A CHECK-UP CHECKLIST Kids' safety, health go to top of back-to-school list


Margie Gaines is preparing to send her son Marcus to pre- kindergarten at Thomas G. Hayes Elementary School. He is the proud owner of new sneakers, T-shirts and jeans, and his school bag will brim with crayons and construction paper.

But those aren't the only things this 4-year-old will need when he starts school in September.

"Today Marcus got a shot for polio and measles, mumps and rubella," said his mother at the Harriet Lane Primary Care Clinic at the Johns Hopkins Children's Center. "He has always been a healthy child and I want him to stay that way when he goes to school."

Vaccines and booster shots are an important -- and required -- part of maintaining a child's health. But staying happy and healthy in school is an on-going process enhanced by attentive parents who are sensitive to all of their children's physical and emotional needs, say health professionals.

Here are some basic tips for making your child's entry into the school year as smooth as possible:

* The Maryland Department of Health and Mental Hygiene requires children to have at least four doses in a vaccination series that includes immunization against diphtheria, pertussis (whooping cough) and tetanus.

Documentation of at least four doses of polio vaccine are required before entering kindergarten.

Beginning this year, all children entering kindergarten and sixth grade in Maryland will be required to have a second immunization against measles. With measles on the rise across the nation, the American Academy of Pediatrics "recommended reimmunization with a booster," says Dr. Nelson W. Davidson, attending pediatrician at Union Memorial Hospital. The measles booster includes immunization against mumps and rubella, as well.

* Annual "well-child check-ups are important because preventive measures help identify health problems before they reach the point that they interfere with a child's education," says Dr. Peter Beilenson, director of School Health for the Baltimore City Health Department.

A routine checkup often includes basic hearing and vision screenings, which may or may not also take place within a school system. "Especially with kids early on, if they're having difficulty in school, a lot of times it is maybe a hearing problem, especially if they have had a lot of ear infections or tubes in their ears on account of ear infections," Dr. Davidson says.

The recent increase in tuberculosis cases has also made testing for the disease a routine aspect of most physical examinations, says Dr. William Devoe, chief of pediatrics at St. Joseph Hospital.

* To avoid infection at school, scraped knees and cuts should be covered. Parents should try to teach their children not to share drinks and food, Dr. Davidson says. Children should also be instructed in basic hygiene, such as washing hands after using the bathroom and blowing their noses, he says.

Safety measures, such as learning to cross the street, and using bicycle helmets and seatbelts are also important preseason lessons that bear repeating.

* Develop a menu of easy, healthy meals for lunch boxes. Variety, ample calories and nutrients are key. "Be sure to include one protein, vegetable, fruit and start in your child's lunch eacy day," says Catherine Genthner, chief dietitian at St. Joseph's.

* Emotional well-being is as important as physical health for a budding student. For children who may suffer from "school phobia," a form of Separation Anxiety Disorder, a strict schedule at home breeds familiarity and confidence. "Kids get scared of lots of things. They feel safest with structure," says Wayne Steedman, related service manager for the Forbush School at the Sheppard and Enoch Pratt Hospital.

Parents should help children establish a bedtime ritual at a fixed time every evening, he says. Mornings, as well, should also give children a predictable routine with extra time built in to accommodate dawdlers on their reluctant way to school.

"As painful as it is," stick to the schedule, Mr. Steedman says. "The child will settle in.

* When children come up with somatic complaints in an apparent effort to avoid school, establish rules, Mr. Steedman says. "Children love rules. . . . They know what's expected [which] makes the world a safer place," he says.

For example, if a child claims to have a fever, take her temperature. Let the thermometer be the inanimate arbitrator of whether or not the child is sick enough to remain at home, Mr. Steedman says.

* Children with special needs should be desensitized to their new school environment, says Mark Bailey, director of child life and education at Mount Washington Pediatric Hospital. "A lot of special-needs children have fears that to a normal child may seem unfounded. We certainly have patients who have an absolute fear of getting on a bus" and have no concept of the transportation process, he says.

For these children, Mr. Bailey arranges field trips that include bus journeys and visits to new schools in order to familiarize them with their new environment.

Parents of special needs children should "become involved," accompany them to the bus stop, and "try to reassure the child, talking [the situation] through to the extent that the child can understand, Mr. Bailey says.

Children newly confined to a wheel chair, or scarred from a severe burn, who are returning to a familiar environment also benefit from a preliminary visit to their old school, Mr. Bailey says. Eventually, their classmates will realize "it's still the same child."

Children without special needs, "especially first-time kids" will also warm up more readily to their new way of life with a dry-run visit to a new school, Dr. Davidson says. "A lot of them will be very scared. There will be a lot of tears at night. It may be their first experience of being away from home."

Emotional support can make that first day of school a positive experience. "Before walking out that door to school there's nothing better than a good hug from mom or dad to give a child a boost," Dr. Beilenson says.

Vaccination sites

Following are the dates, locations and times where the state will provide free shots to Maryland children under 6 years old and to children entering the sixth grade.

Saturday and Sunday:

*Towson Center, Towson State University, 10 a.m. to 6 p.m.

*Charlotte Hall Veteran's Home, Maryland Route 5, 10 a.m. to 6 p.m.


*Washington County Health Department, 1302 Pennsylvania Ave., Hagerstown, 10 a.m. to 6 p.m.

Aug. 22-23

*301 W. Preston St., Baltimore, 10 a.m. to 4 p.m.

*Prince George's Community College, Largo Student Center, 301 Largo Road, 10 a.m. to 4 p.m.

*Allegany County Health Department, Willowbrook Road, Cumberland, 10 a.m. to 4 p.m.

Aug. 23

*North Point Government Center at Merritt Boulevard and Wise Avenue, Baltimore County, 10 a.m. to 4 p.m.

Aug. 29-30

*301 W. Preston St., Baltimore, 10 a.m. to 4 p.m.

*Easton Armory, rear barracks, Route 50, Talbot County, 10 a.m to 4 p.m.

Aug. 29

*Carroll County Health Department, 540 Washington Road, Westminster, 10 a.m. to 4 p.m.

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