The new school (health) rules

Back to school can also mean back to germs, breaks, sprains and concussions.

While most of us know kids need a good night's sleep and a good breakfast, just what exactly do experts define as "good"? And what other basics should parents put on their checklist to ensure a more healthful year ahead?

Here are a dozen rules to help you help your kids better prevent schoolhouse maladies.

1. A recipe for a good day. It's easy to pop your late-waking, picky eater in the car with a box of dry cereal or a toasted plain bagel for the drive to school. But the No. 1 thing that will keep your children alert all day is ensuring that they have something healthful to eat in the morning, says Diana Sugiuchi, nutritionist and owner of Nourish Family Nutrition. She suggests packing kids with protein, like eggs, milk or yogurt, and a complex carbohydrate, like a whole grain or fruit. "The kinds of foods that you choose will make a big difference in the ability to concentrate and energy levels," she says. Simple carbohydrates, like sugary cereals, fruit juice and white bread, won't keep kids feeling full for long, while the protein and complex carbs will. Make that bagel whole grain and top it with peanut butter for an easy but smarter start.

2. Whether your kid is off to college or kindergarten, get the 411 on shots. Dr. Virginia Keane, associate professor of pediatrics at the University of Maryland School of Medicine, says the first step to having a healthy school year is making sure your child is up to date on his or her vaccines. "All of these infections are still around, so your child is susceptible without being vaccinated," she says. Maryland students are required to be vaccinated against diphtheria, tetanus and pertussis, polio, hepatitis B, measles, mumps, rubella and varicella. Children younger than 7 are required to have four doses of the DTP/DTaP vaccination, while children older than 7 are required to have three doses of tetanus and diphtheria containing DTP, DTaP, Tdap, DT or Td. Also: Students younger than 13 are required to have one dose of the chickenpox vaccine, while two doses are required for previously unvaccinated students 13 or older. Be sure to check with the school for any particular requirements it might have.

3. Flu vaccines are not just for the old and infirm. The flu vaccine is not a 100 percent guarantee that your family will stay flu-free, but it will cut your chances, Keane says. Most schools offer vaccinations; check with your pediatrician for other locations. Children who fear shots can opt for needle-free versions.

4. Make your kids a little OCD about hand-washing. Encourage children to wash their hands: After they use the restroom, before they eat lunch, after recess, after they cough or sneeze — frequent hand-washing is a great way to prevent illness. Keane also suggests wiping down elementary school children's desks with cleaning wipes once a week. (Buy a big box for the teacher to keep the whole classroom on the same germ-free page, so to speak.)

5. Just add water, and more water. Send your kids to school with a water bottle: Sugiuchi suggests sending your children to class with a refillable water bottle. "Being well hydrated during the day makes a big difference in energy and the way they feel."

6. Know why sports drinks are not always a winning option. While sports and energy drinks are popular with children, plain old water is the best option. Meredith Harter, clinical dietitian at the Johns Hopkins Children's Center, says a sports drink every now and then, perhaps during a vigorous sporting event, is OK, but in general, water is the best way to go. According to the American Council on Exercise, children and adults should drink 17 to 20 ounces of water two to three hours before the start of exercise, eight ounces of fluid 20 to 30 minutes prior to exercise or during warm up, seven to 10 ounces of fluid every 10 to 20 minutes during exercise and an additional eight ounces of fluid within 30 minutes after exercising. Harter says milk and water should be the staple liquids in children's diets. "Most juices, fruit punches or sodas are mostly just calories," she says. "The 150 calorie soda could have been a mini bag of popcorn that will be more satisfying." For kids who think water is boring, Harter suggests looking to fruit-infused flavored waters. Still not convinced to stick to water? A new study published by researchers at the School of Dental Medicine at Southern Illinois University in General Dentistry suggests that the high-acid levels found in energy and sports drinks can erode tooth enamel.

7. Talk to your kid about bullying. And keep talking to him. Mental health is just as important as physical health. Keane advises sitting down regularly with your children to make sure they are not victims or proponents of bullying, and also that they and their friends have healthy relationships. "Just have a non-judgmental conversation to say that this happens when kids get together," Keane said. "You want to make sure they're not doing it to someone else, and if it's happening to them that they tell you so you can make it stop."

8. Know what's new about protecting your kid's noggin. In July, the Maryland State School Board added new requirements and regulations for schools to help protect student athletes from brain injury. By the end of this month, each local school system will have trained coaches in concussion symptoms, risk and management to better educate them on when athletes should be removed from play. Schools will also be required to implement policies that assure students and their parents receive information about the nature and risk of concussions. Keane suggests that parents should pay close attention to these new measures, possibly scheduling or attending a group meeting with their children and coaches to talk about risk. "If kids are going to participate in contact sports, they should probably have a meeting with coaches to talk about hydration, head injuries and injuries on the field," she says. "It's important for parents to know how staff will handle injuries and how parents will be contacted."

9. Don't be a part of a failure to communicate. Even if your child has his or her diabetes regimen under control, it's important for the school nurse and teachers to know what to do in case of an emergency, Keane says. Leave extra asthma medicine with the nurse, or if your child has severe allergies, make sure he or she carries an EpiPen.

10. Know when to keep sick kids home, and when to send them to school. While some feel you should keep kids with the sniffles home to prevent spreading germs, Keane says it will already be too late. "Usually, three days before the cold you have been shedding the virus, so by the time you have a sore throat and a cough, you've already spread that to the classroom," Keane said. "So staying home for minor symptoms is pointless. Don't let your kid miss out on learning." On the other hand, Keane says, children should never be at school with a fever, and they should go 24 hours without one before they are allowed to go back.

11. Even non-athletes need to get a move on. The American College of Sports Medicine released results of a University of Rome study in March that found adding physical activity into the school day helps children concentrate on their academic work. Even if your children aren't interested in sports, consider encouraging them to add a block of physical activity to their school schedule. According to the Physical Activity Guidelines for Americans published by the U.S. Department of Health and Human Services, children 6 to 17 years old should be getting one hour or more of physical activity every day. Three days a week they should be participating in a vigorous-intensity activity. As well, they should do muscle-strengthening and bone-strengthening activity three days a week. In children in this age group, health benefits of physical activity include improved bone health, reduced symptoms of anxiety and depression and improved cardio-respiratory endurance and muscular fitness.

12. And make sure they get to sleep, perchance to dream. Keane suggests taking TVs and computers out of bedrooms at night and only allowing quiet activities before bed, like reading or drawing. The Centers for Disease Control and Prevention have the following guidelines for making sure your child gets enough sleep:

3-5 years: 11-13 hours

5-10 years: 10-11 hours

10-17 years: 81/2 -91/2 hours

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