Germs, bullies, killer schedules and lousy lunches. What can a parent to do? Plenty, actually.
By Melissa Healy, Los Angeles Times | http://lat.ms/qBDxfE
Schools are a minefield of health hazards — arguably one of the most dangerous possible places for children to be. (Kirk McKoy / Los Angeles Times)
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Later school start times and Zzzs to A's:August 1, 2011 - No doubt, summer has its dangers for kids: its Code Red air-quality days, its risk of sunburn, heatstroke, drowning and food poisoning, its poison ivy and whatnot. As conscientious parents reapply sunscreen to their young ones for the 4,000th time, they might well savor the prospect of a return to the safe, secure routines of school.
They do so at their children's peril. Schools are a minefield of health hazards — arguably one of the most dangerous possible places for children to be. Spending their days there may not kill our children outright, but a number of recent trends, on top of some long-standing truths about packing children together tightly, makes schools a contributor to the health problems of many children.
No, I have not been sniffing felt-tip markers (we haven't done our back-to-school shopping yet either). I draw this alarming conclusion from a growing chorus of public health warnings about school lunches, squeezed time for recess and physical education, crumbling public infrastructure, mounting curricular demands and germ incubation in schools.
From the moment our children drag their overloaded backpacks up the school bus steps to the late-evening hour at which many finish their homework and send their last text, school imposes sedentary behavior on them, plies them with lousy nutritional choices, exposes them to myriad communicable diseases and environmental toxins, primes their stress-hormone pumps and messes with their internal clocks.
And those backpacks? Kids who should only encounter the word "sciatica" in a spelling bee are flocking to orthopedists' offices complaining of back pain and nerve compression because they have little choice but to tote a full day's worth of textbooks on their backs. It's a wonder they can hobble up to the stage at the end of it all to collect a diploma.
Don't get me wrong: I truly identify with that old TV ad in which a dad rolls his shopping cart giddily up and down the school-supply aisle to the strains of "It's the most wonderful time of the year!" My kids' first day of school is circled in red on my calendar: The return to class will be good for my mental health, even if it may not be a boon to theirs.
Still, though experts have a lot of concerns about the effect of schools on students' health, they also have lots of suggestions on things we all can do to minimize risks.
Inactivity
In elementary schools, children are admonished not to run in the halls. In middle and high schools, students might sprint through a throng to reach their next class on time, often with a 40-pound backpack slung on their shoulder because they don't have time to stop at their lockers. That's about as much exercise as many of them get. Second only to the couch in most kids' homes, school has become a no-exercise zone.
According to figures released by the Centers for Disease Control and Prevention in 2006, only 3.8% of elementary schools, 7.9% of middle schools and 2.1% of high schools provide daily physical education or its equivalent for the entire school year. And 22% of schools do not require students to take any physical education at all.
Since 2002, when the "No Child Left Behind" law began imposing penalties for schools that failed to show academic progress, there's widespread evidence that many struggling schools — often in lower-income communities where obesity rates are high and opportunities for outdoor play after school are limited — have curtailed and canceled recess and physical education classes to concentrate more on the subjects that standardized tests would measure.
The Institute of Medicine and the CDC — joined by such national organizations as the American Heart Assn., American Cancer Society and American Diabetes Assn. — recommend 150 minutes of physical education a week for children in elementary school and 225 minutes a week for middle school and high school. At least 50% of P.E. class time should be spent in moderate to vigorous physical activity. It's a target that very few schools meet.
Meanwhile, safety- (and litigation-) conscious school districts are imposing ever-more stringent limits on where and what children can play during free time on the playground. Rough-and-tumble is strictly out. And in many school districts, recess is canceled when the temperature dips into freezing territory or there's even a trace of precipitation.
Emblematic of these new strictures on physical activity is the fate of the jungle gym, which is fast disappearing from the American schoolyard. The CDC recommends climbing equipment — including monkey bars and jungle gyms — as a way for children to build muscle strength. And child development experts believe such equipment is key to allowing children to explore risk-taking and overcome natural fears. But 23% of childhood playground injuries take place on "climbers" — a number that could be held in check by putting better, more shock-absorbing surfaces beneath them, according to the National Program for Playground Safety, an organization that conducts research and training on playground safety issues. For many school districts, letting children explore such risks on school grounds just won't do, and putting more mulch underfoot doesn't preclude the possibility of a broken arm. So jungle gyms are being retired in droves.
What you can do: The "Let's Move!" campaign, launched by First Lady Michelle Obama, has a range of suggestions to make school a more active place. First step: Create a School Health Advisory Council — a forum for parents and school administrators to review rules governing recess, make the most of physical education classes and encourage walking to school by identifying hazards (broken sidewalks, lack of crosswalks, traffic that moves too fast) — that discourage the practice. "Let's Move!" suggests that parents and teachers should agree that recess, or any chance to get out and move, should never be withheld as punishment and that imposing exercise (such as push-ups) as punishment for bad behavior sends the wrong message as well.
