← The Pediatrician Next Door - Simple Advice on Parenting and Family Health
The Pediatrician Next Door - Simple Advice on Parenting and Family Health
Ep. 128: Back to School Tips: Sleep, Anxiety & Avoiding Sick Days
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Dr. Wendy Hunter
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See Mintmo Are you staring down the first month of school and thinking, why is my kid suddenly so anxious, so clingy? Why won't they go to sleep before 10pm? If you're getting ready to go back to school, this episode is for you. Hi, I am Dr. Wendy Hunter and I wish back to school was just new pencils and lunch boxes which are awesome and fun. But back to school also comes with big emotions and disrupted routines and I get asked a lot of same questions this time every year. So today I'm going to answer them for you. I'm going to talk about separation anxiety, sleep reset, school germs, social struggles, and yes, the ever mysterious full water bottle that returns home completely untouched. That's what's next. I'm Dr. Wendy Hunter and I'm the pediatrician next door. I'm that doctor friend you call for practical advice about your kid's health. I mix the science medicine with the reality of parenting. Welcome to Back to School time. That means lots of excitement and also a lot of questions. I am going to start with one big emotional question that I heard recently. It's something that I've actually heard from many parents lately and honestly, it's something I have experienced as a parent too. Okay, here is the question I got My kid suddenly has separation anxiety again. Is this normal? Okay, I've seen this firsthand so I think I have an idea what this parent is talking about. It could be a kid clinging to your Leg at drop off. Or maybe you're getting tearful goodbyes and your child saying please don't leave me when you're at the classroom door, even though they were totally fine even last year during school. If this is true, you are not alone. I have been hearing this a lot lately from parents and yes, it is totally normal. So let's talk about some separation anxiety. It is unfortunately not just a toddler thing. It actually shows up in little waves that can appear at different ages, especially during transitions. Like, I don't know, going back to school after a long summer of sleeping in and being with you constantly. That actually reminds me of a colleague who just told me that during the pandemic, her family lived in their RV for almost a year with their dog and and now they live in a 1500 square foot house. But every time my friend turns around, her 8 year old daughter and the dog are always standing like right directly next to her. You know, these are hard habits to break when you get comfy, being close all the time. Here's what's happening. During summer, your child probably had a lot of time with you or with other adults and their little nervous system got very comfortable in that predictability and safety. And then bam. All of a sudden, school time hits. They have a new classroom, a new teacher, all new routines. Everything suddenly is completely brand new and unfamiliar. I mean, put yourself in your child's position. This is totally going to set off an alarm in their brain that says like, wait, wait, wait, where is my safe person? What is going on here? Why is everything new? Even older kids, like, you know, second graders, sometimes even tweens, they can feel this. They can't always voice it. And the funny thing is, it doesn't always have to happen on the first day or the first week of school. Sometimes it hits during the second or third week, once all the novelty has worn off and they hit the reality of like having to do this every day. So what can you do? First, it's a good idea to pause and recognize that separation anxiety is actually a sign that your child has a really strong bond with you. And that's a wonderful thing. But we want to help them build confidence to separate from you in return over and over again and trust that there is that relationship. So here are some things that I have actually seen help in this situation. The first thing is you want to keep your goodbye short and sweet. You know, those long goodbyes, you can accidentally dial up the drama. So be careful about that. Here's my hottest Use a routine ritual you know I love rituals. I talk about this all the time. They add predictability to our lives. So maybe create a special handshake with your child or give them a sticker of the day every day when you drop them off. Or I like using a whispered mantra. So something that you say that your child can repeat again and again that makes them feel connected to you. Something like say even when we're apart, we're still connected. Just whisper that to your child. Or say my love goes with you everywhere and they can chant that again later to themselves if they need something to feel comfortable with. Or for younger kids, you might want to say one that rhymes. I mean come up with something cute, but something like hug, kiss, goodbye, I'll see you soon. Oh my my, that works. I don't know, I just came up with that. Next, acknowledge your child's feelings. We talk about this again all the time, but