Melanie Cole, MS (Host): Is it really that time again already? Are there kiddos going back to school already? I don't know where the time is going and why it's going so fast. Welcome to It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. And joining me to talk about getting our kids ready to go back to school is fan favorite, Dr. Neela Sethi. She's a pediatrician on the medical staff at Henry Mayo Newhall Hospital.

Dr. Sethi, thank you so much. You're always such a pleasure to have on here. But yikes, I mean, it's really gone so fast. I don't even know where the summer went. So, why don't we jump right into your best advice when you are talking to parents and they're going, "I don't even know what to do to start"? What's your best advice to get our kids starting now to get ready to go back to school?

Dr. Neela Sethi: Absolutely. I always tell parents, and this is a recurring theme for you and I, Melanie, is somewhere in the middle, parents love to go to extremes when it comes to back-to-school. So, there's the parent that's like, "Two weeks before, I'm going to get my kids to start to go to bed at 9:00 PM so that they can wake up early. And I'm going to be super strict about making sure that they get rest." And what ends up happening is resentment builds, because those kids still have two weeks of summer and they are not interested in going to bed at 9:00 PM as we know. I have two teenagers in my house, they're not going to bed at 9:00 PM. And it ends up causing anxiety and pre-school blues too soon.

And then, I have the other parent that says, "Well, I just want this to squeeze in every last bit of summer and do every last thing, and I'm not going to come up with a regimen for them," and their kids are going to bed at 1:00 or 2:00 AM for two and a half months straight, and then are dragging and can't get back into a pattern for the start of school.

So, I think somewhere in the middle. A few days before, you start with lights off earlier, decreasing screen time, making sure that they're not sleeping until 1:00 or 2:00 PM, getting them up earlier so that they can just start getting their circadian rhythm in the right pattern before school starts.

Now, there is one part of that that I always mention to parents, which is very important, which is they like to get their kids up in the morning with no plans. They just think that they're doing a good job by getting them awake. Well, guess what? When you have a teenager or even a middle school or even an elementary school kid who's been up late, and then you wake them up early with no plans, they're just going to go downstairs and turn the TV on and go right back to sleep. So, that means waking them up earlier, not at 6:00 AM, but earlier, and planning an activity with them, doing something with them so that you're getting the benefit of increasing their sleep time, putting them to bed earlier and waking them earlier. And in addition to that, having that squeezing in the last bit of summer time together and the bonding.

And so, I think a few days before is great, and I think waking them up earlier is great, but making sure that you're having activities from them or spending time with them on those early wake days because they're going to resent you. So if you can go and have fun and then they're nice and tired, so then they sleep well that night, it ends up benefiting everybody.

Melanie Cole, MS: You always have the best advice and you're so spot on, certainly because you have two teenagers, then we know you're right in the thick of it. And my kids being in their 20s, I remember all of this. And you're right on when you say they're just going to go right back to sleep, and unless you drag them out.

Now, obviously Dr. Sethi, a second grader is going to be a little bit different than maybe a high schooler. So, sort it out a little bit, because maybe our high schooler has had a summer job. So, maybe that they've had to get up, and it's not going to be quite as much of a shock as a second grader or maybe they did have camp, maybe they didn't. So, there's so many variables there. Sort that out a little bit when we've got the younger kiddos getting ready to go to a new grade, which is always so exciting. And then, our older kids who are like, "Ugh, please, I gotta start again." So, sort it a bit for us.

Dr. Neela Sethi: Absolutely. I think, and this is going to be a recurring theme for me from now to the end of time, with the teens, it's more important to focus on the mental health component of what's happening. "Are you mentally prepared for school? What's happening? What anxiety do you have about your teachers? How does your schedule look? How are you feeling? What's your confidence level? How can you prepare and get yourself into the right mental state to be able to handle the stresses that are coming?" Especially now, my daughter's going to be a sophomore, so she's got more AP classes. We're starting with just some early college prep talks, things like that, which it's like her grades now matter for college applications. And so, she's got more pressure on her plus friends and social behaviors and all of those things.

