As if kindergartners don't have enough to worry about -- the right lunch box, a cool enough backpack, the correct amount of pencils -- they have to be on the sharp end of at least four vaccines before they walk into their classroom next week.

But a few seconds of pain followed by some mild muscle soreness is nothing compared to two weeks of chicken pox or a bad case of whooping cough. Plus, the bravery of enduring the pokes is often rewarded with a sticker or rub-on tattoo from the needle-wielding nurse.

As 5-year-olds enter the Helena school system, administrators are going to expect them to be boostered up on DTaP (diphtheria, tetanus and pertussis), polio and MMR (measles, mumps and rubella). Varicella (chicken pox) and hepatitis A vaccines are also highly recommended.

";I just tell the parents, 'You're going to cry; your child's going to cry; I'm going to cry,' " said public health nurse Kay Robertson. ";You sing and dance. You do whatever it takes."

Hopefully they forget the experience by the time they reach middle school, when they face another series of shots.

As seventh-graders, tweens are ready for Tdap (tetanus, diphtheria, pertussis), Robertson said. This booster vaccine was developed in 2005, the year after whooping cough hit the adolescent population fairly hard, Robertson explained.

Medical experts realized that the protection from DTaP vaccines given at infancy and toddlerhood wears off by adolescence, a time when kids are gathering in larger social groups.

When parents bring their seventh-graders into a health care provider's office for the Tdap vaccine, they most likely will be provided with information of other recommended vaccines such as hepatitis A and B, meningococcal, seasonal flu, chicken pox and HPV (human papillomavirus).

";We bring it up," Robertson said. ";It's becoming a great conversation starter."

Seventh-graders handle the vaccines a little better than the kindergartners, according to Robertson.

";Seventh-graders think they're brave," Robertson said. ";Some get big tears, others say, 'Is that all?' "

This is actually a good question, this year in particular because of H1N1. With the development of an H1N1 vaccine, kids could be among the first in line to receive the two-dose vaccine once it becomes available.

";The school district is working with the county on a plan once H1N1 vaccines arrive," said school nurse Kathy Boutilier.

Robertson said the vaccines could arrive in late October or early November and the county and school district are considering setting up shot clinics at the schools.

";We're all watching what happens when all the schools come back together," Robertson said.

In the meantime, school nurses will be working with students on influenza prevention methods, Boutilier said.

School nurses are teaching basic ideas such as frequent hand washing with soap and water; respiratory hygiene -- covering your mouth when you cough or sneeze; avoiding touching eyes, nose and mouth; and avoiding contact with sick people, Boutilier said.

";The most important thing of all is to stay home when you're sick," Boutilier said.

Both Robertson and Boutilier say they're gearing up for the flu season.

";It's going to be interesting," Robertson said. ";I think more seasonal flu shots will be given."

";I'm anticipating a typical influenza season, but earlier," Boutilier said. ";H1N1 is just an influenza virus we haven't experienced yet."