We are a pediatrician and a child psychiatrist. Ask us anything about back to school wellness.

My son is twelve and absolutely hates school. When I ask him about it his teachers always hate him, or he has no friends, or the work is too hard. I'm having a hard time convincing him to look for good things in his day. He gets average B's, we had him in math tutoring when he had a rough stretch. Are there any tips? This year he starts with two electives he chose so I'm hoping he will enjoy his school time more.

Middle school is a tough time. I’m sorry that he’s had a rough run. Since it's the beginning of a new year, I would emphasize that, and always try to put things in a positive light. ‘Are your teachers helpful? Science seems so interesting,' or, 'Who do you like in your class?’ Sometimes frustration with middle school social situations can result in inability to focus on classwork too, so definitely try to find out if there is any bullying or other issues that you can help with.

Lastly, make sure that you are present a lot, even if he’s not talking to you, this makes him feel secure and he may tell you more details. And sleep is really important for him to focus and be in a good mood to tackle the day -- 12 year olds need about 9-11 hours of sleep. - Hansa Bhargava, MD

So I dont have kids and I'm not planning on having any anytime soon as I'm a (23m) young guy but I had an unbelievably supportive father who fostered academic success, in my belief, the best that he possibly could. However, I always underperformed in school. I accelled in athletics and discussion based classes and have done very well for my self in my military career thus far. I only talk about my self for background. My question is how do I, or what is the best way to, foster an environment for my future son or daughter that they have my questioning attitude and extrovert personality but still value grades and success in the educational system with out thinking it means EVERYTHING?

This is a wonderful and thoughtful question. I think its important to 1. Be present with your kids- this is hard sometimes 2. Give them creative outlets like art and music 3. Have a loving environment with friends and family. Communication is the key- and constantly giving them the message of being loved but asking them to work hard in whatever they do. - Hansa Bhargava, MD

What are the best tips to motivating kids out of bed in the morning when they are clearly awake but don’t want to leave from under the covers?

Another struggle, we all have as parents! A few tips that may help this is, setting expectations the night before. Depending on the age of the child, you could offer sticker ‘rewards’ for getting out of bed, or asking the child to be the ‘helper’ for breakfast. Also, its important for kids to get enough sleep - this can be anywhere from 10-13 hours depending on how old your child is. Hope this helps! - Hansa Bhargava, MD

This is a bit of a stretch, I’m a college student. I was wondering what are some things a doctor would recommend to reduce anxiety as finals and exams come around?

Back to basics is really important. Good nutrition, good hydration and taking deep breaths. If you can take 5-10 minutes to meditate, science has shown that can really reduce stress. Also, sleep is extremely important. Also, there are some great apps out there like Woebot, that can help with depression. - Hansa Bhargava, MD

How to get you kid back to school sleep schedule ?

This is a common struggle for a lot of families. One strategy that can work well is to start early. Let’s say your child needs to be in bed by 8PM but has been going to sleep closer to 10PM over the summer. You may want to start a few weeks before school starts and slowly move their bedtime (and wake time) by 20 minutes every few days. This way everyone can start the school year well rested! - Smitha Bhandari, MD

I used to work at a school and we had to take the kids through active shooter drills. That’s one of the things I never had to go through.

How do you recommend you talk to a child about potential tragedies at school like shootings? Like how do you impact the urgency of the matter without scaring them?

This is a great question and such an important topic. Kids are more exposed to media and news than ever before so they are hyperaware. This makes it more important to have family discussions around these topics frequently. Talk to them about the events you hear in the news, and also ask them about what might be worrying them. Remember to keep a warm and low tone in your voice, and also remember they are always hearing what you may say to others. Lastly, continue to let them know that they are safe and loved. With life being stressful, it becomes even more important to work in time for family time. - Hansa Bhargava, MD

As I’m currently watching my 4 year old having a hard time adapting on his preschools camera access system, this AMA pops up in my notifications.

My son was with me at home from birth until this last week when he started full-time preschool, so he could adapt, learn and socialize, and I could go back to work full time. The morning drop offs are absolutely rough, as he is full blown crying and trying to run out of the door after me. I feel like I am damaging his trust and creating a sense of abandonment when I have to leave him. When I watch him on the camera, he will sit in the corner and isolate himself, not really wanting to interact with any other children. Today, at the suggestion of his teacher, he was allowed to bring in one stuffed toy from home to comfort himself during the day, and he promised to actively participate, but I’m watching his carry it around and trying to isolate again.

