August is Eye Health and Safety Month


Healthy eyes and vision are a critical part of kids' development. Their eyes should be examined regularly, as many vision problems and eye diseases can be detected and treated early.

Eye Doctors
Be sure to make vision care and eye checks a part of your child's routine medical care.
Different kinds of doctors offer eye care, and the names can be confusing:
  • ·        Ophthalmologists are medical doctors who provide comprehensive eye care with medicine and surgery.
  • ·        Pediatric ophthalmologists are doctors who have additional special training to treat kids' eye problems.
  • ·        Optometrists provide services that may be similar to ophthalmologists, but they don't perform surgery. Some optometrists specialize in kids' eye problems.
  • ·        Opticians fit and adjust eyeglasses.

Eye Exams
Routine medical exams for kids' vision include:
  • ·        Newborns should be checked for general eye health by a pediatrician or family physician in the hospital nursery.
  • ·        High-risk newborns (including premature infants), those with a family history of eye problems, and those with obvious eye irregularities should be examined by an eye doctor.
  • ·        In the first year of life, all infants should be routinely screened for eye health during checkups with their pediatrician or family doctor.
  • ·        Around age 3½, children should have eye health screenings and visual acuity tests (tests that measure sharpness of vision) with their pediatrician or family doctor.
  • ·        Around age 5, children should have their vision and eye alignment checked by their pediatrician or family doctor. Those who fail either test should be examined by an eye doctor.
  • ·        After age 5, routine screenings should be done, and if symptoms such as squinting or frequent headaches occur. (Many times, a teacher will notice that a child isn't seeing well in class.)
  • ·       Children who wear prescription glasses or contacts should have annual checkups by an eye doctor to screen for vision changes.

Spotting Eye Problems
Signs that a child may have vision problems include:
  • ·        constant eye rubbing
  • ·        extreme light sensitivity
  • ·        poor focusing
  • ·        poor visual tracking (following an object)
  • ·        abnormal alignment or movement of the eyes (after 6 months of age)
  • ·        chronic redness of the eyes
  • ·        chronic tearing of the eyes
  • ·        a white pupil instead of black

In school-age children, other signs to watch for include:
  • ·        being unable to see objects at a distance
  • ·        having trouble reading the blackboard
  • ·        squinting
  • ·        difficulty reading
  • ·        sitting too close to the TV

Watch your child for signs of poor vision or crossed eyes. If you notice any eye problems, have your child examined right away so that the problem doesn't become permanent. If caught early, eye conditions often can be corrected.

Common Eye Problems
Several eye conditions can affect kids. Most are detected by a vision screening using an acuity chart during the preschool years.

Amblyopia ("lazy eye") is poor vision in an eye that may appear to be normal. Two common causes are crossed eyes and a difference in the refractive error between the two eyes. If untreated, amblyopia can cause irreversible visual loss in the affected eye. (By then, the brain's "programming" will ignore signals from that eye.) Amblyopia is best treated as early as possible, ideally before a child is 8 years old.

Strabismus is a misalignment of the eyes; they may turn in, out, up, or down. If the same eye is chronically misaligned, amblyopia may also develop in that eye. With early detection, vision can be restored by patching the properly aligned eye, which forces the misaligned one to work. Surgery or specially designed glasses also may help the eyes to align.

Refractive errors mean that the shape of the eye doesn't refract (bend) light properly, so images appear blurred. Refractive errors also can cause amblyopia. Nearsightedness is the most common refractive error in school-age children; others include farsightedness and astigmatism:

  • Nearsightedness is poor distance vision (also called myopia), which is usually treated with glasses or contacts.
  • Farsightedness (also called hyperopia), which is usually treated with glasses or contacts.
  • Astigmatism is imperfect curvature of the front surface of the eye, which is usually treated with glasses if it causes blurred vision or discomfort.

Other eye conditions need immediate attention, such as retinopathy of prematurity (a disease that affects the eyes of premature babies) and those associated with a family history, including:
  • ·        Retinoblastoma is a malignant tumor that usually appears in the first 3 years of life. The affected eye or eyes may have visual loss and whiteness in the pupil.
  • ·        Infantile cataracts can occur in newborns. A cataract is a clouding of the eye's lens.
  • ·        Congenital glaucoma in infants is a rare condition that may be inherited. It is the result of high pressure in the eye from incorrect or incomplete development of the eye drainage canals before birth and can be treated with medication and surgery.
  • ·        Genetic or metabolic diseases of the eye, such as inherited disorders that make a child more likely to develop retinoblastoma or cataracts, may require kids to have eye exams at an early age and regular screenings.

