SALT LAKE CITY -- It is getting to be "back-to-school" time in Utah, and pediatricians say a visit to the doctor is as important as new pencils or new shoes before kids return to the classroom.

Since so many children have been home-schooled for the past year, a new report showed they may be behind on their childhood inoculations, which doesn't include the COVID-19 vaccine.

The report from the American Academy of Pediatrics and the Georgetown University Health Policy Institute indicated last year saw at least a 27% drop in kids' doctor visits.

Dr. Jennifer Brinton, president of the Utah Chapter of the American Academy of Pediatrics, said it is important for children to be healthy when they return to school.

"It's very important for kids to stay up to date on their immunizations," Brinton urged. "And unfortunately, with all the disruptions that have happened with the pandemic, nationally and in Utah, we have children who are behind on immunizations of all ages, infants on up to teenagers."

Parents in Utah must provide evidence of kids' receiving six different vaccinations, including polio, mumps-measles-rubella and hepatitis. Check with your child's school for the list. Some parents don't immunize kids for religious reasons or concerns about potential health risks, although those are reported to be extremely rare.

Brinton pointed out having to stay home with a serious illness can cause a child to miss days or even weeks of class time, and catching up on their lessons afterward is a major challenge.

"It's interesting, especially those first few years of school, as kids are learning the alphabet, learning basic math," Brinton remarked. "When they miss those classes because of illness, it takes a long time to make up for it. It can put them back, behind in school, for years."

Dr. Lee Beers, president of the American Academy of Pediatrics, said parents need to make sure every child in their community has equal access to a clean bill of health to return to school.

"Children from households that are low-income and children of color are more likely to have missed vaccines, and more likely to have missed their well visits," Beers reported. "It's so important that we remove any barriers we can to make sure that all kids can get in to see their pediatrician as soon as possible."

The report said while most parts of the country have vaccinated enough children to reach "herd immunity," there are still concerning outbreaks of infectious diseases, like measles and mumps.

School is starting up again for Idaho kids and teachers, and community members and parents can help keep the focus on positive experiences.

Kim Hemmert, grants manager with Idaho Children's Trust Fund, said there are four building blocks that adults can engage children in to ensure healthy outcomes from positive experiences, or HOPE - an acronym used among child well-being advocates.

She said the first block is relationships.

"Every child really needs one person in their life who is that solid champion for that child," said Hemmert, "that safe, stable and nurturing relationship."

The other three are a safe, stable and nurturing environment; engagement in the community; and social and emotional learning.

Hemmert said there are exercises to help kids focus on these components. For instance, teachers can ask students to share their favorite memory from the summer, engaging all four of these building blocks.

"That helps to establish and remember who those trusted relationships are," said Hemmert. "It's already in that safe, stable and nurturing environment in the classroom. You're sharing the memory of your engagement with the community. And it allows the students to be able to articulate and communicate those emotions."

Other examples include returning students showing new students the "rules of the school."

Schools also can welcome families and children into the classroom a few weeks before the year starts so that kids can become familiar with the school and reduce their nervousness on the first day.

Hemmert said schools are a good venue to reflect on positive experiences.

"For a lot of kids, going back to school is going back to a very structured environment," said Hemmert, "and oftentimes kids do well with structure."

The first day of school varies across Idaho. Boise started on Wednesday and Nampa begins today, while other districts will start closer to Labor Day.

New Hampshire ranks second in the country on measures of child well-being, according to the new 2022 Kids Count Data Book from the Annie E. Casey Foundation.

The Granite State scores well for economic well-being, education, health, and family and community factors. However, researchers also found rising rates of attempted suicide nationally, especially for students of color or LGBTQ youths.

In New Hampshire, said Emma Sevigny, children's behavioral health policy coordinator with New Futures, a health advocacy nonprofit in Concord, said the new 988 mental-health hotline is paired with local crisis-intervention services.

"And with it, we have a rapid response team that's available to give support to kids in their communities," she said, "so if we can improve that system and ensure that there is sustainable funding for it, that's a huge step in the right direction."

The report ranked New Hampshire fourth in education, but it drops to seventh for the number of 3- and 4-year-olds not attending preschool. Sevigny said she would like to see more subsidies to help parents afford preschool.

Leslie Boissiere, vice president for external affairs at the Annie E. Casey Foundation, said she'd like to see Congress renew the extended Child Tax Credit that boosted the bottom line for low-income families during the pandemic, but was allowed to expire.

"It's incredibly important that decisionmakers seize the opportunity and the lessons learned during the COVID-19 period, when more resources were provided to families, so that we can make sure that every child has their basic needs met," she said, "that fewer children live in poverty, and that the overall well-being of children in this country increases."

In the legislative session next year, state lawmakers will decide whether to reauthorize the expansion of Medicaid, a lifeline for many struggling families.

Massachusetts ranks first in the nation for children's well-being, according to the 2022 Kids Count Data Book from the Annie E. Casey Foundation.

Experts gave the Bay State high marks for combating poverty and boosting educational achievement. However, the report also found an increase of more than 50% in children ages 3 to 17 with anxiety or depression between 2016 and 2020, nearly double the national average.

Mary McGeown, executive director of the Massachusetts Society for the Prevention of Cruelty to Children, said the state faces a shortage of inpatient psychiatric beds.

"On any given day there are hundreds of kids who need inpatient care, who have gone to an emergency room seeking help," she said, "and they wait there days, weeks, and sometimes months for access to a bed."

Gov. Charlie Baker signed a comprehensive mental-health bill Wednesday that sets up a dashboard to manage psychiatric beds, invests in school-based behavioral health and more.

McGeown credited Massachusetts' top overall score to its success in getting almost all children covered by health insurance, as well as targeted supports to schools and low-income families during the pandemic.

Leslie Boissiere, vice president for external affairs at the Annie E. Casey Foundation, said the nation's recovery remains very uneven, with continued economic hardship, both in highly urban and rural areas.

"Enacting policies that we know can lift children out of poverty and also can secure the financial security of low-income families," she said. "Things like expansion of the Child Tax Credit. Putting resources in the hands of low-income families, so that they can provide for the basic needs of their children."

The report recommends expanding the Earned Income Tax Credit, which provides cash supports to low-income families.