School as germ pool
As a gathering place for hundreds — sometimes thousands — of individuals who are, as epidemiologists put it, "immunologically naive," schools are veritable Petri dishes for germs, and ideally suited to the maximum transmission of those germs among students and between those students and their families at home.
A September 2010 study published in the Journal of Infectious Diseases found that the first day of school fired the starting gun on the recent pandemic of H1N1 swine flu: Researchers from the University of Washington found that, on average, 14 days after schools opened in the fall of 2009, outpatient visits for influenza-like illness spiked at doctors' offices across the country. The result "provides evidence that transmission in schools catalyzes community-wide transmission," the authors wrote.
For the lucky virus that makes its way into school attached to a student's hands, lips, nose or respiratory tract, the prospects for finding new hosts for its offspring are virtually limitless. Students share everything: desks, books, writing implements, lunch and — in some dark corners — saliva. Hugging among teenagers has become such a routine form of greeting that schools have begun to set limits on the practice, lest it get out of hand or make students late for class.
In such a fecund atmosphere, only a virus so wimpy it doesn't deserve to survive — or so powerful it kills its victims instantly — wouldn't thrive, spread and even combine with other viruses like it to create new strains of pathogens.
It's no wonder that when H1N1 flu threatened to mushroom, the federal government scrambled to provide school districts with guidance about how and when school closures might help stem the pandemic.
What you can do: Experts agree that in addition to knowing and practicing the basics of hand washing, kids can withstand the onslaught of germs best by getting enough sleep, eating a healthful and varied diet and getting all their recommended vaccinations, including the yearly vaccination for influenza.
Poor nutrition
At the risk of piling on, let me just say that the typical nutritional offerings of the nation's schools fall somewhere between fair and failing. And they have certainly lagged far behind nutritional research findings, which tout the importance of whole grains, fresh fruits and vegetables, and low saturated fat and sugar content. (That same research has not been kind to the widely held belief among school administrators that the French fry and tater tot count as vegetables.)
Some 31.6 million children in 99,685 public schools across the country eat a school lunch on a typical day. For many, it is intended to be a principal source of their daily nutrients. Last year, an anonymous Midwestern teacher calling herself "Mrs. Q" ate a school lunch every day and posted a daily blog about the experience. She chronicled a pretty typical lineup of offerings: mushy canned vegetables, bagel dogs, tater tots, pizza and bright-red slushies, which she reported her students regularly ate first, since they had a mere 20 minutes to eat and didn't want to miss out on it.
To be sure, the better-school-lunch movement has gained a toehold in many schools, which have begun to offer kids salads and whole grains and fresh fruits. And they've gotten a big push from the Healthy, Hunger-Free Kids Act of 2010, which over the next several years will require all foods sold in schools — including those in à la carte lines, vending machines and on the standard lunch tray — to adhere to new dietary standards.
The heart of the act is $4.5 billion in new funding, the first hike in federal reimbursement for school lunches in more than 30 years. Those funds are to be used to upgrade school meals, help link school districts with local farms to supply fresh produce, expand access to drinking water in schools and improve the quality of "surplus foods" that the U.S. Department of Agriculture makes available to schools (think giant slabs of orange processed cheese). But such new spending is likely to take a significant hit in the latest round of deficit-reduction efforts, and school districts — most of which already supply school lunch at a loss — will find it hard to provide healthier fare with little or no new money.
What you can do: There are two solutions to school lunch: the every-student-for-himself strategy and the communitarian route. If your child is open to carrying a packed lunch to school, it's not hard to find great, healthful components, including fresh fruits and vegetables, whole grain breads and bars, cheese or yogurt. The American Dietetic Assn. suggests you involve your kids in choosing foods they'll eat and not trade or throw away — and that you "change it up" frequently. "Let's Move!" encourages parents to agitate for school gardens and nutrition education as a way to get kids pumped about eating well — and possibly to help supply the cafeteria with fresh produce. Personally, I am a great fan of Jamie Oliver's efforts. (Good news if your kids eat in L.A. Unified cafeterias: Pizza and chicken nuggets are off the menu come September.)
Bullying
If we learned anything by reading William Golding's "Lord of the Flies" in middle school, it is that children can be very cruel to each other, whether surrounded by institutional walls or not. OK, school isn't exactly a deserted island where one's very survival is at stake, but it has its stresses, including crowded halls, limited free time and the inevitable emergence of tribalism and hierarchy.
