And then there is new information. And I think we're waiting for some additional guidance, but certainly expect that that will come in the coming weeks and months, around approval for treatments for RSV that may help prevent RSV illness in our younger kids. And certainly making sure that we're thinking about that as we think about how we are protecting the household from illness as well, since the older kids may bring that RSV into the house, we want to make sure that we're sort of thoughtful about protecting the entire household of kids in that space. And then we are awaiting additional guidance on new COVID vaccines to address the current strains that we're seeing and, and providing the protection.

Many people have suggested that we can expect that in for the coming years that we'll have an annual COVID vaccine and so we are waiting for those results and determining where that sits in the pediatric population and what type of protection we want to provide for our kids, particularly our school aged children.

CP
Do you think those vaccines will be coming before the end of 2023 in terms of COVID or that will be more into 2024.

NB
I know the recommendation has been that they come out with a new booster that would address the current strains, and thatwould likely happen before the end of this calendar year, and we hope that that will occur in conjunction with the flu vaccine. I have not seen current data that suggests that those would be combined at this point.

CP
Right. Okay. And finally, any last words you want to give to pediatric healthcare providers in general about getting their patients ready for a new year?

NB
Yeah, I think the most important things for us as pediatricians to remember are to support our patients and families as we think about what they need from a preventive health perspective. So certainly vaccines as well as developmental and behavioral screenings, remembering that, as I said earlier, that the start of every school year is a new transition for every child. Very few children have the same teacher from one year to the next. And so getting to know those new expectations, working together in that space, new classmates, for some kids, new schools, all of that comes with stress and strain. And certainly our kids have been through immense amounts of stress and strain over the past 3 years. And so helping families prepare for that, helping them make sure that they are building in those routines that they need to do, but also that they're creating opportunities for kids to be kids and have fun and enjoy themselves is an important part of what we can do as pediatricians and reminding families about that.

CP
Wonderful. As always, you bring such sound sensible advice to our audience. I really appreciate it. Thank you so much for joining us today.

NB
Thank you for having me.