- Coming up on the debut edition of WTVP's "Docs On Call", kids are back to school, but are they back at their best?

(soft dramatic music) (soft dramatic music continues) Good evening and thanks for joining us, I'm Mark Welp.

WTVP's "Docs on Call" is our latest local program, and it's dedicated to informing you about something that affects everyone, health.

Each week we'll tackle an important topic to your family, and this week we're talking back to school.

Dr. Terry Ho is a board certified pediatrician, and the Managing Medical Director of Pediatrician Practices with OSF Healthcare.

Dr. Keith Hanson is also a board certified pediatrician, and Medical Director of the General Pediatrics Unit at OSF Healthcare Children's Hospital of Illinois.

And he's Section Chief of Pediatric Hospital Medicine at the University of Illinois College of Medicine Peoria.

I'm already spent just introducing you guys.

- Yeah.

- How are ya?

- Good.

- Good.

- Good.

Great to see you.

- Thank you for having us.

- Let's talk about back to school.

You know, kids are already back in school, but it's still a little early, and hopefully they had a chance to change their routines up a little bit between summer and school.

But if they haven't, what do you recommend to parents to help their kids, you know, get to bed earlier, get up earlier, things like that?

- Yeah, you know, it's tough.

I have two kids of my own, and I know that we always try to encourage routine and try to get structure, but summer's a good time to just let loose, have fun, try to enjoy time away from school and having vacation.

So, it is hard to remember to kind of reset, right?

And I know I'm a big proponent of trying to encourage that structure and trying to have routine.

'Cause we know how important that is for the kids getting back to school, and not just for the kids, but for us, for parents in general too.

So, our hope is that a few weeks prior to school starting, we've already hope to establish that routine again, talking about, you know, getting to bed a little bit earlier, talking about making sure that we have our structure and routine ready to get back to the classroom.

But if you haven't, there's always time.

There's always time to try to work back to get that routine.

And I think a lot of it personally starts with us as the parents.

Setting good examples for our kids, because ultimately if we have good routine, our kids, our family will have good routine too.

So just trying to make those things a priority.

And I try to encourage that to our parents that, you know, if we set a good example for our kids getting to bed, making sure that we're eating our routine meals, balanced diet, then our kids will see that, and hopefully take the lead on that and follow suit too.

- Yeah, I wanna get to nutrition in just a second.

But Dr. Hanson, you know, if, if a child, let's say they go to sleep at eight o'clock, but they've got that pesky little cell phone... - Mhm, mhm.

- What are your recommendations in terms of, you know, how much time they should spend or not spend on that before they go to bed?

- Yeah, I mean definitely want the screens outta the room at nighttime, otherwise they are gonna be on it.

You know, I just had to take cell phones outta my kids' rooms the other night.

They weren't even using it, but you know, it was in there, it's that risk, right?

And they definitely should limit that, you know, for a few hours, ideally ahead of bed.

So, we do try and set those screen time limits.

You know, maybe screen time ends at seven if your bedtime is nine.

Just kinda let your brain wind down.

Not that the extra stimulation from those screens that might even help keep you up you know, even past your normal bedtime.

There's some evidence that that blue light from those screens kinda reset your body's sleep-wake cycle.

And so if you're on it too late, that can definitely mess those things up.

So there's lots of things about not eating right before bed, obviously no caffeinated drinks too late in the day.

Avoiding screens as you kinda get closer to bed will kind of help you have that normal bedtime routine, for sure.

- Sure.

And Dr. Ho, what are your feelings on how much sleep?

- [Terry] Yeah.

- Someone should get.

And let's start from, say, kindergarten all the way up through college.

- Yeah, it's always such a big question, is that target, that goal, right?

And we know that's challenging and hard, because every day is different.

And every family situation is different.

But if we try to keep an eye or have at least a target goal, maybe we can try to get there.

So for most little kids, elementary school, grade school kids, we're hoping that you get 10 plus.

And you know, I think that, you know, ideal situation, we're talking 12 hours, right?

But we do know, again, life is busy.

Kids have activities even starting younger and younger these days.

As you get to the junior high and then to the high school, the teenagers, we're hoping you get that eight to 10.

