Mister Rogers on Distracted Daycare: What He Would Say

Mister Rogers probably would have had plenty to say about distracted daycare.  We know that, because in 1983, a 30-minute special entitled “Mister Rogers Talks with Parents about Daycare,” was broadcast on U.S. national television. Hosted by none other than Fred Rogers of Mister Rogers’ Neighborhood fame, the program advised parents on topics germane to the placement of children in daycare, including

1) managing separation anxiety,

2) transitioning from home life to the daycare environment, and

3) choosing a daycare that works best for parents and child.

Unfortunately, Mister Rogers’ daycare special was filmed prior to the advent of mobile internet technology. So, it did not broach the subject of distracted caregiving and its dangerous consequences for child wellbeing.

If the show were aired today, it would need to address the risks of entrusting the health and safety of children to daycare workers who regularly check their portable internet-enabled devices to the point of distraction.

In the present article I define the problem of distracted daycare, explain its ramifications for child welfare and imagine a similar contemporary television show, “Mister Rogers Talks with Parents about Distracted Daycare.” In this fictional show, Mister Rogers would offer advice to parents concerning how to protect their children against the threat posed by distracted daycare workers.

What Is Distracted Daycare?

‘Distracted daycare’ indicates those distracted caregiving behaviors displayed by workers in modern daycare businesses, behaviors that potentially endanger the health and safety of the same children these workers are paid to educate, care for and protect. It can also indicate a daycare business where distracted behaviors are rampant among the caregiving staff.

Distracted daycare and distracted parenting are manifestations of a more general phenomenon: distracted caregiving. So, let’s start by defining that term.

Distracted caregiving is a form of escapism. With the aid of a smartphone, tablet or other internet-enabled device, caregivers flee to social media sites in order to escape the daily grind of household chores and the banal duties of child rearing. The receipt of push-notices (or pings) immediately draws the caregiver’s attention away from the child’s needs and towards a virtual world of titillating adult experience.

Surge In Distracted Caregiving

The past ten years have witnessed a surge in distracted caregiving and studies documenting the phenomenon:

  • In a Boston Medical Center study,caregivers were observed interacting with children while dining at restaurants. Of 55 caregivers, 40 were distracted by their portable devices to such an extent that, according to the researchers, their “primary engagement was with the device rather than the child.”
  • Another study found that regular distraction undermines a caregiver’s ability to properly monitor children’s activities, provide educational instruction or prevent accidents that lead to physical injury.
  • A third study links unintended physical injury to children with poor caregiver supervision or caregivers with high-risk personality traits.

Maximizing Profit

In today’s predominantly private daycare ecosystem, the problem of distracted caregiving is magnified. In order to maximize profit, childcare businesses employ low-paid, contingent workers from the most “wired” generations. These daycare employees, often called “teachers” or “teacher’s assistants,” typically feel:

1) Resentful towards daycare owners and clients for their low wages;

2) Entitled to use internet-enabled devices during work hours even if there is a policy against it;

3) Blameless for any accidents that could have been prevented had they not been distracted; and

4) Convinced that they should protect and be protected by fellow daycare workers when accused of distracted caregiving, even if the coverup involves lying or other forms of deceit (what I call “distracted daycare workers’ omerta”).

How Does Distracted Caregiving Harm The Child?

Distracted caregiving in private daycares is a pressing child welfare issue. The harms children suffer as a result of distracted caregiving are very real. They can be divided into three categories: physical, cognitive and emotional.

Physical Injury

The most obvious harm children suffer as a result of distracted caregiving is physical injury. Between 2000 and 2007, the U.S. Consumer Product Safety Commission compiled statistical data that support the claim that caregiver inattention causes physical harm to children:

1) Playground injuries involving children less than 5 years old spiked 17%

2) Nursery accidents went up 31%

3) Swimming pool injuries jumped 36%

However, in specific cases, it proves difficult to assign blame for these injuries. Distracted caregivers will typically minimize or deny the distraction, refusing to acknowledge that the child’s injury could have been prevented if but for the distracted behavior.

