Patient Presentation
A 12-year-old male came to clinic for his health maintenance examination. He was going to start junior high school in the fall and was excited to talk about trying out for the cross country and track teams. “There’s going to be a lot more kids though so I don’t know if I’ll get to run,” he offered. The past medical history showed a healthy male with no previous athletic injuries.

The pertinent physical exam showed a happy young tween with normal vital signs and growth parameters. His examination was normal. The diagnosis of a healthy male was made. The pediatrician discussed that many sports and other activities at the junior high level were open for all students to be a part of. “Oh, that’s good because I want to be with my friends. I just don’t know if I will be good enough,” the tween said. “You just start doing some running now – a little at a time every day and you’ll be surprised how much you will improve,” the pediatrician offered. He went on, “I also recommend that you practice learning to use a combination lock this summer too because you will have to do that at school too. Sounds like you will have some friends to have lunch with when you start but try to make some new friends too in class and on the teams. There’s always room for more friends in your life. And if you have problems with your classes, just remember to talk with your Dad or with your teachers. They are there to help you.”

Discussion
Starting junior high and high school are big moments for teenagers. They are milestones on the way to adulthood. They require the student to take additional steps toward independence. The schools are usually physically larger at each step and require the student to interact with more teachers, school personnel and other students. Students start to independently engage within the larger community by participation in after school activities such as sports, music, volunteering, etc. Junior high and high school are excellent times to try different activities. Before junior high, many adult relationships the students have are extensions of the parents or families’ relationships. The students in junior high and high school now have more opportunities to create their own relationships with adults on a separate and equal basis.

Learning Point
Ways that parents can help their teenager start junior high, senior high or even a new school year include:

• Location
  • Often transitioning to junior high and high school involves changing school buildings. This may also involve taking new or different modes of transportation such as the bus or maybe driving to school. The bus route should be reviewed including the times and location of pickup and dropoff. Students who drive to school should practice their route including parking locations and any specific local parking rules. Plan for alternatives if the school day starts late or ends early. What will the student do?
• School supplies and clothing
  • Schools will often have a list of needed school supplies but often the list changes once the student is in the classroom. Consider purchasing a limited amount of general supplies before school. Similarly clothing should make the student feel comfortable and is serviceable. Know the school dress code rules and allow the student to choose the clothes they want to wear within reason. Consider purchasing a limited amount of clothing before school and then seeing what might be more fashionable and accepted after the school year begins and purchasing other clothing then.
• Combination locks
  • The idea of not being able to open their locker can be scary for many students, especially for new junior high students. Sometimes students are so afraid that will carry all their books and belonging and become “walking lockers.”Getting a combination lock and practicing before school starts can help students. After a locker is assigned, having the student open the locker a couple of times with a parent or older sibling available also helps with this fear. Remember that students often have more than one locker that they use including their regular locker, gym locker, athletic locker, and musical instrument locker. It’s not surprising that this can be a little overwhelming for them even at the high school level with many other things to remember.
• Friends
  • Having a “buddy” for the first few days of school can help with the transition as the student often feels more comfortable with a friendly face and knows they won’t be “alone” for lunch, the bus ride, or during class.
  • Students should be encouraged to continue good relationships with their friends but also to try to meet new friends. If the student is afraid they won’t have friends asking questions such as “Do you know anyone from your old school?” is a good starting place. “I know you had friends at your old school. What do you think could happen if you didn’t make new friends?” or “What made those friendships successful?” can help the student think about the situation and what they could do to help themselves.
• Multiple classes and being late to class
  • Taking a tour of the school building to learn the location of classrooms, lockers, restroom and lunch room helps to get the student off to a good start.
  • Once classes are assigned, walking around the school to find the classrooms will help with the worries that many students have about getting to class on time. An older student often has many tips to get from class to class effectively.
  • If the schedule changes from day to day, going over the schedule the night before can be helpful especially at the beginning of the year, especially for junior high students.
• Increased Academic Work
  • As students advance though their school career, the expectations also increase. They have to master the content but also have to learn from multiple teachers who may have different teaching styles than they are used to.
  • Many teachers have syllabi that give an overview of their classroom expectations for homework, grading, how to contact the teacher and how to get extra help if needed. Reading the syllabi, by both students and parents, can help the student to know more about the class at the beginning of the year. Keep it for a reference for when the student needs to get extra help or to contact the teacher. Students should be their own advocate and contact the teacher themself at first. If there is a problem then the parent can work with the student to help contact the teacher and get the necessary help.
  • Identifying a “study buddy” for each class is a great way for students to have someone to contact if they miss an assignment or to clarify an assignment.
  • Create a homework place for the student to do their homework that is well lit, comfortable and has necessary supplies close at hand. Students have been sitting in desks all day so some student will want to work on their bed or on the floor. This is okay if they are efficient and able to complete the work in a reasonable amount of time and learn the material. Distractions such as televisions, computers, and phones should be kept out of the homework space if possible. They can be used as a “study break” for a short period of time while homework is being completed. Internet use for school is common and it is recommended that all Internet use occur in a common place of the home such as the kitchen so parents can appropriately monitor its use.
  • A general rule for homework is about 10 minutes per year of school. While there will be daily differences, if the student is consistently spending a long time doing homework, talk with them about if they are having problems organizing the work, efficiently completing the work, problems understanding the work in general or in a specific subject. This may help the student and the parent understand if there is a time management or prioritization problem or if the students needs additional help in a particular subject or even has an underlying attention or learning problem.
• Time management and school planners
  • Using time wisely is one of the most important skills that junior high and high school students need to learn.
  • Using a paper or electronic school planner or calendar (or even a small notebook) is a must for students. Recording daily homework assignments, longer-term project deadlines and school and home activities in one place helps them to learn to plan and prioritize their time wisely. This is a necessary skill and parents may need to help them to learn to use their planner.
  • As different people like to record this information in different ways, different planners can be tried. Paper planners are inexpensive and easy to use, but may not be in the right location all the time or can be lost. Electronic planners are easily backed up so are less likely to be lost. An electronic student planner can be linked to a teacher’s electronic class calendar so the information doesn’t have to be copied. Electronic planners require Internet access though and may not be available during the school day or at other times.
  • Whatever planner is used it should be readily available and easy for the student to use. Parents can help the students by showing or reviewing with students reviewing different ways to use a planner.
• Setting priorities
  • Balancing busy schedules can be difficult for students.
  • Students need to remain healthy which means that physiologic needs should come first when planning their general daily schedule. Regular sleep (and enough sleep ~8-10 hours/day) and meal times should be the first priority for planning a regular daily schedule. As school is the student’s occupation and is a large component of their day, planning the school day and homework is usually the next priority. After this students should schedule family, extracurricular and other personal time as a third priority. While there will be day-to-day and week-to-week variations, a general daily schedule helps students prioritize the important parts of their days in a healthy way.
  • Parents can help the students by enforcing regular sleep and eating schedules, and helping students learn to prioritize all of their daily activities.
  • Extracurricular activities at the junior high levels often allow all or most students to participate. At the high school level, some activities, such as sports, may require tryouts or auditions. Usually there are many other activities for students to participate in, if they do not “make the team” in one activity.
• Technology
  • Technology can improve the educational opportunities for students in and out of the classroom. It can also improve communication among teachers, coaches, parents, peers and students. Technology has to be used wisely though.
  • Technology and the learning environment need to both be respected. In general, computers, phones and other devices should be put away while in class and doing homework. Study breaks or passing time between classes usually are appropriate opportunities to use the devices. Expectation for social media use should be discussed and rules enforced by parents and teachers. Student often do need access to a cellphone (their own, parent or peer) as many schools do not have pay phones and offices are locked at off times. Students can be in contact with parents about after school activities and to check in about their location at home or school. Students should remember that having and using a cellphone or other device is a privilege and with that goes the responsibility of appropriate use.
• Communication
  • Teenagers are trying to become adults during their adolescent years. They may not communicate the way they did as school agers or as an adult would. Parents should continue to talk with their teenager, even if answers are not as forthcoming and discussions are short. Asking open-ended questions can often be helpful because it allows the students to better describe how their day was, or what they did in class. Parents do not need to offer solutions to every problem a students has as often students, like adults, often just need a person to talk to about an issue. Listening by parents should not be underestimated.
  • Parents should keep listening and talking with their student even if they think the student isn’t listening. Family meals or even a beverage break can be good times to talk with students. Car rides may not be a good time as students are often tired after school and activities. It may also be the first time since the morning that there has been some quiet too because school is a noisy place.
• Stress
  • All people have some type of stress in their life and teenagers are no different. Being upset about not understanding the English assignment, hearing a nasty comment by another student, messing up on the choir audition or just even forgetting a school supply can cause stress. Students who are doing well in school, have several friends they talk about, are able to eat meals regularly and getting sleep regularly probably are doing well. Students who may not be handling their stress well may need professional help. Talking with the school guidance counselor, medical professional or spiritual counselor may offer some ideas about how to help the student.
  • Indications that students may not be doing well include:
    • Poor sleep pattern, poor eating pattern or poor grooming
    • Personality changes such as being more angry or violent, being withdrawn, moodiness, or irritability
    • Having anxiety or panic attacks or sadness or depression or becoming violent
    • Loss of friends or abrupt change in the group of friends
    • Any indications the student may be using tobacco or drugs
    • Physical symptoms such as headaches, abdominal pain or chest pain
    • Constantly talking about being hassled or hurried
  • It is understandable that some of these signs occur for short time periods such as around final exams or other stressful times. But if they occur most days, are getting worse, or extend beyond a reasonable time period, students usually should get some professional help.

