School

Vaccines: Back in the Spotlight

A blog such as ours that focuses on children’s health can’t neglect discussing vaccinations. This is especially true given the fact that diseases that were once effectively eliminated are re-emerging as major threats to children’s health. The New York Times has reported on an outbreak of measles - a disease that has the potential for deadly and debilitating complications - in a suburb of Portland, Oregon. Oregon has one of the most flexible policies that allow parents to opt out of vaccinating their children for various reasons.


All states allow parents to opt out for medical reasons, and most also permit religious reasons. However, the states that allow exemptions for “personal” or “philosophical” reasons leave room for debunked conspiracy theories to threaten the health of children in schools or public places. The NYT reports that multiple studies published in multiple leading medical journals have proven that there is no link between vaccines and conditions like autism, even among children who might be at higher risk of having the disorder (e.g. children with a sibling with autism.)


The question of vaccination is probably unique in that its benefits may not be immediately obvious. After all, an infant receiving multiple vaccinations according to the widely-approved schedule will not seem to be at obvious risk for those diseases. However, as children grow and encounter new environments, it is essential that they are well-equipped to thrive in them.  


Vaccine science has come so far since the first inoculation of a patient against a form of smallpox. In the present day, to make outbreaks of preventable disease “the new normal” (as one doctor put it) would be a huge step backward for medicine and for society’s commitment to children’s well-being.


Prioritizing Well-Being Over Stress

It’s important to motivate children and teens to succeed and do what they love, but a recent newscast in NPR talks about the risks of pushing kids too hard to do well. (The NPR newscast includes a 7-minute talk about this topic which you might find interesting!) It is not a stretch to say that students today feel immense pressure to compete against their classmates and friends to do well, and this stress can be a major contributing factor to anxiety and depression.

 

Some parents admit that they “totally bought into the idea” that their job is to push their kids to succeed and overcome obstacles. But if the pressure is too much, this effort can backfire. One high school in New York invited a psychologist to evaluate the student body using the Youth Self-Report, and found evidence of high levels of stress. This includes internalizing symptoms, or feelings of sadness, anxiety and depression; physical symptoms like headaches and stomachaches, and drug and alcohol use.

 

According to experts, substance abuse is actually something that affluent teenagers may use even more than inner-city kids, as “a form of self-medication” against the stress of high expectations to do as well as peers or parents.  This means that the need for conversation around mental health applies to inner-city and wealthy suburban schools alike.

 

Parents can play a huge role in promoting well-being as a priority that takes precedence over grades. They can have constructive conversations about stresses their families face, which are not likely to be ones they face in isolation. They can also work with schools in order to improve environments at school and at home. Research-based “resilience training programs” that teach “coping and happiness skills” are taking off at school, even for elementary students. Researchers today are finding that “resilience training can help reduce symptoms of depressive or negative thinking among children”

 

Student-directed initiatives also give students an opportunity to talk with each other about topics they might not readily share with parents or teachers, and gives them an active role in their own mental health.

 

All of these efforts should be directed towards valuing well-being and celebrating diverse kinds of passion and success. As a society, we should acknowledge that “a culture shift” is necessary to value all kinds of success instead of prioritizing and zeroing in on certain academic successes or career paths.

 

Lunches For Students in NYC Schools

The new school year in New York City has just begun, and this year there is big news to accompany it: New York City will start offering free lunch at all of its public schools starting this year, according to The New York Times. All 1.1 million NYC public school students will benefit from this program. The universal free lunch is a welcome addition to the already-existing universal free breakfast for NYC public school students.

 

This announcement is notable for several reasons. Although NYC is not the first major city to offer free lunch at public schools (it follows Boston, Chicago, Detroit, and Dallas), it has far more children to feed than the cities listed above. Also, a majority of NYC public school students (75%) already come from families that qualify for free or reduced-price lunches. The combination of these facts means that this new expansion in free lunches affects many New York students and families. According to the Times, this change will impact 200,000 students and save each of their families about $300 per year.