So, what I tell teen parents, the most important thing that you can do for them is to be there for them. Listen to them, prep them. And there's a 90-day sort of rule that we use for teens, and we really actually do for younger kids as well, where it takes about 90 days to get settled into school. It doesn't happen overnight. So if they're feeling like they're not acclimating and they feel like they're having a hard time with friends or they're feeling like they don't love school, like they come back like, "I hated it, mom. I hated it It was the worst day ever," try and take a breath and give them those 90 days. Because usually after 90 days, they'll find their feet, their footing.

With the little ones, they are a little different. Of course, they have mental health issues, but what they need is a lot of positive reinforcement and they do need to be focused on sleep and actual preparation. They like to have their things. Do you have their lunch packed? Do you have their backpack packed? Do they have their school supplies? Have you visited their classroom? Do they know their teachers? Do they know who they're sitting by? Do they know the schedule? Do they know what time lunch is at? Do they know what time you're picking them up? Have you walked them through their day? Have you picked out their first day of school outfit? Have you talked to the other moms so that they know that their friends are going to be there? Is there a way you could even meet their friends beforehand so everybody can walk in together? There's a lot of preparing in a mental health way for younger ones that you can do, but you show up for them differently than you would for a high schooler.

Now that being said, there's overlap, right? So, my kids we're doing back-to-school shopping today, and they are going to get their colored pencils and all their binders and all of those things, but it's a little different. It's more like a checklist versus the younger where it's really empowering for them to go and pick out their lunchbox and pick out their backpack and pick out their water bottle, and to have all those things set and to go into that next grade with confidence, knowing that they're prepared.

Melanie Cole, MS: Wow. I mean, you're going to make me cry because I remember those days and I remember the first day of kindergarten for both kids and standing in the line with their backpack and being so nervous. And you're right, because it is different depending on the age.

And when you mention mental health, and you and I have had so many talks about mental health, Dr. Sethi, the anxiety that comes with it, as you just said, prep is key, especially for our littler ones. They want to know that they've got all of their folders and their binders, and their crayons, and everything all set to go. But the anxiety for our older ones is of a different nature. Is there going to be bullying? Are they in their classes with their friends? What is different about this next year and the college prep? All of that anxiety. So, how do we mitigate-- how are you mitigating some of that anxiety while you think about grades for school and AP classes? And as you said, it's completely different. What can we do to help them? And while you're telling us that, what are some signs that that anxiety that we're seeing isn't just, "Hey, we can prep for this. We know you're going to have this many papers this year. So, let's make sure that we kind of get ahead of the game with our homework and that sort of thing. The anxiety's of a different nature. What can we do about that?

Dr. Neela Sethi: So, that's a great question. I think we talked about the younger kids and the handholding and just being that mama bear for them and showing up for them. And we used to do dry runs with our kids when they were in elementary. It's like, "Okay, do you want to drive by the school? Do you remember this gate? This is where your classroom is. This is your teacher." Going to your back-to-school night.

For the older kids, it's communication, communication, communication. Reassurance, reassurance, reassurance. "I am here for you. I am going to walk you through whatever. Whatever you navigate, I'm here for you. I am an eager listening ear. If you want to talk, great. If you don't want to talk, that's okay. What you need, I am here for." And then, the secondary part of that is, "Okay, when are we in a like red zone?" We usually allow parents that like 90 days, unless there's some major like red flags, which we'll talk about. We really tell parents, think about that from a psychological standpoint. It just takes a little bit to get your footing. And you feel more comfortable with time where you then figure out who's in your classes and you figure out what the schedule is and you get your sleep-wake cycle. So, we try to say before you panic, give them time.

Now, there are red flags to look for in teens. If they frankly don't want to go to school, and this happens over and over and over, that's something to talk to your pediatrician about. That's something to seek therapy for. And it's not just a one day thing, right? We're all going to have bad days. My daughter-- and there's times it's hard to wake her, you know? And she's like, "Oh gosh, I just wish I could call in sick," we all have that. But I mean, it's a consecutive thing where you cannot get your kid motivated. If you're noticing that their behaviors are changing, meaning they used to be this great eater and all of a sudden they're not eating, they're coming back and they haven't eaten breakfast, they haven't eaten lunch and they're eating a poor dinner, that's a red flag. Or the opposite where they are eating everything in sight and you are like, "Okay, this is not my normal kid. They're normally not like that. Undereating or overeating, those are both considered red flags." If they last for long periods of time, really strange sleep-wake cycles where you think you're putting them and getting them settled at 9:00 or 10:00 and you happen to use the restroom at 2:00 or 3:00 in the morning, they're still up or they're sleeping midday. Those are red flags.

