Parents might well savor the prospect of a return to the safe, secure routines of school. But they do so at their children's peril.
Schools are a minefield of health hazards — arguably one of the most dangerous possible places for children to be and a contributor to the health problems of many children.
As a gathering place for hundreds — sometimes thousands — of individuals who are, as epidemiologists put it, "immunologically naive," schools are veritable Petri dishes for germs and ideally suited to the maximum transmission of those germs among students and between those students and their families at home.
A September study published in the Journal of Infectious Diseases found that the start of the school year fired the starting gun on the recent pandemic of H1N1 swine flu: Researchers from the University of Washington found that, on average, 14 days after schools opened in fall 2009, outpatient visits for influenzalike illness spiked at doctors' offices across the country.
For the lucky virus that makes its way into school attached to a student's hands, lips, nose or respiratory tract, the prospects for finding new hosts for its offspring are virtually limitless.
It's no wonder that when H1N1 flu threatened to mushroom, the federal government scrambled to provide school districts with guidance about how and when school closings might help stem the pandemic.
Though experts have a lot of concerns about the effect of schools on students' health, they also have lots of suggestions on things we all can do to minimize risks. For example, experts agree that in addition to knowing and practicing the basics of hand washing, kids can withstand the onslaught of germs best by getting enough sleep, eating a healthful and varied diet, and getting all their recommended vaccinations, including the yearly vaccination for influenza. Here are other suggestions:
In elementary schools, children are admonished not to run in the halls. In middle and high schools, students might sprint through a throng to reach their next class on time, often with a 40-pound backpack slung on their shoulders because they don't have time to stop at their lockers. That's about as much exercise as many of them get.
Since 2002, when the No Child Left Behind law began imposing penalties for schools that failed to show academic progress, there's widespread evidence that many struggling schools — often in lower-income communities where obesity rates are high and opportunities for outdoor play after school are limited — have curtailed and canceled recess and physical education classes to concentrate more on the subjects that standardized tests measure.
The Institute of Medicine and the Centers for Disease Control — joined by such national organizations as the American Heart Association, American Cancer Society and American Diabetes Association — recommend 150 minutes of physical education a week for children in elementary school and 225 minutes a week for middle school and high school. It's a target very few schools meet.
What you can do: The Let's Move! campaign, launched by first lady Michelle Obama, has a range of suggestions to make school a more active place. First step: Create a school health advisory council — a forum for parents and school administrators to review rules governing recess, make the most of physical education classes and encourage walking to school by identifying hazards (broken sidewalks, lack of crosswalks, traffic that moves too fast) — that discourage the practice. Let's Move! suggests that parents and teachers should agree that recess, or any chance to get out and move, should never be withheld as punishment and that imposing exercise as punishment for bad behavior sends the wrong message as well.
American schoolchildren, particularly teens, are among the most sleep-deprived people anywhere, meaning that most routinely get far less than the roughly nine hours of sleep recommended for them by the National Sleep Foundation. And though television, Facebook and cellphones all play a role, school is a major contributor to their chronic sleep deficit.
The health consequences might be far-reaching. A growing body of evidence links too little sleep with a heightened risk of obesity, diabetes, high blood pressure, depression and anxiety, not to mention grumpiness, poor memory and attention, and driving accidents.
The National Sleep Foundation and a growing corps of researchers have become active in encouraging school districts to "flip" their schedules, starting elementary school kids' days about 7:30 a.m. and pushing high school start times back to between 8:30 and 9 a.m. (Fayette County Public Schools made that change in 1998.)
In other studies, later school start times were linked to a dramatic drop in students reporting to the nurse with a wide range of physical complaints typically linked to fatigue and stress.
What you can do: Experts suggest that parents negotiate and enforce limits on late-evening time spent watching TV, texting and on social networking sites. Finally, the National Sleep Foundation warns that letting kids make up their sleep deficit by staying in bed till noon on weekends will cause their distorted time clocks to get even more out of phase.
Some 31.6 million children in 99,685 public schools across the country eat a school lunch on a typical day. For many, it is intended to be a principal source of their daily nutrients.
To be sure, the better-school-lunch movement has gained a toehold in many schools, which have begun to offer kids salads, whole grains and fresh fruits. And they've gotten a big push from the Healthy, Hunger-Free Kids Act of 2010, which during the next several years will require all foods sold in schools — including those in a la carte lines, vending machines and on the standard lunch tray — to adhere to new dietary standards.
The heart of the act is $4.5 billion in new funding, the first increase in federal reimbursement for school lunches in more than 30 years.
But such new spending is likely to take a significant hit in the latest round of deficit-reduction efforts, and school districts — most of which already supply school lunch at a loss — will find it hard to provide healthier fare with little or no new money.
What you can do: If your child is open to carrying a packed lunch, it's not hard to find great, healthful components, including fresh fruits and vegetables; whole grain breads; and bars, cheese or yogurt. Let's Move! encourages parents to agitate for school gardens and nutrition education as a way to get kids pumped about eating well — and possibly to help supply the cafeteria with fresh produce.
If we learned anything by reading William Golding's Lord of the Flies in school, it is that children can be very cruel to one another, whether surrounded by institutional walls or not.
In a 2009 nationally representative sample of youth in grades 9 to 12, the CDC found that 11.1 percent of high school kids reported being in a physical fight on school property in the 12 months preceding the survey. And 19.9 percent reported being bullied on school property in the 12 months preceding the survey. Boys were more likely than girls to have engaged in physical fighting (15.1 percent versus 6.7 percent). Girls were more likely to report being bullied than were boys (21.2 percent versus 18.7 percent).
Far more likely than physical injury at school, however, is the prospect of being taunted, teased and generally humiliated. For years after they were bullied, adults who were victims in their teen years have higher rates of depression and low self- esteem, and are more likely to ponder suicide.
The much-discussed threat of cyberbullying affects as many as three in four teenagers in a given year, according to a 2008 UCLA study.
What you can do: Stop Bullying (Stopbullying.gov) provides a clearinghouse for research and resources for parents and schools.
If your child is a victim of bullying, get help — from the teacher, a more senior school administrator or your state's Department of Education if your child is not getting the protection he needs.
Those who study the matter say stress is a central feature of many students' school experience. And the resultant health risks — including suppressed immunity, cardiovascular disease and depression — are undeniable.
In a survey of more than 10,000 middle and high school students conducted by Stanford University education professor Denise Pope, students at 20 high-achieving schools in California made that clear. More than two in three who responded said they were "often" or "always" stressed by schoolwork, and students' "top 10" sources of stress were overwhelmingly school-related.
What you can do: The American Academy of Child and Adolescent Psychiatry offers advice to help teens cope with stress, and parents can guide them with most of it: Eat and exercise regularly, learn relaxation techniques and self-assertiveness skills, challenge harsh assessments of yourself and your situation, and work at feeling good about doing a "good enough" job at school rather than expecting perfection.
Mental health experts underscore the importance of developing a network of friends to help cope positively with stress. And, above all, teens should get help — from a parent, guidance counselor, physician or mental health professional — when stress turns the corner into debilitating anxiety or depression.