The Myopia Epidemic: Protecting Your Child

Myopia, or nearsightedness, has reached epidemic proportions in parts of Asia. The National Eye Institute warns that by 2020, 39 million Americans will be nearsighted, and that the figure will grow to 44.5 million by 2050. The myopia epidemic begins with children and teenagers, so that some call it the childhood myopia epidemic. Mild to moderate cases of childhood myopia tend not to have any serious long-term effects on health or vision. Progressive myopia, on the other hand, comes with a higher risk of serious complications including detached retina and glaucoma.

In myopia, the eyeball is either too long from front to back, or the cornea, the clear covering of the front of the eye, has a steep curve. This changes the way light rays land on the eye. When all works as it should, light rays find their way to the retina. The retina is light-sensitive tissue at the back of the eye.

In myopia, the different shape of the eye changes its slope, causing light rays to fall just in front of, instead of directly on the retina. The result is a change in vision.  Myopia means that objects that are close up are seen clearly, while faraway objects are blurry.

Myopia is nearsightedness. Hyperopia is farsightedness.

For most people, nearsightedness gets worse over time. Glasses and contact lenses are used to restore normal vision. For those looking for a more permanent solution, surgery may be a good option.

The Myopia Epidemic

The extent of the myopia epidemic in Asia is striking. Back in the 1950’s just 10-20 percent of the population in China had myopia. Now, as many as 90 percent of teenagers and young adults are nearsighted. It’s not just China, either. In Seoul, 96.5 percent of 19-year-old men are nearsighted.

Students in Chinese classroom illustrate effects of myopia epidemic
JIANGXI CHINA-April 19, 2018: April 19, 2018: junior high school students in Jiangxi, China, affected by myopia epidemic, wear spectacles for nearsightedness in class. The prevalence of myopia in China ranks first in the world.

Asia may have seen the worst of the myopia epidemic, but nearsightedness is also affecting the West. Half of all young adults in the United States and Europe are nearsighted. That’s double what it was 50 years ago. Some experts think that as many as one-third of the entire world population, 2.5 billion people, may have myopia by 2020. And it’s mostly happening to our young people.

Myopia Risk Factors for Children

Myopia is, in part, something a child inherits from his parents. But myopia can also develop from pollution in the environment or from stress on the eyes. Spending long hours reading, doing close work like embroidery, or working at a computer screen, are examples of activities that stress the eyes, and may cause or worsen nearsightedness. Spending 2 hours a day outside, on the other hand, can stop myopia from getting worse.

Here is a list of risk factors for myopia and myopia progression from the American Academy of Ophthalmology:

  • Near work or visual activity that forces the eyes to keep near objects in focus
  • High level of education
  • Low levels of outdoor activity
  • Diet
  • Television
  • Computer games
  • Electronic devices
  • Pollution
  • Female gender
  • Season of birth/daylight hours
  • Parents are nearsighted
  • Use of a night light
  • Younger age at diagnosis
  • High IQ score

Myopia And Free Radicals

There is evidence that oxidative stress inside the eye causes eye problems, including nearsightedness. This type of stress can increase the amount of something called reactive oxygen species (ROS) in the eye and in the retina, in particular. ROS is a type of unstable molecule or free radical, that interacts with other molecules and contains oxygen. Too much ROS can cause damage to DNA, RNA, and proteins, and may even cause cell death. The retina has continuous exposure to light, and this causes a buildup of ROS.

Antioxidants are known to fight eye problems caused by oxidative stress. Eating a diet rich in antioxidants can help stop the progression of myopia. For this reason, kids should eat foods containing vitamins A, C, and E; beta carotene; and zinc/copper.

Zinc is of particular importance to the retina. Not getting enough zinc can damage eye tissues and other structures important to the eyes. Too much zinc can cause a copper deficiency, so you want your child to eat foods that contain both copper and zinc. Foods containing copper and zinc include seafood, beef, beans, and seeds.

Foods rich in zinc
Foods rich in zinc can help protect your child from the myopia epidemic

Myopia: Genes Or Lifestyle?

Experts used to believe that developing myopia was all in the genes. A study from 1963, for instance, found that nearsightedness is more common in identical twins than in non-identical twins. This would suggest that DNA plays a big role in who develops myopia. Since that time, scientists have found over 100 regions of DNA that can be linked to myopia.

It was obvious, on the other hand, that myopia was caused by more than genes. A 1969 study of Inuit people in Alaska showed that lifestyle changes may be causing myopia. Of the 131 adults in the community, just two were nearsighted. But over half of the children and grandchildren of this community were found to be nearsighted. It was clear they weren’t inheriting the condition from their parents and grandparents. Something else was going on.

Researchers figured the difference might have to do with reading. It’s not a new idea. Moms have always told children not to read in dark rooms and to give the eyes a break  every once in awhile. And in fact, over 400 years ago, Johannes Kepler, a German astronomer and optics experts, said he’d become nearsighted because of all his studying and book-learning. Leading ophthalmologists of the 1800s recommended that students use headrests to create a distance between the eyes and a book’s text. This was meant to prevent reading too close, which was thought to strain the eyes.

Myopia And Reading

The myopia epidemic does seem to be connected to reading, but it’s not so much about reading books. Today, kids are spending most of their time reading from computer and smartphone screens. That’s also true in East Asia, but kids there aren’t just chatting and going on social media: they’re using computers and smartphones to study, too.

Just how much are the kids in Asia studying? A report from 2014 by Organisation for Economic Co-operation and Development (OECD) found that the average 15-year-old in Shanghai spent 14 hours a week on homework, compared with 6 hours in the United States, and just 5 hours in the United Kingdom.

Anywhere that there is a focus on education, you’re going to see lots of myopia. In the 1990s in Israel, for example, teenage boys who studied in yeshiva seminaries had higher rates of myopia than their peers. In seminaries, the boys spend the entire day, every day, studying religious texts. Taken on the face of things, it did seem to researchers as though reading up close for long periods over time may change the shape of the eye and the way light hits (or doesn’t hit) the retina.

Yeshiva students are affected by the myopia epidemic
Yeshiva students spend long hours studying religious texts

But the idea was myth-busted when, during the early 2000s, researchers tried to find a link between myopia and the number of books read each week or hours spent using computers. These factors, as it turned out, didn’t seem to be the main contributor to a young person becoming nearsighted. In 2007, however, the light went on, so to speak. That’s when researchers figured out that kids in California who became nearsighted had stopped spending time out of doors. A year later, a much larger study done in Australia of 4,000 Sydney children over three years’ time, found that the kids who spent less time outside had a higher risk for developing nearsightedness.

Myopia And Natural Light

Why is it so important for kids to spend time out of doors? It has to do with getting enough natural daylight. It seems that indoor light is always going to be less bright than outdoor light. The natural light outside is brighter than the most brightly lit indoor room, even on the cloudiest days. Light bulbs just can’t compete with Mother Nature.

In the winter, kids may be less inclined to play outside. It’s also true that the days are shorter during the colder months. That may be the reason that more kids become myopic in winter than in summer. There’s just less exposure to natural light at that time.

It’s not just the natural light that helps preserve eyesight and prevent nearsightedness. Being out of doors means being in wide open spaces. That means that the eyes have more room to focus. That’s better for vision than being in an indoor room that forces the eyes to focus at shorter distances.

Kids at risk for myopia should try to spend 14 hours a week out of doors. That’s about two hours a day. And of course, if they can spend more time out of doors, they absolutely should.

girl walks dog in park
Walking the dog is a great way to avoid becoming a statistic in the myopia epidemic

Here are some recommended outdoor activities:

  • Sports (baseball, basketball, tennis, and etc.)
  • Walking the family dog
  • Hanging out in parks
  • Hiking
  • Riding a bike

Balancing Study Periods With Rest

Kids can’t be outside all day and they do have to study. That’s why it’s important to limit the amount of time spent doing close work. Kids should also take a break from close work every half an hour. During these breaks, if they can’t go outside, kids should at least look out the window to give their eyes a rest. When kids are reading, watching television, or using computer and phone screens, they should have good light and not sit too close to books and screens.

Natural sunlight seems to be the simplest solution to avoiding childhood myopia, or prevent it from worsening. But researchers have been working on other means to stop childhood myopia from getting worse. There are corrective lenses that reshape the eyes. There’s also research to suggest that using atropine eye drops at night may help to get myopia progression in children under control. The problem is that researchers don’t yet know why these drops help. What they do know: atropine is known to block neurotransmitters.

The upshot of all this research on childhood myopia? Balance study time with time spent resting the eyes. Have children go outside as much as possible, at least two hours a day. When children are studying, make sure there’s good light and that they don’t sit too close to their work

Childhood Myopia And Eye Exams

Beyond all that, make sure your child has an eye exam once a year, so the doctor can see if or how your child’s eyes are changing. That should be on a parent’s to-do list whether or not a child complains about his vision. Kids generally don’t complain about being nearsighted. They just figure out how to make do.

Child having eye exam

Do you think your child may be at risk for becoming nearsighted? Bring your child to an eye doctor as soon as possible. Finding and treating myopia is still the best way to keep your child from becoming a statistic in the childhood myopia epidemic.

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Untreated ADHD May Reduce Life Expectancy

ADHD can make young people impulsive, and increases the risk for dangerous behavior. According to a new study, this translates to shorter lives for young people and adults with ADHD who forgo treatment. Treatment, on the other hand, can increase the lifespan of those with ADHD by an average of 9-13 years.

This new research on untreated ADHD is the brainchild of Russell A. Barkley, Ph.D., who investigated the connection between ADHD and 14 important health factors, among them nutrition, exercise, and tobacco and alcohol use. Dr. Barkley spoke about his findings during his keynote address at the 2018 Annual International Conference on ADHD in St. Louis, Missouri, where he was presented with the CHADD Lifetime Achievement Award.