And again, we also know that because days are different, maybe we start trying to incorporate catch up days, right?

That on the weekend, if you have that ability, or on a night that you have nothing to do, important to maybe tell your kids, or even as a family, "Hey, let's take it easy today.

Let's catch up on our sleep.

Let's try to recover from that previous day."

You know, it's interesting you talk about technology, because I actually use it in my talk about speech, even though we're talking about removing devices and stuff.

Oftentimes what I actually ask a teenager or talk to a parent about is, you know, for someone with a device, every night, you're plugging that in.

You're charging that device so that the next day it works well.

Well, it's no different than us with sleep, right?

In a way, we recharge by getting good sleep.

So I think a lot of teens respond to that, 'cause they kind of understand like, "I gotta make sure I plug that in.

I gotta plug in my devices."

So if they kind of think about it that way, that they have to recharge, plug themselves back in, then they can function at their best the following day.

- [Mark] That's a good one.

I'm gonna try that.

- Yeah.

- With my kid.

You also mentioned nutrition earlier.

Is breakfast still the most important meal of the day, as we've all heard most of our lives?

- Absolutely.

Absolutely.

And it kind of falls back on that kind of recharging and being good to go for the rest of your day in that breakfast.

You know, if we're missing that meal, we're functioning with lower energy throughout our whole day.

And I think that's important not just for the kids, but also as adults.

Again, setting that example, knowing that, you know, if we can all sit down together, or at least try to be intentional about it, we can really help set a good example for our kids that it's not important for them now, and then also as they go off to school, go off to college, or even at that point, starting their own families down the road.

- And a lot of us, you know, we're busy in the morning, parents are going one way, kids are going the other.

It's really easy to pour that colorful cereal into a bowl and just add some milk.

I mean, that's obviously not ideal, but is it better than nothing?

- Yeah, I would say it's better than nothing.

You know, you do what you have to do with your life, and your finances, and those kind of things.

So I think the main thing, as Dr. Ho said, a regular schedule, regular meals, and then a variety of things, right?

Like you can have sweets sometimes and things like that.

It's more about everything in moderation.

You know, it's really hard to count like "How many vegetables did they have today?"

All those sorts of things in real life, right?

So, as long as you're having a variety of those different food groups throughout the day, that's really what we'd really wanna look for.

But you can always prepare meals the night before for breakfast or those sorts of things.

And I also would encourage people to, you know, depending on the age of the child, involve them in preparing their meals, right?

You know, kids can start cooking meals as they get to those tween years, definitely teenagers.

Breakfast is easy.

Might not require any stove action or anything like that.

So, involving the kids is very helpful.

And just to piggyback on what Dr. Ho said about sitting down to eat, really kinda taking that time is like a dedicated time to maybe decompress a little bit at the end of the day, talk, have no devices at your dinner table, those sorts of things I think is also really important for building those healthy habits - When your kids get older and they have more freedom, let's say they go to high school, and they could get whatever they want at the cafeteria.

- Yeah.

- Or maybe they can even go off campus.

How do you convince your kids to try and eat healthy and have a balanced lunch?

- Yeah, that's tough.

I have a high schooler right now, and I get to see what he orders and what he gets, and keeping my fingers crossed he always makes the right choices, but we also know that there's certain things that teenagers like, right?

- [Mark] Yeah.

- So I think your hope is that, you know, starts young, establishing those good habits and again, kind of going back to the kids seeing us as their biggest role model, right?

And so if we have good habits and are encouraging our fruits and vegetables, our balanced diet, our balanced plates, hopefully our kids will latch onto that as well.

And I think those gentle reminders.

We've tried to get away from telling our kids too much "no", right?

I think generations, this is kind of, you know, it's just different these days.

And we also don't wanna set up negative food relationships.

We don't want to always tell them, "You can't have this or you can't have that."

Because I think sometimes then that actually leads them to wanting to have that even more.

And so, talking about balance, and just those general reminders that, hey, let's remember the fruits, let's remember the veggies.

Let's try to be balanced with our choices.

I like what Dr. Hanson said.

You know, I think sugary sweets and treats every once in a while...

They're kids, right?

We're realistic that they're gonna get those.

But if we can keep things in moderation, that'll be the most important thing.

