building good lifestyle habits for your kids this back-to-school season

with the rush for back-to-school gear and supplies, getting kids prepared for the fall routine can be hectic. but there are important health aspects to set students up for educational success that are important and impactful as well.

dr. peter azzopardi, chief and medical director of pediatrics at scarborough health network (shn)in scarborough, ont., has dedicated his career to the well-being of kids and teens, along with raising kids of his own. his dad was a pediatrician, and his son has just started his professional career as a pediatrician at shn (at a different site for some degree of separation from his dad).

“i’m really still a kid at heart and, you know, working with young people, children, parents has always been something that brings me a lot of joy. it’s not a job for me,” he says.

“interacting and connecting with kids and teenagers, dealing with the anxieties of being a new parent—all of these things are part and parcel of the career.”

because, yes, kids get sick. prevention lies in good lifestyle habits that parents and caregivers help establish for kids, but also model, so take note. here’s a wellness checklist to guide the way:

make sleep a priority

the school sleep routine may look very different from the more relaxed bedtimes and mornings of summer, so shifting to earlier sleep and wake times can be a transition. kids, especially teenagers, need enough sleep. “it’s something we really downplay in our society,” says dr. azzopardi, although he notes that some high schools have adopted later start times to allow teens to sleep in compared to the usual workday.

“but it really comes down to setting up an appropriate bedtime where you can put the electronics away and move to a quiet, dark room and just get some shuteye. teenagers always underestimate how much sleep they need. most are surprised when i tell them that the average teenager needs nine to 10 hours of deep sleep per night. and they just look at me like, ‘how am i going to fit in all my instagrams and my chats and all of those things into that kind of schedule?'”

he tells patients that our bodies are like machines that need fuel and rest. “if we keep overworking our machine and we don’t get that rest, then we start to pay for the consequences. usually that turns out to be issues with mood, issues with motivation, memory and concentration. all of these are impacted heavily when kids and teens aren’t getting enough sleep.”

some teens have admitted they’re often up well past 2 a.m. doing activities online, then having to get up at 7 a.m. to get ready for school and skipping breakfast, setting up a bad pattern.

he asks parents and teens to watch for warning signs of too little sleep, such as feeling more irritable than usual, lacking interest or motivation, or feeling tired after school, so they feel compelled to nap, which interferes with nighttime rest.

plan regular meals, including breakfast

breakfast is often skipped, which kids may learn from adults, leading to poor performance and mid-morning sugar cravings.

an australian study published in public health nutrition in 2021looked at a sample of almost 62,000 students, both children and adolescents, finding that those who consistently skipped breakfast experienced lower cognitive and emotional engagement, which could be linked to short-term energy supply and long-term health impacts.

authors note that the relationship between breakfast skipping and academic outcomes has been well-studied, but the relationship between breakfast skipping and other school-related outcomes has not been evaluated to the same extent. school engagement, including behavioural, emotional, and cognitive engagement, has been identified as an important and potentially malleable predictor of positive school and later-life outcomes.

as dr. azzopardi says, “anybody who’s weight conscious thinks that they can sort of get through breakfast because they don’t feel hungry. and i remind kids that breakfast is made up of two words: break and fast. we have to break our fast to get our engine working and to turn our computer on. if we don’t give our body some fuel in the morning, we are still in sleep mode. and it’s really important to try to get some nutrition. it doesn’t have to be a world-class buffet breakfast. it just needs to be some nutrition, some fluid to get the engine going, and then they can catch up with more balanced meals later in the day.”

lunch is important for refuelling, and dr. azzopardi suggests starting kids early by having them make their own lunches with a parent’s oversight or doing it side-by-side so they have some choice, which can help improve their compliance with eating. no parent likes to see the untouched lunch come back home.

he continues, “lunch should have a bit of a social time to it as well, and hopefully putting phones away at lunchtime, especially for our teenagers, is also important to help improve social interactions.”

family dinner offers food and connection

there’s a lot to be said for being a role model for our kids and how that plays out over time. “remember that our children learn from us. so we have to watch our own behaviours with electronics and screen time and so forth, and communications,” he says, cautioning against having text conversations with our teens. he advocates having one meal a day as a family, typically dinner.