you don't want to over explain. You can just simply say I see you feel nervous and I believe in you, but you don't have to go on and on. You need to trust that they can handle their emotions and to walk away. Lastly, stay consistent. Also never sneak away. That erodes trust. So just stay consistent in whatever routine you have at drop off and don't give in to your child skipping school or saying they just want to wait five more minutes. That can go on for 700 five minute periods. Most kids are going to adjust in a few weeks to school, especially if they have this prediction predictability to their schedule. But here's what I want you to watch for. If your child is having extreme distress at school, drop off after three or four weeks, or if it's interfering with sleep like they can't fall asleep because they're worried about school the next day, or interfering with their appetite or any ability to function during the school day. Or if they start avoiding school altogether, you may want to address this further, especially if they start to have physical symptoms like stomach aches every morning. That's when it might be more than just a rough transition. This could be a form of school related anxiety or a true separation anxiety disorder. And I want you to know that help is available. A good place to start is with your pediatrician because we can rule out medical issues like hyperthyroid or I don't know what. And also many schools have counselors on site who can meet with your child. So you just need to ask now more than ever. There are also excellent virtual therapy options and those are designed just for kids so you can Internet search for those remember this. Every time your child does something hard, like walking into school while their heart is pounding, they're actually flexing their emotional muscles. Just like physical strength. We build emotional strength by practicing. So yes, anxiety is normal. Yes, it's hard. You're not doing it wrong. You're actually really helping your child to grow. Okay, let's move on to a question that is not so emotionally taxing. Although it's about sleep. And if you're not getting enough sleep, that can actually be like really emotional. Here's the next question I get all the time is what are my go to tips for sleep schedule reset? Yes. Yes, yes. The post summer sleep schedule crisis. It sneaks up on us every year, even though we know it's coming. I know it's Thursday night and your kid is staying up late binging TV or reading a book, and then all of a sudden it's Sunday and you are googling how to get a feral child back on a school sleep schedule in 24 hours. Okay, first you need to know why sleep schedules get off track. It's because our bodies run on circadian rhythms. I know you know this. We have internal clocks that respond to light and dark cycles in the earth. And in summer, with later sunsets and our flexible routines and no real pressure to get up and moving in the morning, our internal clock shifts later. And it's not just behavioral. Light exposure and melatonin production in our brain really do change in the summer months when kids start staying up later and sleeping in their brains get the chemical message. This is the new normal. And the problem is when you suddenly have to shift bedtime back by two hours to start school, your child's body is not going to just fall in line. It's like trying to fly to New York and have no jet lag. You just can't do it. Or can you? I don't know. I can't. When kids don't get enough sleep or their circadian rhythm is not aligned correctly, you're going to see more than just sleepiness. You might see morning meltdowns and trouble focusing, maybe hyperactivity and probably big emotions. And yes, you also might be grumpy. And I feel you. I have yelled, get in the car. We are already late at least 10 times every new school year. And then I feel like a horrible parent. So here are my go to strategies to reset your child's sleep schedule gently and realistically. You can do this. Okay, everyone knows this one, so I'll move through it quickly. But you want to Start by shifting their bedtime gradually. You can move it by like 15 to 30 minutes every two to three nights. That means if they're falling asleep at 10 right now, you can aim for 9:30 or 9:45 the first night, then 9, then 8:30 and so on. You can't just like move to 8pm overnight. That will make everyone frustrated because they will lie in bed awake. But I know it's really hard to shift bedtime and that's why my secret weapon is to work on wake up time instead. Because the real reset happens in the morning. So pick a consistent wake up time, even on the weekends and stick to it within an hour. So that early morning light exposure can help you to recalibrate your brain clock. So if school wake up time is going to be 7am, do not let your children sleep until 10 on Saturdays or the days leading up to school. An 8am Wake up is probably fine and a good compromise. But if you can stick to a consistent wake up time every single day, then you don't need to worry as much about bedtime. That's gonna fall in line on its own. I know you all ask me about melatonin and yes it can be helpful, but it is not magic and you need to know