Your child spends more time at school than anywhere else except home. Schools can have a major effect on children's health. Schools can teach children about health, and promote healthy behaviors. Physical education classes give children a chance to get exercise.

Schools work to

• Prevent risky behaviors such as alcohol and tobacco use, or bullying
• Encourage healthy habits like exercise and healthy eating
• Deal with specific health problems in students, such as asthma, obesity and infectious diseases

The school building and environment should be a safe and healthy place for your child.

School readiness refers to having the skills, knowledge, abilities, and attitudes needed for success in school and for later learning and life.
School readiness includes:

• The child’s ability to meet milestones appropriate for their stage of development, including motor skills, language development, and general knowledge; their curiosity and enthusiasm; and their ability to explore and try new things
• The environment provided by the school, including high-quality instruction, leadership, appropriate teacher training, and support of relationships with parents and the community
• Appropriate support from the child’s family and community, such as daily learning opportunities and supporting the child’s mental and physical health

Reading, writing, and math are the building blocks of learning. Mastering these subjects early on can affect many areas of life, including school, work, and even overall health. It’s normal to make mistakes and even struggle a little when learning new things. But repeated, long-lasting problems may be a sign of a learning disability.

Learning disabilities aren’t related to how smart a child is. They’re caused by differences in the brain that are present from birth, or shortly after. These differences affect how the brain handles information and can create issues with reading, writing, and math.

“Typically, in the first few years of elementary school, some children, in spite of adequate instruction, have a hard time and can’t master the skills of reading and writing as efficiently as their peers,” says Dr. Benedetto Vitiello, a child mental health expert at NIH. “So the issue is usually brought up as a learning problem.”

In general, the earlier a learning disability is recognized and addressed, the greater the likelihood for success in school and later in life. “Initial screening and then ongoing monitoring of children’s performance is important for being able to tell quickly when they start to struggle,” explains Dr. Brett Miller, a reading and writing disabilities expert at NIH. “If you’re not actively looking for it, you can miss opportunities to intervene early.”

Each learning disability has its own signs. A child with a reading disability may be a poor speller or have trouble reading quickly or recognizing common words. A child with a writing disability may write very slowly, have poor handwriting, or have trouble expressing ideas in writing and organizing text. A math disability can make it hard for a child to understand basic math concepts (like multiplication), make change in cash transactions, or do math-related word problems.

Learning difficulties can affect more than school performance. If not addressed, they can also affect health. A learning disability can make it hard to understand written health information, follow a doctor’s directions, or take the proper amount of medication at the right times. Learning disabilities can also lead to a poor understanding of the benefits of healthy behaviors, such as exercise, and of health risks, such as obesity. This lack of knowledge can result in unhealthy behaviors and increased chances for disease.

Not all struggling learners have a disability. Many factors affect a person’s ability to learn. Some students may learn more slowly or need more practice than their classmates. Poor vision or hearing can cause a child to miss what’s being taught. Poor nutrition or exposure to toxins early in life can also contribute to learning difficulties.

If a child is struggling in school, parents or teachers can request an evaluation for a learning disability. The U.S. Individuals with Disabilities Education Improvement Act requires that public schools provide free special education support to children, including children with specific learning disabilities, who need such services. To qualify for these services, a child must be evaluated by the school and meet specific federal and state requirements. An evaluation may include a medical exam, a discussion of family history, and intellectual and school performance testing.

Many people with learning disabilities can develop strategies to cope with their disorder. A teacher or other learning specialist can help kids learn skills that build on their strengths to counter-balance their weaknesses. Educators may provide special teaching methods, make changes to the classroom, or use technologies that can assist a child’s learning needs.

A child with a learning disability may also struggle with low self-esteem, lack of confidence, and frustration. In the case of a math learning disability, math anxiety may play a role in worsening math abilities. A counselor can help children use coping skills and build healthy attitudes about their ability to learn.

“If appropriate interventions are provided, many of these challenges can be minimized,” explains Dr. Kathy Mann Koepke, a math learning disability expert at NIH. “Parents and teachers should be aware that their own words and behavior around learning and doing math are implicitly learned by the young people around them and may lessen or worsen math anxiety.”

“We often talk about these conditions in isolation, but some people have more than one challenge,” Miller says. Sometimes children with learning disabilities have another learning disorder or other condition, such as attention deficit hyperactivity disorder (ADHD).

“ADHD can be confused with a learning problem,” Vitiello says. ADHD makes it difficult for a child to pay attention, stay focused, organize information, and finish tasks. This can interfere with schoolwork, home life, and friendships. But ADHD is not considered a learning disability. It requires its own treatments, which may include behavior therapy and medications.

“Parents play an important role in treatment, especially for children in elementary school,” Vitiello says. Medications and behavioral interventions are often delivered at home. Teachers can usually advise parents on how to help kids at home, such as by scheduling appropriate amounts of time for learning-related activities. Parents can also help by minimizing distractions and encouraging kids to stay on task, such as when doing homework. Effective intervention requires consistency and a partnership between school and home.

Many complex factors can contribute to development of learning disabilities. Learning disorders tend to run in families. Home, family, and daily life also have a strong effect on a child’s ability to learn starting from a very early age. Parents can help their children develop skills and build knowledge during the first few years of life that will support later learning.

“Early exposure to a rich environment is important for brain development,” Mann Koepke says. Engage your child in different learning activities from the start. Before they’re even speaking, kids are learning. “Even if it’s just listening and watching as you talk about what you’re doing in your daily tasks,” she says.

Point out and talk with children about the names, colors, shapes, sizes, and numbers of objects in their environment. Try to use comparison words like “more than” or “less than.” This will help teach your child about the relationships between things, which is important for learning math concepts, says Mann Koepke. Even basic things, like getting enough sleep and eating a healthy diet, can help children’s brain development and their ability to learn.

NIH is continuing to invest in research centers that study learning challenges and their treatments, with a special focus on understudied and high-risk groups.

Although there are no “cures,” early interventions offer essential learning tools and strategies to help lessen the effects of learning disabilities. With support from caregivers, educators, and health providers, people with learning disabilities can be successful at school, work, and in their personal lives.

Signs of a Learning Disability

Consider talking with your doctor if you notice these signs:

• difficulty with reading and/or writing
• problems with math skills
• difficulty remembering
• trouble following directions
• difficulty with concepts related to time
• problems staying organized

When setting off for kindergarten or first grade, a child may feel prepared with a backpack loaded with crayons, pencils, and paper. But a good start in the classroom depends on more than just school supplies. Healthy hearing, vision, speech, and language are key to success at school. If a child has problems in these areas, the sooner they’re spotted, the better they can be treated.

Sometimes problems with senses, speech, or language fly under the radar. A child with a lazy eye or a little hearing loss might get along just fine at home or in daycare. But when children get to school, minor difficulties may start to catch up with them. They may have trouble focusing and flourishing in the classroom. NIH-funded scientists are searching for better ways to recognize and treat these types of problems as early as possible.

Nearly all newborns are screened for hearing loss before leaving the hospital. For newborns diagnosed with hearing loss, interventions such as hearing aids or cochlear implants should begin no later than 6 months of age. When interventions begin early, children with hearing loss can develop language skills that help them communicate.

Hearing problems can also arise in older kids. “Some children are born with normal hearing and develop hearing loss later for various reasons,” says Dr. Mary Pat Moeller, who studies childhood deafness and language development at Boys Town National Research Hospital in Nebraska. Head injuries, meningitis, and chronic fluid behind the eardrum from repeated bouts of ear infections are just a few conditions that can lead to later hearing loss.

“We rely on normal hearing to pick up concepts and learn new words,” Moeller says. But a noisy classroom can be tough for kids who can’t hear well. “Children with undetected hearing loss may look like they have attention deficits. They may miss what they’ve been told because they’re just not hearing clearly,” she says.

Screening for hearing loss in school-age kids is a familiar process. Children wear headphones and raise their hands as they hear a series of tones. Some 5% to 10% of school-age children don’t pass these tests. Kids with hearing loss can be fitted with hearing aids or benefit from cochlear implants or assistive devices. For example, teachers can wear microphones that send their voices directly to the children’s ears. Even children with minimal hearing loss can benefit from this type of technology.

Children learn language by listening to others and engaging in conversations. But kids with hearing loss can miss out on some of this experience. Moeller and her colleagues are studying how children with hearing loss develop language. Results from this NIH-funded research point to several factors that can help. These include the quality and fit of hearing aids, how often kids get speech and language training, and how often parents have conversations with their children.

