Malaga doctor's guide to helping children start the school year with strong immune defences

"It's very common for parents to come to us at the start of the school year asking for a supplement to prevent their child from falling ill," she states. What she focuses on, instead, are the five pillars of health: good food, physical exercise, sleep, vaccination and hygiene.

In Andalucía, nursery, primary and special needs education begin on Thursday, 10 September, while lower secondary education (ESO), alongside upper secondary education (Bachillerato) and vocational training (FP), begins on 15 September.

Paediatricians "prescribe iron and vitamins" in specific cases, when children have nutritional deficiencies, for example.

With the start of the school year, runny noses, coughs, colds and various viruses emerge, almost simultaneously. To what extent is it normal for a child to have a runny nose for practically the whole of autumn and winter, suffering one cold after another?

"It's very important to distinguish between a child simply having a runny nose and them actually being ill, because we mustn't forget that a runny nose, a cough and a fever are defence mechanisms. We produce mucus to prevent microorganisms from entering through the nostrils," Dr González says.

"It's true that there are babies and children who, quite literally, have a runny nose throughout the winter months," she explains, adding that it's okay for them to continue going to nursery and school, as long as they feel good and don't have other symptoms.

"If they just have a runny nose but are full of energy, happy and able to take part in physical activities, they can certainly go to nursery. However, if, in addition to the runny nose, they are irritable, tired or have a fever, they shouldn't go," Dr González says.

Her advice in such cases? Plenty of rest until they feel better.

"In most cases, many of us parents are forced by work or by our own personal circumstances to say: 'They've had a slight fever, but they're not feeling unwell, a little Apiretal or Dalsy and off to nursery they go'. You see that quite often and then there's the other extreme: 'They've been a bit off today, so I'm going to keep them at home'. The virtue lies in striking a balance," Dr González explains.

When a child has a fever but is otherwise well, the best remedy is a fever-reducing medicine and at-home monitoring over the next 24 hours, which is usually how long it takes for the source of the fever to become apparent.

Very often, parents take their children to the doctor far too early.

That said, there are certain symptoms that should prompt parents to seek medical attention. "When they're listless, when you notice they're excessively drowsy, when they develop skin lesions, uncontrollable vomiting that requires rehydration or diarrhoea leading to dehydration," Dr González says.

Do children suffer from post-holiday syndrome?

"There's a lot of talk about it, but it isn't a medical diagnosis. There is, however, a significant adjustment problem for children, as we expect them to switch from more flexible routines to, suddenly, having to get up early. This can have repercussions: the child may be more tired, not perform as well or experience anxiety. It can be a serious problem if the adjustment isn't managed properly," she states.

Parents should start helping their children adjust in the two weeks leading up to the start of term. "You need to put them to bed progressively earlier and wake them up progressively earlier and establish more structured daily routines: for example, limiting screen time, not allowing screens at bedtime and not letting them take their phones into their bedrooms or to the table at mealtimes," Dr González suggests.

Failure to re-establish a stable sleep routine in children can affect "their academic performance and immune system: going to school when tired can cause anxiety and prevent them from performing well".

"Three- to five-year-old children should sleep between ten and 13 hours a day; six- to 12-year-olds should get nine or ten hours; and older children, 13 to 18, should get between eight and 12 hours a day."

What are the most common mistakes parents make when it comes to rucksacks, desks and posture? The weight of the rucksack should not exceed ten to 15 per cent of the child's body weight.

"We must repeatedly stress the importance of leaving things at school, bringing only what is necessary and checking the rucksack once a week," Dr González says.

Children often carry their rucksack on one shoulder, "which is very bad from a musculoskeletal point of view". "They should carry it on both shoulders. The rucksacks should have wide shoulder straps, sit close to the body, not sag and be properly fitted to the back." That said, "carrying a rucksack incorrectly does not cause scoliosis".

As for shoes, they should be "the right size, fit well, have a little room to spare, be flexible and breathable".

As for screens, it is best to avoid them at least an hour before bedtime and during mealtime. Devices should also not replace outdoor activities.

Younger children should use them for no more than 30 minutes. Eight-year-olds can use them for around an hour or two a day at most. The less time, the better.

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