When I pick him up at the end of the day, he’s all chipper and tells me he has a good day, but it’s hard to determine what to believe from how he acts at morning drop offs and when I view him during the day.

Is there another way we could handle this so he’s not upset and I don’t feel like I’m hurting his mental well-being? He has always been an emotional soul, and I see empathic traits in him.

Transitions can be hard for lots of kids. It may take a few weeks to adjust to the new routine. For some kids, it can help to start the day with a lot of positive reassurance. You can say things like “You are going to have a great day at school. It will be so fun to see your friends and play.” Talk to your child about walking into the classroom calmly and try to minimize the time during drop off. As a parent, it can be hard to resist the urge to comfort your child but sometimes that can reinforce the “full blown crying.” Also it may help to talk to the teachers about your concerns so they can provide extra support in the classroom. - Smitha Bhandari, MD

Here is a question from the other side of things. As a post doc psychology resident in pediatrics with a focus on autism, in the past few years I have seen the referral's for ASD SKYROCKET.

What can we do as a field to help teachers, parents, and other medical professionals such as yourselves to better identify possible cases of autism?

We have been having a huge problems with kids coming in referred for ASD and our waitlist for testing is going on 3 months, but a lot of the cases I end up seeing are very clearly being categorized as ASD inappropriately.

This is a great question. As awareness and education about autism increases parents, educators, and caregivers are trying to screen kids earlier and earlier as we have learned that early intervention programs can have a big impact. Screening tools, like the M-CHAT-R, a checklist typically administered at your pediatrician’s office are designed to flag or alert any kids who might be at risk. I think continued research into refining these kinds of tools will help them to be more efficient. - Smitha Bhandari, MD

Our daughter just started Kindergarten and has been exhibiting some bad behavior at home. She is saying she loves her new school and class, but is it typical that the new change would manifest some negative attitudes at home?

Yes, sometimes a change like the start of school can definitely cause ‘grumpy’ behavior. Additionally, most kids are not used to waking up early either and it takes time to get into the swing of things. She also may be hungry when she gets home.

I would suggest giving her a balanced after school snack, hydration and then an early bedtime for the next week or so and see if that helps. - Hansa Bhargava MD

My daughter just started kindergarten classes at an international private school. She seems to like it. We also have her participate in after school activities such as ballet and swimming. We are thinking of putting her into Kumon classes as they just opened up a branch near our house and offering a super promotion. I just wonder if we have her into too many after school activities that may cause her more stress in the future. How do you find the right balance between school and extra curricular activities for a child?

Great question! I think many parents struggle with this question -- and even though we want to expose our kids to everything and give them the best chance at success, overscheduling of activities can actually act as a detriment to other aspects such as time to bond with family, and time to just play. Family bonds and play actually helps the brain develop and lays down the groundwork to be successful and protect against stress and anxiety. For your daughter, maybe you can choose 2 activities outside of school, and then also schedule in time to spend with you and other family. This will create a more balanced life -- for now and in the future -- for her. - Dr Hansa Bhargava, MD

We have a 5 year daughter who is extremely smart but resistant to learning. Every teacher she has says the exact same thing. She wants to do everything herself even when she does not know how to do it.

If she likes something or is good at it, then she will do it. But if something is difficult, she gives up quite easily.

She always has to be forced to do things that are new or she will not do them. Once she is forced to and learns, then she accepts and excels.

We have always tried to be supportive and teach her that you have to try hard in whatever you do.

Are there any specific techniques to help with this kind of resistance to learning? and resitance from accepting help?

Firstly, you are doing a great job as parents. Guiding her to the right activities, even if she’s resistant, is a good thing. At this age, many kids want to do what they want. Structure, positivity and setting up expectations really helps. For example, letting her know the positive things about learning ‘math’ - why it's important. Also, setting up a time when she does her ‘math’ work, doing it with her in a ‘fun’ and happy way and giving her a positive reward like a walk in the park or a sticker or time with daddy, etc. Lastly, basics, such as sleep, hydration and good nutrition also help! And always feel free to talk to your school for more hints- most teachers are well trained in this area too. - Hansa Bhargava, MD

I have two little girls, 6 and 3. Oldest has ADHD-c and is currently being seen by a child psychiatrist and a therapist. I feel like we've come a long way in helping her and she starts 1st grade gifted program in just a few weeks.