A different source of language problems is a disorder called specific language impairment, or developmental language disorder. This condition affects an estimated 7% of children in kindergarten. Kids with specific language impairment have trouble learning new words and engaging in conversation. They might produce grammatically incorrect sentences like “What he want for dinner?” or they might have a small vocabulary.

“Both of those are fundamental to being able to communicate with the teacher, to understanding what the teacher is saying to them, and to forming social relationships with their peers,” says Dr. Mabel Rice, an NIH-funded researcher who studies childhood language disorders at the University of Kansas.

For example, a child with specific language impairment might not understand that “It’s time to put your things away now” means “Put your things away.” Children who don’t understand complicated sentences can seem like they’re disobedient, Rice says. More complicated grammar is also good for making friends. Saying “I would like it if you’d come play with me” might attract more playmates than “Come over here.”

In the past, parents were sometimes blamed for a child’s language disability. They might have been faulted for not reading enough to their children. But research suggests that specific language impairment has other roots. The disorder tends to run in families, which hints that genes play a role. Rice led a study of over 300 people, including children with specific language impairment and their families. The scientists identified a gene that’s also linked to dyslexia and other learning disabilities. The finding might eventually lead to better understanding and treatment of these disorders.

Kids don’t usually grow out of specific language impairment. Their language improves, but they can continue to struggle with subtleties even after they enter the workforce. “It is very important to identify these kids, particularly at school entry or before school entry,” Rice says. Many school districts screen children for specific language impairment before kindergarten. Language therapy can help children catch up.

Poor vision can also cause trouble in school, and the problems may go unnoticed. Vision problems are common in preschoolers, but kids don’t always tell others about their symptoms. Children might even think it’s normal to see double or for things to be blurry. But poor eyesight can cause headaches and hinder reading. Some children with vision problems might seem to have attention difficulties, since eyestrain and headaches can make it hard to stay on task.

The most common cause of vision impairment in children is amblyopia, or lazy eye. It often arises if the eyes point in different directions, or if one eye produces a better image than the other. The brain starts to shut down signals from the weaker eye. Treatment encourages use of the weaker eye, sometimes by putting a patch over the other eye. NIH-funded research has found that treatment for amblyopia is more effective if begun when a child is young.

Some children are nearsighted, with problems focusing on faraway objects like the chalkboard. It’s less common for youngsters to be farsighted, with trouble focusing on up-close items. Both can be corrected with eyeglasses or contact lenses.

To catch problems early, NIH funded a study of thousands of preschoolers to find the best ways to screen for impaired vision. “How often screening is done and what screening is done varies widely from state to state,” says Dr. Marjean Kulp, a vision researcher at Ohio State University.

The study evaluated different tests and identified a few that could best detect vision problems—even when performed by people who aren’t vision specialists.

Screenings only identify potential problems, and they don’t catch everything. Children should have regular exams by an eye care professional.

Early detection and treatment of hearing, vision, and language problems can give kids a better learning experience.

Signs of Eye, Ear, or Language Problems

Talk with a health care provider if your child:

• doesn’t respond consistently to sounds or to his or her name.
• asks for things to be repeated or says “huh?” a lot.
• turns the volume up on the TV and other electronic devices.
• speaks unclearly.
• has trouble following spoken directions.
• leaves words out of sentences when talking.
• uses tenses (past, present, and future) improperly.
• has trouble catching balls or seeing distant objects.
• has eyes that cross or point outward.
• avoids close work or holds books unusually close when reading.
• complains of eye discomfort, headaches, or blurred vision.

Measles, polio, chickenpox are common vaccine-preventable diseases

 Vaccines help your body fight off infections.

August is National Immunization Awareness Month, which brings attention to the value of protecting yourself and your family from vaccine-preventable diseases like chickenpox and the flu.

Vaccines help control and sometimes get rid of diseases like measles or polio that in years past sickened or killed many people. They offer protection from viruses and bacteria that can make us very sick. 

Vaccine research is a priority for the National Institute of Allergy and Infectious Diseases. It supports research to identify potential vaccines for a variety of emerging infectious diseases, including COVID-19, Zika virus, and HIV/AIDS.

Helping our immune systems work better

"Vaccines help control and sometimes get rid of diseases like measles or polio."

Your immune system is a complex network of cells, tissues, and organs that works together to protect your body. A strong immune system will detect foreign substances—like harmful bacteria and viruses—and attack them. A person with a weak immune system has a harder time fighting off these substances. 

When you get a vaccine, it sparks your immune system to create immune responses that help your body fight off infection. This also helps your body react more quickly the next time the bacteria invades.

Getting vaccinated

Most vaccines are given as a shot into muscle or the skin by a health care professional. Some are also given through a liquid or spray in the mouth or nose.

Some vaccines may cause mild reactions, such as soreness where the shot was given, a rash, or a fever. But serious reactions are rare. Your health care provider should review your medical history before giving vaccines to you or a family member.

Keeping kids and adults healthy

Some people with weakened immune systems or those who are pregnant may not be able to get vaccines. This is why getting vaccinated not only helps you, but others in the community too. This type of protection is known as "community immunity." For this reason, proof of vaccination is often needed before your child can enter school or child care.

So, before you enroll your child in school or drop them off at college, talk to your doctor to make sure their immunization schedule is up to date.

Tdap combines protection against tetanus, diphtheria, and acellular pertussis. Tdap is for children 7 and older, adolescents, and adults.

DTaP combines protection against diphtheria, tetanus, and pertussis. 
DTaP is for children under the age of 7.

MMR combines protection against measles, mumps, and rubella.

Autism spectrum disorder (ASD) is a developmental disability that can cause significant social, communication, and behavioral challenges. Recent estimates from CDC’s Autism and Developmental Disabilities Monitoring Network found that about 1 in 54 children have been identified with ASD in communities across the United States. CDC is committed to providing essential data on ASD, searching for causes of and factors that increase the risk for ASD, and developing resources that help identify children with ASD as early as possible.

Vaccines do not cause autism.

Some people have had concerns that ASD might be linked to the vaccines children receive, but studies have shown that there is no link between receiving vaccines and developing ASD. In 2011, an Institute of Medicine (IOM) report on eight vaccines given to children and adults found that with rare exceptions, these vaccines are very safe.

A 2013 CDC study added to the research showing that vaccines do not cause ASD. The study looked at the number of antigens (substances in vaccines that cause the body’s immune system to produce disease-fighting antibodies) from vaccines during the first two years of life. The results showed that the total amount of antigen from vaccines received was the same between children with ASD and those that did not have ASD.

Vaccine ingredients do not cause autism.

One vaccine ingredient that has been studied specifically is thimerosal, a mercury-based preservative used to prevent contamination of multidose vials of vaccines. Research shows that thimerosal does not cause ASD. In fact, a 2004 scientific review by the IOM concluded that “the evidence favors rejection of a causal relationship between thimerosal–containing vaccines and autism.” Since 2003, there have been nine CDC-funded or conducted studies that have found no link between thimerosal-containing vaccines and ASD, as well as no link between the measles, mumps, and rubella (MMR) vaccine and ASD in children.

Between 1999 and 2001, thimerosal was removed or reduced to trace amounts in all childhood vaccines except for some flu vaccines. This was done as part of a broader national effort to reduce all types of mercury exposure in children before studies were conducted that determined that thimerosal was not harmful. It was done as a precaution. Currently, the only childhood vaccines that contain thimerosal are flu vaccines packaged in multidose vials. Thimerosal-free alternatives are also available for flu vaccine. For more information, see the Timeline for Thimerosal in Vaccines.

Besides thimerosal, some people have had concerns about other vaccine ingredients in relation to ASD as well. However, no links have been found between any vaccine ingredients and ASD.

Combination vaccines reduce the number of shots your child needs while protecting against the same number of serious diseases.

Fewer shots, but same protection

Combination vaccines take two or more vaccines that could be given individually and put them into one shot.

So, at a doctor’s visit, your child may only get two or three shots to protect him from five diseases, instead of five individual shots.

Several vaccines are so common that they are generally known by their initials: MMR (measles, mumps, and rubella) and DTaP (diphtheria, tetanus, and pertussis). Each protect your child against three diseases. However, today these two particular vaccines are not considered true combination vaccines because in the United States, you cannot get separate vaccines for all of the diseases that MMR and DTaP protect against.

Common combination vaccines for children

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All vaccines, including combination vaccines, can help protect your child from various diseases.

