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    By who you are · 21 tips

    Parents of school-age children

    Some physical and mental health matters can't wait until after exams. Also, how to guide a child without hurting them.

    1 What can't wait

    Children once they start school

    Take a child to the hospital right away for sudden, worsening severe pain; don't make him hold out until school ends

    Some illnesses are counted in hours. If a boy has sudden severe pain on one side of the scrotum, it may be testicular torsion: the blood vessel attached to the testicle has twisted shut and cut off its blood supply. If it is treated within 6 hours, 97.2% of testicles are saved. By 19 to 24 hours, only 42.5% are. This kind of pain can't wait until school lets out or until exams are over.

    • Top value
    • Evidence A
    • Buys life
    • For: Child aged 3–18
    Children once they start school

    Don't put off treatment that is due just to “wait until exams are over”; some windows follow bone age, not the exam calendar

    Scoliosis is a sideways curve of the spine. A brace is a hard-shell vest worn on the body to hold the spine in place. Worn while the bones are still growing, 75% of children had not curved to 50 degrees by the time the bones finished growing, versus only 42% of children who were just watched without a brace. The time when a brace can work follows when the bones finish growing, not the high school or college entrance exams (中考高考); if you wait until after the exams, you may miss it.

    • High value
    • Evidence A
    • Buys life
    • For: Child aged 3–18
    Children once they start school

    If a child is bullied, report it to the school the same day and ask for a written response; report fights, extortion and rumor-spreading straight to the police

    A child bullied by peers is about 2.2 times as likely to have thoughts of suicide, and about 2.6 times as likely to have attempted suicide, as a child who is not bullied. When a school receives a report, it has to investigate immediately. If the incident is judged to be bullying, the school must discipline the students involved, and serious cases may not be hidden and must be reported to the public security authorities (公安, the police). So report on the same day, ask the school to go through the formal determination process, and keep a written record.

    • High value
    • Evidence A
    • Buys life
    • For: Child aged 3–18
    Children once they start school

    Have a child aged 12 to 18 screened for depression once, and don't treat the school's psychological assessment as a diagnosis

    American prevention guidelines recommend screening children aged 12 to 18 for major depression; for ages 11 and under the evidence is not enough. In the U.S., suicide is the second leading cause of death among children aged 10 to 19. The school's yearly psychological assessment is only a broad survey and can't be taken as a diagnosis. If the child says they feel awful, go straight to a psychiatry or clinical psychology department.

    • High value
    • Evidence B
    • Buys life
    • For: Child aged 3–18
    Emergencies: what to do first

    If a child swallows a button battery, or swallows two or more strong magnetic beads, go at once to the emergency room of a hospital that has endoscopy; don't wait for it to pass on its own and don't make the child vomit

    A button battery stuck in the esophagus can cause a serious burn in as little as 2 hours, and the child may look fine at first. Two or more magnetic beads will attract each other through the intestinal wall and can press a hole through the bowel. If you suspect your child swallowed one, go to the hospital for an X-ray right away; don't make the child vomit, don't wait for it to pass on its own, and don't wait for symptoms before going.

    • Top value
    • Evidence B
    • Buys life
    • For: Child under 3, Child aged 3–18
    Emergencies: what to do first

    If a permanent tooth (one that grew in after the baby teeth) is knocked out whole, hold it by the crown and rinse it briefly, put it back if you can, and if you can't, soak it in milk and see a dentist right away; don't put a baby tooth back

    Hold the tooth by the crown and don't touch the root. If it is dirty, rinse it gently with milk or saline. If you can put it back in its place, do so, and bite on a clean cloth. If you can't, soak it in milk and see a dentist right away; don't wrap it dry in a tissue. Of teeth put back on the spot, about 20% later fuse to the bone at the root; of teeth left dry for an hour or more, more than 80% do. Don't put a baby tooth back.

    • High value
    • Evidence B
    • Buys life
    Children once they start school

    If a child hits their head during sports and afterward has a headache, dizziness or feels dazed, don't let them play again that day; if there is repeated vomiting, growing drowsiness or a worsening headache, go to the emergency department right away

    Children who kept playing after a concussion took an average of 44 days to recover, versus about 22 days for those taken out on the spot. If anything seems off after a blow to the head, don't let them play again that day, and wait until a doctor says it's okay. Repeated vomiting, growing drowsiness so they can't be woken, a worsening headache, slurred speech and seizures are all signs to go to the emergency department right away.

