WIESBADEN, Germany - Just as math and reading skills build on one another over the school years, so do good health habits, according to Wiesbaden school nurses.

In elementary school children need to learn the basics, such as good hand washing techniques, said Robin Harvel, school nurse at Aukamm Elementary School.

In middle school, when students receive more homework, backpack safety becomes important so students do not injure their backs, said Maresa Laxa, school nurse at Wiesbaden Middle School.

In high school, busy students want to avoid consuming too much caffeine and make sure they eat well, said Duangjai Solo-Foote, school nurse at Wiesbaden High School.

No matter what the grade, however, it is always a good idea to review previous years' lessons. As students return to school, good hand washing techniques, for example, are as important for first-graders as they are for 12th-graders.

It is also important that parents of all students make sure youths get a good night's rest and eat a nutritious breakfast, Harvel said.

Students can help stop the spread of germs by covering up coughs, Harvel said.

In addition, parents should keep students home if they have a fever of 100.5 degrees Fahrenheit or more, Harvel said. Students should not return to school until 24 hours after the fever is gone.

When students get to middle school, those same lessons apply, but the issue of backpack safety becomes important as well.

Laxa said she refers parents and students to a recent newsletter by John Pentikis, ergonomist for the U.S. Army Public Health Command, for tips on how to prevent back injuries from backpacks.

The Consumer Product Safety Commission reported 7,300 injuries due to backpacks in 2006, Pentikis wrote in the newsletter.

Backpacks should not weigh more than 10 to 15 percent of the student's weight, according to Pentikis. For a student who weighs 60 pounds, for example, the student can carry between six and nine pounds, but no more.

Backpacks should be as light as possible, match the size of the user, have wide, padded shoulder straps and include a waist strap, a padded back and a lumbar cushion, according to Pentikis.

In addition, students and parents should pack heavier items in the center of the backpack, and evenly distribute weight by using all the backpack's compartments, according to Pentikis.

Students should always use both shoulder straps and the waist strap, and adjust the backpack so it is resting on the curve of the lower back, according to Pentikis.

Students should avoid resting the backpack more than four inches below the waist, Pentikis said.

Backpack safety continues to be important in high school, but new issues also arise.

Many parents of high school students do not know the problems associated with energy drinks, which are popular with high school students, Solo-Foote said.

Energy drinks contain a lot of caffeine, Solo-Foote said, and that can cause students to experience an energy rush immediately after drinking the beverage, and then experience an energy crash that will cause them to come to school drained.

One student a few years ago had a seizure after consuming too much energy drink, Solo-Foote said.

Breakfast skipping is also an issue with busy high school students, Solo-Foote said, and students should always eat breakfast before coming to school.

At every age, it is also necessary that students get plenty of exercise after school each day, Harvel said.

Parents also have a good place to go with any health-related questions, Harvel said.

"If you have any health concerns or questions, please feel free to contact your school nurse," Harvel said.