According to Wally Ghurabi, the director of the Nethercutt Emergency Center, “Folks are not going to admit the fact that—look I was doing this [e.g. texting or posting on social media], and that’s why … [the] kid fell off [the playground equipment] and broke his arm.”

Cognitive Damage

Distracted caregiving can also undermine children’s cognitive development, resulting in postponed speech acquisition, social-emotional delays and, in extreme cases, the onset of psychopathological disorders. 90% of brain development occurs in a child’s first three years of life. Neglecting to interact with the child during these formative years can cause lasting cognitive damage. Children can, as a result, develop an array of pathologies that survive into adulthood, including an aversion to healthy relationships, anti-social behavior, and several psychopathological disorders, such as oppositional defiant disorder and conduct disorder.

Emotional Harm

A third harm distracted caregivers inflict upon children is emotional trauma. In the Boston Medical Center study of caregivers dining with children, researchers observed regularities in the caregivers’ distracted behavior and the child’s emotional reactions. When the child attempted to gain the caregiver’s attention, the most common caregiver reaction was to reject the child’s intervention and express irritation.

These negative and insensitive interactions between caregivers and children can produce deleterious long-term effects on a child’s emotional well-being. One study finds that a lack of attentive care in the first three years of a child’s life makes the child more prone to emotional disorders, especially depression, in their adolescent years. Distracted caregiving can effectively stunt a child’s capacity to develop healthy emotional relationships with others.

Despite the overwhelming evidence that distracted caregiving endangers children physically, cognitively and emotionally, distracted daycare is nevertheless an under-reported child welfare issue. Many childcare businesses seek to deny, obfuscate and cover up incidents involving harm to children in their care. Likewise, due to under-reporting, most state and county agencies tasked to regulate private daycares have yet to realize the full magnitude of the problem.

Mister Rogers Talks With Parents About Distracted Daycare

Mr. Rogers on distracted daycare
What would Mr. Rogers have said about distracted daycare?

Imagine a contemporary television special entitled “Mister Rogers Talks with Parents about Distracted Daycare.” What advice might Mister Rogers offer parents concerned about the dangers of distracted daycare?

Selecting A Daycare

While no daycare is perfect, parents should select a childcare facility that minimizes the dangers distracted daycare workers pose to their children’s safety. In Mister Rogers’ special, he took a tour of several daycares, speaking to owners, directors and workers.

Four things that parents should look for are (1) an open-door policy, (2) a no-internet-enabled-devices-during-work-hours policy, (3) a camera surveillance network in all rooms and areas (including the playground) where children stay (not including restrooms) and (4) public complaints and notices.

Open-Door Policy

  • Open-door policy. The daycare that parents eventually select should have an open-door policy. With such a policy, parents can show up to the daycare at any time unannounced to observe daycare activities and worker behaviors (for an example see Toddler Town Chicago’s Open Door Parental Policy). Parent coach and author of The Nanny Whisperer, Tammy Gold, also recommends intensive parental monitoring of “babysitters, daycare workers or nannies [who] are on their smartphones, texting, emailing and otherwise distracted.” However, not all daycare businesses will open the doors for parents to make surprise inspections, citing the parent’s presence as a disruption to the flow of student activities.

No Internet-Enabled Devices

  • No-internet-enabled-devices-during-work-hours policy. The daycare should also have human resources policy forbidding the use of internet-enabled devices by workers during operating hours (for an example, see Kinder House Day Care Technology Policy). While some daycares have a no-portable-device-in-the-classrooms policy, others adopt a more laissez-faire approach, only banning recordings of children that daycare workers might post to social media sites. The daycare owner and/or director should be able to produce the no-internet-enabled-devices-during-work-hours policy on demand, explain how it is enforced and report how many violations of the policy have occurred in the past year.