 

New York schools are encouraging families to fill out household income forms that will help the state to better identify students it can aid. The state recently updated the ways in which it tracks and matches families that qualify for benefits like Medicaid. With the updated changes, the new lunch policy should not cost the city more money.

 

School lunches have been making headlines recently for at least two major reasons. Strong evidence for the link between a healthy lunch and school performance or emotional health exists, and researchers are continually confirming this fact. Also, the stigma some students face in a phenomenon known as lunch-shaming - or “holding students publicly accountable for unpaid school lunch bills” - has been generating debate nationwide. The new initiative should directly bolster the former [finding] and work to reduce the latter.

 

Children should have access to all the resources that are possible in order to help them succeed in school. A lunch program for the public school students of the largest city in the US is a big step in the right direction.



 

When Children Talk About Loss

The New York Times recently addressed a difficult topic: when a child dies, how does their death impact their siblings and family in the short and long-run? The author of the post, a professor of pediatrics, noted that as devastating a child’s death is for a parent, the loss felt by a sibling must be even more unbearable. After all, siblings often share more time together than with parents, and have shared much of their young lives together at school.

 

According to the article, a sibling’s untimely death can have numerous physical and mental health repercussions for living siblings and families. Living siblings might also primarily be affected by the same disease or disorder that caused the first death, exacerbating existing health problems, and raising risks of long-term health, social, and behavioral problems.

 

This phenomenon is the main subject of a recent study in JAMA Pediatrics, referenced in the New York Times article. Researchers who followed children in Denmark and Sweden from 1973 through 2013 found that the children who lost a sibling before age 18 were 70 percent more likely to die in the decades following the event. The death of a sibling is not a causal factor for increased mortality, but it is definitely a part of the picture. Of course, another factor that could lead to increased risk of death after that of a sibling is the emotional damage of grief, and the difficulty of coping with that grief.

 

This means that support for bereaved siblings needs to be a priority for family members and healthcare professionals. It’s important for major publications like the New York Times to report on findings from the medical community that might be difficult subject matters. Similarly, it’s important for family members and parents to have conversations about loss in order to help children cope with grief and to build resiliency.

 

“Family resilience” is found in at least one academic paper on the subject of recovery after the loss of a child. This study had two findings that are especially relevant: families that viewed the grieving and recovery process as a challenge to overcome, and families that felt community support were related to the family’s grieving and recovery process, adapted better than families who did not have a strong community support. The interaction between a bereaved family and the rest of society can be an indication of how well-equipped everyone is to deal with loss.

 

Other ways people are dealing with the impact of loss in the family is to open doors for conversation. For example, Facebook COO, Sheryl Sandberg, wrote an article in The New York Times a couple of months ago after the sudden loss of her husband. In order to foster resiliency in her children, and to support them in their remembrance of their father, Sandberg is determined to keep open communication a constant. This approach would transform hardship into a growth opportunity, with the goal of resiliency.

 

We may all know people in our lives that have experienced loss. If more people knew about these findings, then support systems in schools and other community settings can work with families to have a positive impact on children’s lives as they overcome loss.

New School Lessons: Eating Healthy

We hear a lot about the obesity epidemic in the United States, especially among children and adolescents. However, the impact that school meals have on childhood weight and overall health has been overlooked. A piece in the Wall Street Journal earlier this year looks at five creative ways schools can encourage students to eat more healthily. These interventions have been formulated to help schools meet the guidelines under the Healthy Hunger-Free Kids Act of 2010.

 

Intervention One: Product Placement

Salad bars that feature at the front, or in the center, of a school lunch line are much more likely to attract students. Some Maryland elementary schools opened all-you-can-eat salad bars that featured five different fruits and five different vegetables a day and saw the number of students buying salad go up. In fact, one study found that strategic placement of vegetable options can increase consumption by as many as five times. Other schools planned the timing of vegetable snacks, so that hungry students were more likely to reach for them before a meal.