“Our research shows that ADHD is much more than a neurodevelopmental disorder, it’s a significant public health issue,” says Dr. Barkley. “In evaluating the health consequences of ADHD over time, we found that ADHD adversely affects every aspect of quality of life and longevity. This is due to the inherent deficiencies in self-regulation associated with ADHD that lead to poor self-care and impulsive, high-risk behavior. The findings are sobering, but also encouraging, as ADHD is the most treatable mental health disorder in psychiatry.”

Russell A. Barkley, Ph.D., is an internationally recognized authority on attention-deficit/hyperactivity disorder (ADHD) in children and adults. Dr. Barkley serves as a Clinical Professor of Psychiatry at the Virginia Treatment Center for Children and Virginia Commonwealth University Medical Center in Richmond, Virginia.

Long-Held Suspicions

Dr. Barkley and his team culled data from a Milwaukee, Wisconsin study, that followed patients, mostly male and with ADHD, from childhood into adulthood. The researchers analyzed the data with an actuarial-based life expectancy calculator. The calculator was developed by the Goldenson Center for Actuarial Research at the University of Connecticut. “Dr. Barkley’s research confirms what we’ve suspected for some time,” says CHADD Resident Expert L. Eugene Arnold, MD, M.Ed., Professor Emeritus of Psychiatry and Behavioral Sciences, Nisonger Center Clinical Trials Program, Ohio State University.

Dr. Barkley compared the risk of shortened life expectancy from untreated ADHD to other major health risks. “If you look at the four biggest health risks in the U.S.—poor diet, insufficient exercise, obesity, and smoking—ADHD presents a greater risk than all four of these concerns combined,” said Dr. Barkley.

The study in question wasn’t large, by any standards. The data looked at was gathered from just 131 participants with ADHD, plus a control group of 71 participants. The researchers, on the other hand, followed the participants until age 32, a much longer period than for most longitudinal studies on children with ADHD.

Impulsive Behavior

What is it that cuts the lifespans of those with untreated ADHD? According to the data in this research trial, it’s mostly about suicide and accidental injury. Suicidal thoughts can come to anyone who’s feeling down. But if you have untreated ADHD and you’re impulsive, you might just act on those thoughts without further ado. Not to mention, if you’ve got ADHD, you have trouble organizing yourself to do things as you should, so it’s easy to get hurt doing everyday things like cooking.

While limited in size, the study does go beyond the obvious to look at lifestyle issues that may be exacerbated by having ADHD. Things like not getting regular exercise, not eating right, or getting enough sleep. There’s also the fact that people with untreated ADHD may not attain adequate education, which puts them in a riskier demographic. And of course, the risks of obesity and substance abuse are both increased in those with ADHD.

Dr. Arnold suggests that ADHD has yet to be seen by the powers that be as an important health risk. “ADHD is a major health problem that has not been evaluated in that light by policymakers,” said Dr. Arnold. “It needs to be taken much more seriously.”

Policymakers Don’t See ADHD

If you were to examine the factors that contribute to risky lifestyle behaviors, ADHD would crop up again and again. According to Dr. Barkley, if you want to reduce these behaviors, you have to treat the underlying causes. In many cases, that means treating the symptoms of ADHD. But, says Dr. Barkley, those experts who can influence us in those spheres, for example our primary care physicians, pediatricians, cardiologists, and other healthcare professionals—don’t often turn to ADHD as the possible reason for a patients’ inability to follow medical advice to make positive lifestyle changes.

“Healthcare professionals need to look behind the curtain for ADHD,” says Dr. Barkley. “Patients who struggle to follow their physicians’ advice to manage weight, stop smoking, or reduce sugar intake, among other concerns, should be screened for ADHD and treated accordingly. We need to educate our colleagues about the symptoms of ADHD, the substantial impact this disorder can have, and how to screen for it. The good news is, with accurate diagnosis and the continued use of evidence-based treatments including cognitive therapy, educational support, skills training, and medications, people with ADHD may add years back to their lives. And collectively, we can make a significant impact on some of the biggest health concerns we face as a nation.”

Dysgraphia: The Learning Disorder That Makes it Hard to Write

Dysgraphia is a learning disability that makes it difficult to write. The word comes from the Greek dys (difficulty) and graphia (making letter forms). A person with dysgraphia knows what to write and how to write, but copying and turning thoughts into words is a challenge.

Dysgraphia, like other learning difficulties, has nothing to do with intelligence or motivation but with how the brain processes the information it receives. It’s a condition that never goes away, though there are methods and tools to improve writing. A child may have other learning difficulties along with dysgraphia, for instance, dyslexia, dyspraxia, language disorders, or ADHD.

Children with dysgraphia may find it difficult to hold a pen or pencil. They may find it hard to line up letters as they should, even with the help of lined paper. They may also have trouble spelling words or taking the thoughts in their heads and putting them down in writing.

For some children it’s an organization, storage, and memory problem. A child may have learned everything he needs to know about writing. Finding, sorting it all out, and using that information is another thing.

Girl with dysgraphia thinking letters

Writing is complicated. Think about your hand picking up a pencil and placing it in the writing position. Watch your hand move this way and that as you write the different letters and punctuation. There is a lot going on there with your fine motor skills as your brain tells your hand how to make all those many, small graceful movements.

At the same time as you’re using all those many fine motor skills, you’re also using language processing skills. Your brain must think how to take all the thoughts and words in your head and turn them into written words and thoughts on paper. You need good hand-to-eye coordination to get pencil to paper, get letters and words to be approximately the same size, and to line them up, nice and straight on the page. You have to know where it makes sense to put a space between letters, words, and paragraphs, (and where it does not).

All of these many brain-based activities must be working just so for writing to come out right, for letters and words to be neat and readable. But in dysgraphia, something, somewhere along the line, goes wrong. It could be any number of things. The result is that the child finds it difficult to write, and we find her writing difficult to read.

The brain is a lot like a circuit board. The connections from one part of the brain to another are called synapses. Synapses are like thin threads or wires and there are lots of them in the brain. Just like the wires in a circuit board, synapses can get kinked up or twisted. They can get crossed or connect to the wrong place.

Colorful tangled wires

Now think how many brain processes are used for writing. That means lots of opportunity for things going wrong. You may never know why your child has dysgraphia, since the exact cause could be so many different things and even many different things at once. It’s actually miraculous that any of us can write smoothly and well, since writing is such a complicated process. For the child with dysgraphia, writing is a long, slow, sometimes even painful process, and the results may still be quite difficult to read.

Dysgraphia Defined

The word “dysgraphia” doesn’t appear in the Diagnostic and Statistical Manual of Mental Disorders-5 (DSM-5). Instead, the DSM-5 calls dysgraphia “an impairment in written expression.” Because of this, most experts refer to dysgraphia this way. For most people however, “dysgraphia” is easier to say and use.

A child with dysgraphia should qualify for special education services under the Individuals with Disabilities Education Act (IDEA). To qualify for help, a child must have a condition that is named or described under IDEA. Like the DSM-5, IDEA doesn’t actually use the word “dysgraphia.” But IDEA does specify that children with specific learning disabilities are entitled to help. The DSM-5 classifies “an impairment in written expression” (dysgraphia) under the category: “specific learning disability.” IDEA defines a specific learning disability as something that makes it hard to understand or use language, either spoken or written, so it’s difficult to “listen, think, speak, read, write, spell, or to do mathematical calculations.”

Lots of children have messy handwriting when they are first learning to write. For some children, however, poor handwriting continues over a period of years, even with lots of practice and help. That’s when it’s time to look into whether the child might have dysgraphia.

Experts think that memory plays an important role in dysgraphia. The brain pulls in information through our five senses and stores it for later use. Think about the way you automatically raise your cup of coffee when going over a bump when riding in a car or airplane. You don’t think about it, it’s information you absorbed. You don’t know why you do it. You just know that if you don’t, your coffee will spill.

Arm holding up coffee cup

There are all kinds of information like this that you have absorbed through your senses and stored in your brain. These bits of information help you do your daily tasks, including writing. The information could be something as small as how to grasp a pencil, or how to turn that pencil with your fingers and hand to make a circle, a curve, or a loop. It could be about how to cross a t or dot an i. When a person gets ready to write, he has to find and use all these bits of information that are stored in his short-term or long-term memory. Then he must think how he wants to use all this information and in what order to use it so that his writing makes sense on the page.

In someone with dysgraphia, something goes wrong with this process. It may be about how the bits of writing information are organized and stored in the memory. Or it may be about getting the words out and onto paper or a computer screen. The result is writing that is full of mistakes and difficult to read. What we see may not even be what the child meant to write.

Girl writing on chalkboard

Sometimes dysgraphia is about the working memory. The child may not be able to remember how a new word is supposed to look and be written. He can’t write the word or type it, because he can’t remember how it goes. When a child can’t remember how words look in written form, he is said to have a problem with orthographic coding.

Dysgraphia may be genetic, which means that dysgraphia may run in families. If a child is behind the class into his writing and has some symptoms of dysgraphia, he should be evaluated for the condition.

Dysgraphia Symptoms

Dysgraphia symptoms fit into six groups:

Visual-spatial: Has trouble telling shapes apart, and leaving the right amount of space between letters and words. Finds it difficult to write words in one direction, for instance left to right. Has difficulty writing on the line or inside a margin. Finds it hard to read maps, and to draw or copy a shape. Is slow to copy text. Letters may be written in all different directions, with letters and words running together.

Fine motor: Finds it difficult to hold a pencil the right way. Other things that are hard to do: tracing, tying shoelaces, cutting up food, doing puzzles, typing, coloring inside the lines, using a scissors. Holds arm, wrist, body, or paper in an awkward manner when writing.

Language processing: Needs more time than others to get his thoughts typed out or written on paper. Finds it difficult to follow directions or understand game rules. Forgets what he was going to write in the middle of writing or loses his train of thought.

