Category: Health

Backpacks can be fashionable and functional, but they can also be too heavy — weighed down by digital devices, musical instruments, sports equipment and more. Some kids carry home a laptop or tablet and textbooks, too.

It’s good to be prepared, but kids who walk to school or participate in extracurricular activities may be lugging more than their bodies can handle. Lockers and classroom storage aren’t available everywhere — and a child carrying too much weight might not be ready to learn.

As families begin back-to-school shopping, here’s how to know if your child’s backpack is too heavy, and how to lighten their load.

How heavy is too heavy?

The modern school backpack has evolved, but it hasn’t necessarily gotten lighter. Whether students have textbooks, digital devices or both, they often are accompanied by notebooks, water bottles, lunch containers, workout clothes and more. Individually, those items may not seem heavy, but together they can add unnecessary strain to children’s bodies.

According to the American Academy of Pediatrics, signs a backpack may be too heavy include a child leaning forward to support its weight or having difficulty walking. Straps should not dig into shoulders.

Don’t wait for a child to express discomfort or pain to lighten the load, experts say.

Dr. Sadika Kendi, a physician who chairs the academy’s injury-prevention efforts, says back injuries are uncommon but possible, particularly if a child falls while carrying a heavy backpack.

“It’s worse if, for example, they trip and fall and they have a huge, heavy backpack on their back. Then that’s just more weight that could increase the severity of an injury,” she said.

Although 10% to 15% of a child’s body weight is often cited as a backpack guideline, there isn’t enough evidence to establish a one-size-fits-all approach, Kendi said. Because children vary in size, strength, physical development and daily routines, caregivers should consider their child’s individual needs and, in general, keep backpacks as light as possible.

Teachers say leave this stuff at home

After families receive back-to-school checklists for classroom materials, they should take an audit of what a child really must carry every day.

Samantha Ness, a history teacher in Phoenix, said parents should focus on making sure children have basic supplies rather than getting caught up in trendy, decorative or expensive items. Her students have access to classroom textbooks but are still expected to carry a laptop and charger each day. As technology becomes more central to schoolwork, some students have stopped bringing paper, she said. They rely instead on their devices, which can also become distractions.

“When considering the things going into their backpacks, how is it going to help them be successful in the classroom?” said Ness, who has been teaching for about 10 years.

In Fairfax County, Virginia, the school district is bringing back math textbooks after a backlash against technology. That was a win for the group Fairfax County Parents for Intentional Technology, but it also means hard decisions about weight in backpacks.

Parents should think carefully about whether a child really needs to carry both books and a laptop every day, said mom Alix Fetch, a spokesperson for the parents group. Some elementary schools don’t require students to take computers home, while others allow parents to opt out, she said. Block scheduling can also mean older students don’t need every textbook every day.

Fetch said her 7-year-old typically carries lunch, a water bottle and occasionally a folder with homework or notes from the teacher. Even that can feel burdensome, she said, particularly when students move between classrooms for activities such as art or music. And the inside of the bag can still be messy.

“Kids are still kids. There’s food in their backpack and water, and they’re scrunching up papers,” Fetch said.

As students get older, Ness said, backpacks can become more personal storage than school storage, carrying items such as makeup, nail polish and hair dryers.

“They’re using their backpacks more as purses and like storage than they are actually using them for school,” she said.

How to carry the load safely

Experts recommend choosing a backpack that fits the child and has two broad, padded shoulder straps, a padded back, compartments to distribute weight and a waist or chest strap to redistribute the load. The American Academy of Pediatrics also recommends teaching children to pick up and carry backpacks safely, including bending at the knees rather than the waist when lifting heavier bags to avoid strain.

Backpacks with wheels can be helpful, especially for children with injuries, but experts say they may be problematic in schools with stairs or crowded walkways, where they can pose a tripping hazard.

Children should remove their backpacks before riding in a moving vehicle, Kendi said, because wearing one can interfere with how a seat belt works during a crash or sudden stop. Instead, place the backpack beside the child, even if leaving it on seems more convenient during drop-off.

“Don’t wear it in a car or any form of transportation while that car is moving,” Kendi said. “It’s just incredibly dangerous.”

Regularly cleaning out backpacks can also help reduce unnecessary weight and keep track of notes, permission slips and assignments. Some teachers recommend doing it weekly to catch missing work, spills from leaky water bottles and accumulating crumbs.

Around the end of last year, Ronmel Rangel, 63, began to feel a familiar discomfort in his lower abdomen. Twenty-five years earlier, while living in his native Venezuela, he had undergone surgery to repair a hernia on the right side of his groin.

Now, the same pain had returned — on the left.

This time, Rangel was in the U.S. and lacked health insurance. In 2019, he moved to Portland, Maine, where one of his daughters lives.

As a green-card holder, he qualified to purchase health insurance through the Affordable Care Act marketplace. But he quickly realized that the premiums for someone his age were beyond his budget. He decided to go without insurance, even though it had been a priority for him.

Instead, Rangel signed up for a plan at a concierge practice where patients pay as little as $70 a month for services, including unlimited office visits and minor procedures such as stitches and biopsies.

But when Rangel was diagnosed with a hernia, surgery became unavoidable. Ben Hagopian, his primary care physician, helped him compile a list of hospitals and surgical centers to consider. Rangel has a PhD in management, a field he pursued while serving in the navy in Venezuela. Armed with that knowledge and a naturally inquisitive mind, he began researching prices.

His efforts paid off when the bill came.

