Home Articles Ask a pediatrician: Back-to-school Q&A

Ask a pediatrician: Back-to-school Q&A

Back-to-school Q&A

It’s the start of a new school year, and both kids and parents may never have been more excited for a return to the classroom! Dr. Chan Lowe, chief of pediatric hospital medicine at Banner-Diamond Children’s Medical Center in Tucson and the incoming president of the American Academy of Pediatrics-Arizona Chapter, answers our back-to-school questions, from addressing separation anxiety after months of at-home learning to how we can help kids can stay safe and address learning losses and other challenges.

“It is unlikely that COVID-19 will be fully gone anytime soon, so it is important for us to try to get back to normal as much as we can,” Dr. Lowe says, adding that kids are not immune, so we still have to be diligent. “For those that aren’t [yet eligible for the COVID-19 vaccine], continuing to avoid large crowds, wearing masks and practicing good hand hygiene, etc. can help protect them from becoming ill.”

Here’s what he shares about helping families get a good start on the new school year.

How can families help kids get prepared and off to a good start this school year? Start the conversation early. Parents can begin by discussing school starting, what it might be like (including possible differences from before the pandemic, like wearing a mask at school, etc.) and giving kids a chance to ask questions. If the school [offers] the opportunity, a visit to the classroom can also help ease anxiety in kids who have not been to school yet or those who seem more anxious.

Kids who haven’t been to in-person school for many months could experience separation anxiety. How can parents recognize its symptoms and mitigate it? Symptoms of separation anxiety include increased “clinginess” from the child toward parents, increased panicking or behaving in a more agitated way when away from parents, repeatedly asking when a parent will return (more than just the occasional checking in) and physical complaints like stomach aches or headaches. Return of bedwetting when a child had previously been dry can also be a symptom of anxiety.

One strategy to help minimize and relieve separation anxiety is creating a consistent and relatively short “goodbye routine.” While it may seem like prolonging goodbyes is kind, [long goodbyes] can increase anxiety in children. Be specific regarding when you will be seeing each other again. Consistency is very helpful. If possible, having the child arrive at school at the same time each day helps establish a routine that children can anticipate. Children are also very perceptive and will pick up on anxiety in parents. Changes are hard on parents also, and parents may themselves feel some separation anxiety. Dealing with our own anxiety will help our children.

Parents can also practice being apart by having children spend time with another caregiver (grandparents, family friends they know, etc.) to help the child begin to build their confidence back up around being away from parents. It is also important to be consistent with what is promised. If parents say they’ll pick up a child from school at 3 p.m., it is very important to follow through. This helps reinforce trustworthiness in a parent’s promises and can help comfort the child when parents are away.

Parents got an up-close look at their child’s education during months of online learning. How can parents know whether any learning struggles (paying attention, completing tasks or understanding lessons) were due to the pandemic or a sign of something more serious? If parents have any concerns, pediatricians are always happy to talk with them and their children to be sure all is OK. With a return to in-person classes, there may be an adjustment time that occurs while children get used to being back in the classroom. While it was often necessary to convert to online teaching, this does bring with it the drawback of training children to look at a computer screen all day. A return to having a teacher in front of them may take a bit more focus than before. If children are really struggling with concentration, it is worth a discussion with your pediatrician. While the online classroom time may have contributed to a change in ability to focus, it may also be that underlying ADHD is now beginning to show up.

Families are also concerned about learning losses in the wake of the pandemic. What advice do you have for parents who are concerned? The transition to online, at-home learning was an abrupt change for most children. Many parents are concerned that children may not have been learning optimally. Teachers are aware of these issues. It is possible that many students may need a bit of catching up in their learning, and I anticipate that classes will be designed to accommodate these issues. It is also possible that learning difficulties may have developed (independent of the pandemic) that are now beginning to show up. If there are concerns about this, parents can speak with their school or pediatrician to get further testing.

August is National Immunization Awareness Month. It comes at a time when the Centers for Disease Control and Prevention is concerned that orders for routine childhood vaccines have fallen. Have you noticed families falling behind on routine vaccinations? Childhood vaccines are critical to keeping children safe from illnesses, as well as people in the community who cannot be immunized. With concerns about COVID-19, visits to pediatricians did drop off in many cases. This created difficulties in ensuring children were being vaccinated on time. Pediatricians have worked to try to prevent these delays; however, some children likely did fall behind. While vaccine hesitancy has existed since vaccines were created, this remains relatively uncommon. The current delays are likely largely in part due to the difficulties created by the COVID-19 pandemic.

