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Preschoolers and School-Age Children
Questions and Answers
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Here are some of the most frequently asked questions that parents of preschoolers and school-age children ask their child’s doctor.
Thanks to Mark D. Widome, M.D. a general pediatrician and professor of pediatrics at Penn State College of Medicine in Hershey, Pennsylvania.
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Should my child get a flu shot?
Influenza vaccine is recommended for people who are
at high risk of having complications from the flu: people over
age 65, people with asthma, chronic lung or heart
conditions, diabetes, or other chronic conditions. However,
the vaccine can be given to anyone who wants to reduce his
or her chances of getting the flu. Influenza infection rates are
higher in children than in adults, though adults tend to have
more complications. The vaccine can be given to children as
young as six months of age, and it may be given at the same
time as other childhood immunizations. Children under the
age of nine who have never had the flu vaccine before
should get two doses of the vaccine, one month apart. For
everyone else, a single dose in October or November will
provide optimal protection for the flu season. People who
have had severe allergic reactions to eggs (anaphylaxis)
should not receive the vaccine.
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When should a sick child miss school?
Except for certain contagious diseases such as strep
throat, chickenpox, and pink eye, the usual criteria for
keeping a child home from school should be the child’s level
of comfort. If your child seems to be sufficiently
uncomfortable to participate in school activities and to
benefit from the day in school, then he should stay home. If
he requires additional care that won’t be available in school,
that is an additional reason to stay home. A mild cough,
runny nose, or congestion is not necessarily a reason to stay
home. Fever, vomiting, diarrhea, or a cough that will disturb
the class make it impractical to go to school. Children with
strep throat may return to school after they have been on
antibiotics for a full 24 hours. Children with chickenpox may
return to school after all the pox have crusted over, usually
five to seven days after the beginning of the outbreak. With
pink eye, the child may return to school when there is no
more eye drainage, assuming the child can observe
reasonably good hygiene. Children with ear infections can
return to school immediately if they are not very
uncomfortable with fever or earache. Most children with
rashes caused by viral infections can return to school once
the fever is gone. The same is usually true for the common
cold.
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What is the best way to treat a fever?
Treat fevers when they are uncomfortable for your
child. A low-grade fever (under 101 degrees) in a
comfortable child can usually be left alone. Higher
temperatures can be treated with either acetaminophen or
ibuprofen in recommended doses for your child’s weight.
There is seldom any justification for using both
acetaminophen and ibuprofen at the same time. Either of
these medicines will work best if they are followed 20
minutes later by a warm bath. The medicine works by
lowering the “thermostat” in your child’s body, while the
warm bath will allow the body to lose excess heat to the
surrounding bath water once the body’s thermostat is reset
to a lower number. Remember, that a child’s temperature
does not need to come down to 98.6 for him to feel better.
If the temperature only comes down a degree or two, your
child will feel much better. Also, when you bathe your child,
make sure the bathroom is warm enough to prevent your
child from feeling chilled. Otherwise, your child’s body will
get the message that it should try to keep heat inside.
(That’s what goose bumps do.) Dress your feverish child
lightly — underwear is fine — rather than bundling him up.
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What if my child won't eat vegetables?
Don’t worry if your child does not seem to like — and
will not eat — vegetables. Beginning around the first
birthday, children are often described by their parents as
“picky eaters.” The good appetites that 8- and
10-month-olds exhibit are seldom seen in 15-month-olds.
There are a number of reasons, but the most important is
that kids grow slower after their first birthdays than before.
Children gain, on average, 14 pounds in the first year and
only about seven pounds in the second year. Toddlers and
preschoolers don’t need as many calories to support growth
as do infants. Also, after the first birthday, kids are more
insistent on making their own decisions, and feel a need to
be in control of what and when they eat. It is important that
parents recognize these changes so that they do not push
children to eat more than they need and want — that only
leads to food battles.
I’ve not seen children get into nutritional trouble just
because they won’t eat their vegetables. While vegetables
are a good source of Vitamins A and C, as well as some
minerals, these nutrients are widely available in the diet from
other sources. Children will go for months or years avoiding
certain foods and then come back to them when you least
expect it. Some children seem to exist on three or four
“favorite” foods and little else. They remain perfectly
healthy, which indicates that the child’s diet, while
unconventional, is more “balanced” than it first appears. If
your child refuses all green and yellow vegetables, don’t be
concerned. Don’t push him to eat the foods he is refusing; it
does no good. Be patient, and simply offer a variety of
healthy foods. Let your child pick and choose what his
body needs.
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Do healthy children need vitamins?