If you notice what we call anhedonia, where the things that brought them joy don't. So, I know there's a couple things with my kids where I know they're going to say yes to, right? It's like I know their favorite restaurant. I know their favorite dinner. I know when they want to see their favorite person. And if I were to notice that my like eight-ball-kind-of-mom moments are not hitting for them and they're not kind of gravitating towards that, that's a red flag, or they're not wanting to practice. They don't want to hang with friends. They don't want to watch their favorite movie. They don't like their favorite candy. They don't want to go to their favorite restaurant.

Those are things where you start saying, "Okay, is this a pattern? And if so, should we seek help?" And my message to parents is the more that you can seek help sooner, the better. You need to find a pediatrician that you really care for that's going to lead you down that path. We're going to be able to say, "Hey, buddy, what's happening at school?"

In my teens, when I see that they have a lot of school anxiety, I'll pull the parents from their room and say, "Okay, tell me what's really going on. Is someone being unkind to you? Are you nervous about something?" Sometimes they get so nervous that they're going to mess up that they actually self-sabotage. And they will actually do poorly because they're like, "I was going to do poorly anyway, so I might as well just do poorly." Sometimes their negative voices in their head are so much that they need a therapist to navigate, and sometimes they're really dealing with a minor depressive episode or an anxiety episode that needs extra help or even medication. And none of those things are a bad thing. They all just need to be diagnosed and be taken to the right person and just to seek professional help.

And then, on the flip side, there's times that they're just teenagers. And they're just being moody and they don't want to wake up and they're playing video games, or they're FaceTiming with friends in the middle of the night, or they're on Snapchat instead of going to sleep. And you as a mother or a father know what those are. And you can say, "Nope, buddy, you're fine. You're not actually depressed, you're not actually having anxiety. You need to put your phone down and you need to get to bed and you need to get your schoolwork done. You're completely capable." And I leave that to the parents to navigate that.

Melanie Cole, MS: Certainly is a lot of navigating in those years. And you're right, our pediatrician is the best resource that we have. I just loved mine. And you're lucky you weren't mine. I would've loved to have you as a pediatrician. I'm sure I was a nightmare. But I loved her and she was so easy to call and say, you know, "This is going on," or "This is going on." She would talk to the kids. So, a great resource. They are the gold standards. You pediatricians, bless your hearts, man. I don't know how you do it dealing with us parents because we are nuts sometimes. But that's really, really important advice that you gave us, is to start there and recognize those red flags.

Now, we've just touched on nutrition a little bit, and you and I have talked about this before. And breakfast, certainly kids are running in the morning. Now, the bus is at 7:20 and you know they got to get out and everything. But I'd like you to give parents some tips for packing a lunch, maybe starting the night before. Getting that breakfast ready, maybe doing overnight oats, whatever it is to get it ready so that the kids do eat that breakfast. Because, I mean, I saw it with my son. If he didn't, he couldn't think straight. He certainly couldn't do gymnastics. He couldn't think straight. So, it's so important for parents to know the importance of healthy nutrition.

Dr. Neela Sethi: Absolutely. I think breakfast is a hard one. When they're younger, I think you have a little bit more control. So for a younger elementary and even middle school, I think the more that you can push it, the better. We know that they do better and their brain cells function better when they have proper nutrition in the morning.

For the high schoolers, they don't do a great job eating breakfast. Some do, and I love the ones that do, but a lot don't. And so, what I try to tell parents is, can you prep them with something that they can have at 10 o'clock? And I don't love protein bars. They're not my favorite thing, but there are some cleaner ones out there. But even if it's a yogurt and some fruit or something that they can carry, or even if it's a drink of some sort that has protein in it, and it's something where they can grab and they can kind of have it quickly so that they can kind of start their day, I do believe they do better. I force my kids for breakfast. I really do. I just force the issue. And so, we have an egg sandwich thing and we have different variations, and I just hand them to them to the car. I wake up early, I make egg sandwiches. They get in the car and they're not hungry. I hand them the egg sandwiches and, 90% of the time, those things are done.

Melanie Cole, MS: They eat them right away. They smell so good too.