The medical service

Rangel had what is called an inguinal hernia, which occurs when the contents of the abdomen bulge through a weak spot in the lower abdominal wall. The condition is relatively common, particularly among older adults.

In most cases, surgery is required to fix the muscle wall and can be performed as an outpatient procedure. There are three main surgical approaches to repair an inguinal hernia: open, laparoscopic, and robot-assisted. Studies have shown that the three approaches have similarly low rates of hernia recurrence and are safe and effective.

Rangel underwent an open repair, an approach often preferred by physicians for recurrent hernias. He said his operation lasted less than two hours, and he walked out of the surgical center shortly afterward.

The bill

$2,900: The flat rate Rangel ultimately paid for his hernia repair at an outpatient surgery center in Maryland, including the surgeon’s fee and anesthesia. He said he also paid around $1,800 to travel to the surgery center from his home in Maine, including airfare, meals, and lodging for him and his wife.

The billing problem: No insurance — but time to shop

Because Rangel did not have insurance, he had no protections from high costs — except time and his ability to shop for an acceptable price for his procedure.

Rangel’s first stop was a nonprofit hospital close to home. He scheduled a consultation with a surgeon with MaineHealth, the state’s largest health system, and received an estimate showing it would cost approximately $23,000 to repair his hernia laparoscopically.

Laparoscopic procedures generally cost more because surgeons use more advanced tools. Still, the average laparoscopic inguinal hernia repair costs nearly twice as much at a hospital as it does at an ambulatory surgery center for a patient covered by Medicare, which pays $5,280 for the hospital-based option.

“I wasn’t going to mortgage my life just to have surgery and spend the next 30 years paying off the debt,” said Rangel, now 64.

So, he kept shopping. He considered a surgical center in Oklahoma that was far cheaper, but he ultimately ruled it out because it was so far away. He also explored traveling to Universidad de los Andes in Santiago, Chile, where another of his daughters lives. There, his hernia repair would have cost about $7,000, but once he added thousands of dollars in travel expenses, that option no longer made financial sense.

Gerard Anderson, a professor who analyzes healthcare spending at the Johns Hopkins Bloomberg School of Public Health, said patients without health insurance are often the ones hit hardest by wide price variations.

A closer look at any hospital bill helps explain why. “Every hospital is different,” he said, “but generally about half of the total charge is the facility fee,” a charge added to hospital care to help cover overhead costs.

Anderson said hospitals often mark up prices far more than smaller facilities do.

Medical billing researchers say the price gap between hospitals and ambulatory surgery centers partially reflects the higher overhead costs of operating a hospital.

Hagopian, Rangel’s physician, acknowledged that hospitals have higher administrative expenses. “But that doesn’t explain the high costs.”

MaineHealth declined to comment to KFF Health News, directing questions about the hospital-based procedure’s cost to Jeffrey Austin, president of the Maine Hospital Association.

Austin said that, unlike surgery centers, hospitals must absorb the costs of providing “money-losing” services, such as behavioral healthcare and care for Medicaid patients. He added that revenue generated by large hospitals in a health system supports other facilities, improving access to care.

Hospital prices, which can vary widely, are also driven by negotiations with insurers and market concentration. For uninsured patients, those list prices can become the starting point for negotiations — or the full amount owed.

Anderson noted that standardized payment rates exist for Medicare and Medicaid but not for most privately priced medical services. “In the private sector, providers can charge whatever they want.”

The resolution

Rangel has another daughter in Argentina, a son in Venezuela, and other family in Spain. But he decided to stop looking around the globe for a good price, because he finally found what he was looking for in Maryland.

In April, he traveled to the Affordable Hernia Surgery center in Rockville, where he said “an efficient, well-coordinated system” guided him through the entire process.

“I received professional and very human care,” Rangel said. He was fully recovered within two weeks, as his surgeon predicted, he said.

The surgery center charged Rangel a flat fee for his hernia repair. The added travel expenses for the two-day trip with his wife went toward airline tickets, transportation, meals, and one night in a hotel.

Rangel said he paid about $4,700 total.

Alan Kravitz, the surgeon who performed Rangel’s operation, said the price difference uninsured patients face compared with insured patients is far from fair. “In the predatory and strategic world of U.S. healthcare pricing, uninsured patients generally get charged more than providers would accept from Medicare or commercial insurance.”

Kravitz then pulled out an estimate another patient had received for an inguinal hernia repair from a different large health system. The price: $37,000.

The takeaway

Without insurance, many patients are on their own to negotiate.

“With the help of their primary physicians, patients can dig into prices and compare their options to avoid falling into medical debt,” Rangel said.

That approach, however, is most feasible for elective procedures with several surgical options offering comparable outcomes.

Patients facing medical emergencies do not have the luxury of comparing prices before seeking care, though many hospitals offer cash-pay discounts or charity care for those paying without insurance.

Billing analysts say patients who do have time to shop should look beyond cost alone. They recommend checking the quality of hospitals and surgical centers by reviewing publicly available ratings and patient reviews. Research has found that higher prices do not necessarily translate into a better quality of care, but it’s also important to select a reputable care provider.

Comparison shopping for medical care can be time-consuming. But for patients facing elective procedures, the effort can pay off — sometimes saving thousands of dollars.

“This was a learning experience for me,” Rangel said, “and I hope it will be for other people, too.”

Bill of the Month is a crowdsourced investigation by KFF Health News and The Washington Post’s Well+Being that dissects and explains medical bills.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF — the independent source for health policy research, polling, and journalism.