 

Intervention Two: New and Improved Advertising

Changing children’s preferences can be as simple as slicing up fruits for those with orthodontic appliances, or using more colorful bins to display fruits at lunch. “Stealth nutrition,” according to the WSJ piece, can also come in the form of food names that appeal to a young crowd (e.g. “X-Ray Carrots or Turbo Tomatoes.”) Attention-grabbing cartoon stickers on fruits can also increase consumption.

 

Intervention Three: Tracking Real Consumption

This is an intervention that can reduce waste, and at the same time, determines which foods are popular with students and which are not.  Researchers at some Chicago elementary schools recorded what foods were purchased and thrown out in order to determine the relative popularity of certain food groups.

 

Such measures can also increase parental involvement: some schools send home weekly report cards that record what a child ate throughout the week, based on lunch swipe summaries. Instead of remaining in the dark about what their children eat at school, parents can talk with their children about their meals or even compensate for missing nutrients at home.

 

Intervention Four: Bring in the Experts

Children can’t be expected to enjoy food that adults would also avoid. Chefs can consult for school menus or cook directly in schools. Over time, partnerships with chefs and local food sources can have a big impact.

 

Intervention Five: Field Trip!

Nutrition education should not have to be boring. In fact, it absolutely should not be, since a child’s first impression of a food item is crucial. Some elementary schools have started taking students on field trips to local farms, teaching ways of sustainability along with familiarizing students with new fruits and vegetables. They encourage students to make note of how a fruit smells, or what color a vegetable might be.  In NYC, the Wellness in School Program encourages students to make healthy choices for themselves based on what they observe in the fresh produce and nutrition labels they encounter.


 

2017 Pedometer Program Recap

This year, we got kids to become more physically active through yet another successful Step It Up pedometer program. We worked with two schools and one community-based organization, and provided students and teachers with 200 pedometers this year.

Throughout Step It Up, we have spoken to a student, teachers, and a social worker about their experiences, and found that pedometers more than increased physical activity among participants. Step It Up helped students become more competitive, learn about goal-setting, and encouraged students to collaborate with each other to work as a team.

We would also like to give a huge thanks to the everyone who participated and supportedStep It Up. Thanks to you, we are one step closer to getting more kids moving and forming healthy habits.

We spoke to some of the teachers and students from the program and here is what they had to say about Step It Up:

The pedometers are a great tool for students to use...This day and age, it’s crucial to have integration of technology with fitness...The pedometers are great to bring into any physical education or health class to jumpstart fitness, especially for students who are apprehensive about working out in groups because they’re embarrassed or nervous. When it’s just them, alone, and the pedometer, they don’t have any hold-ups. They can just go out and do it.
— Eric Seely, teacher at Achievement First University Prep High School
Some of the students did a family thing. They got their sister or brother involved to walk with them when they were getting their steps.
— Steve Lieberman, teacher at EPIC High School
Because they were working so closely together for the pedometer program, they had to work together...to get them out of their funk and [that] made their relationship stronger.
— Lucas Slattery, social worker at Boys Hope Girls Hope
The pedometers motivated me to be a lot more fit and be active in my life...Instead of exercising just once a week, I upped it to three and then to four times a week, to meet the steps, I decided to run more... I definitely saw how effective the pedometers were.
— Jabari Boss, 12th grade student at Achievement First University Prep High School

Feeding Mind and Body: A New Role for Schools

Back in April, we wrote about how American households are not immune to the phenomenon of food insecurity. A recent New York Times piece discusses the importance of school meals in students’ development and learning. The benefits of having ready access to nutritious meals are, according to a research team at the University of California-Berkeley, threefold: “physical development” (e.g. eyesight), “cognition” (concentration and memory), and “behavior” (hyperactivity) are all directly impacted by what a student eats during the crucial formative years between kindergarten and high school.

 

When Michelle Obama was the first lady, she started health initiatives in school districts nationwide by setting up programs that incentivize schools to invest in healthier options for students. These programs did indeed have an impact: one study found that simply moving the salad bar from the margins to the middle of the serving area increased uptake. However, the current Congress has taken steps to dismantle many of these initiatives. It is surprising that a topic as seemingly uncontroversial as student nutrition could be treated as a partisan issue, especially given the fact that experts from multiple disciplines agree on its importance.