Spelling and Handwriting: Spelling rules are difficult to understand, for instance: i before e, except after c. Finds it hard to tell if a word is spelled wrong. May have perfect spelling when spelling aloud, but makes spelling mistakes when writing. May misspell the same words a number of different ways. Spell check is more confusing than helpful—he looks at the spelling suggestions and can’t figure out which is the right word to choose. Doesn’t know when to use upper or lowercase letters—his writing is a jumble of both. May mix printing and cursive in the same word or sentence. May not be able to read back to you what he’s written in his own handwriting. Tries to get out of writing. His hand gets tired and cramps up and aches as he writes. Goes through many erasers.

Grammar: Can’t figure out punctuation—may use the wrong punctuation, not enough punctuation, or too much punctuation (for example, too many commas, or run-on sentences that lack period or full stop punctuation marks, so that they never seem to end). May use different verb tenses in the same sentence or paragraph, for example, “When running, Sally ran to the beach.” Forgets to begin sentences with capital letters. Sentences may look unfinished, or be written in list format.

Language organization: Finds it difficult to tell stories, and may begin in the middle. May leave out important ideas, thinking you already know what he’s talking about. He might add many extra unimportant details, because he doesn’t know which facts are or aren’t important to a story. Uses vague language to describe things, so you don’t know what he’s talking about. A story he tells may seem to have no point, or the point is repeated many times over. Two or more sentences may get mixed up, so they’re impossible to understand. He’s better at telling you something than writing it out for you.

Dysgraphia

Dysgraphia Symptoms by Age

Symptoms of dysgraphia are different at different ages. You might not know a child has dysgraphia until the child begins learning how to write.

In preschool children, you might suspect dysgraphia in the child who hates to color and tries to get out of writing and drawing.

Children already in elementary school may mix up print and cursive in the same word or sentence. They can’t seem to stay on the lines and their letters aren’t even in size or height. School children with dysgraphia may need to sound out words as they write them. They may find it hard to get their thoughts out in written form.

High school students with dysgraphia may keep their sentences very simple. They make many grammar mistakes compared to their classmates.

Impact of Dysgraphia

In some children, dysgraphia is mild, in others, the symptoms are severe. That means that the impact of dysgraphia is different for each person. Here are some of the more common areas of difficulty for children (and adults) with dysgraphia:

Life: Children with dysgraphia may have trouble with their fine motor skills. It can be hard for them to tie their shoes or button a shirt. Scrambling an egg may be hard to do. Since writing and typing is difficult, it’s hard for them to make grocery or to-do lists.

School: Students with dysgraphia may push off or avoid writing assignments. It takes longer for them to write and their writing may be full of mistakes. It’s hard for them to take notes and it’s hard for them to read them. They may not complete their assignments on time. These issues can cause children to fall behind their classmates.

Social and Emotional: The challenges of dysgraphia can affect a child’s self-esteem and make it hard to develop friendships. Children with dysgraphia feel different than the other children they know. They have trouble expressing their thoughts. They feel frustrated at how hard it is for them to do their schoolwork. The thought of going to school or doing schoolwork, is a source of stress. When a child has not been identified as having dysgraphia, her teachers may not understand that the student has a real condition. A teacher may tell a child that she’s not working hard enough or that her writing is “messy” or “careless.” These labels can be hurtful, especially when the child is trying hard, and still failing. When children with dysgraphia fall behind in school, they may feel discouraged. They may even decide to drop out of school.

Diagnosing Dysgraphia

Signs of dysgraphia can be seen in preschool and elementary school children. Often, however, the condition is not diagnosed until middle school or high school. As with all learning difficulties, the earlier a child is diagnosed, the sooner the child can get help.

Dysgraphia is diagnosed by psychologists who specialize in learning disorders. Your child will need to be evaluated. During the evaluation, the tester will assess the child’s fine motor skills and writing ability. The evaluator will also want to see how your child expresses himself in writing.

Your child will also be asked to copy text and write sentences. The evaluator will watch your child as he writes to see how he writes, his posture, the way he holds the pencil, and whether it looks like the child’s hand is cramping as he writes. He will look at the child’s handwriting and measure the child’s fine motor speed as he taps his fingers, or flexes his wrists.

Other professionals, for instance school psychologists or special education teachers, may look at how the child’s difficulties affect his social life, his school work, or his emotions and self-esteem.

Getting Help

Once a child is diagnosed with dysgraphia, he should qualify for special education services. A team of teachers and experts will work with you to create an Individualized Education Program (IEP). Your child may receive tutoring in handwriting, and receive accommodations and modifications to address his specific issues. If your child isn’t found to be eligible for an IEP, request a written 504 plan that lays out how the school will work with your child to accommodate his needs.

Some schools use the response to intervention (RTI) approach. This helps identify any learning difficulties and offers extra group help to students who are behind in class. If group instruction doesn’t seem to help your child, the school may move to private, one-on-one tutoring.

Types of Dysgraphia Help

There are three kinds of help your child can receive for dysgraphia: accommodations, modifications, and remediation:

Accommodations change the way your child learns. Examples of accommodations include letting a child type on a keyboard instead of writing by hand; using voice-to-text software for note-taking and written assignments; or taking tests orally, instead of in writing.

Modifications change the content of what your child learns. Your child may be able to write shorter written reports, or receive fewer or different test questions than the other students in the class.

Remediation is extra work in the skills your child needs. Your child may spend more time doing tasks like copying letters and drawing inside raised lines. A child with dysgraphia may receive occupational therapy such as hand exercises to improve strength, agility, and hand-to-eye coordination.

Some children also find that medication for ADHD can ease the symptoms of dysgraphia.

Dysgraphia Home Help

At home, here are some of the many things parents can do to help children with dysgraphia:

Keep a notebook: Watch your child and write down what you observe about your child’s writing issues. How is your child sitting? What time of day is writing more difficult? Does stress make things worse? What makes things better or easier? Your notebook will be a big help when you discuss your child’s progress with teachers and other experts and educators.

Do hand exercises before and during homework: Have your child stretch the fingers of his hands several times, shake his hands out, or rub his hands together before doing written work. You may want to have your child take several breaks in his homework to repeat these exercises. The purpose of these exercises is to warm up the muscles and relieve built-up muscle tension, too.

Find fun ways to improve motor skills and increase strength: Have your child crumple a piece of paper, squeeze a wet sponge, squirt a water gun, or work with modeling clay.

child crumpling paper into a ball

Always watch your child to see how she’s handling these activities. Try not to overwhelm the child. Offer lots of praise for real accomplishments. It may not be easy—it never is—but with your help and support, your child will learn to cope with dysgraphia and succeed in school and in life.

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Developmental Coordination Disorder (DCD): Why is My Child so Clumsy?

Developmental coordination disorder (DCD) is a condition that lasts a lifetime, and can make children appear to be clumsy. Children with DCD have trouble learning motor skills and coordinating the way they move. They might have trouble tying their shoes and buttoning buttons. In school, they may have trouble with writing, drawing, and sports. DCD is also known as dyspraxia and sensory-based motor disorder (SBMD).

Children with DCD may be late with developmental milestones such as crawling, walking, feeding themselves, and getting dressed without help. At first, a parent or a pediatrician may not see these delays as a sign of a condition. DCD may not be diagnosed until a child is five years old, or older.

While DCD affects both boys and girls, it is 3-4 times more common in boys. The condition seems to run in families. Experts think that at least 5 percent of children have DCD. The main treatment for DCD is occupational therapy (OT). If you think your child may have DCD, you should speak to your child’s doctor.

A child with DCD will not outgrow the condition, since it is a lifelong condition. Once diagnosed, however, a child with DCD can learn how to cope with the condition. Children can also do a great deal to improve their motor skills.

Is DCD a Learning Disability?

DCD isn’t thought of as a specific learning disability like dyslexia or dyscalculia. Experts think of it as a neurodevelopmental disorder, like ADHD. DCD often comes with or is comorbid with other issues or disabilities. Since the symptoms of various conditions can look the same or overlap, DCD may be confused with something else or misdiagnosed.

A child with DCD will not outgrow the condition, since it is a lifelong condition. Once diagnosed, however, a child can learn how to cope with the condition. A great deal can also be done to improve motor skills.

DCD Signs and Symptoms

DCD makes life a struggle both inside and outside of the classroom. In school, children with the condition may have trouble organizing their books, notebooks, pens, pencils, and erasers. They can have trouble taking notes or copying from the blackboard.

Outside the classroom, children may have trouble tying their shoes, pouring a bowl or cereal, or brushing their teeth. As DCD affects their balance, they may find it hard to sit on chair without constantly squirming. This can make eating difficult and messy.

DCD means that the skills that we call on to help us move, don’t work right. These movement skills include:

  • Fine motor skills
  • Gross motor skills
  • Motor planning
  • Coordinating movement (coordination)

When motor skills don’t work as they should, there may be problems with everyday life. Your child may find it hard to:

  • Keep his/her balance
  • Quickly change the way he or she is moving to avoid bumping into things or getting hurt
  • Get his/her body to move the right way
  • Learn new ways to move
  • Predict what will happen when s/he moves this way or that
  • Figure out and solve motor tasks (like buttoning a button)

Just Clumsy?

Most of us learn from experience. A child with DCD may not learn the right way to move from past mistakes. All of us have clumsy moments. We may misjudge how close a hand is to a glass a milk and knock it over. But after we clean up the mess and pour a fresh glass of milk, there are no more accidents. A child with DCD, on the other hand, may knock that glass of milk over again and again.

Children with DCD have trouble figuring out the order of how they must move to do a task. This is called sequencing. Trouble with sequencing can make it difficult to put one foot in front of the other when walking, for instance. That means that children with DCD may bump into other people, fall a lot, or drop things they are holding as they walk.

Kids don’t all learn to crawl, walk, and get dressed at exactly the same time. Some do these things earlier, and some later. That makes it hard to spot a problem like DCD. A parent or a pediatrician may think these delays are just normal for the child. They may think a child will outgrow being clumsy.