Benefits of combination vaccines

Combining vaccines into fewer shots may mean that more children will get recommended vaccinations on time. And that means fewer delays in disease protection.

Benefits for children

• Fewer shots
• Less pain and discomfort
• On-time protection

Benefits for parents

• Fewer visits to doctor
• Less hassle and cost with fewer visits
• Less time off from work or family activity

Safety and effectiveness

Before a combination vaccine is approved for use, it goes through careful testing to make sure the combination vaccine is as safe and effective as each of the individual vaccines given separately. And, just as with individual vaccines, there are systems in place to watch for any rare reactions to combination vaccines that can be detected only after the vaccine is used widely.

Combination vaccines have been in use in the United States since the mid-1940s.

Side effects

Side effects from combination vaccines are usually mild. They are similar to those of the individual vaccines given separately.

Sometimes combination vaccines cause slightly more pain or swelling where the shot was given. But if your child got the shots individually, he or she might have pain or swelling in two or three spots, instead of just one.

If your child has moderate or serious side effects from a combination vaccine, tell your child’s doctor. If the separate vaccines are available, the doctor may be able to give additional doses of certain vaccines separately.

Growing future for combination vaccines

As scientists develop and test new vaccines to protect children against more diseases, more combination vaccines may become available. This will allow children to get additional protection with fewer shots.

Recommendations for the MMRV vaccine

The MMRV vaccine combines the MMR (for measles, mumps, and rubella) vaccine with the chickenpox vaccine.

Some children who get the first MMRV shot at 12 through 23 months of age may have a higher chance of a seizure caused by fever after the shot. But, this is not common. These “febrile” seizures are scary for parents, but they are not harmful to children.

Because of this slightly higher risk of seizures, the Centers for Disease Control and Prevention recommend that children under 4 years old get the first dose of MMR and chickenpox vaccines separately.

Why Vaccinate?

On-time vaccination throughout childhood is essential because it helps provide immunity before children are exposed to potentially life-threatening diseases. Vaccines are tested to ensure that they are safe and effective for children to receive at the recommended ages.

Infant and Toddler Years: Birth to Age 2

Vaccination helps give infants and toddlers a healthy start. More than one dose is necessary for many vaccines, to build and boost immunity.

Because influenza viruses are constantly changing and the body’s immune response declines over time, everyone over the age of 6 months needs a flu shot every year.

Recommended vaccines:

• Chickenpox (varicella) vaccine: At 12 through 15 months
• Diphtheria, tetanus, and pertussis (DTaP) vaccine: At 2 months, 4 months, 6 months, and 15 through 18 months
• Flu vaccine: Every year by the end of October, if possible, starting at 6 months Haemophilus influenzae type b (Hib) vaccine: At 2 months, 4 months, 6 months (if needed; depends on brand), and 12 through 15 months
• Hepatitis A vaccine: At 12 through 23 months and a second dose 6 months following first dose
• Hepatitis B vaccine: Shortly after birth, at 1 through 2 months, and at 6 through 18 months
• Measles, mumps, rubella (MMR) vaccine: At 12 through15 months; however, infants 6 through 11 months old should have one dose of MMR vaccine before traveling abroad
• Pneumococcal (PCV13) vaccine: At 2 months, 4 months, 6 months, and 12 through 15 months
• Polio (IPV) vaccine: At 2 months, 4 months, and 6 through 18 months
• Rotavirus (RV) vaccine: At 2 months and 4 months (for Rotarix brand); or 2 months, 4 months, and 6 months (for RotaTeq brand)

Chickenpox (varicella) vaccine

Varicella vaccine protects against chickenpox, which can be serious and even life-threatening, especially in babies, adults, and people with weakened immune systems. Symptoms include tiredness, a fever, and an itchy rash of blisters.

Diphtheria, tetanus, and pertussis (DTaP) vaccine

DTaP vaccine protects against three serious diseases:

• Diphtheria is a serious infection that causes a thick covering in the back of the nose or throat. It can lead to difficulty breathing, heart failure, paralysis, and even death.
• Tetanus is a potentially deadly infection that causes painful muscle stiffness and lockjaw.
• Whooping cough, or pertussis, is a highly contagious disease known for uncontrollable, violent coughing that often makes it hard to breathe. It can be deadly for babies.

Flu vaccine

Seasonal flu vaccine protects against flu, a potentially serious, contagious respiratory illness caused by influenza viruses. Changes in immune, heart, and lung functions during pregnancy make pregnant women more likely to get seriously ill from the flu. The flu may also increase the chances that the developing baby will have serious problems. Everyone 6 months and older should get a flu vaccine every year by the end of October, if possible.

Hepatitis A vaccine

Hepatitis A vaccine protects against a serious, contagious liver disease caused by the hepatitis A virus. Symptoms can include fever, loss of appetite, tiredness, stomach pain, vomiting, dark urine, and yellow skin and eyes. Infected children may not have symptoms, but may still pass the disease to others.

Hepatitis B vaccine

Hepatitis B vaccine protects against hepatitis B, a virus that can cause chronic swelling of the liver and possible lifelong complications. Nine out of 10 infants who contract hepatitis B from their mothers become chronically infected.

Measles, mumps, rubella (MMR) vaccine

Measles, mumps, rubella (MMR) vaccine protects against three serious diseases:

• The measles virus can cause a fever that can get very high, a distinctive rash, cough, runny nose, and red eyes. Sometimes, it can also cause diarrhea and ear infection. It can also lead to pneumonia (infection in the lungs), brain damage, deafness, and death.
• Mumps typically starts with a fever, headache, muscle aches, tiredness, and loss of appetite. Then, most people’s salivary glands swell, which causes puffy cheeks and a swollen jaw. Mumps is pretty mild in most people but can sometimes cause lasting problems, such as deafness, meningitis (infection of the covering around the brain and spinal cord), and swelling of the brain, testicles, ovaries, or breasts.
• Rubella may cause a rash or fever, but many people have no symptoms. Rubella can cause miscarriage or serious birth defects in a developing baby if a woman is infected while she is pregnant. Infected children can spread rubella to pregnant women.

Pneumococcal conjugate vaccine (PCV13) and pneumococcal polysaccharide vaccine (PPSV23)

PCV13 protects against 13 strains of pneumococcal bacteria and PPSV23 protects against 23 strains of pneumococcal bacteria. Both vaccines provide protection against illnesses like meningitis and bacteremia. PCV13 also provides protection against pneumonia. Talk to your doctor and child’s doctor about which vaccines they recommend.

Polio (IPV) vaccine

IPV vaccine protects against polio, a highly infectious disease caused by a virus that can invade the brain and spinal cord. Polio can cause lifelong paralysis and even death.

Rotavirus (RV) vaccine

RV vaccine protects against a contagious virus that causes severe diarrhea, often with vomiting, fever, and abdominal pain, requiring hospitalization. It is most common in infants and young children. Adults who get rotavirus tend to have milder symptoms.

Vaccines and Immunization

You can help protect yourself and others against seasonal flu and other vaccine-preventable diseases by getting immunized.

Vaccines are some of the safest medical products. But, like any other medical product, there may be risks. Talk to your health care provider about the value of vaccines and their side effects.

Vaccines to consider

Influenza (flu): People who are 6 months and older should get the flu vaccine (flu shot). Get the vaccine each year because flu virus can change from one year to the next.

Pneumococcal: Older people and those with certain medical conditions are most susceptible to pneumonia. People under 65 will need a booster shot when they reach 65 if more than five years have passed since the initial dose. Learn about pneumococcal pneumonia and vaccines.

Hepatitis A: Recommended for those who travel to other countries or live in a U.S. community with high rates of hepatitis A; or who have chronic liver disease, engage in male-to-male sex, or inject drugs. Learn more about the hepatitis A vaccine.

Hepatitis B: More contagious than HIV, hepatitis B is the type of hepatitis most often spread through sexual contact. It can also be passed from an infected mother to newborn, the sharing of needles or personal items with an infected person, and other contact involving bodily fluids. The hepatitis B vaccine can prevent the disease.

Measles, mumps, rubella (MMR): People born after 1956 and all women of childbearing age who have not had these diseases or been vaccinated against them need to get the shots to be protected.

Chickenpox (varicella): Protection is necessary for those born in the U.S. after 1966 and have not had this disease and have not been vaccinated. Adults are at a far greater risk of complications.