- I would say too, again, empowering the kid to help out with that process.

So, you know, I also have a teenager, and if I know he's gonna be staying after school for some activity, ask him at the beginning of the day or day before, "What's your plan for your dinner?"

You know what I mean?

If you have no plan, you might end up at the vending machine, or something like that, right?

But if you kind think about it ahead of time, you're bringing something, or you're planning to go pick up something specific.

And so I think, again, empowering 'em to be part of that process, and then that's opportunity for you to kinda coach them or kinda encourage those good habits too, so.

- Sure.

Now, one of the things that we've all had to deal with, usually before going to school, or at least maybe having it done within a few weeks of getting into school, vaccinations.

So, let's talk about the importance of those, and typically what kind of vaccinations kids need to get before they go back to school.

- Yeah, the big vaccines happen for our kindergartners.

So our kids going into kindergarten have a routine series of vaccines that we've been giving for decades.

And so, you, myself, Dr. Hanson, all have had these vaccines.

And so they're tried and true.

We know their benefit, we've seen their benefit.

And so, hopefully, with your routine checkups the kids and parents have been bringing their kids to, their families to, they're getting those vaccines on schedule.

So again, schools will require those kindergarten vaccines.

The next set of required vaccines comes at sixth grade.

And then there's a set of vaccines that your high schoolers will get to.

So, the big thing with that is hopefully trying to stay up to date with the vaccines by just having your routine yearly checkups.

You know, it's the importance of coming back to always having a well child check, and a good relationship with your pediatrician.

By having those relationships and by seeing your doctors annually, what will happen is that we can catch you up when you need to be caught up, and then you're not scrambling in the last minute to be able to get them.

And so again, just stressing those annual physicals, those annual checkups, no different than us as adults needing those annual checkups, our kids need them just as much, and maybe even more important too.

- Let's talk about... A lot of people say schools are just big Petri dishes, lots of germs all over the place.

Let's talk about how we can try, and before our kids get sick, try and prevent some of that.

What are some good hygiene tips you can give parents?

- Yeah.

I mean, hygiene's really hard on kids, right?

So, you know, working in the hospital with the kids, they get viruses and infections all the time.

It seems sometimes it's like there's nothing you can do about it, right?

Because they are Petri dishes.

Especially these younger kids where they just have snot everywhere, and hard to get 'em to wash their hands.

But I think you do have to start early, encouraging them about hand washing, not just when their hands are dirty, but before you eat, after you eat, kinda before playtime.

All of those kinds of things.

So, again, it's again about forming those habits early.

It's really hard though, even to teach them how to wipe their noses with a Kleenex, right?

If you imagine those toddlers and younger kids.

And so doing your best early, and kind of developing those habits really as soon as they're able to start doing those things.

But it is very challenging.

You know, kids get between six to 12 viral illnesses a year.

Younger kids tend to get more, right?

Because they have those kind of early immune systems, and so they are sick frequently.

And so sometimes it does feel like there's not much you can do.

But I think those kind of basic habits early on.

And then of course if your kid is sick, potentially keeping them home from school and those sorts of things.

Or limiting playtime or birthday parties if at all possible.

And so I think people just need to be more cautious about those things.

It certainly is challenging to know is it a runny nose from a cold is it from allergies?

Always a very common thing to wonder.

And so we all just do our best and try and prevent those illness from spreading.

- I know a lot of schools these days have their own guidelines to go by, you know, let's say if you've had a fever, then you shouldn't come back- - [Keith] Yes.

- Within 24 hours, things like that.

- [Keith] Right.

- I guess for the parents' point of view, if your child is sick, how do you know when it's serious enough to go to a doctor or maybe a prompt care?

- Yeah, I would say it's always a hard thing to know, right?

And so I get asked that question a lot.

You know, when we have a kid in the hospital like, "Should I have brought them in sooner?

What can I do next time?"

It's very hard to know.

So I would say, use your best judgment.

If you're ever really worried about your child, bring them in, right?

We're never gonna say that was the wrong thing to do, to bring 'em to the emergency room or an urgent care.

But the biggest things that really put kids in the hospital, for example, or in the emergency room is breathing troubles, you know, from those viruses that go around, pneumonia and things like that.