Once a child is in preschool, and the issues persist, it may become easier to see there is a real problem. That means that it is usually not until preschool that a child with DCD is diagnosed and given treatment. At that point, parents can look back and realize they were seeing the signs and symptoms of a real condition in their child, all along.

Signs and Symptoms by Age

Here are some signs of DCD in children, according to age:

Preschoolers

  • Finds it hard to hold and use spoons and forks
  • Finds it hard to throw a ball
  • Doesn’t realize he or she is playing too roughly
  • Is always bumping into other kids
  • Squirms in his/her seat
  • Can’t seem to sit upright
  • Falls off of chairs

Kindergarten through Second Grade:

  • Finds it hard to hold and use crayons, pencils, and scissors
  • Can’t write letters the right way
  • Can’t seem to get the spacing right between letters
  • Going up and down the stairs is difficult
  • Always bumping into people
  • Still finds it hard to get dressed or brush his/her teeth

Third through Seventh Grade:

  • Needs more time to write than the other kids
  • It’s hard to cut up his/her food
  • Still finds it hard to tie shoes or button buttons, so getting dressed is hard
  • Math is difficult because s/he finds it difficult to line up the columns of numbers the right way

Eighth through Twelfth Grade:

  • Finds it hard to type and text
  • Has trouble with visual spatial tasks, for instance understanding how to work with shapes in geometry class.
  • Finds it a daily challenge to open the latch on his/her school locker
  • It’s hard to learn how to drive

DCD or something else?

It’s usual for children with DCD to also have learning disabilities or attention difficulties. The most common problem seen together with DCD is ADHD. Experts think that half of all children with DCD have ADHD, too.

Sometimes DCD seems to be something different. Kids with the condition have trouble sitting still or sitting up straight. They may squirm in their seats in an effort to keep their balance. Even a teacher with lots of experience may see the squirming and decide the child has ADHD. Or the child may have both DCD and ADHD, but the squirming and clumsiness can make the experts miss the DCD part of the problem.

To confuse things further, other issues can make children fidget or squirm. Sensory processing issues can cause these behaviors. A label inside a shirt collar can drive a kid with sensory processing problems to squirm and fidget every bit as much as a child with DCD, trying to sit still in his/her chair.

But DCD can just look like other issues. For example, because of balance problems, these kids often have trouble sitting upright or sitting still. They may move around a lot to keep their bodies up.

Conditions with similar symptoms

There are many issues that can come with DCD or be confused with the condition, including:

Because DCD may be confused with or come along with other conditions, it’s important for a child to have a full evaluation. That way, if a child has other issues, these too will be diagnosed and treated.

DCD Risk Factors

We don’t know what causes DCD. We do know some of the risk factors, including:

  • Male gender
  • Small for size at birth
  • Born early, before the 37th week
  • Low birth weight
  • Family history of DCD
  • Maternal alcohol or drug use during pregnancy

Evaluating your child

If you suspect your child may have DCD, see your child’s doctor. Your child’s pediatrician may be able to diagnose the condition. Or the pediatrician may work with other experts, for instance, a developmental behavioral pediatrician, a pediatric neurologist or a child psychologist, to evaluate and diagnose the problem.

The most common ages to evaluate for DCD are 5 and 6. Evaluators will look at motor and cognitive skills. They’ll ask questions about other factors that could be having an impact, too, in school and home life. They’ll also want to know whether your child has hit certain milestones in development and when symptoms began.

Evaluating children for DCD calls for assessing how your child moves. Here are some of the movement skills that evaluators will seek to assess:

  • Balance
  • Coordination
  • Fine motor control
  • Motor planning
  • Range of motion
  • Strength

The evaluators will want to see how well your child moves by having him do things like cut out paper shapes with a scissors, or string beads. Your child may be asked to draw different shapes or color a picture, to see how well s/he stays within the lines. These tasks show a child’s visual perception skills.

Therapy for DCD

The main treatment for DCD is occupational therapy (OT). An occupational therapist will work with your child to improve movement and motor skills. In order to improve handwriting skills, for instance, the occupational therapist may have your child practice tracing letters. A child who struggles with tying shoelaces, can practice on a lacing board.

Children with DCD who have an IEP or a 504 plan, may be able to receive OT for free in school. You may be able to get OT covered through your insurance plan. You can also hire a private occupational therapist.

Some children with DCD also need to work with a physical therapist. Physical therapy can help improve balance and strengthen muscle tone.

In school, children with DCD may need accommodations to manage their schoolwork. They may need extra time for tests or written work, because writing is difficult. Assistive technology for instance speech-to-text tools that can take dictation, can also be a big help in getting a child with DCD through school. The teacher may be willing to let your child use these accommodations in the classroom. Otherwise, your child can receive formal accommodations with an IEP or 504 plan.

Love and Support

The most important thing you can do for your child with DCD is to offer support and understanding for the challenges your child will confront every day. Advocating for your child is part of that. You may have to explain that your child didn’t mean to bump into his friend yet again, or that your child has trouble sitting still, because he has DCD. When you mention DCD, you can expect to be met with blank stares—sometimes even from your child’s teachers. (You can always tell people that Harry Potter actor Daniel Radcliffe also has DCD—to Google it!)

Daniel Radcliffe
Actor Daniel Radcliffe has DCD, photo credit: Joella Marano [CC BY-SA 2.0 (https://creativecommons.org/licenses/by-sa/2.0)]
Children with DCD, like children with any other disorder or condition, can suffer from self-esteem issues. Your support and understanding go a long way toward helping your child overcome these feelings of not being good enough. Work on building up your child with sincere praise for real efforts. Notice any improvement in your child’s motor skills and let him/her know you noticed! Give your child opportunities to practice motor skills at home.

Help your child break down difficult tasks into smaller parts and offer lots of practice on a regular basis. Find ways to change tasks so they become easier. You might, for instance, use special grips for pencils and pens that make them easier to hold. With occupational therapy, physical therapy, help at home, and accommodations in and out of the classroom, your child is bound to improve his or her motor skills to some degree.

David Branson, Daniel Radcliffe, and photographer David Bailey all have DCD
Left to right: David Branson, Daniel Radcliffe, David Bailey (photo credits: Joella Marano, David Shankbone, Ben Broomfield, via Wikimedia Commons)

Be patient and always remember that it’s not easy to live with DCD. Encourage your child however you can and always be ready with your sympathy and understanding. Remind your child that many great and successful people have DCD. (In addition to actor Daniel Radcliffe, there’s entrepreneur Richard Branson and photographer David Bailey—imagine having to hold that camera still!) Most of all, let your child know your love is there to be counted on, no matter what happens today or any other day, in or out of the classroom.

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Dyscalculia: Does Your Child Have Trouble With Numbers?

Dyscalculia is what we call it when a child has trouble understanding, learning, and using numbers. Children with dyscalculia may have trouble reading and writing numbers, or using them to make sums. They may also find it hard to remember strings of numbers, for instance, a telephone number. As a learning difficulty, dyscalculia is a lot like dyslexia, but with numbers instead of letters, words, reading, and writing.

Many children think of math as their least favorite subject. They may struggle with assignments. In dyscalculia, however, a child’s troubles with math go beyond simple frustration. When a child has a serious, long-lasting problem with even basic math, it may be a sign of dyscalculia.

Dyscalculia is not very common. While there are no exact statistics available, experts think that anywhere from 5 to 7 percent of all elementary school children have dyscalculia. Both boys and girls can have dyscalculia in equal numbers.

Is Dyscalculia a Disability?

Dyscalculia is a learning disability or disorder. But some people prefer to call dyscalculia a learning “difference” or “difficulty.” These words don’t feel as much like a negative or hurtful label.

It’s important to know that dyscalculia is not the only learning difficulty that causes problems with math. Other learning problems that can make math a challenge include ADHD, dyslexia, and visual or auditory processing disorders. Then again, a child can have more than one learning difficulty. A child may, for example, have both dyscalculia and ADHD, or dyslexia and a visual processing disorder.

Trouble with math may lead to testing for dyscalculia. But math is just one challenge for people with the learning difficulty. Dyscalculia affects everyday life and it doesn’t go away. A person with dyscalculia may, for instance, always find it hard to follow a recipe, remember a phone number, or read a map. It’s good to know there are strategies to help children develop the skills they need to live a normal, happy life.

Math frustration boy with dyscalculia

 

Children with dyscalculia may struggle with math in many different ways. A child with dyscalculia may not understand amounts or the difference between largest and smallest. The child may not see the numeral 3 is the same as the word three. The plus sign may not mean anything to the child or may not seem different than the multiplication sign. Some call these skills number sense.

It makes sense that children with poor number sense skills will also have trouble with math. The child with dyscalculia may understand the logic behind a math problem. He may, for example, understand that he is to take an apple and put it next to another apple and that this is called “adding.” But he doesn’t see one apple and think “one,” so he cannot tell you that one plus one equals two. He may also find it difficult to understand that two apples are more than one apple.

Children with dyscalculia have trouble with their working memory. The working memory is the part of your memory that keeps items you need in the short term for the work you are doing. A child with dyscalculia may not be able to work through a math problem with multiple steps. It can be hard to hold the numbers in mind as the child completes each step.

Girl Struggles with Math Dyscalculia

 

Dyscalculia can cause different problems in different children. That means the symptoms of one child with dyscalculia may be different from those of another child with the learning difference. It’s a good idea to write down what you see as you observe your child. Sharing your notes with the child’s doctor or teacher can help them find the best way to work with or get help for your child.

Signs of dyscalculia can be seen in a preschooler, but may be difficult to spot. After all, lots of children have a difficult time learning basic concepts like numbers and math. As the child becomes older, however, it becomes clear that there is a real problem that isn’t going away with time.