Questions for Further Discussion
1. What other advice would you offer to students starting junior high or high school?
2. How can young adults keep themselves safe at college? A review is here

3. What does a child need to be ready to go to kindergarten? A review is here
4. What does the literature say about the best school starting times for junior or senior high school students?

Related Cases

Disease: Starting Junior or Senior High School | School Health

Symptom/Presentation: Health Maintenance and Disease Prevention

Specialty: General Pediatrics | Psychiatry and Psychology | School

Age: Teenager

To Learn More
To view pediatric review articles on this topic from the past year check PubMed.

Evidence-based medicine information on this topic can be found at SearchingPediatrics.com, the National Guideline Clearinghouse and the Cochrane Database of Systematic Reviews.

Information prescriptions for patients can be found at MedlinePlus for this topic: School Health

To view current news articles on this topic check Google News.

To view images related to this topic check Google Images.

To view videos related to this topic check YouTube Videos.

GreatSchools.org. Getting Ready for Middle School. Available from the Internet at http://www.greatschools.org/gk/articles/getting-ready-for-middle-school/ (rev. 2016 cited 8/31/16).

Secondary Sara. 5 Ways to Prepare Your Students for Middle School. Available from the Internet at http://minds-in-bloom.com/2015/02/5-ways-to-prepare-students-for-middle.html (rev. cited 8/31/16).

Scholastic. Preparing for Middle School. http://www.scholastic.com/parents/resources/article/what-to-expect-grade/preparing-middle-school (cited 8/31/16).

Scholastic. Kids’ Biggest Middle School Fears. Available from the Internet at http://www.scholastic.com/parents/resources/article/back-to-school/kids-biggest-middle-school-fears (cited 8/31/16).

Scholastic. Making the Transition. Available from the Internet at http://www.scholastic.com/parents/resources/article/back-to-school/making-transition (cited 8/31/16).

HealthyChildren.org. Helping Your Teen Succeed in School. Available from the Internet at https://www.healthychildren.org/English/ages-stages/teen/school/Pages/Helping-Your-Teen-Succeed-In-School.aspx (rev. 11/21/15, cited 8/31/16).

Author
Donna M. D’Alessandro, MD
Professor of Pediatrics, University of Iowa Children’s Hospital