Back to School

Kirk D. Coverston, MD, FAAP

Summer days are far from over, with plenty of pool parties and beach days ahead, but lingering behind all the fun is the anticipation for a …"NEW SCHOOL YEAR!"

That’s right, I said it, and school days are coming soon. So what do you need to make your child “medically” ready for school?

Book your appointment with your child’s primary doctor for a yearly physical.  Yearly physicals are important, not just for entering kindergarten and first grade, but yearly because they serve for a way to monitor your child’s growth, development and behavior and to catch early any potential health issues, i.e. scoliosis, cardiac, respiratory or bone/skin lesion issues.

The yearly physical is also an important time to discuss with your doctor any health care concerns. You may need a physician’s order for the school to follow during the school year.  This would be the time to obtain yearly physician’s orders for asthma inhalers, epi pens for anaphylaxis, diabetic orders, seizure emergency medication orders and routine medications (over-the-counter medications that are not provided in school) that you would like your child to have access to during the school year, such as Tylenol or Ibuprofen for frequent headaches, etc. 

Your doctor can inform the school of updates to your child’s medical needs, medications or a medical diagnosis that requires monitoring. The school needs this information in order to keep your child safe and well at school.

California (Health and Safety Code - Section 324.3) requires that your child show proof of obtaining a physical examination in the first grade. Using the day your child starts first grade, physicals dated 18 months prior and 90 days into first grade fulfill this requirement.  Also, well exams can be accepted for up to one year for sports physicals.

Another important part of a yearly physical is the evaluation of your child’s immunization status. There are two benchmark grades in your child’s school career that immunizations are required and evaluated for participation in school.   The first is kindergarten and the second is entering the 7th grade.  During your kindergarten registration, and probably a few times afterwards, you were given a letter to inform you of the missing immunizations needed for your child to start kindergarten (H. & S.C. 3381).  These immunizations need to be obtained and turned into your school office before the first day of school, otherwise California state law is very specific about excluding your child from starting school (that’s right – it means your child cannot start school) if he or she is not in compliance with these requirements (C.E.C 460105).  

Some counties also require a TB test to be completed prior to starting school, so check with your school to see if your county is one of them. This test needs to show two dates: the date the test was given and the date the test was read (between 48-72 hours), along with the results – either negative or positive.

The second benchmark under California state law (AB354) is reached when your student enters 7th grade.  A Tdap (Tetanus, diphtheria, pertussis) booster is required that documents it was given at 7 years of age or older.  This is also the benchmark where, if you obtained a personal exemption waiver for your child before the new immunization laws went into effect, you will need to show that your child has obtained all the immunizations that were required at kindergarten, or are in the process of obtaining them via a “catch up schedule.” 

As with all required immunizations, there is a very specific medical exemption waiver that can be completed only by a doctor.  Other immunizations to talk over with your doctor at this age are the Meningococcal (4 strain) and Human Papilloma Virus (HPV). 

Let’s not forgot your child who is entering into college or military service. While not required by law, it is highly recommended that adult children be vaccinated for the Meningococcal B strain, which is given in a series of two shots, one month apart. 

So rub another layer of suntan lotion on and jump back into the pool, enjoy the rest of the summer and know that you have your child’s physical already scheduled and their school health needs met for the upcoming year.

(Kirk D. Coverston, MD, FAAP, is a Board-certified pediatrician with his private practice at Visalia Medical Clinic. His practice covers all general pediatrics, from newborns to adolescence, with a special interest in behavioral pediatrics and ADHD.)