Dr. Neela Sethi: Yeah, it's a warm, yummy egg sandwich. It's protein, it's carbs, it's fat, you know, and they get it and they eat it. So, that's what I do in my house, just to have them have something. Because what happens with these teens is that they miss breakfast, and they either overeat because they're starving and they make really horrible choices. When they do overeat or they drag, they drag, they drag. And when they drag, then we see all the bad stuff happening, because they're not paying attention in school and their grades can suffer. So, nutrition is of huge importance. And yes, the more that you can prepare, the better.

I get like the Trader Joe's precooked bacon, I get the Trader Joe's precooked apple sausage. I have my English muffins precut and set. I pop them. I have a complete system for how I do breakfast in the morning, and I just try my best knowing that they're going to make better choices later if they're not starving.

Melanie Cole, MS: Me too. I did the same with my kids. I did a lot of stuff the night before. I had a lot of stuff prepared. And for parents, I mean, really the advice she just gave you is key. Because if you're running around getting ready for work and your kids are running around getting ready for school, nobody's in a great mood. And it's really hard to then take everything out and cut the strawberries and wash the blueberries and do whatever it is you're going to do. So, whatever you can get done that night before is going to be paramount to making those better choices and packing lunches. Anything that's dried, you can pack, pre-pack the night before and then just pull the other stuff right out of the fridge. I mean, a lot of ways and there's a lot of resources to do that. Now, Dr. Sethi, as much advice as you're giving us, I'd like to ask you for one more piece.

Dr. Neela Sethi: Please.

Melanie Cole, MS: Wrap it up for us. I'd like you to talk to parents like you do every day as a pediatrician and tell them what you want them to know about that communication, about that prep work of kind of starting now, but moderating, not starting too early, and really getting our kids geared up, because it's a tough time in this country and everybody's on edge and there's a lot of anxiety. And going back to school just kind of layers that on. So, offer it up and give us your best advice as the expert that you are.

Dr. Neela Sethi: Absolutely. It would go something like this: Hey, mom. Hey, dad. Just so you know, you are still in control. And while you may feel like things are out of control and the world is not in your control, what you do have control over is the love and the advice and the communication and the nutrition that you provide to your child. No one knows your kid more than you. No one knows your kid better than you. Trust your gut instinct and pre prepare. Now, again, everything in moderation. You don't need to take two weeks to plan back to school. You don't need to create anxiety for your kid by overprepping. But you also don't need to be flippant about it and just wish and hope that it all happens the night before. That's not good for your kid either. And that creates anxiety because they're not prepared. Take a few days. Take a week. Start them on a better sleep cycle. Spend quality time with them. Talk to them. Tell them, "I'm here for you. I love you. Let's talk about choices for lunches that you would like. What are some breakfast items? Maybe we're going to go to the grocery store today. Let's practice some recipes. Did you like that sandwich? Did you not? Did you like this bread? Did you not--" Put them in the driver's seat? Empower them. Make them feel like they have control in a world where they don't.

And then, go easy on yourself. Kids are very resilient. They are going to be okay. Give them that 90 days to sort of settle in. Don't beat yourself up if the first day or the first week or the first couple weeks doesn't go well. On the flip, follow your gut instinct. If your mommy or your daddy instinct is telling you that something's not right, seek help. Go to your pediatrician, talk to them, tell them that you're worried. Go to your school counselor and say, "Hey, things aren't working right for my kid or don't feel right." Advocate for your child, but do it in an empowered way. You are going to do great. It's going to be a great year.

Melanie Cole, MS: It's going to be a great year. What a lovely way to end this episode, because it's true and it can be such a wonderful time for the kids. As much as they might say they don't like school, they really do because there's the social aspect and the learning and the growing. And, you know, really, it tests their brain and helps them to develop into the adults that we want them to develop into. So, that's what it's all about, and the resilience, as you say.

Thank you so much, Dr. Sethi, for joining us. As always, what a great, great guest you are and just full of so much great advice. So, thank you again for joining us. And you can find more back-to-school tips in the Henry Mayo Newhall Hospital free online health library at library.henrymayo.com. That concludes this episode of It's Your Health Radio with Henry Mayo Newhall Hospital. I'm Melanie Cole. Thanks so much for joining us today.