 

In states that have prioritized school nutrition, the results have been clear. Students at schools that work with healthy lunch vendors score significantly higher on standardized tests than their counterparts at schools without healthy options. Some schools have even ventured into providing breakfast and dinner for students that might otherwise go hungry outside of school hours (e.g. during after school activities.)

 

Funding is certainly always a factor, as school budgets face real challenges in delivering quality education with limited resources. However, research shows that some of the objections to healthy meals are untrue. If we think of student nutrition as an investment in their academic and personal development, and by extension, an investment in the future of society, prioritizing student health should be a no-brainer. It’s as clear as the very benefits of healthy food.

 

 

 

 

A Home Away from Home: Schools and Students after Trauma

NPR recently discussed some of the challenges and opportunities facing teachers of students who may have been exposed to trauma. In New Orleans, where public schools have largely been replaced by charter schools after Hurricane Katrina, schoolteachers have become accustomed to having students who may have experienced abuse or neglect, have absent or jailed parents, or have witnessed crimes. School discipline policies that previously only focused on a child’s errant behavior are now undergoing an update that takes these environmental factors into account.

 

There are currently five charter schools in New Orleans that are seeking to become “more trauma-informed.” In other words, these schools are starting to incorporate knowledge about their students’ lives outside of school in order to address their social, emotional, behavioral, and development needs. These changes are bound to have an impact, considering the fact that children in New Orleans screen for post-traumatic stress disorder (PTSD) at three times the national rate. Mental health experts and workers have only recently begun to understand that trauma dramatically changes the brain and intensifies the fight-or-flight response in young children.

 

Children with exposure to trauma might be disruptive in school, or they may be withdrawn and inattentive. Teachers are learning to look for signs of both ends of the spectrum and everything in between. They are also engineering new ways to resolve conflict instead of resorting to detention or suspension since sending a child back to a damaging home environment is not the best way to solve problems in the long run.

 

For example, some teachers begin classes with social-emotional learning, and students in disagreement are invited to use group discussion to resolve their problems. Another way teachers are approaching disruptive students is by renaming “time out” as “wellness centers”, and multiple teachers collaborate with each other to work the same students over the course of a day. The article also details the moving stories of students who have seen real change with this type of support that they cannot find at home.

 

Certain statistics aside, this story is not unique to New Orleans. In many urban areas, when children experience poverty and hardship, and there are desperate consequences at home and in their daily lives, teachers everywhere can be heroes that foster a “home away from home” in their classroom. However, these New Orleans teachers and schools have ventured into an unknown space in their mission to understand each of their students, and to address a holistic approach to health. By addressing issues, and not punishing students, a very challenging method, teachers play a vital role in the health and well-being of their students.

 

Sleep, School, and the Teenager

The New York Times recently reported that biology may be to blame when it comes to teenagers’ sleep schedules. Young children who wake up early usually grow into teenagers who are difficult to rouse in time for school even though middle and high schools classes start earlier. Apparently, “adolescent bodies” naturally want to operate on a schedule shifted later than those of young children: they want to go to bed late, and get up late. This phenomenon - adolescent sleep delay - is not limited to humans; in fact, other mammals display it as well.

 

The consequence of this relative incompatibility between a teen’s body clock and school schedule appears in performance. Students tend to do better in tests - both cognitive and coursework related - taken in the afternoon. To catch up on alertness, adolescents might turn to caffeine for help during the day, leading to a “tired but wired” state that one clinical psychologist said led to more risk-taking behavior. Even without specific risk-taking, tired adolescents in general are in more danger than if they were well-rested, especially if they drive amid such fatigue.

 

Sleep is important in the discussion about adolescent health because of its link to what experts call the “adolescent health paradox:” teenagers, who are in a “developmental period of physical strength and resilience, face disproportionately high mortality rates.” According to the article, programs aimed at specific issues like substance abuse or unsafe sex are expensive and not always successful. Approaching sleep as one of the facets of overall health that can support teenagers during their development would be much more meaningful.