With those stresses come bullying and violence. In a 2009 nationally representative sample of youth in grades 9-12, the CDC found that 11.1% of high school kids reported being in a physical fight on school property in the 12 months preceding the survey. And 19.9% reported being bullied on school property in the 12 months preceding the survey. Boys were more likely than girls to have engaged in physical fighting (15.1% versus 6.7%). Girls were more likely to report being bullied than were boys (21.2% versus 18.7%).
The same survey found that 5.6% of those surveyed said they had personally carried a weapon (a gun, knife or club) into school in the preceding 30 days. And 7.7% reported they had been threatened or injured with a weapon at school in the past year. From 1992 to 2006, 116 students were killed in 109 separate incidents in schools.
Far more likely than physical injury at school, however, is the prospect of being taunted, teased and generally humiliated — which, despite the old saw, may have a more corrosive and enduring effect on a child's well-being than sticks and stones. For years after they were bullied, adults who were victims in their teen years have higher rates of depression and low self-esteem and are more likely to ponder suicide.
The much-discussed threat of cyberbullying affects as many as 3 in 4 teenagers in a given year, according to a 2008 UCLA study. And while cyberbullying often takes place out of school, school is where bullies meet, target and often torment their online victims first, says study author Jaana Juvonen, a UCLA professor of developmental psychology. And the forms that bullying take online and in school, she noted, "are more alike than different."
What you can do: Stop Bullying (www.stopbullying.gov), a clearinghouse for research and resources for parents and schools, notes that parents will often be the first to detect the signs of bullying — if they're paying attention and know what to look for. Parents should ask "what's up" at school and listen for signs of distress, including physical complaints such as headaches and stomach pain, frequent bad dreams or changes in appetite or sleep. A child who comes home with missing or ripped clothing (or lost books, electronics or jewelry) may be being bullied. And if your child is a victim of bullying, get help — from the teacher, a more senior school administrator or your state's Department of Education if your child is not getting the protection he needs. Common Sense Media (www.commonsensemedia.org), a nonprofit organization that offers advice and research on keeping kids safe in the digital world, urges parents to ask questions and become savvy about their kids' online habits, including the social networking sites they frequent. Help them understand the fine line between funny and cruel in digital communications, and make sure they talk to someone adult about their online world — even if it's not you.
On the first day of her freshman year, my teenage daughter got a text from a friend a couple of years ahead of her. It said: "Social life, good grades, sleep: Pick two. Welcome to high school."
We all know which gets short shrift. American schoolchildren, particularly teens, are among the most sleep-deprived people anywhere, meaning that most routinely get far less than the roughly nine hours of sleep recommended for them by the National Sleep Foundation. And though television, Facebook and cellphones all play a role, school is a major contributor to their chronic sleep deficit.
The health consequences may be far-reaching. A growing body of evidence links too little sleep with a heightened risk of obesity, diabetes, high blood pressure, depression and anxiety, not to mention grumpiness, poor memory and attention, and driving accidents.
For students intent on selecting the "good grades" part of the equation, a mounting pile of homework — much of it aimed at preparing students for standardized tests — is a major factor. "Kids are made to work what amounts to a second shift at home after working all day on academics," says Boston writer Alfie Kohn, author of such books as "The Homework Myth" (2006) and "Feel-Bad Education" (2011). "That creates family conflict, frustration, exhaustion and loss of interest in learning."
But even if homework magically disappeared, school schedules conspire with biology to make our kids, in the words of teen sleep researcher Dr. Judith Owens, "pathologically sleepy." Specifically, the mismatch between teens' internal clocks and middle school and high school start times is widely thought to be a major drain on adolescent health. During puberty, a child's sleep hormones change along with all those other ones, shifting later the time at which they wind down for the night. For high school students due in class by 7:30, a six-to-seven-hour stretch of sleep is more typical than the recommended nine hours.
The National Sleep Foundation and a growing corps of researchers have become active in encouraging school districts to "flip" their schedules, starting elementary school kids' days around 7:30 and pushing high school start times back to between 8:30 and 9 a.m.
A July 2010 study by Owens, a sleep expert with Hasbro Children's Hospital in Providence, R.I., found that, at a private school in the town of Newport even a 30-minute delay in school start times led to students getting an average of 45 minutes of extra sleep each night and reporting fewer symptoms of depression and "fatigue-related" health complaints, and greater enthusiasm for participating in school activities.
After the Minneapolis public school system shifted the first bell at seven high schools from 7:15 to 8:40 in 1997 and 1998, Dr. Kyla Wahlstrom, a leading sleep researcher, found many of the same changes among students. And a 2008 study of Fayette County, Ky. found a significant decrease in the rate of teens' motor vehicle accidents after the high school day was shifted outward. In other studies, later school start times were linked to a dramatic drop in students reporting to the nurse with a wide range of physical complaints typically linked to fatigue and stress.