    • High value
    • Evidence B
    • Buys life
    • For: Child aged 3–18

    2 Eyes and teeth

    Children once they start school

    Get a child at least 2 hours outdoors every day, the only way to prevent myopia that is currently supported by a randomized trial

    In first grade, an extra 40-minute outdoor class every day cut the share of children who newly became nearsighted over three years from about 40% to about 30%. The National Health Commission (卫健委) recommends at least 2 hours outdoors in the daytime every day, or 14 hours a week in total. Cloudy days count.

    • High value
    • Evidence A
    • Buys life
    • For: Child aged 3–18
    Children once they start school

    Treat myopia as damage that stays: the stronger the prescription, the more retinal detachment, macular disease and glaucoma later

    Myopia does not get better by itself, and the prescription does not go back down. It is also more than a matter of “just wearing glasses.” Compared with people who are not nearsighted, the chance of myopic maculopathy is more than ten times higher with mild myopia and several hundred times higher with 600 degrees (度, the Chinese unit for eyeglass strength) or more. Retinal detachment is about 3 times higher with mild myopia and about 13 times higher at 600 degrees or more. So the deeper a child's prescription gets, the greater the risk to carry later.

    • Top value
    • Evidence A
    • Buys life
    • For: Child aged 3–18
    Children once they start school

    If poor eyesight is found, get a dilated eye exam at a hospital, then go back for follow-up at the intervals the doctor gives

    In a dilated eye exam (散瞳验光), an eye drop is put in first to relax the muscle inside the eye that does the focusing, and then the prescription is measured. It is done at a hospital and is the most accurate way to diagnose myopia. The National Health Commission (卫健委) states that the drops do not damage healthy eyes and that vision returns to normal after the drops wear off. Don't treat a single computerized test at an eyeglass shop as a diagnosis, and don't hold off on glasses for the child out of fear that the prescription will go up.

    • Moderate value
    • Evidence B
    • Buys life
    • For: Child aged 3–18
    Children once they start school

    Don't buy products or services that claim to “cure myopia” or “reduce the prescription”

    The State Administration for Market Regulation (市场监管总局) has said plainly that “with current medical technology, myopia cannot be cured.” Ads that use claims such as “restore,” “reduce the prescription,” “myopia cure” or “prescription repair” are to be dealt with strictly. When you see such words, rule the product out and don't bother comparing prices. Eye-protection devices count as medical devices, and online platforms are responsible for checking that sellers are qualified to sell them.

    • High value
    • Evidence B
    • Saves money
    • For: Child aged 3–18
    Children once they start school

    Get pit-and-fissure sealants once the permanent molars come in

    A pit-and-fissure sealant (窝沟封闭) uses resin to seal the grooves on the chewing surface of the big back teeth, so food debris can't get stuck in them. Two years after it is done, the chance of cavities is about one eighth of that without sealing. Without it, 16% of tooth surfaces get cavities, and with it only about 5%. It is still effective after four years.

    • Moderate value
    • Evidence A
    • Buys life
    • For: Child aged 3–18

    3 How to guide your child

    Children once they start school

    Don't hit your child, and don't yell or call them stupid: children who are often hit or yelled at have more behavior and emotional problems

    Children who are often hit have more aggression and psychological problems, are more distant from their parents, and are hit harder more often. Whether hitting makes a child obey on the spot is unclear from the evidence. Children who were often yelled at and called stupid at age 13 went on to have more trouble and more depression, and parents being affectionate otherwise did not cancel that out.

    • Moderate value
    • Evidence A
    • Buys life
    • Disputed
    • For: Child under 3, Child aged 3–18
    Children once they start school

    Take a parenting course that teaches concrete methods if your child is hard to manage and you keep losing control and hitting or yelling

    For children who are hard to manage, when parents took a course that teaches concrete ways to manage them, the children's problems with hitting and breaking rules decreased, and the parents' moods got better. Parents also hit and scolded less, most clearly right after the course and still there a year or two later, though much smaller. A course of this type was also tried in Shanghai and worked.