 

It is difficult to think of ways to feasibly incorporate sleep support into, say, the academically-rigorous nature of high school and even middle school. However, it is important for schools and parents to remember the effect a 24-hour sleep cycle can have on a student’s concentration, mood, or emotional decisions and health. The link between sleep health and behavioral health is real, and there is evidence for the connection to academic performance as well. There are some sleep scientists or child psychologists who actually advocate later school start times. While it may be difficult to implement such structural changes, it is important to remember the importance of the science behind such proposals impacting students and classrooms every day.

Water Quality in NYC Schools

A recent article in The New York Times reports that new lead testing in New York City schools reveals that many schools have lead levels that are higher than those recommended by the Environmental Protection Agency.

 

After high lead levels were exposed in Flint, Michigan, New York City officials were prompted to check lead levels in schools. However, the first round of testing was considered illegitimate after it was revealed that officials had run water for hours before testing the water for lead, a process called flushing that can artificially lower the lead levels in water.

 

Eighty three percent of school buildings in New York have at least one outlet with a lead level above the threshold of 15 parts per billion. Two school buildings in Queens had some of the worst results: in one school with 1,500 students, 34 outlets had levels above 15 parts per billion.

 

The New York City Department of Education (NYCDOE) responded quickly, sending home letters detailing these results and pledging action. NYCDOE has turned off outlets in question and will not be turning them back on until their levels are found to be under the threshold.  The potential impact of this finding cannot be overstated. It reflects a deeply ingrained system of negligence in the largest school system in the United States (over 1.1 million students attend more than 1,800 schools in New York City).  Despite a gradual decrease of children lead poisoning cases in New York City over the past decade, a problem of this scope shows that the tragedy of Flint is not unique to one particular city.

 

Children are a vulnerable portion of the population when it comes to environmental hazards. They spend their childhood in old school buildings with other students and teachers and will suffer consequences if lawmakers or officials shirk their duty to protect them. Parents are also left similarly helpless if a school system, as large as New York City’s, does not work to maintain the health of its students.

 

Thankfully, this detection occurred before cases of lead poisoning led to tragedy. Perhaps New York is indebted to Flint in that respect. Hopefully, New York City can set a model of decisive, proactive prevention of lead poisoning for future cities and school districts.  In the meantime, it is important for parents to stay involved and informed of their children’s health at school, and for parents to work with schools in order to provide the best possible learning environment for young students.

Securing a Good Start to Education

Today’s topic addresses one that may seem obvious to us, but also surprising in the United States. Children who grow up hungry in the first few years of childhood have been shown to lag behind classmates in school years later. Food insecurity, or being without reliable access to nutritious food, is a phenomenon that can be found in the United States: more than 13 million children are currently living in food-insecure homes nationwide. A recent article summarized in NPR (originally published in the journal Child Development) found that children who live in these homes before the age of five are more likely to lag behind their classmates in school socially and cognitively.

 

Also, it appears that these children don’t catch up to their peers. Researchers used data from the U.S. Department of Education from 2000 to 2006 to follow more than 10,000 children born in these households throughout their young childhood. They also interviewed the parents of these children to ask them about recent times they may have worried about food for the household. The researchers found that the younger that children were when they were exposed to food hardship, the stronger the negative effect on their performance in kindergarten (performance was measured by their ability to pay attention in class, their tendency to be hyperactive or throw tantrums, and their math and reading skills).

 

This negative effect might not be entirely attributable to the children themselves. After all, if children are hungry, then their parents are likely to be as well. The researchers affirmed that parents who are hungry can be more irritable and tired, and are less likely to engage with their children. These findings are certainly not surprising, but they confirm some important facts about early childhood and the important link between nutrition, parent interaction, and school performance. It is difficult to design interventions for very young children before they attend daycare or preschool, but the projections from this stage in life to performance in school cannot be ignored.