But the logistics and cost of changing schedules is daunting, because it interferes with after-school sports practices, many students' jobs obligations, and bus schedules that must work like clockwork. Even though dozens of school systems across the United States have debated the possibility of change in recent years, only a very few — including school systems in Connecticut, Massachusetts and Virginia — have adopted the shift made earlier in Minnesota and Kentucky.
What you can do: If your school district is considering a flip, the lessons of those who have done it are instructive: Wahlstrom reports that they have found it less disruptive and expensive than was feared. Short of that, experts suggest that parents negotiate and enforce limits on late-evening time spent texting and on social networking sites: Those, as well as TV, can needlessly rob a kid of sleep. Finally, the National Sleep Foundation warns that letting kids make up their sleep deficit by staying in bed 'til noon on weekends will cause their distorted time clocks to get even more out of phase. Weekend wake-up times should be no more than two hours later than those of the school week, the foundation's experts suggest.
Infrastructure hazards
American public schools, with a few gleaming exceptions in affluent and fast-growing suburbs, are a crumbling and crowded mess, exposing students to close quarters, makeshift classrooms and contaminants of all sorts.
The last time a comprehensive tally was done on the repair and maintenance needs of the nation's schoolhouses was 1999, when the Department of Education concluded it would take $127 billion to bring U.S. schools into good operating condition. Crumbling ceilings, leaky roofs, broken pipes and moldy basements are part of that picture; overcrowded classrooms and the widespread use of temporary "portable classrooms" linked to a wide range of indoor air-quality problems are another. In 2008, California's Department of Education reported it needed $9 billion for new construction and $3.5 billion to repair and modernize its public schools.
But as states and school districts have faced declining revenues and shrinking budgets, many of the infrastructure issues highlighted in 1999 have gone unresolved or gotten worse.
For most kids, school's smells and discomforts may just be gross. But for many kids — especially for the 1 in 13 American schoolchildren who have asthma — they can be downright unhealthful. Each year, the American Lung Assn. estimates, American kids miss more than 12 million school days due to poor indoor air quality — from dust, mold, allergens and poor circulation — that exacerbates asthma and other respiratory diseases.
What you can do: The Environmental Protection Agency has an Indoor Air Quality Tools for Schools Action Kit that details how parents and school administrators can, at little or no cost, address classroom air problems that can worsen students' asthmatic or allergic symptoms (www.epa.gov/iaq/schools/actionkit.html). The American Lung Assn. underscores that secondhand smoke in poorly ventilated schools remains an important touch point for action: Supporting programs that help school employees quit helps kids avoid breathing difficulties. Finally, there's no substitute for ensuring that kids with asthma or allergies are medically managed to minimize their sensitivity to irritants from crowded and crumbling schools.
Stress
Is school more stressful than it once was, or do we just talk about it more? That's hard to know. But those who study the matter say whether it's new or not, stress is a central feature of many students' experience of school. And the resultant health risks — including suppressed immunity, cardiovascular disease and depression — are undeniable.
In a survey of more than 10,000 middle and high school students conducted by Stanford University education professor Denise Pope, students at 20 high-achieving schools in California made that clear. More than 2 in 3 who responded said they were "often" or "always" stressed by schoolwork, and students' "top 10" sources of stress were overwhelmingly school-related. The physical symptoms of stress — including stomach pain, headaches and difficulty sleeping — were widely reported by students, especially girls, who are more likely to report such "internalizing" symptoms.
"It's definitely affecting their health," says Pope, who adds that the level of stress such students routinely feel also subverts the goal of education: to help students learn to solve problems and think creatively.
Kohn, meanwhile, is sure that student stress has gotten worse, and he says it is by no means limited to high-achieving schools. "Most of the stuff at school that is undermining our children's psychological health is not an inevitable result of childhood or education: It's a direct result of the insanity that goes by the name of accountability-driven school reform."
Teachers "have a gun to their heads — raise test scores or else," Kohn adds. "And that pressure is then passed down to the kids." No wonder, he notes, that the Stanford Achievement Test now comes with instructions for teachers on what to do if a student vomits on a test.
What you can do: The American Academy of Child and Adolescent Psychiatry offers advice to help teens cope with stress, and parents can guide them with most of it: Eat and exercise regularly, learn relaxation techniques and self-assertiveness skills, challenge harsh assessments of yourself and your situation, and work at feeling good about doing a "good enough" job at school rather than expecting perfection. Mental health experts underscore the importance of developing a network of friends to help cope positively with stress. And, above all, teens should get help — from a parent, guidance counselor, physician or mental health professional — when stress turns the corner into debilitating anxiety or depression.
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