    • Moderate value
    • Evidence A
    • Buys life
    • For: Child under 3, Child aged 3–18
    Children once they start school

    Check whether sleep, homework and getting outdoors are being squeezed out before you fix on how long a child plays

    Only about two or three people in every hundred really meet the bar for “gaming disorder.” If the questionnaire's cutoff is set low and it is aimed at teenagers, the share comes out inflated. In real records from game companies, how much someone plays has almost no link to well-being. Under the rules, minors may play only from 8 p.m. to 9 p.m. on Fridays, Saturdays, Sundays and public holidays.

    • Moderate value
    • Evidence B
    • Saves time
    • For: Child aged 3–18
    Children once they start school

    Give no screens at ages 0 to 3, avoid them as far as possible at 3 to 6, and keep non-study use to no more than 1 hour a day for school-age children

    The National Health Commission (国家卫健委) asks for no screens at ages 0 to 3 and as little contact as possible at ages 3 to 6. For primary and secondary students, use that is not for study should be no more than 15 minutes at a time and no more than 1 hour a day. The reason given is that long periods of close-up eye use bring myopia on earlier. The evidence linking screens to myopia is not that firm. What has actually been shown to work in a trial is 2 hours outdoors every day.

    • Moderate value
    • Evidence B
    • Buys life
    • For: Child under 3, Child aged 3–18
    Children once they start school

    Don't send a child to a locked-down “internet addiction school” or “special training camp”: the law forbids using methods that harm body and mind to curb internet addiction, and children have been locked up to death

    The law expressly forbids using methods that harm a child's body and mind to curb internet addiction. At a special training school in Hefei, a newly delivered boy was handcuffed in a confinement room and died after about 44 hours. At Yuzhang Academy (豫章书院) in Nanchang, students were locked in confinement; four people were sentenced, and the parents' demand for a refund of tuition was not upheld by the court.

    • High value
    • Evidence C
    • Buys life
    • For: Child aged 3–18
    Children once they start school

    Don't scold a child who says they like the same sex, throw them out or send them for “conversion”: how the family reacts is linked to whether they attempt suicide

    Among middle school students in China, children who like the same sex or like both sexes were about 3 to 5.5 times as likely as others to have attempted suicide in the past year. Research abroad has found that children who were strongly rejected by their families in adolescence later attempted suicide far more often. Children whom parents sent for “conversion” also attempted suicide far more often.

    • High value
    • Evidence B
    • Buys life
    • For: Child aged 3–18
    Children once they start school

    Teach a child which parts of the body are private, and to tell you at home if anyone touches them or asks for secrecy; if the child tells you, believe them first and don't scold, then take them to report to the police and to a doctor

    Children who have taken a sexual-abuse prevention course made protective moves far more often in drills where someone posing as a stranger tried to lure them. What they learned was still there six months later, and the children did not become more afraid. Whether it actually leads to less abuse has not been measured. Among people who sexually abuse children, acquaintances make up a high share, so teach the child which parts others may not touch, and that if someone touches them or asks them to keep a secret, they should tell you at home.

    • Moderate value
    • Evidence B
    • Buys life
    • For: Child aged 3–18

    4 School rules

    Children once they start school

    Read the report from the yearly school health checkup yourself, and take any abnormal item to a hospital the same year

    Primary and secondary schools organize a health checkup for students once a year. The key items on the report are overweight, obesity, undernutrition, abnormal spinal curvature, poor eyesight and tooth decay. Don't glance at height and weight and put the report away. If any of these items is abnormal, take the child to a specialist to get it sorted out that same year.

    • High value
    • Evidence B
    • Buys life
    • For: Child aged 3–18
    Don't waste your money

    Teach your child one sentence: anyone who tells you to use a parent's phone or read out a verification code is a scammer

    The 6 types of scams use different tricks, but the last step is always the same: getting the child to use a parent's phone to transfer money or read out a verification code. So one sentence is enough to teach: whoever tells you to touch a parent's phone or give out a verification code is a scammer. Add one more: "If you get scammed, tell me first, and I won't scold you."

    • High value
    • Evidence B
    • Saves money
    • For: Child aged 3–18

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