how to use it. Melatonin can be a tool, especially for tweens and teens who have natural rhythms that lean a little bit later in the evening. But melatonin is not a cure all. If you use melatonin, you want to start with a low dose and give it earlier than you think. So give like 1 milligram and give it an hour or even two hours before bedtime, not right before lights out. And you want to only use it for short term use so you can talk to your pediatrician if you're using it very often. It's really best if it's used as a crutch while you're trying to shift your sleep habits. Not in slight instead of having good habits. Which brings me to one of the most important things and that is creating a calming bedtime routine. And that's really for your whole entire life. You know, the brain needs cues to wind down, so obviously turn screens off at least 30 minutes before bed, more like an hour, maybe keep the lights dimmer. And I always recommend doing something low stimulation before bed, like a bath or, or books or chatting in bed cuddles, maybe some gentle music. The important thing is to do the same thing at the same time every night because it becomes like a familiar staircase basically that leads the brain to sleep. And my last tip is kind of an unusual one. It is to teach your children about the janitors of the brain. Yes, this is my very favorite part of sleep science. When you sleep, the brain sends in a crew of proteins. They are microscopic janitors. It's called the glymphatic system and they literally clean out waste and toxins that build up in your brain during the day. If sleep is skipped or cut short, the brain is not fully cleaned. That's why a lack of sleep affects mood and memory and attention and emotional regulation. Think of it this way. Your child's brain needs a good rinse cycle every night. There aren't any shortcuts. So if your child is cranky, unfocused or struggling to fall asleep, don't just assume that it is stress from back to school. Look at their sleep routine. You want to reset it slowly. Stick to a wake up schedule, dim the lights and build in some wind downtime. And remember, this takes time. You're not failing if your kid is still sleepy on day three of school. School is really exhausting and the brain doesn't flip like a switch. It is more like a dimmer. And hey, if you need a bedtime routine too, this pediatrician fully supports grown up sleep, hygiene and a little herbal tea. And on that note, I will be back after a quick break. Abercrombie Denim is everything right now. Denim should feel like this. Confident, easy, like your butt has never looked better. If you didn't know, Abercrombie's Curve Love Denim went viral in 2019 for eliminating waist gap and it's still a game changer. Between that and their classic fits with a straighter line from waist to hip, the perfect denim does exist. Shop Abercrombie Denim in the app online and in store. This episode is brought to you by State Farm. Checking off the boxes on your to do list is a great feeling. And when it comes to checking off coverage, a State Farm agent can help you choose an option that's right for you. Whether you prefer talking in person, on the phone or using the award winning app, it's nice knowing you have help finding coverage that best practice fits your needs. Like a good neighbor, State Farm is there. Learning through play starts with Lego Duplo. With Lego Duplo, toddlers can develop real life skills while having fun with colorful bricks made just for them. Large, easy to grip and safe to explore. When children express themselves with Lego Duplo, they build patience, problem solving and empathy. See your child learn perseverance and self expression with everything they imagine and create. Visit lego.com preschool to learn more. Okay, what do you think is the most common fear that parents have when kids go back to school? It's that your child will be home on a sick day almost immediately. But you literally just went back to school. Okay, here's the question I get all the time. It is, is everyone really getting sick more since school started or am I just noticing it? Oh, no, you are not imagining it. It is not just you. Everyone really is like sick all the time. And we are anticipating it in our office. Back to school season is really like the super bowl of viral transmission if you think about it. After a summer of sunshine and fresh air and lots of personal space, kids are now indoors and in groups sharing pencils and mucus and chewable necklace charms. Classrooms are basically petri dishes of pathogens. And the thing that is so hard in terms of avoiding illness is this. It's that kids shed virus particles before they get sick. So your child's adorable best friend who seems totally fine today, she could actually be blowing rhinovirus all over your child and the reading rug in the classroom before they even have their first sneeze tomorrow. That is how viruses roll. That is how viruses have survived. We all know now since the pandemic how germs spread, so I don't need to get into that. But yes, when school starts, exposures skyrocket, especially for younger kids whose immune systems are still building up their defenses. But don't worry, there are ways to