Common Signs of Dyscalculia

Here are some common signs of dyscalculia, according to age:

Preschool

  • Learning to count is hard. The child skips numbers or says them out of order, long after friends are able to say their numbers in the proper order.
  • Has trouble organizing toys according to size or pointing to the largest or smallest item in a storybook, when asked to do so.
  • Find it difficult to understand the connection between written numbers and what they mean. (Doesn’t understand that “3” means three.)
  • Doesn’t really understand what it means to count. If you ask her for 3 blocks, she will give you an armload instead of counting them out.

Grade School

  • Learning and remembering basic math is difficult, for instance 2+3=5.
  • Can’t remember the names of basic math symbols and finds it a challenge to remember how to use them, too.
  • Counts on fingers, instead of remembering basic math like 2+2=4.
  • Finds it a challenge to understand ideas like greater than and less than.
  • Finds even a visual-spatial representation of numbers, for instance number lines, hard to understand.

Middle School

  • Has trouble understanding place value.
  • Finds it difficult to write numbers clearly.
  • Has trouble lining up or placing numbers in the right column.
  • Struggles with fractions.
  • Measuring ingredients for even a simple recipe is a challenge.
  • Keeping score during sports games is tough.

High School

  • Has trouble using math concepts with money, for example, estimating the total cost of items he wants to purchase, counting out exact change, or calculating the waiter’s tip in a restaurant.
  • Finds it hard to understand graphs, charts, and maps.
  • Struggles with using a measuring cup or measuring spoons.
  • Can’t see another way to do a math problem. For instance, 6-1 is the same as 2+3.

Dyscalculia isn’t just about the problems it causes in school. Having a numbers difficulty also affects everyday life. Getting to an appointment on time is difficult because time is based on numbers. You might accidentally schedule overlapping events, and have to miss out on a promised lunch with a friend.

Dyscalculia gets in the way of figuring out how much time you need to set aside for tasks. This, in turn, can affect your approach to setting up work projects. If you miscalculate how much time you need to complete a project, you end up missing deadlines. In the home, dyscalculia can make it a chore just figuring out how to time dinner so that all the food is ready and on the table at the same time, at the right temperature.

Dyscalculia Comes with Other Issues

Learning difficulties like dyscalculia often come with other such issues. When someone has more than one learning difficulty, the issues are said to be comorbid. Dyscalculia is often comorbid with dyslexia and/or ADHD. Some 43-65 percent of children with math issues also have reading issues. ADHD can make it difficult to pay attention when doing math and may play a part in a child’s math errors.

A child with dyscalculia may be weak in executive function skills, which have to do with working memory, flexible thinking, impulse control, planning, and organization. It is also common for children with dyscalculia to have math anxiety. Math anxiety makes children so afraid of poor results on a math test that their nervousness leads to exactly the poor performance they fear.

Some learning difficulties have symptoms that are similar to the symptoms of dyscalculia. This can make diagnosis difficult. It might look like a child only has dyscalculia, when the child actually has more than one learning disability or difficulty. Or, the child’s dyscalculia may be altogether missed or misdiagnosed as something else.

Girl with math anxiety dyscalculia

If you suspect your child may have dyscalculia, it’s best to have a full evaluation. A full evaluation can reveal whether your child has more than one learning issue. A proper diagnosis will help you know what type of support and therapies your child needs. Most schools will test your child for free.

 

If your child has ADHD, for example, it may be suggested that your child have her math skills reevaluated after getting the symptoms of ADHD under control. The treatment for ADHD may be all your child needs to fix her math issues. This may suggest the problem was never dyscalculia in the first place. It was all about an attention difficulty, and paying attention to detail.

If your child is tested at school, and found to have dyscalculia, it should be possible for the school to get her the help she needs. She may need tutoring or special classes in math. The school may give your child accommodations to make learning easier. An accommodation may be to have your child answer math questions orally instead of having to write them out. Or your child may be allowed to use a calculator in the classroom or do fewer math homework problems.

Causes of Dyscalculia

Sometimes dyscalculia is the result of a genetic disorder. Genetic disorders that may cause dyscalculia include fragile X syndrome, Gerstmann’s syndrome, and Turner’s syndrome. For other children, poor math skills just seem to run in the family.

Sometimes outside, environmental factors can cause dyscalculia. Fetal alcohol syndrome, for example, can lead to dyscalculia. Premature babies and low birth weight babies may later turn out to have dyscalculia.

Helping Children with Dyscalculia

Here are some strategies that can be used in the classroom and at home to help strengthen numbers and math skills:

  • Use real objects to help your child connect numbers to items. You can have your child use an abacus. Or have your child sort buttons by size or color. Once the buttons are in piles, you can have the child tell you which piles are larger and which are smaller. This kind of practice can help to improve your child’s number sense.
  • Give numbers a form by having your child draw pictures of items, or move objects around to show addition and subtraction.
  • Have your child use graph paper for working with numbers and math. This helps keep numbers neat and easier to read.
  • When working on a math problem, cover the rest of the math sheet with a piece of paper. This helps your child focus on the problem at hand.
  • Play board games that build number and math skills
  • Talk up your child’s abilities, to combat low self-esteem caused by poor math skills

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Sleep and the Lawnmower Parent

In Lawnmower Parents Don’t Hover, They Mow, we described the way that lawnmower parents run interference during daytime, removing obstacles and challenges from a child’s path. But lawnmower parents are also active at night, which can turn their children into poor sleepers!  Here are some of the ways that lawnmower parenting might be a problem at bedtime.

Three Basic Bedtime Mistakes

Lawnmower parents tend to make three basic mistakes at bedtime:

  1. Lawnmower parents attempt to turn the child’s bedroom into a perfect sleep environment. They do this by adding sound machines that play the sounds of relaxing ocean waves or rainfall to a child’s bedside table; or they set up essential oil diffusers to waft the scent of lavender through the night air. They might install special light bulbs in their child’s room that block the “blue light” part of the spectrum and cast only a warm, amber glow. Some parents add starlight projectors that make constellations dance on the bedroom ceiling.

Perhaps they play meditation tapes or soothing music as their little ones are drifting off. Some leave the television or a video on each night and turn these off later on, once the child is asleep. They might even try to block every sliver of light from entering the bedroom or install blackout curtains on the windows. Lawnmower parents add all of these things because they think that the bedroom will then be very conducive to sleep. They add them with the hope that their child will then be a wonderful sleeper.

Too Many Sleep Aids

While there is not much of an issue with adding one or two of these items to a child’s bedroom, adding too many of them can definitely lead to sleep problems. A child can become accustomed to having these “sleep aids” available every night, and this can make it hard for a child to sleep anywhere else, without them. It’s almost like building the perfect greenhouse for a special flower. The flower may flourish in that greenhouse, but may do poorly anywhere else.

If their child goes to her best friend’s home for a sleepover, her friend’s home will almost never have these things (and will certainly not have all of them). And, if the child goes to Nana’s house for the weekend, her house almost surely won’t have these items. Summer camp won’t, either. Even luxurious hotels won’t have all of these niceties, so lawnmower parents may find themselves trying to pack up all of these items to bring along on family trips. Most parents, once they consider these drawbacks and inconveniences, would agree that it’s best to help a child learn to sleep in a simple, basic bedroom.

Simple Basic Bedroom

What is in the simple, basic bedroom? Bedrooms should have no electronics at all and this includes TVs, video game players, tablets, and cell phones. If parents are unwilling to remove these completely, they should at least remove remote controls, game controllers and DVDs at bedtime. And from the time a child is first given a cell phone, it is wise to have a “house rule” that this is left to charge overnight somewhere outside of the bedroom.

Bedrooms should have a night light along with a reading light somewhere near the bed along with a basket with some books, drawing pads, and coloring books for older children who need a few minutes to relax and get drowsy enough to fall asleep.

2. Lawnmower parents often stay nearby at bedtime to help their children relax into sleep. Once this job is done, and the children are asleep, parents usually leave the child’s bedroom to finish up their own evening activities or to go to bed themselves. All children, however, wake several times a night and, when they awaken and find their parents “missing,” may need to “find” the parent again in order to get back to sleep.

Even children who co-sleep with a parent might awaken if the parent moves a little “too far away” during the night! The practice of being nearby when a child falls asleep can also lead to bedtime routines that last a long time because children will stay on guard at bedtime to make sure their parents don’t leave before they, the children, are deeply asleep. This can also lead to more frequent nighttime awakenings which require parental help to get the child back to sleep.

lawnmower parents take their children into bed to sleep with them

Lawnmower parents who have fallen into this pattern may want to gradually taper off their presence in the child’s bedroom at bedtime, perhaps by sitting in the doorway and reading until the child is asleep rather than lying in bed with the child. Once the child can fall asleep easily with a parent in the doorway, the parent can usually leave the room entirely at the end of the bedtime routine.

3. Lawnmower parents often respond to all of the child’s extra requests even after the bedtime routine is meant to be over. They do this with the hope that, once the child has everything he or she requests (another cup of warm milk, a different stuffed animal, a special blanket tuck, just one more backrub), he or she will finally fall asleep. This is, however, almost never the case. In reality, of course, responding to all of these callbacks night after night at bedtime actually encourages more and more such requests. Parents end up rewarding the child (unintentionally, of course) for staying awake!

Other children may make “curtain calls,” leaving the bedroom after the bedtime routine is over, suddenly appearing once more before their parents, who may inadvertently reward this behavior, too, by letting children curl up with them on the sofa until they “get sleepy.” This, again, usually leads to extended bedtime routines that can take an hour or two to run to completion.

Getting Kids to Sleep

Bedtime tickets are a quick and easy way to manage the callbacks and curtain calls that most kids like to make after the bedtime routine is over. A bedtime tickets is a small card good for one more callback or curtain call. Parents can make simple bedtime tickets by decorating index cards with their child during the day.

