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Back-to-School: How to Help Young Children Return to the Classroom

Q&A With Cesar Ochoa, MD, Director of Developmental-Behavioral Pediatrics

The start of the school year can be tough for many children. For some, the struggle might last just a few days. For others, however, a difficult transition back to school might be a sign of an undetected behavioral or developmental condition that requires medical attention.

That’s where a pediatrician can help.Cesar Ochoa, MD

“Pediatricians are an important source of support for families as children return to school,” said Shervin Rabizadeh, MD, MBA, chair of the Department of Pediatrics at Cedars-Sinai Guerin Children’s. “Our clinical and support teams are on standby for everything from vaccine updates to emotional and psychological support.”

Part of this care team is Cesar Ochoa, MD, the new director of Developmental-Behavioral Pediatrics at Guerin Children’s. Ochoa spoke with the Cedars-Sinai Newsroom about how parents and caregivers can tell the difference between common back-to-school blues and symptoms of a more serious condition requiring a medical intervention.

If a child is having trouble adjusting to day care, preschool or grade school, when should parents and caregivers seek medical advice?

Anytime the school is expressing concerns, it is important to seek advice right away. Schools have a duty to evaluate children and provide support services—and a child’s pediatrician can help. A pediatrician can help families understand what might be going on and help them access publicly available services.

What behaviors should parents and caregivers be concerned about? 

When there are concerns from the school about disruptive behavior or emotional regulation difficulties, these are important to take note. When a child doesn’t want to go to school, that is also a red flag. Most children like school; it’s a place where they get to interact with other children and grow as individuals.

I would recommend keeping the pediatrician in the loop, so they can do an evaluation and, if needed, refer the child to a specialist. A specialist will try to understand the situation and come up with meaningful interventions.

For example, some children might struggle because of attention-deficit/hyperactivity disorder (ADHD), which affects 6% to 11% of children in the U.S. Sometimes the condition has obvious signs and can become apparent when a child starts day care or kindergarten. ADHD is popularly described as “bouncing off the walls” and quickly calls the attention of teachers.  

In some children, however, the signs of ADHD are different. They are not bouncing off the walls, but they might have trouble paying attention and daydream in class. Some children even figure out how to compensate for their condition and don’t show any academic troubles, but might experience anxiety or depression later on.

Ultimately, the toll ADHD can take on a child is great. This condition can affect a child’s self-esteem and lead to risk-taking behavior. Treatment is vital.

How does autism typically show up?

Autism is a heterogenous condition that affects nearly 3% of children in the U.S. It is important to remember that autism affects everyone differently, which is why we refer to it as “autism spectrum disorder.” Some children present as being in their own world and other children with autism talk on time and meet all other developmental milestones on time. But the common denominator in all children with autism is that they struggle with social communication and reciprocal interactions and have difficulties interacting with other children. Examples of this include misreading or ignoring social cues and having difficulties establishing or maintaining eye contact.

How can parents and caregivers know when a behavior is something the child will grow out of, versus one that requires the help of an expert? 

There are a lot of gray areas. The best approach is maintaining close communication with the school about the intensity of the concern and how things are changing over time. If the same concern keeps coming up, continue reaching out to the pediatrician.

Read more on the Cedars-Sinai Blog: Here Are the Back-To-School Vaccinations Your Kids Need