Healthy children do not need vitamin supplements, and
that includes “picky eaters.” Children’s diets in this country
almost always contain more than adequate vitamins. The
only possible exception (for healthy children) is the
breast-fed baby. Many pediatricians recommend infant
vitamin drops to provide extra vitamin D, especially in the
winter months, when babies get less sunlight. Formula-fed
infants do not need vitamins, because vitamins are already in
the formula.
While an unhealthy diet can impair a child’s growth and
health, vitamins will not correct a diet that is, for example,
too high in fat or one that contains inadequate nutrients such
as calcium, iron, calories, or protein. There is no evidence
that giving vitamin supplements will stimulate the appetite of
a “picky eater.”
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Who needs fluoride and for how long?
Fluoride supplements — liquid drops or chewable
tablets — are recommended for children who live in
communities where the water supply is neither fluoridated
nor contains adequate naturally-occuring fluoride. Much
well water in this country contains inadequate fluoride. Only
about 60 percent of the U.S. population has adequate
fluoride in its drinking water. Fluoridated water reduces
cavities in permanent teeth by as much as 60 percent. In
communities where water does not contain adequate
fluoride, fluoride supplements are recommended until all of
the permanent teeth are fully formed — about 12 years old,
though some would recommend supplemental until age 16.
It is important to take the right amount of fluoride, because
children receiving inadequate fluoride will be more prone to
tooth decay and those receiving too much fluoride can
develop discoloration of their permanent teeth as a result.
Using fluoride toothpaste is not an adequate substitute
for fluoridated water or supplemental fluoride drops or
tablets. Until children are old enough to rinse their mouths
and spit toothpaste out, they should be given no more than a
“taste” of fluoridated toothpaste on their toothbrushes.
Regularly swallowing fluoride toothpaste can lead to
excessive fluoride intake and tooth discoloration
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When do they start going to the dentist?
Healthy children should have their first dental
check-ups sometime between the ages of three and four. If
you are concerned about your child’s teeth or if there is
evidence of decay, you should, of course, consult a dentist
earlier. Children’s teeth should be cleaned by parents, using
a soft cloth or toothbrush, as soon as the teeth erupt.
Toothpaste is not necessary for infants and young children.
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How much sleep do they need?
Kindergarten children need, on average, 11 hours of
sleep. By the time a child is in sixth grade, about 9 1/2 hours
is sufficient. Bed times should be adjusted accordingly, but
parents should recognize that there is a lot of individual
variation in needs from child to child. Activity level will
cause sleep needs to vary. Many parents will discover that
when their child enters first grade and is going to school for
a full day for the first time, that he will come home
“exhausted,” and perhaps fall asleep on the sofa.
As kids enter early adolescence, their sleep needs will
typically increase by an hour or so, coincident with their
growth spurts. Also, with the onset of adolescence, there is
a natural tendency to shift the “sleep phase” later, that is, a
preference to go to bed later and wake up later. This often
conflicts with the early school day in most middle schools
and high schools. It is at this stage that most students need
some guidance from their parents to assure that they get to
bed at a reasonable (and consistent) hour so that they can
be awake for school the next morning.
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When to start?
When to start hearing and vision checks?
Pediatricians assess hearing and vision as part of every
routine exam of infants and toddlers, but they also rely
heavily on the parents assessment of whether their child can
hear or see well. Whenever a parent or physician is
concerned that a child may not be hearing or seeing well,
then hearing or vision should be checked — at any age. By
the time children are 3 1/2 years old, they should all have
had a formal assessment of hearing and vision, consisting of
audiometry (headphones) and acuity testing (a vision chart
or equivalent). If a routine hearing test is not performed,
hearing loss can be easily missed, leading to delayed
language skills and poor school performance. Missed vision
problems can lead to “lazy eye,” resulting in permanent
vision loss in at least one eye. Most causes of hearing and
vision deficits at age three or four years can be corrected
once they are discovered. Parents should make sure that
their child’s physician checks both hearing and vision
sometime between the third and fourth birthdays. A parent’s
concerns about a child’s vision or hearing should never be
dismissed by the physician or the teacher.
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How do I prevent them catching colds?
No single step is more effective in preventing colds than
is frequent handwashing, because cold viruses are usually
spread from hand-to-hand and hand-to-mouth and nose.
Avoiding sick people would be effective, if only it were
possible. While no one would discourage dressing warmly
and wearing a hat in bad weather, these measures will not
prevent the spread of viruses. Likewise, taking vitamins are
other supplements have not been shown to prevent colds.
Complications of colds — ear infections and chest
infections — can be reduced by a third to a half by
providing your child with an environment free of tobacco
smoke.
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