“it sounds like it’s nothing, but that is such a good forum for communication and good social interaction that i think we downplay some of these things very much in terms of the busyness of our lives.”

make space for downtime

while parents often have good intentions by introducing kids to new skills and social groups, having too many activities, particularly during the school year, can be a challenge. this can take time away from other important things, even affecting homework or other responsibilities they need to keep up with academically.

make sure to schedule downtime. rather than always leaving that teenager or child to go off to their room and do something on their own, dr. azzopardi recommends aiming for family time for two days a week where you have a planned activity like a walk in the neighbourhood, a cycle or going someplace to play together as a family so that it doesn’t become “just something that’s boring,” he says.

“it’s a good way to make sure that you stay connected and keep those lines of communication open with your children.”

protect mental health, too

canada has many safeguards that give us healthy children and healthy teenagers, but the rise of mental health issues in kids is cause for concern. as the canadian institutes for public health reports, by age 25, approximately one in five canadians are diagnosed with a mental illness; the majority (70 per cent) experience symptoms before age 18. research shows the prevalence of these disorders, particularly those related to mood and anxiety, may be increasing over time and need to be diagnosed and treated to decrease poor health outcomes, poverty and unemployment.

dr. azzopardi says that the rise in mental health problems for young people is connected to screen time and isolation, and the breakdown of good family communication.

“i think more and more we’re aware of the potential of bad influences, whether it’s cyberbullying, or frankly, the use of ai and these chatbots that are heavily influencing adults, but you can imagine that on a young teenager, these can be extremely addictive and not necessarily in the best interest of your child or teenager.”

he advises talking about these issues and establishing family rules, because all of this will have an influence on their mental health. also, watch for signs that your child is not coping well so you don’t let things get to a point where it becomes unapproachable and something you can’t talk about.

warning signs include overall change in mood, change in willingness to go to school, problems with friends where they’re no longer talking to old friends they used to rely on. “so as teenagers get older, of course, they want more and more privacy, but there’s responsible use of that time and many teenagers will immediately head to their room, shut the door and not be seen until you beg them to come down for dinner and bedtime type of thing. so i think isolation is one of those things that also becomes a challenge.”

reach out to your child or teen, and make sure you have strategies for talking about difficult situations or topics we often try to avoid. his teens would dread the “car ride with dad” where they were a captive audience, and he could broach topics like drugs, alcohol and relationships—easier because you didn’t need to make eye contact.

are vaccinations up to date?

“vaccinations shouldn’t be controversial. they’re one of the best things that science has done for humankind. our vaccines are extremely safe, well-researched and effective. and we are very lucky to have what we do have available,” he says, adding that, in his extensive career, life-threatening problems have disappeared.

he outlines vaccines that start with preschool boosters, scheduled in ontario to be given between ages four and six. one of these is the measles vaccine, critical because there are measles outbreaks and lots of travellers coming in and out of our cities who may be carriers. measles is very contagious, so he suggests getting the vaccine at age four.

with vaccines done in grade 7 for 12-year-olds, the one for hepatitis b and the one for human papillomavirus (hpv) are both viruses that can lead to cancer in adulthood. “by giving those vaccines, you are actually curing cancer, which is quite incredible. so those are extremely important. there’s also a meningitis vaccine at age 12 as well.”

he also urges getting the flu shot every fall, having worked in emergency departments and seeing children, babies and teens coming in with influenza. “people don’t realize that influenza can be seven to 10 days of high fever, severe pneumonia, most of which we have very poor medications or no medications to help.”

for the first 10 to 15 years of his career that spans 36 years, doctors would routinely see children with brain infections or what’s called meningitis, which is almost always a lethal disease, if not very debilitating. “knock on wood, because of good vaccinations for both of the two of the major bacteria that can cause meningitis, we have much reduced rates of meningitis.”

chickenpox, the highly contagious viral infection, can lead to meningitis. “it was widespread among our youth, and it was sort of a part of growing up. you had to get chickenpox at some point, right? most times it’s a very benign disease, but i have seen chickenpox result in at least three children dying because of that particular virus. and now you don’t see chickenpox in canada. the new medical graduates will probably hardly ever see chickenpox because of good vaccination,” he says.

“it’s much better to be vaccinated than to be unvaccinated.”

for more information and resources on raising healthy kids and teens, visit the canadian paediatric society.