Food insecurity is definitely not just a foreign phenomenon, and not just an adult one. That there are millions of American children at risk of being insufficiently prepared for school should shock us all - but thanks to this kind of research, we’ll be able to lay the groundwork for erasing this gap in potential for children starting now.

Navigating Sick Days

The question of whether or not a child should stay home when they’re feeling under the weather inspires a lot of varying advice. According to an article recently published in NPR, rules in elementary schools about when to keep a sick child at home are more liberal than those in daycare centers. Also, surveyors of 1,442 parents with kids who are 6 to 18 years old found that parents had different attitudes about their children missing school based on their children’s age.

 

Some common reasons cited by parents for keeping their kids at home included: diarrhea, a single episode of vomiting or a slight fever. Interestingly, parents of older children were more likely to worry about their kids missing tests at school than parents of younger children did, suggesting that tests and exams might complicate the stay-at-home decision for parents when their children are sick. My own parents definitely also strictly adhered to the “No fever? No skipping” rule.

 

Another important factor parents consider is how contagious they perceive their children’s conditions to be. Evidence on how contagious kids can be are less definitive in older school children since they are usually not confined in a single space all day with ill classmates. For younger children who are in daycare all day, however, they may be prone to stomach bugs, ear infections, and colds than young children who stay at home.

 

Different daycare centers may also have varying suggestions for parents when it comes to children’s attendance. Some daycare facilities may have guidelines that recommend children to stay at home even though their rules don’t always align with pediatricians’ suggestions. This can be aggravating especially if parents cannot stay at home with their sick children, or cannot bring their kids with them to work.

 

Sick days are something we all experience at one point or another growing up. Since there is little uniformity about what symptoms are considered severe or contagious, it’s challenging to find or apply one suggestion to all parents or all students. Keeping an eye out for further research is probably the best thing to do as we continue to adhere to healthy behaviors such as washing our hands, staying hydrated, eating nutritious food, and getting plenty of exercise.

Study: Children’s Obesity Risks Increase During the Summer

This week’s topic may seem a bit funny in the weeks leading up to Thanksgiving, but it is very relevant any time of the year. 


Summer vacation is far away, but there’s reason to think about it ahead of time. A new national study (described here in the NYTimes) found evidence that obesity risks in young children are  higher when they are out of school than when they are in school. The fundamental question in debate surrounding obesity and children’s health is this: Does the cause of obesity exist primarily in school or outside of school? Recently, schools have updated their lunch menus, physical education classes ,and nutrition curriculums to reflect a growing awareness of obesity risks in  children. However, the findings of this study suggest that even with these improvements, healthy habits can be forgotten when they are not continued outside of school. 


Researchers hypothesized that if children's body mass index (BMI) grows the fastest during the school year, factors found in school environments could be a culprit for obesity risks. Conversely, they hypothesized that if BMI grows the fastest during the summer, that would mean the major risk factors could exist outside of school. They examined the weight gain of more than 18,000 children from the time they started kindergarten through when they finished second grade. The authors found that the prevalence of overweight or obese children increased between these years. A more striking finding was that the prevalence of being overweight or obese increased during summer vacation months, but did not increase during the school year. 


Intuitively, we can think of a few reasons why summertime might pose some weight control challenges for children. Children may go to sleep later and get less sleep during the summer, which could increase the risk for weight gain, according to another study in the New York Times. During summer breaks, students may also be prone to snacking and sedentary behaviors because recess and physical education classes are not scheduled into their daily routine.  Maintaining a healthy weight can be as challenging as maintaining reading and writing skills over the summer. Experts recommend that schools begin conversations with parents well before the school year ends to make plans for students’ diets and physical activity over the summer. These preemptive measures may be especially useful for students who may receive healthier meals at schools, but do not have access to nutritious food in their homes. 


Due to the holiday season, November and December is a time when young children spend more time at home with their families. Forming healthy behaviors during shorter breaks from school might help establish healthy habits that will last beyond long summer months.