PALO ALTO, Calif-- Pediatric health and safety experts say it’s no surprise that starting or returning to school creates a multitude of concerns for kids and parents. It’s a major time of adjustment. That’s why the experts at Lucile Packard Children’s Hospital at Stanford have made themselves available for comment on these and other back-to-school issues.
 
Healthy eating in a fast-food world
Julie Matel, MS, dietician and nutritionist at Packard Children’s, suggests recruiting young kids for lunchbox duty. “Involving kids in making their lunch may help lunches get eaten,” said Matel, who suggests preparing the night before to reduce morning craziness. “Parents have to be creative, too," she said. “Nutritious food can be made to sound like fun; for example, try making things like ‘ants on a log,’ which is a celery stick covered with peanut butter and raisins.”
 
“For older kids, lunch is a very social time with a lot of peer pressure,” said Lisa Chamberlain, MD, MPH, and director of advocacy at the hospital’s center for healthy weight. “That means that taking a healthy lunch to school may be a bit uncool for some.” So what’s a parent to do? And what if your child is a charter member of our fast-food nation? Chamberlain offered two tips. “First, families need to discuss how kids spend discretionary money at school. Too many times they'll choose to spend it in vending machines. If this happens, try to encourage healthier choices such as water or yogurt,” advised Chamberlain. “Second, if fast-food is the only option, parents should talk about creative ways to make that experience less detrimental. For instance, kids can keep portion sizes in mind by not choosing to supersize their meal. Plus, they can choose lower-fat and less harmful menu items.”
 
How to pack the backpack
It's easy for a child's backpack to become a health hazard. “It’s not uncommon to hear kids as young as 12 complain of pain in their shoulders, neck and back,” said Packard Children’s Debbie Tong, MA, PT. "It can be due to an overloaded backpack or a backpack improperly worn.” Tong suggested that parents follow the American Physical Therapy Association guidelines stating that a backpack should weigh no more than 15 percent of a child’s weight. “Following this rule will lessen the wear and tear on muscles and ligaments as well as prevent poor posture,” said Tong. “A wheeled backpack is another option but make sure the handle is long enough and the wheels are large for best posture,” added Tong. “Help your child by taking out items that can be left at home and organize the contents to better distribute the weight.”
 
Sleep without a peep
As a father of two school-age children, Rafael Pelayo, MD, director of the pediatric sleep service, has both a personal and professional interest in helping kids get a good night’s sleep. “Start kids on a school schedule at least a week or two before school starts to make the transition from summer easier,” said Pelayo, who stressed the importance of a regular bedtime routine. “A bedtime routine is as important for a 2-year-old as it is for a 12-year-old or a 35-year-old. This means having two to three relaxing activities to help you wind down before falling asleep.” The best? “A National Sleep Foundation poll found that children who read just prior to bed or were read to slept better and longer,” said Pelayo, who has worked with the Foundation on many of its sleep improvement initiatives.
 
Don’t forget exercise
Some schools don’t have PE classes and not every kid is on a school sports team. “Parents can incorporate exercise in other ways,” said Dana Weintraub, MD, a clinical instructor at Packard Children’s. “For instance, instead of having children take the school bus, try starting a ‘walking school bus’  parents or other adults walk groups of children to school together.” Weintraub also said parents should be proactive. “Contact your child’s school, school district or health care provider to find out about after school programs that include physical activity,” Weintraub said, adding that “Many also offer additional benefits such as academic assistance.”
 
Keeping kids active and safe
“In addition to staying active, kids need to make sure they stay safe. Proper stretching and warm-ups are essential to exercise” says James Gamble, MD, orthopedic surgeon at Packard Children’s. “Whether it’s for PE class, an after school activity, or varsity sports, proper precautions need to be taken.” The bone structure of most adolescents is not as developed as adults, meaning there are areas of growing tissue near the end of long bones. Because of this, these growth areas injure more often than tendons and ligaments. This could cause an otherwise minor sprain in adults to be a more serious injury to a teen athlete. Nearly no sport is immune to growth plate injuries. Athletes in contact sports such as football or basketball and overuse sports like gymnastics or baseball are equally susceptible to these types of injuries.

About Lucile Packard Children's Hospital
Ranked as one of the best pediatric hospitals in the nation by U.S. News & World Report and Child magazine, Lucile Packard Children's Hospital at Stanford is a 264-bed hospital devoted to the care of children and expectant mothers. Providing pediatric and obstetric medical and surgical services and associated with the Stanford University School of Medicine, Packard Children's offers patients locally, regionally and nationally the full range of health care programs and services - from preventive and routine care to the diagnosis and treatment of serious illness and injury. For more information, visit http://www.lpch.org.