My question is, how likely is it for my 3yo to also have ADHD? She has some similar frustrating behaviors our oldest had when she was her age (though it appears to be more mild), but we are unable to tell if this is something she picked up from her sister, a stage she's going through, or if this is something we should keep an eye on. On top of that, this one constantly gets random fevers with no other symptoms. We have spoken to her ped and they always say it's fine. But I don't think it is normal to have fever frequently without any specific symptoms of a cold, etc. What is this about?

I think it’s natural for many parents to wonder about siblings when one is diagnosed. Studies have shown that siblings are about 1 and a half times more likely to exhibit symptoms if they have a sibling with ADHD. If a parent has ADHD, a child can be up to 50% more likely to have symptoms as well. - Smitha Bhandari, MD

For the colds, most kids get about 5-6 upper respiratory infections a year, mostly during the winter months. Thats about 1 per month, and it can last for 2-3 weeks. Fevers that last one day don’t happen that much, how do you usually measure the temp? I think that if your pediatrician has looked at your child and she is acting fine, and eating or drinking, then she is probably ok. Definitely have your child looked at by your doctor, though, if you’re worried. - Hansa Bhargava MD

What’s the best way to prevent common illnesses such as a cold?

Some good ways to prevent colds are to to do basic measures such as handwashing, not sharing foods or drinks. Also, making sure the kids have enough sleep and good nutrition can always give the immune system a boost. - Hansa Bhargava, MD

My 14 year old son is depressed. He’s refused help such as a psychologist (he is silent during sessions) and refuses to talk to his pediatrician about it. How can I help him?

I’m so sorry that he is dealing with this. It’s wonderful that you are taking the initiative to see the right doctors. It’s important to keep talking to them despite the silence. In the meantime, is there an uncle, aunt, teacher or coach that he is close to? Sometimes an allied adult can break through. Lastly, speak to the school to make sure there is no bullying or harassment and check his social media accounts too. If you are still worried, definitely speak to the psychologist or a psychiatrist. - Hansa Bhargava MD

I know flu season is coming up- my daughter is almost 3, and she has always gotten the flu shot seasonally since she was about 6 months old. This year, her father isn’t letting her get one because “she doesn’t have any vaccinations scheduled until she’s 4” which is well over a year and a half away. Is there any harm in him not allowing her to get vaccinated for this after she’s regularly had the shot the last two years, or should I push that she get the influenza vaccine again this year regardless of what the pediatrician he takes her to says? She’s just starting preschool, as well as switched pediatricians recently, and I don’t want her to get sick since she seems to pick up every bug or virus around her. Thanks!

It’s important to get the flu vaccine every year because it is ‘reset’ every year. Experts work very hard to use science to predict what the flu will look like each particular year and ‘tailor’ the vaccine to do that. Your daughter will most likely not be protected by last year’s vaccine, so it’s a good idea to have her get it this year too! - Hansa Bhargava MD

Behavioral question.

My son is 4 (almost 5) and recently started preschool. When he comes home from preschool he often has very bratty behavior--whining, demanding, making a mess just to get rise out of us. He is only ever like this after school and then for about an hour. The rest of the time and he is very well behaved and polite. My husband has suggested taking a video of him when he is going through one of these bratty episodes and then showing it to him when he is calm and normal to let him see how he gets. Is this a good idea at all? What should we be doing to correct the after-school behavior?

This is his second year in preschool and we saw the same behavior last year.

This is a great question and one probably many parents can relate to! Sometimes kids can exhibit bratty or whining behavior when they are hungry or tired. It can help to make sure that your child is getting enough rest and eating well at school. He or she may also need a healthy afternoon snack to avoid becoming “hangry.” Sometimes, this type of behavior is a sign that a child is overstimulated, which can often happen during a busy school day. Try to find activities that help your child wind down after their long day. Lastly, the after school-before dinner time is often called the “witching hour.” Parents are sometimes coming home from work, trying to make dinner, get homework done, etc. Your child may be acting out in order to get attention from the busy grown-ups around him. Try to take a minute to talk or play with your child before starting the tasks for the evening or better yet engage them to help with an age-appropriate task. - Smitha Bhandari, MD

How can you let kids off their phone? They're in 8th and 5th grade.