Why/how do you encourage parents to stick to the childhood vaccination schedule? Vaccines are critical to ensuring our children do not contract severe, preventable diseases [such as polio and measles]. These diseases have been so effectively controlled by vaccines that many parents have never seen them. Despite this, the diseases have not been eradicated. Without vaccines, we risk a resurgence of diseases that threaten our children with severe illness, long-term consequences and even death. In addition to protecting the child, vaccines are also critically important in protecting others in our community who cannot be vaccinated for various reasons. If your child has gotten behind in vaccines, there are catch-up schedules that allow for timely vaccination to bring the children back up to date on their immunizations. Your pediatrician will help to determine the best schedule for catch-up vaccinations. Pediatric offices are working hard to ensure [they are] safe for parents and children to visit. We want parents to feel comfortable bringing their children to the office for both well visits and sick visits. If you are not sure if you should bring your child in, give your pediatrician a call, and they can advise you.

Gov. Doug Ducey signed an executive order prohibiting mask mandates in schools, and the state legislature passed a budget that also prohibits school boards from mandating masks. How will schools be able to protect kids — especially ages 11 and younger who can’t yet be vaccinated? Schools need to take a multi-faceted approach to protecting children. Hopefully, we will have a vaccine for our younger children soon, but until then we are dependent on these other strategies. Strategies that schools can employ include trying to maintain distancing when possible and ensuring there is good ventilation in the indoor areas. Children 12 and older can receive the vaccination. If children are showing symptoms of an illness, it will be important for parents to let the school know of this and to avoid having their ill child attend school functions until they know it is safe. Your pediatrician is happy to help provide guidance in those situations.

Will a COVID-19 vaccine be available soon for ages 11 and younger? We hope that a COVID-19 vaccine will be available for children younger than 12 soon. Before vaccines can be made available, it is necessary to ensure they are safe. It is typical for new therapies to begin in adults then slowly make their way down to younger children, because we want to be certain we are not endangering our children. While I am confident that the vaccines will eventually be shown to be safe and effective for younger children, studies are not yet completed to ensure this. There is some thought that a vaccine may be available for younger children late this year or early next year.

What didn’t we ask that you’d like to add? COVID-19 has put us all through experiences we never thought we would have to endure. Fortunately, our children have largely been spared the brunt of the SARS-CoV-2 virus infections, but they are not immune to the disease. If your child is eligible for the COVID-19 vaccine, please consider getting [him or her] immunized. For those who aren’t [eligible for the vaccine], continuing to avoid large crowds, wearing masks and practicing good hand hygiene, etc. can help protect them from becoming ill. It is unlikely that COVID-19 will be fully gone anytime soon, so it is important for us to try to get back to normal as much as we can.

The pandemic has created isolation in many ways, and children are not immune from these stresses. Talk with your children about these issues and explore how they are feeling. They are likely picking up on more than it might seem. As parents, we may not have all the answers to their questions, but talking through the concerns can go a long way toward helping our children understand and adapt. We also want parents to feel comfortable bringing children to their pediatrician if there are any issues. Offices are doing all they can to ensure that the environment is safe for you and your children. If you have any questions regarding your child’s health, please don’t hesitate to reach out to your pediatrician.

Dr. Chan Lowe

Chief of pediatric hospital medicine at Banner-Diamond Children’s Medical Center in Tucson

Dr. Lowe graduated medical school from The University of Arizona in Tucson and subsequently completed his pediatric training there as well.  In 2006, he joined the faculty at the University of Arizona as a pediatric hospitalist and is the chief of pediatric hospital medicine at Banner-Diamond Children’s Medical Center.  Shortly after becoming an attending, he developed an interest in child abuse and helped lead the creation of Banner-University Medical Center’s child protection team, focused on improving the care of this vulnerable population.  He currently serves as the immediate past Chief of Staff at Banner-University Medical Center Tucson.  He serves as chair of the AzAAP CME committee, vice-chair of the AzAAP Hospitalist committee, and president-elect of the AzAAP..

Raising Arizona Kids partners with the Arizona Chapter of the American Academy of Pediatrics to bring evidence-based child-health information to our communities.

Kara G. Morrison
Kara G. Morrison is the editor of Raising Arizona Kids and the mother of Sofia (8).



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