So, if they're really struggling to breathe, you kinda see those sucking of the ribs, and those other kind of things, really fast breathing, that's definitely concerning.

Any change in their behavior where they're really sleepy or hard to wake up.

Signs of dehydration, like they're not peeing very much, and those kind of things, those are definitely red flag signs to bring them in.

But certainly, if there's ever any concerns whatsoever, bring 'em in for evaluation.

If something's gonna be keeping you up at night, I think that's a good rule of thumb, right?

Like, would you not wanna watch them for this period of time?

Then you should probably bring them in sooner rather than later.

- And what about after they've been diagnosed?

What are your recommendations on how long you should wait to send them back to school?

- Again, I get that question from almost every patient in the hospital when they're going home.

"When can I go back to school?"

I say, "I really don't know."

Because as you said, Mark, every school has different rules.

Every daycare has different rules.

Most of the time, daycares and schools are gonna say at least 24 hours fever free is gonna be a minimum required for most places.

And so I definitely say that.

Otherwise, schools tend to let kids back pretty soon.

I would say, "Where did they get that viral illness?"

From the school, right?

So it's already going around.

But you do wanna see that kids are able to control their secretions.

Like they're not drooling and coughing all over other kids, right?

Especially for those younger kids.

If it's more like a diarrhea illness, make sure it's not blow out diaper, it's gonna spread around, those kind of things.

So you definitely wanna see symptoms improving.

But on the other hand, if you wait until the kid has no runny nose, you might never be back in school.

So it's kinda that balance of getting the kids back in school and back into routine and also not wanting to spread things.

- That is true.

Now if a child, let's say they do get a cold or whatever, maybe they have to take an antibiotic for a week.

Or maybe they already have issues where they need to take some kind of prescribed medication every day, what does a parent do in terms of communicating with teachers, school nurses, things like that?

- Yeah, I think post-pandemic, a lot of schools, I think we kind of touched on that, alluded to that, that a lot of schools have pretty good protocols these days about medications, medication distribution, and how they're administering it in school.

So I think it's about just having good dialogue with your schools.

Hopefully reviewing handbooks and protocols that they may have.

And also touching base to see.

I mean, some schools are lucky enough to have school nurses on site.

For sure the staff, teachers, just to be able to let them know good dialogue, communication about, "Hey, my child was sick, and they're gonna be on this medication."

Especially if they need to take it at school, what that looks like.

I think it's important to maybe touch base with your providers, your pediatricians, your doctors, to make sure you know about potential side effects.

What happens if I miss a dose, what happens if I took an extra dose?

'Cause those things do unfortunately accidentally happen.

And so just being prepared for that, and also preparing the school to know that, hey, this is what we're looking at, and what we're going to do.

- When people go before school to get their kids' vaccines up to date and things, usually they do a physical...

Physical, I think they're called wellness checks now.

But how often should a child, you know, and again, let's start young and go older, how often should they get a wellness check?

- Yeah, there's a lot of checks that happen as your children are infants, right?

We talk about the newborn checks, those two week checks, and then the frequency only increase with two months, four months, six months, nine months a year.

They seem like a lot, but that actually happens really fast.

And then from there, they space out a little bit more with our 15 month checkup, 18 month checkup, and then our two year checkup.

That's a lot of visits in the first two years of life.

But a lot of development and a lot of change happens during that time.

A lot of growth in your child, and a lot of points of contact to be able to follow your child's growth and development too.

And then as we start spreading out, they become yearly.

And so, I'm always a big fan of trying to avoid the school physical season, school wellness check season, just because really we should be checking up your kid throughout the year regardless.

So, depending on your child's birthday, let's say they're born in the winter, we should be hopefully seeing them every winter when their birthday cycles back around, regardless of the timeframe of the school.

And then that way you kind of avoid a little bit of that rush in the practices in the offices.

'Cause we know that, you know, if everyone's always trying to get in during the summer for their school physical, it can be hard to get an appointment.

And we're trying to come up with ways to be able to facilitate that, and we have a lot of different ways for you to get those physicals done, whether it's through our urgent care sites or other sites.

We do a lot of popup physicals throughout the summer, little clinics that we offer.

