08/20/2012 11:59 EDT | Updated 10/20/2012 05:12 EDT

Late summer prep can help kids off to a healthy start of school year

TORONTO - Angela Di Paolo enjoyed good health during the maternity leave she took after giving birth to her daughter, who is now two. But when the elementary school teacher went back to work last fall, the miasma of germs that hovers over young school-aged children quickly engulfed her.

In the first week of school she picked up hand, foot and mouth disease, which she unwittingly brought home to her two kids. A bout of bronchitis quickly followed.

Di Paolo, who teaches Grades 2 and 3 at Elizabeth Simcoe Junior Public School in Scarborough, Ont., ended up missing about two weeks of work in September alone.

As parents and teachers of young children well know, the annual resumption of classes is invariably followed by waves of illness. Coughs and colds. Stomach bugs. In some cases unsettled parents have to deal with head lice or scabies, an infectious and itchy skin condition caused by minute mites.

"Every September is just the beginning of the cold and flu season for us. And it progresses from there," says Di Paolo, who capped that eventful fall term with a case of chickenpox just before Christmas.

"It just spreads through the school so quickly."

Where colds and flu normally hit adults in the dead of winter, the massing of hoards of children in late August or early September turns schools into germ factories.

"Probably the rationale for it is most childhood illnesses are caused by viral infections. And viruses are generally quite catchy — so, contagious — and they tend to be spread most easily if you have a whole lot of children in an enclosed space," says Dr. Jeremy Friedman, head of pediatric medicine at Toronto's Hospital for Sick Children.

"You're putting 20 or 25 children in very close proximity, indoors. And essentially anybody who might be harbouring a virus — which, you know, probably is happening all the time — if they're coughing, sneezing, touching things, that virus is obviously much more likely to spread to some of their classmates."

Some of this disease swapping is inevitable. Young children are still building the immunological armour they need to get through a lifetime of exposure to disease threats. Immunity is acquired by exposure to these foes, either through immunization or by contracting and fighting off illness-causing agents.

Friedman likens the spate of sicknesses that school-aged children experience to a rite of passage.

"Honestly, that is what we tell parents, particularly of young children when they're starting daycare or kindergarten," he says.

"That is how you build up your immune system. You have to be exposed to these viruses in order to develop some immunity to them. So yes, I think that is part of the natural progression of things."

The younger the child, the more pronounced the pattern, Friedman says.

"Every single parent who takes their child to kindergarten or daycare will notice in the first few months the sudden upswing there. They're always sick."

Still, he and others say there are steps parents can take in the waning days of summer to improve their kids' chances of making a healthy transition to school.

The start of the school year is a good time to take a look at a child's vaccination status, says Dr. Bob Bortolussi, a pediatric infectious diseases specialist at IWK Health Centre in Halifax, and a past chair of the Canadian Pediatric Society's infectious diseases and immunization committee.

"It's a good reminder," says Bortolussi. "Because ... if kids aren't immunized, all of those — measles, mumps, rubella — can be a problem."

All provinces and territories recommend that children have a booster shot of diphtheria, tetanus, pertussis and polio vaccine between the ages of four and six — so around the time they start kindergarten or Grade 1. Some children in that age group also need a booster of the measles, mumps, rubella and chickenpox shot.

All jurisdictions also recommend a booster shot for pertussis — whooping cough, which has been making an alarming comeback — for junior high school-aged students. It's recommended for Grade 9 students in most provinces and territories, but Grade 7 in Nova Scotia and Grade 8 in Saskatchewan.

(The Public Health Agency of Canada has a useful tool on its website at to help parents keep track of what shots their children need. Plug in your province and your child's grade level and it will tell you what shots he or she should have in the next few years.)

While there are vaccines for the most serious ailments, modern science hasn't yet developed preventatives for the myriad bugs that cause colds — rhinoviruses, adenoviruses, respiratory syncytial virus. Nor is there a vaccine to protect against highly infectious noroviruses, which trigger vomiting and diarrhea.

But teaching kids good hand hygiene should help reduce their risk of contracting these bugs. Bortolussi suggests the next week or two is an opportune time to practise hand washing with children, to remind kids of the importance of washing their hands after going to the bathroom and before eating meals.

Remind them, too, to cover their coughs, Friedman suggests.

"These things, they sound ridiculously like obvious common sense, but they actually have been shown to be the single most effective way of trying to protect your child from these kinds of viral illnesses," he says.

Friedman also suggests using the remaining days of the summer vacation to get school-aged kids back on their school sleep schedule. Adjusting to getting up in time for school isn't easy to do in a single day, he says.

Friedman adds a few words of advice for parents of kids with serious allergies — the type that can induce anaphylatic shock — and asthma.

Children with these conditions should head off to school armed with EpiPens (devices that inject a dose of adrenaline to counter an allergic attack) and MedicAlert bracelets. Teachers should be notified of the condition.

In the case of kids with asthma, parents should give schools asthma plans to be used if their child suffers an attack while at school.