Shingles (herpes zoster): Shingles is a painful, rash-like illness. If you are 50 or older, get Shingrix which provides strong protection from shingles and long-term nerve pain. Even if you’ve had Shingles, it’s important to receive the vaccine because you can get the disease more than once. You may have already got a different shingles vaccine called Zostavax. If you did, you still need 2 doses of Shingrix. Your risk of shingles and complications increases as you age. You need 2 doses of Shingrix. Get the second dose 2 to 6 months after you get the first dose. 

Tetanus, diphtheria, pertussis: Booster doses of tetanus-diptheria (Td) are needed at 10-year intervals. In place of the Td booster, people age 19-64 and those 65 and older who are in contact with infants should get a one-time dose of tetanus-diptheria-pertussis (Tdap) to also protect against whooping cough.

Vaccines for international travelers: Many Veterans and other Americans traveling abroad are likely to be exposed to diseases common in those countries.

What are common side effects of vaccines?

Vaccines, like any medication, may cause some side effects. Most of these side effects are very minor, like soreness where the shot was given, fussiness, or a low-grade fever. These side effects typically only last a couple of days and are treatable. For example, you can apply a cool, wet washcloth on the sore area to ease discomfort.

Can vaccines overload my baby’s immune system?

Vaccines do not overload the immune system. Every day, a healthy baby’s immune system successfully fights off thousands of germs. Antigens are parts of germs that cause the body’s immune system to go to work to build antibodies, which fight off diseases.

The antigens in vaccines come from the germs themselves, but the germs are weakened or killed so they cannot cause serious illness. Even if babies receive several vaccinations in one day, vaccines contain only a tiny fraction of the antigens they encounter every day in their environment. Vaccines give your child the antibodies they need to fight off serious vaccine-preventable diseases.

Drugs at Your Child’s School?

Yes, likely. Youth are using, buying, and selling drugs right on school campuses and at school events in middle schools and secondary schools.

Fact

A national survey showed that almost 20% of the students had been offered, sold or given an illegal drug by someone on school property. (Centers for Disease Control, Youth Behavioral Survey, 2017).

The use, possession, distribution or sale of tobacco, drugs or drug paraphernalia is very hazardous to the students and faculty at a school.

Fact

A study in 2012 showed that students who use marijuana in school had lower grades, lower classroom participation, poor attendance, and were disciplined more than non-users. (Finn, Kristin. Marijuana Use at School and Achievement-Linked Behaviors. The High School Journal. Vol. 95.No. 3, Spring 2012.)

Concerned parents should contact their local school district and ask the following questions:

• What is the extent of alcohol and drug use at the school?
• What are the school district’s policies on student use, possession, distribution or sale of tobacco, alcohol and drugs?
• How many students have been suspended or expelled from the school campus or at a school event for using, buying, or selling drugs? Are they required to attend a drug education class or get referred for a drug assessment? How is local law enforcement involved?
• Is there an alcohol/drug counselor at school or trained school nurse to interview the youth who has been caught using drugs? What is the process for intervention, referral to treatment and recovery?
• Does your child’s school have a health curriculum that includes the risk and harm associated with alcohol and other drug use?
• Does the school have a no alcohol and drug use policy that is enforced?
• Are alcohol and drug-free activities provided by the school during prom night and after sports events?

Make sure you have a copy of the school's drug policy and procedures and go over it with your child. Find out the school's statistics with drug use and what drugs are popular, what's covered in health classes, and whether the information is repeated again in upper grades.

Research shows that there is a definite link between teen substance abuse and how well you do in school. Teens who abuse drugs have lower grades, a higher rate of absence from school and other activities, and an increased potential for dropping out of school.

Although we all know or hear stories about people who use drugs and still get great grades, this is not typical. Most people who use drugs regularly don’t consistently do well in school.

Studies show that marijuana, for example, affects your attention, memory, and ability to learn. Its effects can last for days or weeks after the drug wears off. So, if you are smoking marijuana daily, you are not functioning at your best.

Students who smoke marijuana tend to get lower grades and are more likely to drop out of high school. One recent marijuana study showed that heavy marijuana use in your teen years and continued into adulthood can reduce your IQ up to as much as 8 points.

High school dropout rates have also risen as a result of substance abuse.

A study of teens in 12th grade (16-18 years of age) who dropped out of school before graduation are more likely than their peers to be users of cigarettes, alcohol, marijuana and other illicit drugs.

Illicit drug use among dropouts was higher than for those in school (31.4 percent vs. 18.2 percent). Dropouts were more likely to be current marijuana users than those in school (27.3 percent vs. 15.3 percent) and non-medical users of prescription drugs (9.5 percent vs. 5.1 percent).

Teens who smoke, drink alcohol, binge drink or use marijuana or other drugs are more likely than non-users to drop out of school and less likely than non-users to graduate from high school, attend college or obtain a college degree.

Research has shown that marijuana’s negative effects on attention, memory, and learning can last for days or weeks after the acute effects of the drug wear off, depending on the person’s history with the drug. Consequently, someone who smokes marijuana daily may be functioning at a reduced intellectual level most or all of the time. Considerable evidence suggests that students who smoke marijuana have poorer educational outcomes than their nonsmoking peers. For example, a review of 48 relevant studies found marijuana use to be associated with reduced educational attainment (i.e., reduced chances of graduating). A recent analysis using data from three large studies in Australia and New Zealand found that adolescents who used marijuana regularly were significantly less likely than their non-using peers to finish high school or obtain a degree. They also had a much higher chance of developing dependence, using other drugs, and attempting suicide. Several studies have also linked heavy marijuana use to lower income, greater welfare dependence, unemployment, criminal behavior, and lower life satisfaction.

To what degree marijuana use is directly causal in these associations remains an open question requiring further research. It is possible that other factors independently predispose people to both marijuana use and various negative life outcomes such as school dropout. That said, people report a perceived influence of their marijuana use on poor outcomes on a variety of life satisfaction and achievement measures. One study, for example, compared people involved with current and former long-term, heavy use of marijuana with a control group who reported smoking marijuana at least once in their lives but not more than 50 times. All participants had similar education and income backgrounds, but significant differences were found in their educational attainment: Fewer of those who engaged in heavy cannabis use completed college, and more had yearly household incomes of less than $30,000. When asked how marijuana affected their cognitive abilities, career achievements, social lives, and physical and mental health, the majority of those who used heavily reported that marijuana had negative effects in all these areas of their lives.

Studies have also suggested specific links between marijuana use and adverse consequences in the workplace, such as increased risk for injury or accidents. One study among postal workers found that employees who tested positive for marijuana on a pre-employment urine drug test had 55% more industrial accidents, 85% more injuries, and 75% greater absenteeism compared with those who tested negative for marijuana use.

Most kids and teens will only need help through informal, academic adjustments as they recover from a concussion. However for kids and teens with ongoing symptoms, a variety of formal support services may be available to help them during their recovery. These support services may vary widely among states and school districts. The type of support will differ based on the needs of each student. Some of these support services may include:

• Response to Intervention Protocol (RTI)
• 504 Plan
• Individualized Education Plan (IEP)

Your child or teen may feel frustrated, sad, and even angry because she or he cannot return to school right away, keep up with schoolwork, or hang out as much with their friends. Talk often with your child or teen about this and offer your support and encouragement.

There are steps you can take to feel better after a mild TBI or concussion. If you do not think you are getting better or your symptoms are getting worse, tell your healthcare provider. Your healthcare provider may refer you to a specialist.

Start your recovery by taking it easy

As symptoms improve, you may gradually return to regular activities. Recovery from a mild TBI or concussion means you can do your regular activities without experiencing symptoms. Recovery from a mild TBI or concussion may be slower among:

• Older adults
• Young children
• Teens
• People who have had a concussion or other TBI in the past

The first few days

• Take it easy the first few days after a mild TBI or concussion when symptoms are more severe.
• You may need to take a short time off from work or school, although usually no more than 2 to 3 days.
• Ask your healthcare for written instructions about when you can safely return to work, school, or other activities, such as driving a car.

As you start to feel better

• As you start to feel better after the first few days of your injury, you can gradually return to regular (non-strenuous) activities, such as taking a short walk.
• Avoid activities that make your symptoms come back or get worse.

Whensymptoms are nearly gone

• When your symptoms are mild and nearly gone, you can return to most of your regular activities.
• If your symptoms do not get worse during an activity, then that activity is OK for you. If your symptoms get worse, you should cut back on that activity.

Taking these steps may help speed your recovery:

• Avoid activities that can put you at risk for another injury to your head and brain.
• Stay connected to friends and loved ones and talk with them about how you are feeling. Having support from family and friends can help with your recovery.
• Ask your healthcare provider about medications that are safe to take during recovery to help with symptoms (for example, ibuprofen or acetaminophen for headaches).
• Limit screen time and loud music before bed, sleep in a dark room, and keep to a fixed bedtime and wake-up schedule.