help your kid not get sick. Okay? Obviously, remind your child to wash their hands, blah, blah, blah. But my favorite under the radar trick, which I'm about to share with you, is to keep the inside of their nose moist. Dry nasal passages are basically a welcome mat for viruses. That's why I recommend using saline nasal spray every morning. Or even better, a xylitol based spray like clear brand. It's spelled X L E A R. I don't know how to pronounce that. Give them that like once or twice a day, especially during the cold and flu season. Xylitol can actually prevent viruses from sticking to the nasal lining. That's how viruses get into your body. Unless you have a stomach flu virus, you know, blah, blah, blah. Anyway, it's basically like putting Teflon in their nostrils. When you spray something in their nose, the viruses just like slide off. The other thing that I like to consider is echinacea. You may think about it, there was a really good study that used this one brand, Echinaforce Jr. It's a kid friendly chewable echinacea and it's made from fresh pressed purple cone flour. And the study showed that it actually did reduce the number and duration of respiratory illnesses in children when they used this daily. So I don't tend to push a lot of supplements, but this is one that is a pretty good preventative during peak sick season. The problem is that I think you have to take it several times a day. Okay. And then lastly, I would not be a pediatrician if I didn't remind you to get vaccines. Your child's flu shot is totally going to help reduce severity of illness and make it far less likely for them to give you the flu or to give it to other vulnerable family members, like grandparents or like newborns. Okay. Finally, be realistic. Even if your child has perfect hygiene and takes a bucket of vitamin C, most school age kids are going to get between six and 10 cold viruses a year. That's actually unfortunately how the immune system learns. And it's from practice. So, yes, back to school. Germ season is real. You are not powerless. And with some daily routines and a well stocked nose spray drawer, you can actually help your child get sick less, bounce back faster, and maybe even just completely dodge a few bugs altogether. Now, if only we could prevent them from forgetting their lunchboxes and losing their jackets. Okay, now it's time for another emotionally charged question. Are we ready? Here's the question I got it is how do I talk to my child about being left out socially? This one hurts, right? I know we can handle sniffles and scraped knees because usually a hug works. But the moment your child says, nobody played with me today or they didn't invite me to blah, blah, blah, it hits us right in the gut. So first, you are not overreacting if you feel upset. You're a parent. Watching your child feel left out is perhaps the most universal, heartbreakingly human experience that we can have. But it's also an opportunity, a really big one, to help your child build the kind of emotional resilience that will serve them as adults. And I know you want to jump in and fix the situation, but start by listening, not by fixing. When your child tells you that they felt left out, your first job isn't to solve it. It's to be a soft place to land. You want to be like their emotional pillow. So try saying something like that. Sounds really hard and I'm glad you told me. Sometimes it also helps to reframe the situation. You can give your child a concrete way to picture what happened by maybe telling them a story. So here's one I like to use with my patients, and it kind of depends on the kid's age, but for a lot of kids, this one works. I say, you know, friendships are like levels in a video game. Some friends are on level two with you, and some don't know how to play yet or talk to other people. So they're down on level one, figuring things out, and that's okay. Everyone moves at their own pace. You just have to keep playing and find teammates who can play on your level. Analogies like this help take the sting out of rejection. And they can teach kids that when, when another kid says something that's not nice, it's not necessarily about them, it's often about the other kid. But what if your child is consistently feeling left out? You may need to dig a little bit deeper here to find out what's going on. Just being there for them and listening might not always be enough. This is really hard. Maybe your child just doesn't know how to fit in yet. So in this case, start by getting curious, not emotional. And ask your child some more in depth questions like did you want to join in but you didn't know how? Or what were the other kids doing at the time? Get a sense of the situation. If you have more information, you may need to coach your child about specific social skills, like how to join a group who is already playing. Maybe they don't know how, or how to read social cues or how to invite someone else to play with them. Sometimes a child just needs a little bit of a social script and a confidence boost from you. If your child is chronically excluded or is showing signs of anxiety or even starting to avoid school, that's the time to talk to the teacher or the school