Parents should also ensure that the bedtime routine addresses all of the child’s usual needs: a final bathroom trip; a cup of water on the bedside table; a favorite stuffed animal retrieved from behind the sofa and brought back to the bed. The bedtime routine can be concluded with some cozy reading time followed by a final hug and kiss.

Once the bedtime routine is over, parents can give the child one or two bedtime tickets along with a reminder that the child can trade one ticket each for any further requests occurring after lights out. These callback requests should take only a minute or two to grant (in other words, bedtime tickets can’t be redeemed to hear another bedtime story or, as one child requested, to order a pizza!). If the child calls the parents back to the bedroom, the parent should ask for a ticket and quickly grant the request.

Curtain Calls

If the child makes a curtain call outside the bedroom, the parent should ask to see one bedtime ticket and then walk the child back to the bedroom for another tuck into bed. If the child makes more than two curtain calls, the child should be walked back to the door of the bedroom only and once there, should be asked to get back into bed on his or her own steam.

To make sure that the child doesn’t hold onto the bedtime tickets for an hour or more and only then make a request, parents should explain that the tickets expire within ten minutes and unused ones can be traded for a small reward in the morning.

In summary, most parents (even lawnmower parents!) want their children to be great sleepers. They want them to sleep well wherever they are so they can participate in all of the fun, age-appropriate activities that come their child’s way. That would include, for example, summer camp, sleepovers, and school trips.

Lawnmower parents, like all parents, mean well. it’s simply a case of doing the wrong things with the right intentions. All parents want their children to fall asleep quickly and independently at bedtime, and stay in bed all night long. Which is why it’s a good idea to take a step back and consider: how much  “help” is too much, when it comes to a child’s bedtime routine.

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Lawnmower Parents Don’t Hover They Mow

Lawnmower parents, as a concept, is so new, that when querying experts for this article, one respondent asked, “Do you mean a helicopter parent?”

No. We did not. Helicopters hover. Lawnmowers mow. Hence the difference.

Lawnmower Parents Hamper Independence

Helicopter parents are never out of the picture. They hover over children so they are always in sight, always there to offer support. The helicopter parent hampers a child’s development by shadowing him and preventing his independence.

Lawnmower parents are actually worse. They remove all obstacles from a child’s path. Here is a kid who will never have to experience or deal with anything unpleasant or difficult. When you’re the child of lawnmower parents, it’s all smooth sailing. (And dare we say it, boring.)

Lawnmower Parents=Curling Parents

Kathy Fray, author of OH GROW UP … Toddlers to PreTeens Decoded, explains that while the term “lawnmower parents” is relatively new, the concept is not. “The old term was ‘curling parents’—taken from the Scandinavian sport of throwing the curling-stone to slide across the ice, and the parents running ahead of it with their broom to clear its way smoothly across the ice. But the term ‘lawnmower parenting’ is easier for the majority to understand,” says Fray.

Is this really so bad?

The answer is yes. It is bad. It’s a crippling experience to be the child of a lawnmower parent. The child of lawnmower parents arrives at adulthood with no clue how to handle the inconveniences and difficulties of everyday life. His mom or dad always did it for him.

Finagled Friendships

A child of lawnmower parents, once grown, is completely unprepared to write a check, earn a living, or navigate a highway, or develop intimacy. Intimacy?? He’s never had to work at relationships. Lawnmower parents arranged his playdates, and wangled invites to the important parties so he never felt left out.

The children of lawnmower parents are afforded no opportunities to develop social skills. Should there be a spat at the playground, lawnmower parents are there to swoop in and waft the child away to a calmer, less-challenging environment. How then, can a child learn to work things out with others when there is conflict? How can he or she grow to adulthood and have meaningful relationships?

Lawnmower parents don’t believe in leaving kids to face challenges. Kid doesn’t feel like going to school? Lawnmower parents will let him stay home and write a sick note. Kid calls you because he doesn’t like the lunch being served that day in the school cafeteria? Lawnmower parents rush over from meetings with important clients to bring the child takeout from his favorite burger joint. Kid, on the spur of the moment, doesn’t feel like going to her piano lesson? Lawnmower parents call the piano teacher and cancel on her behalf.

No School of Hard Knocks

The thing about being the child of lawnmower parents is that you never learn the things you need to know. There is no school of hard knocks. No way to understand life if you haven’t ever grappled with its ups and downs, its unpredictable nature.

All parents, lawnmower parents included, take measures to protect their children from danger. We childproof our homes and plug up electric outlets. We pad sharp corners and furnish our homes with an eye to safety for our children. We breastfeed to protect them from allergies and strap them firmly into car seats.

These are sensible measures. Our children are not Mowgli, left in the wild to his own devices. But parenting isn’t only about protecting children from danger, disease, and death. Parenting is also meant to nurture children, and foster their development. And we need to be realistic: if children never get a booboo, never confront pain or injury, they won’t learn how to keep safe. If children never touch something hot, they won’t come to understand the danger that fire represents.

By the same token, if you bring that burger to school instead of forcing your child to manage, he won’t have to adapt. He won’t learn to make the best of things and eat the fruit, if not the sandwich, drink the milk, and ignore the gloppy stew congealing on the tray.

Robbing Children of Opportunities

If you call and cancel your child’s piano lesson, you’re robbing your child of an opportunity to take responsibility for her actions. You haven’t taught her that a piano teacher’s livelihood involves the student’s commitment to showing up at the appointed hour for lessons. You’re making your child selfish, and turning her into a helpless infant, besides.

“The problem with lawnmower parenting is that it takes away opportunities for children to learn coping skills, dealing with differences, problem solving, and how to be resilient in response to difficult situations and, yes, even failure,” says Developmental Psychologist Stephen Glicksman, Ph.D., an adjunct professor of psychology at Yeshiva University and director of clinical innovation at Makor Disability Services. “Think about every hero, real or fictional, that you have ever heard or read about, and then imagine what that hero’s life would have been had someone removed every obstacle in their way; you probably never would have heard of them.

“Every parent wants, and should, try to protect their children from danger, but when protecting from danger shifts to protecting from any feeling of discomfort, challenge, or uncertainty, that’s when problems can arise. And, if you are very demonstrative in your lawnmower parenting and present the world to your child as one in which there are numerous obstacles and dangers to be avoided at every turn, you could even be sowing the seeds for an anxiety disorder,” says Glicksman.

What if some of this sounds familiar to you? Are you concerned you’re a lawnmower parent and hampering your child’s development? Be assured that it’s natural for parents to be protective. We probably all have a little bit of lawnmower parent in us, at heart. We have all been the parent who takes the cop out and makes things easy for our children to make things easier for us. Especially when we’re tired or stressed.

Rising to Challenges

What we need to remember as parents is that a challenge doesn’t have to be a bad thing. One can rise to a challenge. So don’t clear that challenge from your child’s path. Instead, be bold, and give your child a chance to rise.

As you let your child meet life’s challenges, ask yourself:

  • Is this something my child can do on her own?
  • What lesson might my child learn from handling this situation on her own?
  • How can I encourage my child to be independent in this matter?
  • What is the worst that can happen if I let my child handle this?
  • What will happen if my child fails?
  • How can I support my child without taking over?

The lawnmower parent asks, “How can I make things easier for my child?”

If instead you ask, “How can I help my child grow?” you’re more than halfway to healthy parenting and the most terrific, resilient kids.

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Getting Silly With Kids has Proven Benefits

A recent study suggests that parents just getting silly with their kids can prevent problem behaviors like ADHD and aggression. Children, as it turns out, love it when their parents get silly with them. That could mean anything from using funny voices for characters in a storybook, or tapping the child’s nose when reading the word “nose.” And it seems that the benefits of getting silly with kids aren’t exclusive to story time. Any time you are playful with your children, you’re helping to shape their social and emotional development and behavior in a most positive way.

The study, Reading Aloud, Play and Social-Emotional Development (Pediatrics, February 2018), offered a special invention called the Video Interaction Project (VIP) to 225 families with children aged newborn to five years. In the VIP intervention, a program dating back to 1998, a parenting coach spends time with parents discussing their developmental goals for their children during a regular visit to the pediatrician. Parents are given age-appropriate educational toys and books to take home for their children. Then parents are directed to read to and play with their children and the session is captured on videotape. The parenting coach then has the parents watch the videotape, pointing out how children respond to the different thing parents do as they spend time with their children.

“They get to see themselves on videotape and it can be very eye-opening how their child reacts to them when they do different things,” said Adriana Weisleder, a co-author of the study, speaking to the New York Times. “We try to highlight the positive things in that interaction—maybe they feel a little silly, and then we show them on the tape how much their kid loves it when they do these things, how fun it is—it can be very motivating,” concludes Weisleider, who serves as an assistant professor in the Department of Communication Sciences and Disorders at Northwestern University.

Mother reads to two laughing girls
Getting silly during story time is a good thing.

As it turns out, the Video Interaction Project had already proven its worth before this most study took place. An earlier study funded by the National Institute of Child Health and Human Development found that 3-year-olds who had received the intervention had better behavior than those in the control group. They were far less likely to be hyperactive or aggressive than the children who received no intervention at all.

What the new study did was look at those same children a year and a half later, as the children neared the age of school entry. Were those early improvements in behavior still there? Did it really make that much of a difference in a child’s behavior when the playfulness of a parent/child interaction was pointed out to parents? The answer turns out to be yes, absolutely. The children whose families took part in those early interventions had better behavior. They didn’t have attention difficulties, weren’t hyperactive, showed less aggression. And these are the behaviors that can get in the way of a schoolchild’s learning.

The new study also had older children (3-5 years) receive a second intervention. The positive benefits of intervention were all the stronger for the extra “dose” the children received. After all, the intervention pushes positive parenting and the more of that, the better. Fact.

Little Girl touches smiling mothers nose as mom reads storybook
Getting silly during story time is as easy as letting your child “honk” the horn during story time. Your nose, of course, is the horn.

