"Autumn leaves, arrive with a sneeze". This adage predicts the upcoming season quite accurately. As summer winds down and back- to- school mania revs up, parents can prepare their children for staying healthy. Fall’s cooler weather combines with crowded classrooms, and sniffles and coughs herald the onset of the respiratory alert. Children with seasonal allergies and asthma who generally fare quite well in summer’s air, are often in trouble once the weather changes and with it the pattern of mold and leaves. It is a good idea to rethink your asthmatic child’s medication plans, prophylaxis being invaluable for some, in reducing the frequency of school absences due to sleepless cough-filled nights. What works for one child may not work for your child and if yours has a prior history of back- to- school "wheezing blues", a pre-school visit to your pediatrician or a pediatric pulmonary consult, may be advisable. There are several new preventative medications designed to head off the onset of the sneeze-cough-sneeze cycle. A group of them, the leukotriene inhibitors, are building a reputation for re-routing the asthmatic child who frequently ends up "on steroids" each new school season. Inhaled steroids such as Vancenase, are becoming safer and better at averting the need for oral steroids as well. Also a must for these children and their families is influenza prevention. Usually referred to as "the flu", this seasonal respiratory virus is the "granddaddy" of the "common cold", but for children with chronic illness, asthmatics in particular, it can be extremely debilitating and even life threatening. Your child’s pediatrician should be receiving the first batches of influenza vaccine in early October and parents should stay alert to news reports of the vaccine arrival. It generally takes 2 weeks from the time of vaccination for protection to begin and some first time recipients may require a second booster dose in one month.

All children, including preschoolers, need to be taught simple hygiene rules that will help reduce their chances of illness. Teach your children to wash their hands (with soap!) and provide pre-moistened towelettes for use after bathroom and after nose blowing. Insist your children cover their mouths when coughing and give them zip lock bags to throw used tissues into instead of collecting little snot balls on their desktops!. Especially in the younger age groups, give your child an extra day or 2 to really recover from each respiratory illness before returning to the school hot-bed of more germs. Nothing drives a parent madder than seeing slimey-nosed toddlers ushered into the nursery when their own little one just got over the last round of the "sneezies". Be a public health advocate and speak up at your child’s school if there are repeat offenders and insist that schoolrooms have adequate ventilation and children have easy access to tissues and water. Respiratory viruses love dry heat and once the Fall furnaces rev up the lack of humidity adds to our children’s susceptibility to them. Parents of young children in daycare face special health challenges. For the diaper set, relying on the good hygiene of caretakers can be risky business. Be sure to provide many extra diapers and disposable gloves for the teachers’ use when tending to your baby and send good quality wet-wipes and baggies for disposal. Check supplies daily both in order to restock and to be sure these items are being used. Don’t be shy about this issue if you are not satisfied - daycare acquired infectious illness accounts for 35-40% of all childhood hospitalizations per school year! This is no minor matter! In particular, outbreaks of diarrhea disease and severe respiratory illnesses, such as bronchiolitis and RSV have been repeatedly linked to inadequate hygiene in daycare settings. Many parents are caught in the predicament of having to "do something" with their sick children in order not to miss work or even risk losing their job while tending to them. It is wise to plan in advance for these eventualities. Find out what your rights are on the job regarding sick childcare leave and check the policy of your company if it seems unfair to you. Some of the working parents in my practice have made "sick pools" when more than one child in a class is stricken but I have concerns about the stress this system puts on the mom or dad doing nursing duty for more than one child - toddlers are a handful when they are well no less cranky and irritable with illness.

For some toddlers every runny nose means another raging ear infection and these children particularly need the extra days home to build back defenses against the next case of "germ warfare". Old fashioned rest and plenty of fluids and good nutrition and vitamin C are best supplied at home under a parent’s watchful eyes rather than asking the often overwhelmed school teacher to keep an extra watch over your little one. The topic of headlice always rears when school resumes. Countless heads show up in my office, parents begging to be given the green light to return them to school. The rules are simple - prevention is key - keep your children’s hair short or at least braided or tied, and inspect daily. If possible keep your child home for 2-3 days if lice does invade and use a pediculocide that is recommended by your pediatrician (I recommend NIX) and follow instructions exactly. More is not better but a repeat treatment may be necessary on day 3 to catch the few survivors and late hatchers. Carefully pick the eggs out with your fingernails or fine toothed comb and discard them in the toilet. Use vinegar and water washes or a saturated cotton swab to loosen the most stubborn eggs and then shampoo the pickle smell away. Report lice immediately so the school can check for other cases and be patient and cooperative with the seemingly excessive school rules on this matter. No one likes little crawlies in their hair and the "3 day out" requirement in some schools is imminently sensible though sometimes inconvenient for the families involved. I have scolded several of my patients’ parents for not giving full disclosure to the school regarding their child’s lice out of a misplaced sense of embarrassment. There is no shame in having head lice today - some of NYC’s finest private schools have had "lice out" days when school recessed in order to regain control of outbreaks.

Last and hardly least is the issue of stress in children. As Fall means the end of most free unstructured time and the return to discipline and conformity, some children adapt less well than others. Many the child I see with a mysterious daily morning stomach ache or headache or after-school aches and pains that can be directly attributed to our own stressful style of living. Our children are often hurried through breakfast, if they eat at all, rushed to school, and then spend long days learning much more than they should reasonably be expected to learn, often about things that didn’t interest us much either when we were kids. After school programs are so extensive its as if we expect our kids to work double shifts right from early childhood. Our own lives are so busy our kids often don’t even see much of us except in transit to and from and between activities. TV does nothing but numb or bum out our minds depending on whether we watch mindless sitcoms or the nightly news and those who think repetitive video rewinding of Cinderella is much more than obsessive compulsive training camp should think again. Our children’s stomach aches are usually not hypothecated ("If I say my tummy hurts then I can stay home") but rather they are the body’s way of screaming for a break. Belly aches need more tending to than the teaspoon of Children’s Mylanta we may offer (though CM is a great source of Calcium and every home should have some). Parents also need to attend to the emotional state of their children and sometimes stop the music when little bodies start "achy paining". Be careful not to discount or ignore these symptoms and if a day or two of rest or a revising of a too tight schedule doesn’t relieve the complaints, be sure to talk the situation over with your pediatrician. Your pediatrician is trained to advise you in many child related areas beyond sore throats and rashes and can often help you to distinguish between illnesses that need TLC and those that are more serious or require medication. Your pediatrician should be available for phone or in-person consultations on issues of both organic and developmental health issues and parents can often find a good source of seasoned advice here on the little things about raising kids that can be so worrisome. The old saying "Spring ahead, Fall backwards" need not apply to our children’s health. With a little planning, the Autumn leaves may fall on you and yours in the very best of health.