Talk to your healthcare provider if symptoms don’t go away

While most people with a mild TBI or concussion feel better within a couple of weeks, some will have symptoms for months or longer. Talk with your healthcare provider if symptoms:

• Do not go away, or
• Get worse after you return to your regular activities

Anxiety and depression may make it harder to adjust to the symptoms of a mild TBI or concussion

If you have one or more symptoms that last months after the injury, your healthcare provider may talk to you about post-concussive syndrome. Post-concussive syndrome is believed to occur most commonly among people with:

• A history of multiple mild TBI or concussions, or
• Prior health conditions, such as depression and anxiety

Stay connected to others during recovery

There are many organizations who can help you and your family as you recover. You do not have to do it alone. Keep talking with your healthcare provider, family members, caregivers, and loved ones about how you are feeling. If you do not think you are getting better, tell your healthcare provider.

After a concussion, an athlete should only return to sports practices with the approval and under the supervision of their health care provider. When available, be sure to also work closely with your team’s certified athletic trainer.

Below are six gradual steps that you, along with a health care provider, should follow to help safely return an athlete to play. Remember, this is a gradual process. These steps should not be completed in one day, but instead over days, weeks, or months.

6-Step Return to Play Progression

It is important for an athlete’s parent(s) and coach(es) to watch for concussion symptoms after each day’s return to play progression activity. An athlete should only move to the next step if they do not have any new symptoms at the current step. If an athlete’s symptoms come back or if he or she gets new symptoms, this is a sign that the athlete is pushing too hard. The athlete should stop these activities and the athlete’s medical provider should be contacted. After more rest and no concussion symptoms, the athlete can start at the previous step.

Step 1: Back to regular activities (such as school)
Athlete is back to their regular activities (such as school) and has the green-light from their healthcare provider to begin the return to play process. An athlete’s return to regular activities involves a stepwise process. It starts with a few days of rest (2-3 days) and is followed by light activity (such as short walks) and moderate activity (such as riding a stationary bike) that do not worsen symptoms. You can learn more about the steps to return to regular activities at: https://www.cdc.gov/headsup/basics/concussion_recovery.html.

Step 2: Light aerobic activity
Begin with light aerobic exercise only to increase an athlete’s heart rate. This means about 5 to 10 minutes on an exercise bike, walking, or light jogging. No weight lifting at this point.

Step 3: Moderate activity
Continue with activities to increase an athlete’s heart rate with body or head movement. This includes moderate jogging, brief running, moderate-intensity stationary biking, moderate-intensity weightlifting (less time and/or less weight from their typical routine).

Step 4: Heavy, non-contact activity
Add heavy non-contact physical activity, such as sprinting/running, high-intensity stationary biking, regular weightlifting routine, non-contact sport-specific drills (in 3 planes of movement).

Step 5: Practice & full contact
Young athlete may return to practice and full contact (if appropriate for the sport) in controlled practice.

Step 6: Competition
Young athlete may return to competition.

What You Need to Know

• During the school year, kids tend to get sick more often — and spread germs to their friends and classmates.
• COVID-19 can cause serious health problems, so it’s more important than ever to protect your child’s health.
• You can help your child stay healthy and protect the people around them all school year long.

Ask your child’s doctor what vaccines and boosters they need

Vaccines help protect kids from getting very sick from COVID-19, the flu, and other illnesses. Ask your child’s doctor what vaccines and boosters they need to stay healthy. If it’s been a while since your child has seen the doctor, now is a good time to make an appointment for a checkup.

Who needs to get vaccinated?

• Children ages 6 months and older should get vaccinated against COVID-19 and the flu.
• Children ages 5 years and older should also get a COVID-19 booster.

It’s especially important for children who have disabilities or chronic health conditions to get vaccinated, because they are more likely to get very sick if they catch COVID-19 or the flu.

My child has a disability. How can I support them when they get their vaccine?

Sometimes, children and teens with disabilities may struggle with vaccines. When you’re making an appointment for your child to get vaccinated, you can let staff or volunteers know your child might need some accommodations.

For example, you could:

• Ask if your child can get vaccinated in your vehicle or in a quiet room away from crowds
• Ask for sensory modifications, like turning off bright lights
• Ask the vaccine provider to explain what they’re going to do and when they’re going to do it, so your child
  knows what’s going to happen
• Ask the provider to give your child any other vaccines they may need during the same appointment

Where can my child get vaccinated?

In addition to doctor’s offices, many pharmacies, clinics, and health departments offer vaccines. You can visit vaccines.gov and enter your ZIP code to find a vaccine location near you. To find a COVID-19 vaccine, you can also:

• Text your ZIP code to 438829
• Call 1-800-232-0233 (TTY: 888-720-7489)

Keep your child home if they’re not feeling well

Staying home when sick can lower the risk of spreading infectious diseases like COVID-19 and the flu to other people. Children who have symptoms of respiratory or gastrointestinal infections, like cough, fever, sore throat, vomiting, or diarrhea, should stay home.

Remind your child to wash their hands

When your child heads off to school, remind them to wash their hands before and after eating, after using the restroom, and after recess.

Teach your child to cover coughs and sneezes

Ask your child to cover their mouth and nose with a tissue when they cough or sneeze. Then, throw used tissues in the trash. If there aren’t any tissues nearby, encourage your child to cover their nose and mouth with their elbow.

Consider having your child wear a mask to school

Children ages 2 years and older can also wear masks to school. If your child has a disability or chronic health condition, wearing a mask can give extra protection to help them stay healthy. Masks also help to prevent children from spreading COVID-19 to other people around them. Make sure the mask covers your child’s nose and mouth.

Take care of your child’s mental health

The past few years have been a stressful time for many families, and some children may have trouble adjusting to new routines and relationships at school. Changing routines can be especially challenging for children with cerebral palsy, intellectual disabilities, or developmental disabilities such as autism.

Talk to your child’s doctor if you have concerns about the way your child behaves at home, in school, or with friends.

COVID-19 outbreaks can happen in schools and early care and education (ECE) programs, but CDC understands the importance of in-person learning. Based on studies from the previous school year, we know that using multiple prevention strategies can keep children, teachers, and staff safe and keep schools and ECE programs open.

Things Your Child’s School or Child Care Program May Consider

When making decisions about how to keep students and staff safe, school and ECE program administrators should consider:

• How many cases of COVID-19 are in your community.
• The number of people vaccinated in your community.
• Ability of the local health care system to care for new patients.
• Ages of children in the school or ECE program.

As the situation in your community changes, school and ECE program administrators may change policies.

Layered Prevention Strategies

Your child’s school or ECE may layer prevention measures in the classroom or during other activities, meaning they may use many prevention measures at the same time. Using layered prevention measures is important when some prevention measures cannot be used. For example, when people are not able to physically distance from each other, using other prevention strategies, like masking and ventilation, can still help stop the spread of COVID-19.

COVID-19 vaccines

Getting vaccinated is the best way to prevent getting very sick with COVID-19. Everyone 5 years and older is now eligible for COVID-19 vaccination.

Your child’s school or ECE program may provide information to families about how to get vaccinated. They may also offer flexible options for excused absences to allow students time to get vaccinated and stay home if they have side effects after vaccinations.

Masks

When teachers, staff, and children wear a mask, they protect others as well as themselves.

• CDC recommends universal indoor masking in schools and ECE programs for ages 2 years and older and other strategies to prevent spread of COVID-19, regardless of vaccination status. This includes masking during indoor recess, indoor sports, and extracurricular activities.
• Children under 2 years of age should not wear a mask.

• In general, people do not need to wear a mask outdoors. In areas with high numbers of COVID-19 cases, people who are not fully vaccinated may consider wearing a mask in crowded outdoor settings and for activities that involve close contact with others who are not fully vaccinated.

• Masks are required on all public transportation, including school buses. Regardless of the mask policy at school, passengers and drivers must wear a mask on school buses operated by public or private school systems.

Physical distancing and cohorting

Your child’s school or child care program should have a policy about physical distancing.

Young children need to be close to caregivers during diapering, feeding, and comforting. Your child’s ECE program may use cohorting. Cohorting means keeping children together in a small group and having each group stay together throughout an entire day. This is used to limit the number of children and staff who come in contact with each other. Your child’s program may also maximize time outdoors, stagger drop-off and pick-up times, and maintain 6 feet between cohorts.