Screen time and how to limit it is such a big topic! I think setting a good example as parents is important for kids to see. Try to limit your access to your phone when you first get home, during meal times, and especially before bedtime. And explain to them why using a phone responsibly is important. Some parents find it helpful to set limits with phones until chores and homework are complete. Other families find a way to use phones as an incentive or reward. If you or your family are really struggling setting limits, consider a flip phone (vs. a smart phone) or using parental control apps to limit the phone’s access to the internet at certain times. - Smitha Bhandari, MD

My sons first day of school was yesterday he has been taken care of by family his whole life. He’s gotten home the last two days super nervous and is just continually asking us if he has to go back to school. He hasn’t done any of the activities he usually enjoys just constantly following us and us why he has to go back to school. Is there anything we can do to make him less nervous and have him go back to a normal routine?

Back to school is a really tough time for many kids- and it can take a few weeks to normalize. Talking to him and being present is key during these first few weeks. Also, basics like getting enough sleep, making sure he eats will also help. Lastly, make sure there is no bullying or other negative interactions happening at school- talk to him, and if you’re worried don’t be afraid to talk to your child’s school. - Hansa Bhargava MD

What would be some ways that we could make our kids more comfortable in their environment, so they don’t have a sense of being forced to go to school?

It can be helpful to talk to your kids about what they find stressful at school. That way you can help them focus on coming up with solutions. Sometimes, kids struggle with their academics. You can try talking with teachers, providing tutors or other supports, or even looking for learning differences in order to help. Sometimes, kids have a hard time with the social part of school. Here, engaging them in extracurricular activities or helping them arrange playdates can be helpful as well. You can also talk to a school counselor or a therapist in order to get a better idea of what might be bothering them. - Smitha Bhandari, MD

Schools is starting tomorrow for me and I am all ready dreading having to wake up. How do I fix this?

Ah, the plight of all of us! It is really hard to get back into the school year.

I would make sure that you get enough sleep and definitely remember to get enough hydration. Expect that it will take about a week to adjust to the new schedule, and give yourself that time. Lastly, make sure you don’t have too many other activities for the first 2 weeks, so you have time to settle in. - Hansa Bhargava, MD

My almost 2 year old just started Mother’s Day out after being with only me at home...she’s already sick and it’s week one! (Just a cold) But my questions are as follows... 1.) will she be sick a lot now that she’s around other children? Is this normal? And is there any truth to exposing her to germs now will make her healthier later in life? THANK YOU!

So exciting that your child is starting a social program. Being with other kids can definitely help social skills and language development! Kids do tend to get more minor infections like colds etc. when they first start programs that have other children- but that can help them ‘arm’ their immune system, so they don’t get sick later with those germs. I think that in general, it's a good idea for her to start this program, as you will get a lot of good exposure, even if there are some colds etc. - Hansa Bhargava MD

Evidence exists that bullying of medical trainees is more frequent in the psychiatry specialty than in other specialties.

Have you got any thoughts on that?

Some studies have shown that psychiatric trainees experience rates of bullying just as high, if not higher than other specialties. One recent study published in JAMA found similar rates in males and females, but higher rates in foreign-born trainees. Unfortunately, bullying can be seen in workplaces where a hierarchy or power/seniority differential exists. If you have experienced bullying in during training, talk to your residency or medical school coordinator. Bullying is to be taken very seriously as it can lead to depression, burnout, and other negative health effects. - Smitha Bhandari, MD

This may be a dumb question, but does my daughter need any kind of immunizations at her age? She's 11 and in 6th grade. I don't think she's had any shots since she was a preschooler.

Yes, she may need some boosters as well as others. Definitely talk to your doctor. - Hansa Bhargava, MD

My son has been in daycare since he was 4 months old. He gets some type of upper respiratory illness like once a month since he started day care and hes 22 months old now. Will he ever stop getting sick this often?

The short answer is yes. There are hundreds of viruses that your baby is meeting and learning to fight off in this stage of his life. As he gets older, you will probably see a slow down in the number of viral infections that he has. That has definitely been my experience for both of my children! - Neha Pathak, MD

Good ways to help kids not cry who are starting their very first year at elementary school?

She liked preschool well enough, but the length of the days at elementary school seem to be throwing her for a loop.

Just wondering if there are different things we can try to help her feel better about school, and being away from her family for a full school day.

Yes, a few tips: Act excited about her school and talk it up. 'How fun is what you do- I wish I could be there.' Arrange playdates with classmates. And try to make sure she gets a huge snack when she gets home, in case she's hungry, a balanced breakfast and lots of sleep. It's amazing how much of a difference 10 hours of sleep makes! - Hansa Bhargava, MD