Be sure to talk to your doctor if your child is at risk for any of these conditions.

Old wives' tales abound about the eyes. From watching TV to eating carrots, here's the lowdown on some vision facts and fiction.

Myth: Sitting too close to the TV is bad for the eyes.
Fact: Although parents have been saying this ever since TVs first found their way into our homes, there's no evidence that plunking down right in front of the TV set damages someone's eyes. The American Academy of Ophthalmology (AAO) says that kids can actually focus up close without eyestrain better than adults, so they often develop the habit of sitting right in front of the television or holding reading material close to their eyes. However, sitting close to a TV may be a sign of nearsightedness.

Myth: If you cross your eyes, they'll stay that way.
Fact: Contrary to the old saying, eyes will not stay that way if you cross them. If your child is crossing one eye constantly, schedule an evaluation by an ophthalmologist.

Myth: If parents have poor eyesight, their kids will inherit that trait.
Fact: Unfortunately, this one is sometimes true. If you need glasses for good vision or have developed an eye condition (such as cataracts), your kids might inherit that same trait. Discuss your family's visual history with your doctor.

Myth: Eating carrots can improve vision.
Fact: Although it's true that carrots are rich in vitamin A, which is essential for sight, so are many other foods (asparagus, apricots, nectarines, and milk, for example). A well-balanced diet can provide the vitamin A needed for good vision, says the AAO.

Myth: Computer use can damage the eyes.
Fact: According to the AAO, computer use won't harm the eyes. However, when using a computer for long periods of time, the eyes blink less than normal (like they do when reading or performing other close work). This makes the eyes dry, which may lead to a feeling of eyestrain or fatigue. So encourage your kids to take frequent breaks from Internet surfing or video games.

Myth: Two blue-eyed parents can't produce a child with brown eyes.
Fact: Two blue-eyed parents can have a child with brown eyes, although it's very rare. Likewise, two brown-eyed parents can have a child with blue eyes, although this is also uncommon.

Myth: Only boys can be color-blind.
Fact: It's estimated that up to 8% of boys have some degree of color blindness, whereas less than 1% of girls do.

Myth: The eye is full size at birth.
Fact: The eye is NOT full size at birth but continues to grow with your child. This growth partially accounts for refractive (glasses) changes that occur during childhood.

Myth: Wearing glasses too much will make the eyes "dependent" on them.
Fact: Refractive errors (near-sightedness, far-sightedness, or astigmatism) change as kids get older. Many variables come into play, but most of this change is likely due to genetics and continues despite wearing glasses earlier or later or more or less. Wearing glasses does not make the eyes get worse.



Eye injuries are the most common preventable cause of blindness. While many minor eye irritations can be treated at home by flushing the eye with water, more serious injuries need medical attention. So when in doubt, err on the side of caution and call your doctor for help.

What to Do:

Routine Irritations
(sand, dirt, and other foreign bodies on the eye surface)
  • ·        Wash your hands thoroughly before touching the eyelids to examine or flush the eye.
  • ·        Do not touch, press, or rub the eye itself, and do whatever you can to keep your child from touching it (a baby can be swaddled to prevent this).
  • ·        Do not try to remove any foreign body except by flushing. Other methods can scratch the surface of the eye, especially the cornea.
  • ·        Tilt your child's head over a basin or sink with the affected eye down and gently pull down the lower lid. Encourage your child to open the eyes as wide as possible. For an infant or small child, it's helpful to have a second person hold the child's eyes open while you flush.
  • ·        Gently pour a steady stream of lukewarm water (do not heat the water) from a pitcher or faucet over the eye.
  • ·        Flush for up to 15 minutes, checking the eye every 5 minutes to see if the foreign body has been flushed out.
  • ·        Because a particle can scratch the cornea and cause an infection, the eye should be examined by a doctor if irritation continues after flushing.
  • ·        A foreign body that remains after flushing probably will require removal by a trained medical professional.

Embedded Foreign Body
(an object penetrates or enters the globe of the eye)
  • If an object, such as a piece of glass or metal, is sticking out of the eye, take the following steps:
  • ·        Call for emergency medical help or bring the child to the emergency room.
  • ·        Cover the affected eye with a small cup taped in place. The point is to keep all pressure off the eye.
  • ·        Keep your child (and yourself) as calm and comfortable as possible until help arrives.