This is important because the children who take part in the VIP intervention are from low-income families. These children are at greater risk for ADHD and other behavior problems. Children who come to school with behavior issues are less likely to do well in school and get ahead.

What parents should learn from all this is that even if you have no money to spend on clothes for your children or fancy private schools, you can read to, play with, and get silly with your child and it will have a huge positive impact on your child’s emotional and social development, and his or her academic success, too. Dr. Weisleder explains that when parents read to and play with their children, they confront challenges that are outside their everyday experiences. Adults can help children think about how they can deal with these situations.

It could be simpler than that, of course. Getting silly with your kids means bonding with them, having a good time together. “Maybe engaging in more reading and play both directly reduces kids’ behavior problems because they’re happier and also makes parents enjoy their child more and view that relationship more positively,” says Weisleder.

Mother Reads to Daughter in tent with both holding flashlights and smiling
Getting silly can be all about location, location, location. Plus flashlights.

10 Suggestions for Getting Silly

We absolutely agree. And maybe we don’t need to analyze this so closely, but make sure instead to spend lots of time both reading to our children and getting silly with them. To that end, we offer 10 suggestions for getting silly with your kids (feel free to add to our list!):

  1. Hand-washing Fun. Sing “Happy Birthday” twice every time your child washes her hands (you too!). This is the amount of time needed to rinse off those germs with hot sudsy water. But a song makes washing fun and there’s just something ridiculous about singing happy birthday out of context.
  2. Dance Out Your Emotions. Put on some music and dance it out together with your child! Or call out emotions like “Happy” or “Sad” to your child and have her dance the different feelings as you name them.
  3. Tell A Silly Story Together. Take turns telling a story, breaking off at random with one of you taking up the narrative where the other leaves off (and so forth).
  4. Have a water balloon fight! Fill a bucket with tiny water balloons (water bombs). Then go to the nearest sports field and have at it. See who can throw the farthest. Getting wet is all part of the fun.
  5. Turn Getting Dressed Into a Game. For a toddler who hates getting dressed, turn it into a game. “Here comes the Zipper Monster” you can say as you pull up that zipper and make your child squeal with happy surprise. Or tease, “Where’s your head? Where are your arms?? Oh my, I can’t find them at all!” as you pull your child’s sweater over her head and arms.
  6. Use Funny Voices During Story Time. Use different voices for the characters (including animal characters!) in your child’s bedtime story to make the story come alive for her.
  7. Make a Silly Shadow Show. After you turn out the overhead lights leaving only the night light, make an awesome animal shadow show with your child on her bedroom wall. Make those shadows talk to each other, bump into each other, and fake yell at each other.
  1. Compose a Silly Family Symphony. At the dinner table, nod at each member of the family to add a phrase of made-up music or percussion. As each person joins in, you’ll have a crazy music round that sounds like a broken symphony! Keep it going until you all crack up laughing, then begin again, with new sounds and melodies.
  2. Speak Pig Latin. Teach your child Pig Latin and then have an entire conversation in that language!
  3. Make Silly Orange Wedge Smiles. Cut an orange into wedges. Eat the fruit, leaving the rind intact. Put the peels in your mouths over your closed teeth. Orange you glad you smiled? For a variation on this theme, top fingers with raspberry “caps” for instant “manicures.”Man getting silly with orange wedge smile

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Getting Kids Used to a Stepmother

Getting kids used to a stepmother is the kind of thing people dread—and with good reason. Whether the new stepmother comes into the picture after divorce or death, she’s seen by the children as a usurper: someone who stole the real mom’s place. Someone who sleeps with their dad. Even if a child has longed for a new mom, it’s awkward letting this new person into your everyday life with all its small intimacies. This situation requires major adjustment.

Mothers are sacrosanct, irreplaceable. And you’d be surprised at the strength of a child’s loyalty and rebellion against any attempts to offer a substitute. Even where the child maintains a good relationship with the biological mom, there’s bound to be a defensive reaction against a stepmother’s attempts to fit in.

Stepmother as Cool Aunt

When she became a stepmother, Jessica Thompson of California adopted a mantra that served her well: Don’t try to be Mom. Thompson found it was better to think of the stepmother to stepchild relationship as “different.” “The child may want to relate to you as a mother, but not necessarily. Do not force the issue, or take it personally if she never embraces you as a mother. You don’t have the same standing as a mother, so don’t try to discipline as if you are one,” says Thompson, who suggests the natural, biological parent take the lead when it comes to the difficult area of rules and discipline.

“Sometimes stepmoms get the awesome deal of being the ‘fun,’ ‘cool,’ or neutral parent. Aiming for a ‘cool aunt’ type of relationship is a good initial goal. I quickly became the confidante, and a safe place for my stepdaughter to voice frustrations when things got challenging with dad, or at school, and that was a really rewarding relationship. You can be a neutral escape valve and voice of reason, as well as be the one to take the lead in fun activities,” says Thompson.

Age Matters

Parenting Coach Dr. Richard Horowitz, feels that adapting to a stepmom depends, to a large measure, on the age of the child as well as the child’s relationship with the biological mom. “If the biological mother is not part of the child’s life and the child is fairly young (not yet preteen) the stepmother can assume the full role as a mother (nurturing, discipline, etc.). The older the child and the presence of a biological mom makes the situation more challenging. In this case the stepmom along with the biological father must discuss with the child what the stepmom’s role will be and what expectations there are for both parties. This is especially crucial in setting household rules and in determining when stepmom will have standing in regards to rule-setting and enforcement,” says Horowitz.

Have the Talk

Psychologist Wyatt Fisher says that if at all possible, there should be a discussion with the child before the stepmom assumes her new role. This helps prepare the child and lessens the shock of receiving a “new” parent. Once the stepmother comes into the picture, Fisher offers four tips to new stepmoms:

  1. Go slow. Wait until the child warms up to you rather than force the relationship.
  2. Be inviting. Greet the children with smiles and warmth.
  3. Encourage father/child time. It’s important to encourage your husband to spend lots of quality time with the children so they don’t see you as taking their father from them.
  4. Be respectful. Always speak with respect when referring to the child’s biological mom.

Rosalind Sedacca CCT, founder of the Child-Centered Divorce Network and author of How Do I Tell the Kids about the Divorce? agrees with Fisher that adapting to a stepmother is a slow process. Sedacca offers the following six tips for making the transition as smooth as possible:

  1. Introduce children to a potential stepmom very slowly so they have a chance to get acquainted and develop a caring relationship.
  2. Never insist that a stepmom is a replacement for their own mom. Children will be more resistant if a stepparent is imposed upon them or their biological mom is removed from their life.
  3. Stepmoms should never be the disciplinarian to the children. Give Dad that responsibility.
  4. Stepmoms need to earn the trust and respect of the kids which is a gradual process. Dad can be very helpful with this process.
  5. Talk to your kids, listen to what they say, validate their right to feel the way they feel. Don’t make them feel bad or wrong if they are having trouble accepting their new stepmom.
  6. Seek out the support of a family therapist or coach experienced in working with step family dynamics.

In the case of divorce, the main issue with getting used to a stepmother is the fact that “every child wants, wishes, and longs for their mothers and fathers to stay together,” says Dr. Fran Walfish, Beverly Hills family and relationship psychotherapist, author, The Self-Aware Parent, and regular expert child psychologist on The Doctors and CBS TV. “The breakup of the family unit is traumatic—even in the most amicable divorce.

“Kids have a range of feelings that can change at any given moment. Emotionally, children feel sad (about the loss of the exiting parent); angry (‘Why my family?’); worried (about logistics including where will ‘I’ sleep?;  who will take me/pick up from school?; will I still see both sets of grandparents?; and on and on). Behaviorally, you may see your child’s academic grades drop. You may observe her sad (not smiling) or angry, resisting, opposing, or defying you and your rules and expectations,” says Walfish.

Permission to Feel

“As her stepmom, you need to give her permission to have powerful emotions about the huge disruption in her life. Encourage the open direct expression of these feelings,” adds Walfish, cautioning, “Stepmoms, don’t be afraid of her anger. The more comfortable you become with her verbalizing her anger the more validated and accepted she will feel—flaws and all.”

Walfish treats many kids from separated and divorced families and like Sedacca, suggests that counseling can make a difference. “Sometimes, it helps your child to talk to someone outside of Mom, Stepmom, and Dad, like a teacher, counselor, or therapist. Kids may feel worried and guilty about hurting their parents’ feelings. Talk with your child about whom he can go to for comfort and support. Ask him to name people for instance, Grandma, Aunt Susie, Uncle Bob, teacher, or best friend.”

Children are going to have strong feelings as the stepmother enters the scene. “Offer karate, dance, singing, art, or gymnastics classes as a physical outlet for expelling strong feelings,” says Walfish, who says the most important thing is to grant kids permission to love and respect both biological parents. “She is half her real mom and half her real dad.

“If she hears you or her biological mom put her father down it is putting down a part of her. If her biological father makes derogatory remarks about her biological mother tell your stepchild that divorce is a grown-up matter and sometimes moms and dads are mad at each other, but it is not the kids’ fault or responsibility to fix things.”

Blending the Family “Soup”

Parenting Expert Donna Bozzo suggests that finding ways to include children in the process of blending the family is the way toward acceptance of a new stepmom. “Include the kids in the wedding ceremony. Instead of a bride and groom cake topper, how about a full-family cake topper, with kids in tow?” says Bozzo, who suggests that families find fun ways to make things work going forward.

“Think of your new blended family as a kind of soup where different members of the family add their own favorite ingredients to the pot. Like peanut butter and jelly sometimes the sum of two (or more) parts, is greater than the whole,” says Bozzo.

Taking Your Child to the ER

Taking your child to the ER can be a nerve-wracking experience. It’s hard to be rational and calm when your child is injured or experiencing frightening symptoms. The first thing to think about is which emergency room to choose. If you live in a city with a choice of emergency rooms, pick an ER you know to be child-friendly. Or call the doctor’s office for advice on the best ER for your child.