counselor. Sometimes social struggles are just a mismatch of personality or group dynamics. But other times they can be a sign of an underlying challenge like anxiety or ADHD or difficulty reading social cues. There's no shame in getting support. In fact, it can be a game changer for kids who are feeling isolated. The truth is that learning to navigate social ups and downs is unfortunately, again, part of growing up. But it's hard. Rejection hurts. But every time your child experiences it with your support, they're building emotional muscles and self awareness and empathy and resilience. And that is a lot of what kids need to learn in school. You know, it's not just about math and reading. All right, on that note, I saved the most pressing question for last and I'm not being dramatic here, I actually get this one all the time. I got this just last week. In a text, a parent contacted me and said, how much water should my child drink? I get this because parents are constantly battling half full or totally untouched water bottles. And then kids say they're not thirsty. And then there's the mysterious disappearing brand new water bottle. It's the hydration equivalent of socks going missing in the laundry. So let's clear this up and I'm going to start with the very straightforward, simple answer. How much water a kid needs depends a little bit on their age and their size. But a good rule of thumb is that toddlers, so one to three years of age, need about three cups, maybe four cups of water a day. Preschoolers, so age four to five, need about five cups a day. And then school aged kids more like six to eight cups. And teens like eight to 10, which is basically an adult amount of water. Those volumes are just water. Not milk, not juice, not water, melon. And it doesn't have to be exact every day. Some days you'll drink more, some days you'll drink less. But here is my secret indicator of hydration. It's poop. Here's what I tell families in my clinic. If your child's poop is soft and they're peeing every few hours, they're probably drinking plenty. You can count ounces if that really helps you. But if you want a truly practical sign, look in the toilet. If they have hard poop, they need to drink more water. And if it's soft, serve consistency, you're all good. And this question is always followed by what if they won't drink any water? You know, some kids just don't like water or they forget or they think I'm not thirsty when they're actively turning into a raisin. So there are a few ways to make water more appealing. It's not that hard. Pick a good water bottle. That's a fun one. You can add fruit slices. I like to add a frozen fruit because it's easy. You can turn it into a challenge, you know, tell your child, can you take three sips before school starts? Bet you can't race to drink water. That's kind of gross if you drink too much too fast. You can also set a water reminder, like put a sticker around the house that every time they see it, they have to take a few sips of water. Like drink before they wash their hands or drink before they brush their teeth or before dinner. And yes, I always tell parents if the water bottle comes home full from school, the real goal is to make drinking water a habit, not to make them all stressed out about it. And then the other related question I get about water is do kids need electrolyte drinks? And really, they only need them if they're losing fluids, like during sports or sweaty summer days or when they've had a stomach bug. Most kids don't need extra electrolytes in their water bottle. That's more of a marketing trend than any kind of medical need. Unless your child is doing two sports workouts a day in 90 degree heat, plain water is just fine. In fact, some electrolyte drink have added sugar or other unnecessary ingredients that can kind of cancel out the benefits of the water. So unless you have a triathlete on your hands, just keep it simple. Think of drinking water like brushing your teeth. You want to build the habit in your kids, and water works exactly the same way. So next time you open your kid's backpack and find a water bottle as full as it was when they left for school, just remember the goal is consistency over time just to make it a habit. And also maybe label the water bottle again just in case. That's it for today's Back to School. Q and A thank you for spending your time with me. I hope this episode helped you feel a little more prepared and a little less alone in this back to school time. If you loved this episode or you learned something new, please take a moment to follow the show or leave me a review in the Apple podcast or share it with another parent who might need a reminder that they are doing a great job. Until next time, keep trusting your gut. For more from the Pediatrician Next Door, find me on the web@ pediatriciannextdoorpodcast.com if you've got a question about the weird things kids do, send an email to helloediatrician nextdoorpodcast.com for a chance to hear your voice on the show. I'm Dr. Wendy Hunter and I'm the Pediatrician Next Door. This show is produced by Red Rock Music. Make sure to subscribe and leave a review wherever it is you're listening. I'll be back next time with more.