But you know, you could also avoid some of that rush by just getting your checkups throughout the year.

And so, hopefully following those yearly checks from when then they're three, four, and five, all the way until they outgrow our pediatric practices and are handed off to our adult practices, so when our kids are heading off to college.

- Okay.

Speaking of physicals... (Mark chuckles) If your child, you know, again, let's say maybe fifth grade on up, is playing a team sport at school, are there any things parents can do to maybe help prevent injuries in terms of what they teach their kids to do, like stretching and things like that?

Do you have any recommendations on that?

- Yeah, I mean, I think stretching's good.

Working with the coaches and trainers is also very good, because some of that stuff's very sport specific in terms of safety, in terms of equipment, prevention, and all those kinds of things.

I think one thing that I've seen over the years, I think Dr. Ho said earlier, you know, kids are starting sports younger, they're a little bit more intensive younger.

They kinda tend to specialize in a sport younger has been my impression.

And so I think we really wanna watch out for, you know, potential overuse injuries, and kids pushing themselves too much to the point where they are at higher risk for injury.

You know, we see a lot of kids that are super dedicated to the sport, and so they're probably going a little bit more so than they would, like they're kind of injured but they still kinda play through that.

And that just increases their risk for other injuries a lot of times, or worse injuries.

And so I think it's really important to stress the importance of overall health and safety.

And so even if you have like a minor sprain or something, you still want to take it easy and kind of not push things too much.

Another big one that we see kids come into the emergency room in the hospital for is concussions, right?

And so, you know, a teenager that's really dedicated to their sport gets a concussion, it might seem minor, they don't wanna take the rest of the season off, for example.

But we know that if they get hit again, and they have another concussion, that could potentially be a career ending concussion.

So, really if there's kind of any issues, I think it's really important to emphasize, you know, it's okay to say take a step back, it's okay to rest, work with your coaches and trainers on that, because that's potential for serious injury.

- And it seems like especially like the IHSA has put in a lot of rules when it comes to concussion protocol and things like that.

So, things that we didn't have when we were younger.

- Right, exactly.

- You know, Dr. Hanson, I'm glad you brought up the overuse, because really it's a big focus of the American Academy of Pediatrics, you'll see it being brought up by a lot of our orthopedic surgeons as well, is that with this specialization that we're starting to see with a lot of our youth and a lot of our youth athletes, we're just seeing repetitive use, and repetitive use of those muscles unfortunately is leading to a lot of injuries that we previously just weren't seeing.

So it was a really big focus on trying to avoid specialization.

And I know that's really tough in this day and age where a lot of our kids are doing a lot of... Pay to play sports, and doing a lot of those travel youth sports.

And it's really hard I think for a parent to decide, "Well, do I just commit to this one activity?

Or do I let my kid do all the activities?"

Which is also tough on a family and a parent as well.

And so, but really the recommendations that we really wanna get out there are that you should not specialize at an early age.

And the youth, lots of great studies, the youth that are doing multiple sports are able to avoid those repetitive injuries, because they're using different muscles.

So really, really encourage parents to let your kids play and try to do everything, especially at an early age.

- You don't want it to feel like a job, I think is kind of what I always say.

You want it to be fun.

Yeah.

- Sure.

Now, outside of gym class, can you give us some idea of what kind of physical activity kids should be getting, say, you know, how many hours per week or whatever, depending on the age.

Can you tell us a little bit about that?

- Well, I mean, the American Academy of Pediatrics I think recommends an hour of physical activity every day for kids, primarily aerobic, actually, kind of for the reasons that Dr. Ho said.

And so I think, you know, back in our day, sort of kids would just run around the neighborhood and be outside, which is less common these days.

So it can kind of take any form that works for you and your family.

But it is an hour of activity every day, and that can be hard to fit in a school day, with school and other after school activities.

But that is a recommendation, and the focus is on aerobic activity for that cardiovascular health and good growth and development.

So I think it's kinda a personalized decision past that, I don't know what Dr. Ho thinks.

- Yeah, even something as simple as going for a walk.

- Yeah.

- Right?

Going for a walk, you know, getting outside, and hopefully doing it as a family as well.