Chemical Exposure
  • ·        Many chemicals, even those found around the house, can damage an eye. If your child gets a chemical in the eye and you know what it is, look on the product's container for an emergency number to call for instructions.
  • ·        Flush the eye (see Routine Irritations) immediately with lukewarm water for 15 to 30 minutes. If both eyes are affected, flush them in the shower.
  • ·        Call for emergency medical help.

Call your local poison control center for specific instructions. Be prepared to give the exact name of the chemical, if you have it. However, do not delay flushing the eye first.

Black Eyes and Blunt Injuries

A black eye is often a minor injury. But this bruising also can be the result of a significant eye injury or head trauma. A visit to the doctor or an eye specialist might be needed to rule out serious injury, particularly if you're not sure what caused the black eye.

For a black eye:
  • ·        Apply cold compresses intermittently: 5 to 10 minutes on, 10 to 15 minutes off. If you use ice, make sure it's covered with a towel or sock to protect the delicate skin on the eyelid.
  • ·        Use cold compresses for 24 to 48 hours, then switch to applying warm compresses intermittently. This will help the body reabsorb the leakage of blood and may help reduce discoloration.
  • ·        If the child is in pain, give acetaminophen — not aspirin or ibuprofen, which can increase bleeding.
  • ·        Prop the child's head with an extra pillow at night, and encourage him or her to sleep on the uninjured side of the face (pressure can increase swelling).
  • ·        Call your doctor, who may recommend an in-depth evaluation to rule out damage to the eye.

Call immediately if you see any of these problems:
  • ·        increased redness
  • ·        drainage from the eye
  • ·        lasting eye pain
  • ·        any changes in vision
  • ·        any visible abnormality of the eyeball
  • ·        visible bleeding on the white part (sclera) of the eye, especially near the cornea

If the injury happened during one of your child's routine activities, such as a sport, follow up by investing in an ounce of prevention — protective goggles or unbreakable glasses are vitally important.


Scabies  Acne and Mosquito Bites
Rash Comparisons


Scabies (say: SKAY-beez) is an itchy skin condition caused by teeny, tiny mites that dig tunnels underneath the skin's surface. Scabies is caused by a small, eight legged mite called Sarcoptes scabiei.  Mites are part of the arachnid family, the same family that includes spiders and ticks. Scabies mites have eight legs and a round body and are pretty hard to see. When they're fully grown, each mite is no bigger than the size of the point of a pin.  Scabies is spread by close physical contact and is common in school-age children. If left untreated, it will usually spread to all members of a child's family. The mites and their eggs may live on clothes or bed linen for 1-2 days.

Anyone can get scabies — little babies, adults, children. The mites aren't picky. They don't care if you're clean, dirty, rich, or poor. All they want is to live on or in the skin of a human being, and any human being will do.

Signs and symptoms
It is often difficult to diagnose scabies because the symptoms vary and the signs can be very subtle. Commonly, the symptoms include:
  • Bullae - raised, clear fluid-filled spot or lesion that are bigger than 1cm in diameter
  • Papules - solid, raised areas of skin with distinct borders less than 1cm in diameter
  • Pustules - raised, fluid-filled spot that appear yellow
  • Vesicles - raised, clear fluid-filled spots
Lesions or spots are areas of skin disease and are generally small.
A number of mites burrow into the skin, particularly between the fingers, around the wrists and elbows, the armpit, nipples and penis. In infants and young children, there are often vesicles and pustules on the palms and soles and sometimes on the scalp. It is the allergic reaction to these mites that causes the rash and symptoms.
Sometimes the only symptom is an itch, without a rash. Usually the itch is worse at night and after a hot bath or shower. Bathe your child in warm water as hot water may make the itching worse.
Your doctor may make a diagnosis by scraping a burrow and looking at that skin under a microscope. Scabies may be easier to diagnose by rubbing a black marking pen over a suspected burrow and then wiping it off with an alcohol swab. This leaves a burrow outlined with the ink from the pen.
  • The child and all close contacts should be treated at the same time
  • 5% permethrin cream is recommended and should be applied to all body surfaces from the neck down (paying particular attention to hands, under the nails and the genitals) and left on overnight. This treatment can be bought from a pharmacy.
  • Treatment should be repeated a second time, 1 week later
  • In young babies, 6% precipitated sulphur is preferred
  • Bedding and clothing should be washed in hot water and if possible, dried in a machine on a hot setting.
  • Items that cannot be washed and dried this way can be put in air-tight containers or bags for 36 hours or in the freezer for a couple of days.  There’s no need for extensive washing or decontamination of the child’s room or the rest of the house, since the mite usually lives only in people’s skin. 
Do not apply the initial treatment more than twice. The itching caused by scabies may take up to three weeks to go away after treatment. In fact, the treatment itself may cause some irritation. Your doctor can prescribe a corticosteroid cream for this if needed.
Sometimes nodules (raised, solid lesions) caused by scabies can last for months, even with the corticosteroid cream. If this happens, see your doctor for further treatment.
Return to work/school — Children can usually return to school after one treatment for scabies. Classmates and teachers do not usually need to be treated unless there are signs or symptoms of scabies infection.
Key points to remember

