Friday, July 21, 2017

Back to School: from Vaccine requirements to Adjustment tips

Back to School: from Vaccine requirements to Adjustment tips

When I was young, Summers were sacred and school started after Labor day. I am not sure when that shifted, but it seems that these days many of our patients start school in mid August. I am putting this post out now to hopefully avoid the panicked parents who call, needing an immediate check up, sports form, or updated vaccination record prior to school entry. In our office our checkups are already very booked up, so if you haven’t done so already it is probably too late to get in under the wire, but call NOW for any chance of getting in sooner. Below  is the standard school form if you lost yours:

School Form for SFUSD
This is the most updated one that I was able to find online.
There is no charge for forms filled out at the time of an exam.
All other forms have a $10 fee and a one week turn around time
(We try to get to them sooner but there are no promises.) Rush forms  will be done within 48 business hours. There is an additional fee for this.

Take a deep breath. Most schools will accept a promise of a scheduled check up as long as they have an immunization form that is complete. We are happy to work with our families to at least get you scheduled for some of those shots that are needed even if there isn't a check up appointment with the doctor available before school actually starts.

As most of you are aware, In June of last year, California Governor Jerry Brown signed Senate Bill (SB) 277 into law. This law went into effect July 2016. For the school year beginning August/September 2016, all children going into kindergarten, seventh grade or transferring to a new school for the first time had to be fully vaccinated or have a medical exemption. Personal or religious exemptions are no longer accepted.
There is a conditional entry for children who are not fully up to date, but they must have at least one of  all of the required vaccines.

The schools will be checking in to make sure that the series are completed in a timely manner. School districts already have their own systems for tracking and following up with kindergartners who are not fully immunized. Whatever systems the districts are already using will remain in place. Check out this valuable link for a complete list of what is required: Shots for School

For our younger patients, most licensed day care facilities also have a fairly strict vaccination policy. Those requirements are also listed in the above link. That website also has a feature where you can check out your school or daycare to see how well they have been doing in their vaccination efforts.

7th grade  is also the perfect opportunity to vaccinate with the other ACIP (the Advisory Committee on Immunization Practices) recommended vaccines for 11-12 year olds, including HPV and MCV4 (meningococcal).  Students entering the 7th grade  will need to show proof of a Tdap (Tetanus, Diptheria and Pertussis) booster. They also must show proof of two doses of the MMR vaccines.

Vaccinations are only one of the requirements for school entry.
Kindergartners must have a complete physical examination within 6 months prior to entering school. We try to avoid doing the well child exams prior to March for this very reason.

We routinely check their vision, hearing and urine as well as reviewing general health and development. In my opinion, these annual visits with your primary doctor  are just as important as getting the shots.

California law also requires that by May 31st each year, students in their first year of public school must submit proof of an oral health assessment performed by a licensed dental health professional.

I haven’t come across anyone being denied entrance if they haven’t been to the dentist, but it is good idea to be current with the Dentist regardless of the laws:

Routine testing for tuberculosis is not required for SF public schools. Rather than testing every child with a skin or blood test, the San Francisco Department of Public Health strongly supports a medical provider's risk assessment for TB as the universal screening requirement for school entry.  Only children identified as having one or more risk factors for TB infection will need to be tested. The most common risk factors are

  • Contact with a family member with history of or confirmed case of TB
  • Foreign born family or adopted  from country with a high-prevalence of TB
  • travel to high risk country
  • HIV contact
  • family member who has been in jail during past 5 years
  • frequent exposure to homeless, users of street drugs or residents of nursing homes
  • Clinical evidence of TB: Cough lasting  longer than 3 weeks, coughing up blood, night sweats, fever, weight loss.
If you do get your child tested you have 2 options. The PPD is a test applied to the inner arm that needs to be checked 48 to 72 hours after it is placed. There is also a blood test available calledQuantiferon. It is a little more accurate than the skin test, so if you have a real concern, that is something I would consider.

Some of the private schools insist on TB testing for all of their students, regardless of the recommendation of the SF Public Health Department.  I have gone to the mat with one of the local parochial schools and lost.

Okay, aside from the forms and the shots, first day of school, especially if it is a new place is an emotional time. Some kids are excited while others are stressed.

This is a great time to read some books or tell stories about school. If your child has some separation issues, consider giving them a hankie that smells like you that they can put in a pocket. Maybe get a set of best friends necklaces for you and your child to wear and you can look forward to matching them up at the end of the day.
It is a bonus if you know a nice friend who will be in your child’s class. Play-dates together before school starts can help smooth the transition. If you don’t know anyone, some schools will host a back to school event or offer up a roster. Don’t be afraid to cold call one of the new families and introduce yourself.

Try to carve out some extra time during the bedtime routine where you can have your kids tell you all about their day. Don't fall into this common trap:

"How was your day?"

Ask specific questions such as:
Tell me about the kids in your class.
Tell me about the teachers
Share something interesting that you learned today.

Alana loved going into the minutiae of her day so much that she never stopped (you should be so lucky!) This 27 year old calls her daddy daily as she commutes home, and tells Sandy all about her day.

Every year might be different. Some kids who didn’t even look back to say goodbye one year, might pitch a fit in another. Lauren had no trouble saying goodbye to mom and dad her first several years at school until she was in third grade and Alana was in Kindergarten. The Kindergartners day ended earlier than the rest of the school and somehow Lauren found that intolerable. If she caught glimpse of me picking up Alana, she got weepy. I remember having to sneak through the school grounds making sure that there was no way Lauren would see me until it was time for her to go home as well.

It has been several weeks since I have sent out a post that mentioned poop. so I will add one more tip. Please make sure that your kids don't get constipated.  This is pretty common during the back to school season. There are several reasons for this. Some kids tend not to drink as much. Others are simply having too much fun or don't want to get up to leave a classroom. Most kids (and some adults) simply have a strong preference for pooping at home  Some mornings are rushed and there isn't time for a relaxed pooping routine. Keep your antenna up. There are lots of kids that just won't poop at school. Don't let them get backed up.

Prepare for the onslaught of germ season. Good hand-washing habits can help.

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