- [Keith] Yep.

- Good for everybody.

- [Keith] Yeah.

- So far we've focused on the physical aspects of our kids, but let's talk about the mental aspects a little bit.

You know, kids nowadays, they're stressed out, they have anxiety, all kinds of different issues that they're dealing with.

Is there something parents can do in terms of getting their kids ready for a new school year, or if they're having issues at school?

- Yeah, I'm a big fan of trying to encourage that open door policy.

Good dialogue, right?

And so if we have good lines of communication with our children, they'll feel comfortable to come to us when they have any struggles or any problems.

Or even at that, if they don't feel comfortable coming to us, they'll know that it's okay to go to somebody else.

So I think from an early age establishing that, "How are you doing today?"

Right?

Sitting down after school, "How was your day?"

And I think if we're intentional at it as parents, what our kids will realize is, "Mom's gonna ask me, dad's gonna ask."

And so, but if you don't just stop at, "It was fine."

But maybe dig a little bit more, and just ask them, you know, specific questions about their friends, their peer groups, their teachers, right?

And then as they get older, keeping an eye on what they're doing on their devices and social media.

Because we know that those things, we can't avoid them.

They're inevitable that they're gonna have exposure to them.

But if we have that open line of communication, if they have those questions about maybe something they saw or something they heard, they'll feel comfortable hopefully enough to come to us.

I think it's also important to surround your kids with good people, right?

So knowing who their friends are, knowing who the families of their friends are.

Having good dialogue with the teachers so you feel comfortable too, being able to have a good support system, not just within your house, but around your children as well.

Go ahead.

- I wanna say, I'm really glad you asked that, Mark.

'Cause it is a huge issue.

As Dr. Ho said, the social media's an issue.

Post COVID, I think there's lot more of these issues.

And we're seeing more and more kids even at our children's hospital, admitted with psychiatric related complaints, like self-harm attempts, eating disorders, and those kinds of things.

I think the main thing is to be vigilant and use your parental sort of like Spidey-sense, right?

If you feel like something's off, as Dr. Ho said, don't take it, let it just stop at, "Oh, it's fine.

I had a good day."

You know, like what really is going on?

And kind of being on top of those things.

'Cause if you feel like something's off, then probably something is.

And it's definitely better to be aware of it and intervene sooner rather than later.

And so, kind of starting to treat your kid more like an adult where you talk about those things openly as they get older I think is key.

And just being aware of those things kind of early on is important.

- Are there any signs that a parent can look for?

I mean, if someone's tried to harm themselves, that can be obvious but- - [Keith] Yeah.

- You know, other than saying, "Well, he or she is just a teenager, that's just what's happening."

- Yes.

Yeah, normal teen behavior versus concerned.

It is very hard.

But it'd be similar to signs of depression, you know, for example, in an adult, where they're not enjoying things like they used to, they're not interacting with their friends and family as much as they used to.

Kinda that self-isolation.

Not eating well, not sleeping well, all those kind of things.

But you make a great point, that's why it's challenging.

Teenagers all kind of do that to some degree.

But you know, that's why it's important to kind of check in.

If your teenager's been hanging out in the room for a lot, you know, kind of check in, see what's been going on.

Maybe suggest another activity to do as a family to get them out a little bit.

Really kind of proactively look at those things.

I don't know if you have other advice on what else to look for.

- Yeah, I think it's important to...

I hope that most parents will know their children and know their routines.

And so when those routines are a little bit off, that might be a little bit of a sign to maybe do a deeper dive.

And then also, again, just checking in with the people that are around your child.

Because you never know that your kid may feel more comfortable confiding in a friend.

And I know that's sometimes hard as a parent to understand, like, "Why can't they tell us?"

We check in with them, we always ask them.

But sometimes it just might be hard for them to open up.

So, knowing that there's a lot of points of contact that are possible.

And being aware that all of those can be helpful.

- Well, doctors, great information.

I wish we had another half hour, but we're out of time.

Appreciate you being here.

Dr. Ho and Dr. Hanson from OSF Healthcare.

Thanks for all the good advice.

- Thank you so much.

- Thank you.

Thank you for having us.

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Thanks for watching, and take care of yourself and your family.

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