Screening testing

Your child’s school or ECE program may use a screening testing program. Screening testing helps schools and programs identify people infected with COVID-19 but may not be showing symptoms. This helps to quickly isolate anyone who tested positive for COVID-19 and identify anyone who may have been exposed to them so they can quarantine.

Decisions about screening testing will be made at the state or local level. Ask your child’s school or ECE program about any testing, quarantine, or isolation policies.

Ventilation

Improving ventilation can reduce the number of virus particles in the air.

Your child’s school or ECE program may:

• Opening multiple doors and windows.
• Using child-safe fans to increase the effectiveness of open windows.
• Making changes to the heating, ventilation, or air conditioning (HVAC) or air filtration systems.
• Opening or cracking windows in buses and other forms of transportation, if doing so does not pose a safety risk.

Handwashing

Teachers and staff, through the school or ECE, should:

• Teach students to wash their hands with soap and water for at least 20 seconds.
• Remind students to wash hands frequently and help young children with handwashing.
• Provide hand sanitizer with at least 60% alcohol if handwashing is not possible. Young children should have adult supervision when using hand sanitizer.
• Set up handwashing or hand sanitizing stations at facility entrances.
• Wash their hands after holding, washing, or feeding young children.
• Wash their hands before and after changing a child’s diaper or handling infant bottles.

Keep Your Child Home if They Are Sick

If your child is sick or has symptoms of COVID-19, they should stay home. Call your child’s healthcare provider for testing and care. Staying home when sick with COVID-19 keeps COVID-19 infections out of schools and early care and education programs and prevents spread to others.

Know when your child should quarantine or isolate. Talk to your child’s school or ECE program about when your child can return to school after being sick.

Contact tracing

Schools and ECE programs are encouraged to work with state and local health departments to conduct contract tracing. If you are contacted by your health department about your child and a COVID-19 exposure, work with them to know if your child needs to isolate or quarantine.

Visitors

Your child’s school or ECE program may limit nonessential visitors, volunteers, and activities. Visitors should not go into schools if they are sick or have symptoms of COVID-19.

• You may not be able to enter the facility and instead may drop off and pick up your child outside.
• Alternative ways of connecting with your child’s teacher or other parents may be used, such as outdoor or virtual meetings.

ECE programs should not limit access to mothers who are breastfeeding their infants.

Food service and meals

Your child’s school or ECE program may adjust where and when children eat meals. This may include:

• Because masks are removed, physical distancing of at least 6 feet when moving through the food service line and while eating (especially indoors).
• Moving mealtime outside.
• Using additional spaces outside of the cafeteria for mealtime seating, such as the gymnasium or outdoor areas.
• Reminding children to wash hands, before and after eating.
• Improving ventilation in spaces where children eat if they must eat indoors.

Physical education and physically active play

Physical play is important for children. In general, people do not need to wear masks when outdoors. In areas with high numbers of COVID-19 cases, people should consider wearing a mask in crowded outdoor settings and for activities with close contact with others who are not fully vaccinated. When physical education and play are held indoors, children and staff should wear masks. Children and staff should physically distance when possible.

Sports and other activities

Some sports may make players, coaches, and trainers more likely to get and spread COVID-19 because of physical contact and increased breathing. Other extracurricular activities, such as band, choir, theater, and school clubs that meet indoors, may also make students and staff more likely to get or spread COVID-19.

• Get your child vaccinated as soon as they are eligible to be able to participate in sports and other activities as safely as possible.
• Your child should wear a mask when participating in indoor sports or activities.
• Sports and activities should take place outdoors whenever possible.
• Your child should not participate in these activities when they have symptoms of COVID-19 and should be tested.
• Students who participate in indoor sports and other higher-risk activities should continue to wear masks and physically distance as much as possible.
• Sports and activities may be cancelled or happen virtually when the number of cases in the community is extremely high.

• Half of all new STDs reported each year are among young people 15 to 24.
• Nearly 46% of sexually active high school students did not use a condom the last time they had sex.

Many Young People Engage in Sexual Risk Behaviors

Many young people engage in sexual risk behaviors and experiences that can result in unintended health outcomes.

CDC data show that lesbian, gay, and bisexual high school students are at substantial risk for serious health outcomes related to sexual behaviors, violence, substance use, and poor mental health as compared to their peers.

Among U.S. high school students surveyed in 2019

• 38% had ever had sexual intercourse.
• 9% had four or more sexual partners.
• 7% had been physically forced to have sexual intercourse when they did not want to.
• 27% had had sexual intercourse during the previous 3 months, and, of these
  • 46% did not use a condom the last time they had sex.
  • 12% did not use any method to prevent pregnancy.
  • 21% had drunk alcohol or used drugs before last sexual intercourse.
• Less than 10% of all students have ever been tested for HIV.
• Less than 10% of all students have been tested for sexually transmitted diseases during the past year.

Source: National Youth Risk Behavior Survey, 2019

CDC recommends everyone aged 13-64 get tested for HIV at least once as part of routine medical care.

HIV, STDs, and Teen Pregnancy are Health Consequences

Sexual risk behaviors place youth at risk for HIV infection, other STDs, and unintended pregnancy:

HIV

21% of all new HIV diagnoses were among young people (aged 13-24) in 2018; 88% were young men and 12% were young women.

STDs

Half of the 20 million new STDs reported each year were among young people (aged 15 to 24)

Teen Pregnancy

Nearly 180,000 babies were born to teen girls (aged 15–19 years) in 2018.

Abstinence from vaginal, anal, and oral intercourse is the only 100% effective way to prevent HIV, other STDs, and pregnancy. The correct and consistent use of male latex condoms can reduce the risk of STD transmission, including HIV infection. However, no protective method is 100% effective, and condom use cannot guarantee absolute protection against any STD or pregnancy.

Schools and Youth Serving Organizations Can Help

School health programs can help young people adopt lifelong attitudes and behaviors that support their health and well-being—including behaviors that can reduce their risk for HIV and other STDs.

HIV, STD, and teen pregnancy prevention programs in schools should

• Provide health information that is basic, accurate, and directly contributes to health-promoting decisions and behaviors.
• Address the needs of youth who are not having sex as well as youth who are currently sexually active.
• Ensure that all youth are provided with effective education and skills to protect themselves and others from HIV infection, other STDs, and pregnancy.
• Be developed with the active involvement of students and parents.
• Be locally determined and consistent with community values and relevant policies.

Closing to Clean or Disinfect

In general, it is not necessary to close entire facilities to “disinfect” them when MRSA infections occur. Routine cleaning practices are enough in most situations. MRSA skin infections are transmitted primarily by skin-to-skin contact and by contact with surfaces that have come into contact with someone else’s infection. Spread can be prevented by simple measures such as hand hygiene and covering wounds.

Notifications

Usually, it is not be necessary to inform the entire school community about a single MRSA infection.

If a MRSA infection occurs in the school:

• Most schools require that any communicable disease be reported to the student’s teacher or administration. Consult with your school about its policy.
• The school healthcare provider should determine whether some or all students, parents, and staff should be notified.
• If medical personnel are not available at the school, consult with the local public health authorities to guide this decision.
• Repeat cases, spread to other students, or complex cases should be reported to the health department for consultation.

Excluding Students with MRSA Infections from School

Students with MRSA infections can attend school unless a healthcare provider tells them not to. But they should not attend school if:

• There is wound drainage (“pus”) that cannot be covered and contained with a clean, dry bandage.
• They cannot maintain good personal hygiene.

Advice for Teachers

• If you observe a child with open draining wounds or infections, take them to the school nurse. If a nurse is not available, call the child’s guardian and tell them to seek medical attention.
• Reinforce the need for hand hygiene by everyone as a part of general good health practice, particularly before eating, after touching potentially infected wounds or soiled bandages, and after using the bathroom.

Advice for School Health Personnel

• Students with skin infections may need to be referred to a licensed health care provider for diagnosis and treatment. School health personnel should notify parents/guardians when possible skin infections are detected.
• Use standard precautions (e.g., hand hygiene before and after contact, wearing gloves) when caring for broken skin (open wounds) or potential infections.
• Use barriers such as gowns, masks, and eye protection if splashing or other contact with potentially infected body fluids is anticipated.

Pests such as insects, rodents, fungi, and weeds can affect the school environment and the people who work and learn there. These pests can cause human health problems, structural damage, and plant damage.