  • Scabies is spread by close physical contact and is common in school-age children
  • If left untreated, it will usually spread to all members of a child's family
  • The mites and their eggs may live on clothes or bed linen for 1-2 days
  • 5% permethrin cream is recommended and should be applied to all body surfaces from the neck down
  • In extremely young infants, 6% precipitated sulphur is preferred
  • Treatment should be repeated a second time, 1 week later

Flu Season


When flu season arrives, we want to keep the school open and functioning as normal for as long as possible. We need your help to do this.

The School Nurse conducts active fever and symptom screening and will monitor students for symptoms of a respiratory infection such as fever, cough, sore throat, runny or stuffy nose, body aches and fatigue. Any student who has at least 2 of these symptoms will be separated from others and sent home as soon as possible. 

We ask that students with influenza-like illness remain at home until at least 24 hours after they are free of fever (100° F [37.8°C]), or signs of a fever without the use of fever-reducing medications. They should stay home even if they are using antiviral drugs.  If your child has developed severe respiratory symptoms as a part of the flu, we ask that they stay home until the coughing, sneezing and nasal drainage have subsided to a point where they are not actively passing the influenza virus to others.  The CDC has indicated that young children can be contagious for up to 10 days after they get the flu, especially young children who do not practice good respiratory etiquette and hand hygiene without constant adult supervision.

From the CDC:  Many people with influenza illness will continue shedding influenza virus 24 hours after their fevers go away, but at lower levels than during their fever. Shedding of influenza virus, can be detected for 10 days or more in some cases. Therefore, when people who have had influenza-like illness return to work, school, or other community settings they should continue to practice good respiratory etiquette and hand hygiene and avoid close contact with people they know to be at increased risk of influenza-related complications. Because some people may shed influenza virus before they feel ill, and because some people with influenza will not have a fever, it is important that all people cover their cough and wash hands often. To lessen the chance of spreading influenza viruses that are resistant to antiviral medications, adherence to good respiratory etiquette and hand hygiene is as important for people taking antiviral medications as it is for others. 

What Can You As A Parent Do?

Here are a few things you can do to help since flu conditions are now more severe.

·           Teach your children to wash their hands often with soap and water. You can set a good example by doing this yourself.    Washing your hands with soap and water for at least 20 seconds (the time it takes to sing "Happy Birthday" twice) is the best way to keep your hands from spreading the virus. 

·           Teach your children not to share personal items like drinks, food or unwashed utensils, and to cover their coughs and sneezes with tissues.  If they don't have a tissue, they should cough or sneeze into their upper sleeve, not their hands. 

·           Know the signs and symptoms of the flu. Symptoms of the flu include fever (100 degrees Fahrenheit, 37.8 degrees Celsius or greater), cough, sore throat, a runny or stuffy nose, body aches, headache, and feeling very tired.  Some people may also vomit or have diarrhea.

·           Extend the time sick children stay home for at least 7 days, even if they feel better sooner. People who are still sick after 7 days should continue to stay home until at least 24 hours after symptoms have gone away.

·           If a household member is sick, keep any school-aged brothers or sisters home for 5 days from the time the household member became sick. Parents should monitor their health and the health of other school-aged children for fever and other symptoms of the flu.

·           Don't send children to school if they are sick. Any children who are sick at school will be sent home. Staying home when sick will allow your children to rest and allows you to monitor their health closely. Keeping your sick child home is the responsible thing to do. It protects fellow students and school staff, especially those who are at higher risk of severe illness from the flu.

