Rx for Readers: Should my daughter undergo screening tests before school

My daughter is about to start first grade.She is generally healthy, but I wonder whether she should undergo anyscreening tests to see whether she is ready for school. R.A., Ramat Gan

Dr. Akiva Fredkin, director of the Clalit Health Services' Center for Children's Health in Or Akiva, comments:

Besides buying books and a schoolbag before your child entersfirst grade, it is worthwhile making sure she is physically healthy sothat no problem interferes with her studies. Between 3 percent and 5%of first graders suffer from fuzzy or double vision or vision-relatedheadaches. Epidemiological studies show that 15% of schoolchildren havedifficulty seeing distant objects such as the board.

Some schools have school nurses who check these two types ofvision, but studies show that that vision tests by school nursesidentify only half of the problems, so it is best to take her to ahealth fund ophthalmologist. Amblyopia (lazy eye) may also occur, andit must be treated early in the school career. Untreated visionproblems in children often lead to behavioral problems and poor schoolperformance as they can't see the board and are frustrated.

An examination by a pediatric orthopedist is notmandatory, unless the family doctor/pediatrician has found a spinal orpostural problem such as scoliosis. If it is left untreated, carrying aheavy schoolbag can aggravate it. Make sure that the new schoolbag youbuy for her is suited to her body size. The upper border of the bagshould not be higher than her shoulders when worn, and the bottom of itshould be above her buttocks. It should be made from light materialsand have broad shoulder straps, with cushioning protecting her backfrom sharp objects. The straps should be tightened comfortably so thebag is close to her back. According to regulations, the filledschoolbag should not weigh more than one-fifth of the child's bodyweight. Lockers at school are recommended.

Check your daughter's vaccination booklet to ensure that shehas had all of her shots; in first grade, children get oral poliovaccine and a booster of the "triple vaccination" against childhooddiseases. A visit to her dentist is also recommended so she has nocavities or other problems with her teeth, especially as permanentteeth begin to emerge at this age. And if your familydoctor/pediatrician has not done so, check to see whether her weightand height correspond with the norms in charts available in referencebooks on children's health. Deviations from the norm could be the firstsignal of a hormonal or other health problem that should be treatedbefore it manifests itself.

My son, who is entering first grade,insisted that all the sandwiches he took to kindergarten be filled withchocolate spread. I know it is bad for him and his teeth, but I fearthat if I prepare a healthful sandwich, he will leave it in hisschoolbag uneaten. What should I do? H.G., Rehovot

Shira Nehushtan, a clinical dietitian at Ziv Medical Center in Safed, replies:

It is best to have no chocolate spread in the house or at leastto limit it only to special occasions. Parents must get children usedto eating nutritious foods. One can even decorate them with pieces ofvegetables to make them look attractive. Breakfast is very important,and it is best if your child eats something healthful such as a yogurtor whole-grain cereal with milk even before leaving for school. It isworth getting up a few minutes earlier for this.

As for sandwiches, try a variety of whole-grain breads in theform of rolls, sliced bread or pita and find out what he likes. Fillthem with 5%-fat cheese or low-fat yellow cheese with a vegetable;humous; tuna; a hard-boiled egg; peanut butter; or even "chocolatespread" made from carob rather than real chocolate. But if it's a hotday, don't send an egg or tuna salad sandwich that has mayonnaise oreven humous because it is likely to spoil. Always put a bottle ofordinary cold water in the schoolbag that he should refill during theday. Avoid giving him fruit juices and of course sweetened drinks likecolas and prepared chocolate milks. If your child has a long schoolday, fresh fruit, granola bars, cornflakes, low-salt pretzels or driedfruit will fill his energy stores.

The most important thing is to consult with your child on whathealthful things he likes and to explain that junk food reduces hisenergy, will make him tired and harm his health, while fresh foodwithout artificial colors and flavors, lots of sugar and salt will keephim healthy. Make sure he also gets exercise outdoors when he comeshome.

Readers welcomes queries from readers about medicalproblems. Experts will answer those we find most interesting. Write Rxfor Readers, The Jerusalem Post, POB 81, Jerusalem 91000, fax yourquestion to Judy Siegel-Itzkovich at (02) 538-9527, or e-mail it to [email protected], giving your initials, age and residence.

More about:Ramat Gan