It takes more than new school clothes, notebooks, backpacks and art supplies to be sure children are prepared to learn when they return to class this month.
Pediatric health advocates say the back-to-school routine should include a trip to the doctor's office for an annual checkup and screenings for what the experts call health barriers to learning.
“Many factors contribute to less than optimal academic performance, especially for children who live with persistent adversities or chronic stress," the Children's Health Fund says in its 2018 study, 'Missed opportunities: Do states require screening of children for health conditions that interfere with learning?'
“Unrecognized or under-managed health conditions are often among these reasons,” the study's authors said. “Yet many such conditions represent basic health needs, which can be identified relatively easily and can be treated or addressed by a medical professional.”
The six most significant health barriers to learning are uncorrected vision problems, unaddressed hearing difficulties, uncontrolled asthma, dental pain, persistent hunger and unaddressed behavioral health issues, said Dr. Irwin Redlener, pediatrician and president emeritus of Children's Health Fund.
"By establishing a routine, year after year, we can recognize things before they become a problem," said Susan E. Dock, a Certified Registered Nurse Practitioner at Family Medicine of Evangelical-Middleburg. "A yearly physical is always smart."
The organization supports mandatory annual screenings for all six health barriers.
“Of all the things we might do in an annual checkup, these are the things we must do,” Redlener said in a telephone interview from New York.
Redlener and singer-songwriter Paul Simon founded the Children's Health Fund, a nonprofit organization dedicated to providing health care to disadvantaged children and families.
Many of those children face obstacles to education, such as uninvolved or absent parents, inferior schools and stresses at home that are beyond their control, Redlener said.
“The least we can do is find out if they are suffering from any health problems that can affect their learning,” he said.
State of screenings
The “Missed Opportunities” study rated states based on what screenings were required for schools in each state. Pennsylvania was among six states earning a B grade. Only Washington, D.C., was given an A, and a staggering 29 state scored D or F.
In Pennsylvania, only vision and growth screenings are required annually, and they are completed in schools. Schools are required to provide hearing screenings for students in kindergarten and grades one, two, three, seven and 11, the state Health Department website says.
Children entering Pennsylvania schools for the first time and those entering sixth and 11th grades are required to have health exams by clinicians. Pennsylvania also requires students to have updated vaccinations before entering public schools.
The study's authors stressed the value of children getting annual, thorough exams, which include screenings. Redlener says making the health exam an annual requirement could help identify more health barriers to learning.
"It's really preventative medicine," said Dock.
Dr. Jeff Cook of Pediatric Care Specialists says it makes sense to require annual physicals for all students. The Johnstown physicians group encourages annual exams for all its patients.
“If they are in sports, the (Pennsylvania Interscholastic Athletic Association) requires it. They have to get that exam every year,” Cook said. Summer camps require that physical every year. Are schools so much different?”
'Consistency of care'
Annual vision screenings have made a difference for many children by identifying the need for glasses, said Tracy Pecora, school nurse for Greater Johnstown High School.
“It's hard to learn if you can't see the board or the book,” she said.
Although Pecora agrees that all the screenings are valuable, she says consistency in health care can help identify issues beyond the required tests.
She sees many families relying on emergency rooms and urgent-care centers for primary medical care.
“Consistency of care gets lost sometimes,” she said. “It's so important for one physician or practice to be following the child, year in and year out.”
"Having a primary care provider, the same person, do the check-up year after year is great," Dock said. "They can learn the family, building relationships and trust with the children. They can be intimidated by adults. A PCP that sees the same child year-after-year may also recognize a change in vision or hearing."
Doctors are just part of the answer, Cook said, but they can further a child's success by working as a team with parents and schools.
“It's always best to have a close relationship with a health care provider and the school system to give kids the best chance,” Cook said. “And sometimes you have to nudge them in the right direction, as a parent, as an advocate for them.”
Redlener said the “Missed Opportunities” report was developed for four audiences: Parents, doctors, schools and legislators.
Parents should “bring a list” of the screenings to the doctor's office with their children. Schools should make teachers aware of signs that a child is affected by one of the health barriers to learning.
"Parents should be proactive," Dock said. "They see the children every day, we only see them for 30 minutes once a year. Mom and dad will recognize their kids squinting or saying 'what?' more often. If you notice something, say something. It's important for mom and dad to have a good relationship with the PCP."
Doctors should not only be doing the screenings but be asking additional questions about situations at home that could affect learning. And legislators and policymakers should be advocating to make changes to help identify barriers to learning, Redlener said.
Randy Griffith covers health care for The (Johnstown, Pa) Tribune-Democrat. Follow him on Twitter @photogriffer57. Daily Item editor Bill Bowman contributed to this story.