Pests of Concern in Schools

You will need to know what pests you are facing before deciding how to control them. These pest fact sheets will give you a brief overview of some pests that may be issues at your school, including their life cycle, health concerns, and information about control.

• Ants.
• Bed bugs.
• Bees and wasps.
• Biting midges.
• Cockroaches.
• Flies.
• Lice.
• Millipedes.
• Mosquitoes.
• Rodents.
• Termites.
• Ticks.

Where to Look for Pests in Schools

Pests find homes in many places in and around schools, such as:

• Cafeterias - pests are attracted to food and water in confined locations, such as between appliances and in cabinets.
• Classrooms - pest populations increase in untidy areas, such as desks and closets.
• Lockers - clutter and food can quickly collect in lockers throughout the school year, providing a safe harbor and breeding grounds for pests.
• Gyms and locker rooms - these areas can be warm and poorly ventilated, providing breeding grounds for pests.
• Dumpsters - waste receptacles and surrounding areas are vulnerable to pest problems, especially when they are in close proximity to school buildings.
• Exterior conduits - all openings to the outdoors provide easy entry access for pests.
• Landscapes, school grounds and athletic fields - neglected landscapes can attract a wide variety of pests, including those that destroy school structures.
• Buses - present unique pest control challenges when schools initiate programs such as Breakfast on the Bus.

Basic Information on Pest Control in School

By using integrated pest management instead of solely relying on extensive pesticide applications, schools can reduce pest populations and reduce the use of pesticides, making schools safer for children and school personnel.

IPM reduces the use of pesticides by first monitoring pest populations to determine where, when, and what kind of controls should be applied. Schools can reduce pest infestations by identifying and removing conditions that will attract pests.

Preventive measures are easy to implement and often improve the overall maintenance of the school. These measures can include:

• Restricting where food is eaten.
• Moving dumpsters and food disposal containers away from the school.
• Repairing and maintaining leaking pipes.
• Pressure cleaning food service areas.
• Sealing cracks and crevices.
• Instituting sanitation measures.
• Cleaning gutters and directing water flow away from buildings to prevent saturation.
• Educating students and staff about how their actions affect pest management and control.

In addition to adopting preventive measures, the IPM approach includes evaluating a school's pest management practices and choosing lower-risk methods of pest removal and prevention. When developing an IPM program, schools should consider methods that:

• Minimize health risks to humans and the environment.
• Minimize disruption of the natural, outdoor environment.
• Are least toxic to species that are not pests.
• Prevent a recurrence of the pest infestation.
• Are safe and easy to apply effectively.
• Are cost-effective.

What is school violence?

School violence is violence that occurs in the school setting. It describes violent acts that disrupt learning and have a negative effect on students, schools, and the broader community. School is the location where the violence occurs, not a type of violence.

Examples of school violence include:

• Bullying and cyberbullying
• Fighting (e.g., punching, slapping, kicking)
• Weapon use
• Gang violence
• Sexual violence

Places school violence occurs:

• On school property
• On the way to or from school
• During a school-sponsored event
• On the way to or from a school-sponsored event

How big is the problem?

In 2019, CDC’s nationwide Youth Risk Behavior Survey (YRBS) was administered to high school students across the United States. According to YRBS results from 13, 677 students:

• About 1 in 5 high school students reported being bullied on school property in the last year.
• 8% of high school students had been in a physical fight on school property one or more times during the 12 months before the survey.
• More than 7% of high school students had been threatened or injured with a weapon (for example, a gun, knife, or club) on school property one or more times during the 12 months before the survey.
• Almost 9% of high school students had not gone to school at least 1 day during the 30 days before the survey because they felt they would be unsafe at school or on their way to or from school.

How can we prevent violence in schools?

All students have the right to learn in a safe school environment. The good news is school violence can be prevented. Many factors contribute to school violence. Preventing school violence requires addressing the factors that put people at risk for or protect them from violence. Research shows that prevention efforts by teachers, administrators, parents, community members, and even students can reduce violence and improve the school environment.

CDC developed technical packages to help communities and states prioritize prevention strategies based on the best available evidence. The strategies and approaches in the technical packages are intended to shape individual behaviors as well as the relationship, family, school, community, and societal factors that influence risk and protective factors for violence. They are meant to work together and to be used in combination in a multi-level, multi-sector effort to prevent violence.

School is back in session. As you stock up on pencils, take first-day pictures, and adjust to new bus schedules, take a few, quick steps that can keep your child safer during an emergency.

From tornadoes to water main breaks, emergencies can occur with little or no warning—even during the school day. As children head back to school, take a few steps to help protect your child from an emergency and to reunite with your child quickly and safely.

Protecting Your Child Is as Easy as A-B-C

Ask how you would be reunited with your child in an emergency or evacuation

• If students had to evacuate, where should you go to pick them up?
• How would the school notify you in the event of emergency?

Bring extra medication, special foods, or supplies your child would need if you were separated overnight

• What essential supplies would your child need if separated from you overnight? (Medications? Inhaler? Milk? Diapers? Battery pack for special equipment?)
• Does the school have an emergency stockpile of these items or could you bring extras to be kept at school?
• What is the school policy for how and when medicine can be administered to your child?

Complete a backpack contact information card and tuck one in your child’s backpack and your wallet

• Emergencies are chaotic! Make sure your child or their school knows how to reach you, and who should be called if your phone isn’t working.
• Download and complete your own backpack card.

Follow these A-B-C’s so that emergencies are less chaotic, children can be kept safe, and families can be reunited safely as soon as possible.

People of all ages can be bullied. Bullying may take place at home, school, or work.

• A 2013 survey from the National Center for Education Statistics found that bullying continues to affect many school-aged children: Slightly more than 1 out of 5 students in middle and high school experienced “traditional” bullying at school during the 2012–2013 school year. Six percent of students ages 12 to 18 reported that they had been pushed, shoved, tripped, or spit on during the school year. Of these students, 22% reported being injured in the event.
• The 2013 survey found that, during the same school year, 7% of students reported being cyberbullied.
• Data from the 2015 Youth Risk Behavior Surveillance System from the Centers for Disease Control and Prevention indicate that about 20% of U.S. students in grades 9 through 12 experienced bullying on school property within the last year.

Teachers and early care and education (ECE) providers have an important role to play in helping children both prepare for and recover after a public health emergency.

Public health emergencies and disasters affect millions of children worldwide each year. These emergencies and disasters include natural events (such as severe weather, earthquakes, fires, floods, and tsunamis) and man-made events (such as acts of terrorism). An emergency or disaster can be destructive to a child’s physical environment, as well as affect their mental health. As a teacher or ECE provider, you are committed to keeping schools and ECE programs safe and supporting children and their families. If your students experience an emergency or disaster, there are steps you can take to help your students cope and recover.

How can I help my students cope and continue to support their recovery from a disaster?

• Talk to children about what happened in a way they can understand. Keep it simple and appropriate for each child’s age. (Learn more about common reactions by age range)
• Provide children with opportunities to talk about what they went through or what they think about it. Encourage them to share concerns and ask questions. Younger children may draw pictures or may play with toys to express what they think and feel.
• Children react, in part, to what they see from the adults around them. When teachers deal with a disaster calmly and confidently, they can provide the best support for their students.
• Children who were directly exposed to a disaster can become upset again; behavior changes resulting from the event may be long lasting and can worsen or return if these children see or hear reminders of what happened. Be aware that that this could happen and know what resources are available at your school for children and families, should you need to report concerns to the appropriate people at your school.
• Proceeding with normal daily routines, such following familiar schedules when to eat and when to play, can help reduce stress. However, while recovering from disasters, children may have a hard time focusing on learning, they may need more time than usually to master new skills and concepts.

It is difficult to predict how some children will respond to disasters and traumatic events. Because parents, teachers, and other adults see children in different situations, it is important for them to work together to share information about how each child is coping after a traumatic event.

After a disaster, teachers and ECE providers may also be struggling with severe posttraumatic symptoms and personal losses. This might prevent them from effectively participating in post-disaster intervention for the children in their care. In this case, it is important that teachers and ECE providers take care of themselves first and seek help from a professional. CALL or TEXT Substance Abuse and Mental Health Services Administration’s (SAMHSA’s) Disaster Distress Hotline: 1-800-985-5990; People with deafness or hearing loss can use their preferred relay service to call 1-800-985-5990.

School shootings can erode the sense of safety and security people usually feel. This is true at both an individual and community level. These sudden, tragic events challenge our need to see the world as orderly and controllable. People in the affected communities are forced to adapt to extreme loss or disruptions to their lives. Even those who live far away may find themselves feeling fear, anger and loss.