The ideal time to study up on the right ER for your child is actually before there is an emergency. Ask friends about their children’s ER experiences to get recommendations. At your child’s regular check-up ask your child’s pediatrician for advice on the most child-friendly, area ER.

Another way to prepare in advance for emergencies is for parents to keep and maintain a notebook with all the child’s health information. In the notebook, you can list all past and present illnesses, vaccinations, allergies, current medications, and the time of your child’s most recent dose of medicine. These are things the ER staff will want to know. Keep the notebook in your bag so you never lose it and will always have it close at hand, even (and especially) when you’re running out the door to the emergency room.

By the same token, always keep your child’s health-insurance card or information in the same space in your wallet. That way you’ll never have to waste precious time searching for the card during an emergency. It will be one less thing to think about.

Not sure whether your child should go to the ER at all? It could be a call to the doctor can help you decide. For more on this topic, read When to Take a Child to the ER.

Expect a Long Wait

Two kids and a dad (from waist down) in ER waiting room

Once you decide to go to the ER, be aware that a visit to the emergency room may mean a wait of many hours. Make sure you bring change with you, as cell phones are sometimes banned in hospitals. Change is also handy when you want something from the vending machine. Bring toys or activities, and something to eat and drink (check with hospital staff before offering a child food and drink).

Unless your child is three months old or younger, you can feel free to treat a child’s fever before you leave for the ER. It helps the child feel better and can make the wait easier. Bring some more fever-reducing medication along with you to the hospital, in case the wait is many hours long. Your child may need another dose before he is seen.

Try not to bring brothers and sisters to the ER. If you can find a sitter or someone to watch your child’s siblings, it’s best not to bring them along to the ER. Your child needs your full attention. Also, why expose children unnecessarily to diseases that are floating around the hospital?

Review the Facts

As you make your way to the ER, mentally review the facts of your child’s illness or injury, and write them down in your child’s health notebook if your hands are free. That way you’ll be ready to tell the nurse or doctor what has happened and how you’ve treated your child until now. Think back to when your child became ill or injured and make a note of the day and time. If your child has swallowed poison, bring the bottle with you to the ER.

Think over the progression of your child’s illness or injury: how has it changed over time? Has your child had a fever or a rash? Has your child gone to the bathroom? How many times a day? What medications, if any, has your child taken? Does your child have any allergies? These are all things the ER staff will want to know.

Prepare your child on the way to the ER. Tell the child that a doctor (not the pediatrician he knows) will be examining him. At each step of the ER experience, explain the truth about what will happen next. A clear, honest explanation makes your child less anxious. Anxiety over the unknown worsens pain and fear. Knowing what will happen next, even if it’s going to hurt, relieves that anxiety, and helps your child feel better.

Eating and Drinking

On arriving at the ER, ask if your child is allowed to eat and drink. Sometimes you’ll be asked not to give your child food and drink. Some procedures, for instance some CT scans and blood tests, have to be done while fasting. It can be difficult to ignore a child’s pleas to drink and eat, but remember it’s in her own best interests. Reassure her as much as possible.

Remember that a long wait is a good sign. It means your child’s condition isn’t so serious that it cannot wait a bit for treatment. Try to be patient and calm. If your child seems to be getting worse, ask that he be reassessed.

ER waiting room animation

Never lie to a child. Don’t say, “It won’t hurt,” if you know it will. If you know something will hurt, say so, but add something to give the child hope. You might say, “It will hurt, but only for as long as it takes to blink your eye.”

Your Child’s Advocate

If your child needs stitches, a shot, or a blood test, ask if numbing cream can be applied to the area, first. The cream takes about 20 minutes to kick in. If your child’s pain medication is wearing off, let the staff know. Remember that you are your child’s advocate, if you don’t speak up, no one else will.

Do what you can to comfort your child and ease her fears. Hold her, talk to her. Try to keep her from seeing anything scary, such as a tray of instruments or a bloody patient. Read to your child or play a game like “I Spy” to take her mind off of her pain and fear.

Stay by your child’s side as much as possible. Ask if you can stay with your child for procedures like blood tests and x-rays. But if you feel like you’re going to pass out from seeing blood, for instance, make sure you inform the staff.

Your ER Questions

Doctors and nurses seem so busy parents may be afraid to disturb them with their questions. But it’s a parent’s right to ask questions and receive answers. If you want to know why this or that test has been ordered, go ahead and ask. Just be polite.

Make sure you understand the discharge instructions. Are you sure you know when the bandage can be taken off? How to clean your child’s wound? Do you know what to do if your child’s symptoms don’t get better or he feels worse? Do you know how to give your child his medication?

The hospital often recommends a follow-up visit with the child’s pediatrician. Bring your child’s discharge papers with you to the visit. Even if your child needs no follow up visit, drop off a copy of the child’s discharge papers at the doctor’s office. That way, a record of the visit will be included in your child’s medical history.

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When to Take a Child to the ER

Should you take your child to the ER, call the doctor, or wait and see? When you’re just not sure, call the doctor. Even if the pediatrician can’t speak with you, someone in the office should be able to advise you. And if you do need to take your child to the ER, the doctor’s office can call ahead and let them know you’re on the way. That’s a plus.

But let’s back up a bit to the original question: ER or pediatrician? It’s a dilemma just about every parent wrestles with at one point or another. And it’s so hard to think straight when your child is injured or ill.

To the ER or Not? Three Deep Breaths

Even when you’re frightened and anxious, sometimes you can figure things out on your own. That is if you can calm down enough to do a proper assessment of your child’s condition. To help calm down, take three deep breaths. Then remember that being calm and in control of your emotions means you’ll be better able to take care of your child.

Sometimes making decision of what to do next is easy. If your child is just lying there completely out of it, or has severe injuries, don’t wait. Call 911. Ditto if your child’s lips are turning blue. That’s not only the ER, but a ride in an ambulance, most likely. So pick up the phone and dial 911.

Just do it.

Going to the ER Means a Long Wait

But let’s say none of this applies to your child’s condition and it’s the middle of the night. And you know that going to the ER is unpleasant, with a long wait and procedures that might make your child cry. Your child is uncomfortable enough. Do you really need to add to her discomfort? How do you know whether to wait until morning when you can have the doctor decide for you, or whether you need to get moving to the ER now?

Let’s take a look at some common events that may mean a trip to the ER:

Dehydration

Lots of viruses cause diarrhea and vomiting in children. When your child gets a bug with these symptoms, you have to worry about dehydration. Dehydration is definitely a reason to visit the ER, even in the middle of the night. But it usually takes about 24 hours of vomiting and diarrhea to cause dehydration. So the first thing you want to consider is how long your child has been vomiting and experiencing diarrhea. If it’s under 24 hours, you can probably wait.

If your child has been sick for over a day with symptoms of vomiting and diarrhea, you need to watch for signs of dehydration such as:

  • Cracked lips
  • Cold skin
  • Dry mouth
  • Decreased urination
  • Low energy

If your child’s tummy trouble persists, and she can’t keep down even small amounts of liquid, call the doctor. You should try to get the child to take two teaspoons of fluid every 30 minutes. If your child has almost no saliva, can’t make tears when crying, and isn’t peeing at least twice a day, it’s time to go to the ER.

Fever

In small infants (newborn to three months), a rectal temperature of over 38C or 100.4F means: go to the ER now. In this case, don’t give your baby medicine to reduce the fever. The ER doctor will want to see the baby as is, without the effects of medication.

Babies and children three months and older can be given a dose of acetaminophen or ibuprofen for fever according to the dosage instructions on the bottle. Then wait 30 minutes. If your child looks a lot better, is responding to you, and is drinking fluids, you can continue to treat the child at home.

If the child’s symptoms continue, the fever continues past 72 hours, or there’s wheezing, a strange rash, or extreme lethargy, call the doctor.

Breathing Issues

When a child is wheezing or grunting, or her breathing is noisy, fast, or high-pitched, it means your child is having trouble getting air. This can happen when there is a respiratory infection or during an asthma attack. But panting or fast breathing can also occur when kids get fevers. So if your child has a fever, give fever-reducing medication like acetaminophen or ibuprofen and wait 15 minutes. If the fever goes down, and her breathing settles, you can stay home.

If your child has a cough so severe that she cannot sleep or eat, or she has a barking cough, call the doctor.

If the child has so much trouble breathing that she cannot speak, go to the ER.

If the child’s lips are turning blue, call 911.

Odd Rash/Stiff Neck

Does your child have a rash? Press on it. The rash should go back to normal skin color for a second or so. If it does, this means your child has a simple virus and will get better in a couple of days. You can stay home.

If the rash doesn’t pale when you press on it and your child has a fever, this may mean a more serious illness, for instance meningitis. Call the doctor. If your child has neck pain, finds it hard to move his neck, and also has a fever, go to the ER now.

Bad Cuts

Clean the cut well with soap and water. Put pressure on the cut with a clean towel for 10 minutes and then reassess. If the bleeding is under control, but the cut is deep, call the doctor.

Go to the ER if:

  • The child can’t move the injured part
  • There’s lots of bleeding
  • There’s numbness
  • There’s severe swelling

Bump On the Head

A bump on the head isn’t always an emergency. If your child has no dizziness, headaches, or vomiting, you can stay home and the child can return to normal activities. But if your child passes out within a couple hours of bumping his head, call the doctor. Check the child’s head with your hands. If there is a part that seems squishy, go to the ER. If the child can’t stop crying, vomits more than once, or you see blood or fluid coming from the ears or nose, or bruising around the eyes or ears, go to the ER.

Remember that your child takes her cue from you. If you remain calm as you assess your child, your child will feel less anxious and find it easier to cope with the fear and pain of illness. Cuddle your child, and do what you can to distract her from her worries and discomfort.

Mother feels little girl's head for fever, keeps her calm

Next week: Taking Your Child to the ER

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