A back-to-school checklist

August 1, 2004

This is the month that your waiting room fills with children getting ready to go back to school. For the most part, their needs are familiar and you're equipped to meet them. Nevertheless, things sometimes change, so here is a checklist to keep in mind at this turn of the calendar:

• Before school starts, ensure that your patients are up-to-date on their immunizations and in compliance with the state's requirements for school entry. Be aware that, last month, the Centers for Disease Control and Prevention (CDC) recommended routine resumption of the third shot in the pneumococcal conjugate vaccine (PCV7) series; for now, continue to defer the fourth dose in healthy children. A catch-up schedule for eligible children who missed the third shot is available at www.cdc.gov/mmwr/preview/mmwrhtml/mm5326a7.htm.

On another front, remind parents that influenza can be deadly; during the past flu season, 152 influenza-associated deaths in children were reported. All children 6 to 23 months of age, as well as close contacts of children from birth to 23 months and health-care providers, should get an influenza immunization—and don't forget to include yourself. Flu vaccine for the 2004–2005 season will include the Fujian strain that caused so much trouble last year. A planned government stockpile should avert the shortage that plagued providers during the 2003–2004 flu season.

• Educate parents about their child's heightened risk of infectious disease once school begins. Now is a good time to teach parents that most upper respiratory infections are viral and cannot be cured by an antibiotic. This is also your opportunity to prepare parents for the latest recommendation from the American Academy of Pediatrics (AAP) on otitis media, which emphasizes pain control and watchful waiting as first-line therapy—before an antibiotic is prescribed. For a summary of the new policy, visit www.aap.org or read the cover article of the June issue of Contemporary Pediatrics, "How will the new guideline for managing otitis media work in your practice?"

• Expect a fresh round of parental anxiety about head lice. Find out whether schools in your area have a no-nit policy—something the AAP opposes. If children are sent home with a suspected lice infestation, advise a careful search for live lice, in a good light and using a magnifying glass. You may not find any, which should satisfy the parents but may not convince school administrators. Some families may want to schedule a daily comb-out with a lice comb; grooming rituals are known to be soothing.

If you find live lice, parents can treat the infestation with an over-the-counter preparation of permethrin, and treat again if the first shampoo doesn't solve the problem. If lice persist after a second OTC treatment, two prescription pediculicides, lindane and malathion, are approved by the Food and Drug Administration. Counsel parents to use these effective preparations cautiously and according to package instructions: Lindane can cause seizures in the rare patient and malathion is flammable. Some clinicians use ivermectin for persistent or recurrent lice infestations—an off-label use. And what if a parent reports using a home remedy, such as mayonnaise or olive oil, for a child's head lice? There is no evidence that such treatments work, but, if a strategy of folk medicine appeals to a parent, this certainly does no harm.

• Make the most of the preparticipation sports examination—often the only reason a teenager will show up at your office. For a roadmap of how to make this encounter matter, revisit last year's two-part article from the September 2003 issue of Contemporary Pediatrics, "The preparticipation athletic evaluation—Part 1" and "The preparticipation athletic evaluation—Part 2".

• Screen for developmental delays, language problems, ADHD, and learning disabilities that may become apparent in the classroom, especially as children progress to higher grades in which more is demanded of them. Families whose child falls into any of these groups may need your help to advocate for diagnostic and educational services tailored to that child's special needs.