There are elements that research tells us are related to people doing better through adverse situations. With these 5 elements, you can choose the actions that can help you and your family better cope after a school shooting:

• Increase sense of safety
• Increase calming
• Connect with each other
• Build personal and family competence
• Foster hope

How to Apply the 5 Elements

You can modify these elements based on many factors, including the level of disruption in your life and the age of children in the home. Using them as a guide can help you create your own ways to help your family cope.

Pick some of the following ideas within each of these 5 elements or develop your own. Using them can help your family work through the challenges you are facing. If anyone is having a very hard time and needs more help, know that there are resources available to support recovery.

Increase sense of safety

When families don't feel safe it can feel overwhelming. School shootings can result in an ongoing sense of being threatened, so it is important to increase your sense of safety. It is helpful to give consistent safety messages to your family, such as:

• "We will get through this together."
• "No matter what happens, we will do what we need to do to take care of each other."

Some people feel safer by becoming involved in change efforts, activism or community programs that increase safety. For others, it may be more important to focus on what is in their capacity to control, even if those things seem like small actions.

Increase calming

School shootings can cause anxiety. People may have trouble thinking clearly or sleeping soundly. It is important to help yourself and your family find ways to take breaks and calm down, even momentarily.

• Offer simple calming strategies such as slowed, even breathing, talking through concerns, finding distractions (with books, videos or anything that can take your mind off what is happening), and taking short breaks.
• Try noticing and naming your feelings. Ground your attention by focusing on what you can see, feel and hear in the current moment.
• Understand that feelings such as sadness, anxiety and fear are common and that it's okay to talk about them.
• Think about limiting activities that trigger anxiety—such as checking the news—even if you think they are helpful.

Do your best to let family know that their well-being is one of your priorities. Keep to a routine. Structure helps younger children know what to expect and can be calming. Consider scheduling into your day shared activities that have meaning for your family.

Connect with each other

Be dedicated about connecting with loved ones within and outside the immediate family. Include family members who don't live in your home to make the circle wider.

Build personal and family competence

There are many ways to build competence and develop skills that can help you get through your current challenges. For instance, involve the family in a problem-solving approach to challenges, where you talk through problems; break them down into smaller chunks; brainstorm creative solutions together; negotiate the solutions that will work best for everyone; and take small, steady steps towards your goals.

Role-model competence. Demonstrating patience with yourself will show your children how to do the same. Just being your best self—whatever that best self is in that moment given the circumstances—will inspire others. As you strive to do your best remember to keep your expectations realistic. A crisis can make it hard to keep up our usual standards in what we think, feel, or do. You may need to adapt your expectations of what a good day is, and of what you demand from yourself.

Foster hope

It is natural that families may be scared, in shock, angry, sorrowful or discouraged following school shootings. This is particularly true for those in the communities where the violence took place. Focusing on the ways you and your family are safe or strong can help to foster hope. You can also discuss positive things that you see others doing, ways you believe that the situation will become better with time, or ways in which you are grateful. Ask others in your life to share how they have maintained hope or seen things from a more hopeful perspective. Highlight that many people are working hard to keep schools safe and help people recover.

Many people turn to their values or beliefs as a way to make meaning or raise hope in a difficult time. For some, that might mean helping others or engaging in protest and activism. Others who have faith in a higher power spend more time in activities that foster those beliefs, like prayer, meditation, reading or reflection. Researchers have found that resilient families share open communication about feelings, engage in group problem-solving, make meaning in the face of adversity, share their hopes in overcoming challenges, encourage each other, and work to tolerate uncertainty. They also find ways to transform adversity through beliefs, positive growth, spirituality or religion.

Summary

The strategies you choose can make a difference in maintaining hope, ability to endure, connectedness, ability to remain calm, and sense of safety. As you practice these actions, adapt them to your current circumstances. Do your best from moment to moment and remember that you don't need to be perfect or steady at all times. Try to be kind to yourself and remember that anything you do to role model these strategies will help your children grow and be able to help others as friends or caregivers themselves.

People who are more directly affected by the shooting or those with previous histories of trauma or prior mental health conditions may need to get more tailored or individual support. Meeting with others who have faced similar challenges can help, however, mental health treatment may also be needed. If you feel very distressed or unable to function, contact a medical or mental health provider. There are effective treatments for acute stress disorder, PTSD, and complicated grief—all problems that can develop after a trauma. The sooner you get help, the sooner you will start to feel better.

Creating protective community environments where young people live and play is necessary to help reduce youth violence. Some environmental features are linked to violence and crime. These features can include the physical design of a space, the number of people in the space, and how the space is being cared for and used.

Crime Prevention Through Environmental Design (CPTED)

Crime Prevention Through Environmental Design (CPTED) is an approach that focuses on improving the design of the built environment to help reduce opportunities for disputes and violence and promote positive behavior.

Communities applying CPTED activities reported decreases in gun violence, youth homicide, disorderly conduct, and violent crime. Communities also reported positive impacts on residents’ stress, community pride, and physical health. Some examples of these CPTED activities include:

• Repairing abandoned building and vacant lots
• Cleaning and maintaining neighborhood green spaces
• Upkeep of neighborhood housing

CPTED and School Violence

CDC developed the CPTED School Assessment (CSA). This tool assesses the use of CPTED principles in three areas of schools: grounds, buildings, and interiors.

CPTED principles that schools can consider include:

1. Natural surveillance
   This refers to the placement of physical features that improve visibility. Example: The strategic use of windows that look out on the school entrance so students can see into the school and know that others can see them.
2. Access management
   This includes using signs, well-marked entrances and exits, and landscaping to improve or limit access to certain areas. Example: Landscaping that reduces access to unsupervised locations on the school grounds.
3. Territoriality
   This involves creating a welcoming environment. Example: Motivational signs, displays of student art, and the use of school colors to create warmth and express pride.
4. Physical maintenance
   This includes repair and general upkeep of space. Example: Removing graffiti and making repairs to restrooms, light fixtures, and stairways to maintain safety and comfort.
5. Order maintenance
   This includes addressing and reducing negative behavior. Example: Having an adult present at all times while students move from one location to another.

The principles of CPTED may benefit schools by:

• Creating a warm and welcoming environment
• Fostering a sense of physical and social order
• Creating a sense of ownership by students
• Sending positive messages to students
• Maximizing the presence of authority figures
• Minimizing opportunities for out-of-sight activities
• Managing access to all school areas

Environmental design alone will not prevent all school violence. However, CPTED is a promising prevention strategy that may lead to safer schools. For more information about prevention strategies CDC’s technical package, A Comprehensive Technical Package for the Prevention of Youth Violence and Associated Risk Behaviors, highlights strategies based on the best available evidence to help states and communities prevent or reduce youth violence.

Children with autism are guaranteed free, appropriate public education under the federal laws of Public Law 108-177: Individuals with Disabilities Education Improvement Act (2004), sometimes called "IDEA."

IDEA ensures that children diagnosed with certain disabilities or conditions, including autism spectrum disorder (ASD), get free educational services and educational devices to help them to learn as much as they can.

NICHD-funded researchers have also incorporated communications interventions for children with ASD within the classroom setting, with successful outcomes. Although the specific interventions used in the study are not a guaranteed part of IDEA, components from the program could provide an important evidence-based foundation for future school-based therapies.

IDEA Covers Children and Young Adults

In most states, each child is entitled to these services from age 3 years through high school, or until age 21, whichever comes first. Some states now offer these types of services beyond age 21. You can find the specific rules of IDEA for each state from the National Early Childhood Technical Assistance Center.

Educational Environment

IDEA states that children must be taught in the "least restrictive environment, appropriate for that individual child." This means the teaching environment should:

• Be designed to meet a child's specific needs and skills
• Minimize restrictions on the child's access to typical learning experiences and interactions

Educating people with autism often includes a combination of one-on-one, small group, and regular classroom instruction.

Individualized Education Program (IEP)

The special education team in your child's school will work with you to design an IEP (also called an individualized education plan) for your child. An IEP is a written document that:

• Lists individualized goals for your child
• Specifies the plan for services your child will receive
• Lists the developmental specialists who will work with your child

Qualifying for Special Education

To qualify for access to special education services, the child must be evaluated by the school system and meet specific criteria as outlined by federal and state guidelines. To learn how to have your child assessed for special services, you can:

• Contact a local school principal or special education coordinator

Consult a parents' organization to get information on therapeutic and educational services and how to get these services for a child.