A Healthy School Year

A School Nurse’s thoughts on food, sleep, hygiene, stress, allergies, medication, keeping kids home, and begin a new year:

Exercise and nutrition are key to your child's well-being. These as sensitive issues for many parents. While parents want healthy children, it's hard to stop serving processed food or to limit children's excessive electronic-game playing and TV viewing.  Parents often lose sight of basic nutrition by focusing only on obesity or anorexia. Eating issues are especially challenging in our society, where portions are super-sized.  Use cooking time as a springboard for discussion about food choices.  When children prepare food, they become more familiar with healthy ingredients.  I am always concerned about children who skip breakfast--noting that many wind up in my office with headaches.  As I explain to them, “breakfast” means breaking the fast from dinner last night.  If they don’t feed their brains after the fast they cannot think straight with a hunger-headache.  Morning is their most productive learning time.  If you don’t feed them a good breakfast, you are not giving them a good start to their best time of the day.

Many children are sleep deprived. They're up late online or watching TV in their rooms. The next morning they're on their way to school at 7:30 AM. A child who is exhausted can't concentrate in school.

Hand washing is the key to curbing colds, viruses, and other infections. Children should learn to sneeze into the nook of their arms and parents should make sure that alcohol-free liquid hand cleaners (Purell, for example) are readily available in their child's classrooms when hand washing cannot be the first option.  If your teacher doesn’t have alcohol-free hand sanitizer in their room, buy them a bottle!

Children sometimes come into my office because they need a respite--some time to unwind. Children may be grappling with difficult situations at home or going through a stressful phase in their life.  We need to teach children to relax, to take deep breaths.   I often treat children with stress-related headaches and stomachaches. Children often confide in me that their stress stems from their social life as well as from schoolwork.  Parents may not always be aware of just how much things like tests, birthday parties, and peers affect their children.  First and foremost, parents need to "relax." Parents worry too much--and often about the wrong things. In trying to micromanage their children's lives, they may transfer their own anxiety to their kids. Kids need to develop the confidence that they'll be okay and this is best taught by the parents!

I would like to remind parents of the benefits of play to relieve stress. Children need to be outside, using their imaginations. Creative games, board games, active games, and fantasy play all help reduce their stress.

Is your child a frequent visitor to the nurse?  Try this Three Things Rule for children to begin teaching them ways to promote their own comfort and solve their own problems.  Got a belly ache?  You cannot come to the nurse until you have tried the following:   1. Used the bathroom   2. Eaten a non-junk food snack   3. Had 2 glasses of water.  In other words, gas pains, bathroom needs, thirst, and hunger are things kids can solve without a nurse. This can work for other discomforts too.  This is not about discouraging kids from seeking help, this is about teaching them self-care and prevention.  Parents can help by making sure their child has a water bottle every day (not just the one for lunch) and a non-junk food snack or two in their backpacks.

Food allergies, notably to peanuts, have become an increasing concern--and that many children keep EpiPens in the classroom or nurse's office to use in case of emergency.   When sending snacks, please do not send anything with peanuts or tree nuts in them.  Find out if there are other allergies specific to children in your child’s classroom and don’t send snacks or birthday treats that contain those ingredients.

I see a lot of asthma, made worse by pollutants.  Second-hand smoke or allergies to a pet may trigger a reaction, as can cleaning fluid fumes and perfumes.  I can’t tell you the number of children that are suppose to be carrying their inhalers that are not.  Many a parent has been called and had to run frantically to school with a rescue inhaler.

I treat a number of children on medication for ADHD.  Unfortunately, some parents don't tell the school that a child is on medication. It is not until they forgot to take it at home and they have become unmanagable, that I find out the child is on medication for this problem.

Keep the nurse informed.  It may not be until a school trip that the school is informed that a child needs to bring an inhaler or medication.

Influenza, Strep throat and pink eye (conjunctivitis) are among the biggest problems when it comes to infectious diseases.  While parents need clear guidelines about when to keep children home, many working parents face difficult choices--and just hope that their children don't get sick.  I will call a parent to pick up a child from school if a fever goes over 100, and despite the inconvenience, I have found most parents are generally cooperative.  Arrangements should be made before school starts for an emergency contact in case a parent just can’t leave work, perhaps a relative that stays home or a close friend who would be willing to watch your child so you can finish your work day.  There's no point in a child being in the classroom if he can't function.  

Go to the post on When to Keep Your Child Home for more advice on this subject ... and remember:  A sick child cannot learn effectively and is unable to participate in classes in a meaningful way. Keeping a sick child home prevents the spread of illness in the school community and allows the child opportunity to rest and recover.