Camera Surveillance

  • Camera surveillance network. Ideally, the daycare should have cameras recording all activities in the child areas during working hours. However, most daycare businesses still do not accommodate the request for camera recordings on the grounds of employee privacy. The reason for this is that direct surveillance of daycare businesses makes it difficult for these businesses to attract and retain low-paid daycare workers. Such workers may see the easy access to their portable devices as a trade-off for low wages. Even where there is camera surveillance, many employees know the blind spots of these cameras, the places where they can check internet-enabled devices without fear of detection.

Public Complaints And Notices

4) Public complaints and notices. At the very least, parents should contact the public agency (usually state or county) that regulates private daycares and ask how many complaints and notices the daycare has received in the previous 12 months. If there are many, or if they are serious, give that daycare a miss.

Demanding Accountability

Parents should hold daycare workers, directors and owners to account for any harms to their children that they believe resulted from daycare workers’ distracted behavior. A significant obstacle to making these allegations stick is the inability of parents to easily gather evidence that the worker’s distracted behavior contributed to the harm or that the harm could have been prevented if the worker were not distracted.

In most U.S. states, daycare businesses must complete an incident report and inform the parents when a child is physically harmed on daycare premises. Claims that repeated injuries were self-inflicted is a possible warning sign that the harms were the result of daycare workers’ distracted behavior.

If the child is pre-verbal (can’t yet speak), it is difficult to determine the truth of these claims. Parents should interview the director and the worker to determine the exact circumstances under which the injuries occurred. Lodging a complaint against the daycare with the state or county agency that regulates private daycare businesses is always an option.

Communication is also essential. Parents should talk to other parents about the problem. Sharing incident reports allows them to detect patterns of distracted behavior among specific daycare workers. Parents need not be ashamed to withdraw the child from the daycare if they suspect that it is a site where distracted behaviour is rife among the caregiving staff.

Last Resort – Suing The Daycare

Although no parent plans to sue their child’s daycare, in cases where a worker’s distracted behavior causes severe injury to a child, filing a lawsuit is a perfectly reasonable response. It can also be employed as a last resort, in case satisfaction cannot be had through less formal channels.

Following the example of Mister Rogers, it helps to consult experts on technical matters.The Injury Claim Coach is a good resource. Here, legal experts explain that most daycares require parents to sign waivers of legal liability. The waivers, however, are not an adequate defense in a court of law. Indeed, they are commonly struck down by courts as contrary to public policy.

Distracted Daycare: A Story

Injury Claim Coach offers an example of a child injured by a daycare worker because of “lack of supervision” and distracted behavior (cell phone use). In the example, 12 three-year-olds were left alone as the caregiver spoke on her cellphone. While the caregiver was distracted by her phone conversation, one of her charges repeatedly bit a second child on his back:

Later that evening, when the child’s mother was bathing him, she noticed several deep bite marks on his back. The mother applied an antibiotic to the wounds and bandaged them. The next morning, the child had a high fever. The emergency room physician diagnosed the child with a staph infection likely caused by the bite marks.

The parent alleged in court that the daycare was negligent and breached its duty of care to protect her child. The court agreed and ruled the daycare center was negligent. The court said the teacher breached her duty by leaving the children alone. “But for” the teacher’s actions, the child might not have the infection.

Satisfying Legal Standards

The standard legal elements that must be satisfied for a distracted daycare injury claim (civil suit for negligence) to be successful include:

1) The daycare center shoulders a duty of care (obligation) to prevent the child from suffering undue harm

2) The daycare center breached (violated) its duty of care

3) The child’s injuries were directly and proximately caused by the breach;

4) The daycare staff or management could foresee the injury

5) The nature and value of the child’s injuries must be proven.

The major roadblock for parents alleging that the children’s injuries were caused by a daycare worker’s distracted behavior is satisfying the threshold of proof required by a court of law (usually preponderance of evidence). Evidence that distraction contributed to the harm — in other words, “but for” the distraction the harm would not have ensued — is often difficult for parents to gather and easy for daycare owners, directors, and workers to hide.

Surveillance Cameras

Since parents wish to avoid sending their children to distracted daycares, naming and shaming these private businesses is a valid option. Another option is petitioning state and local governments to actively police distracted behavior in private daycares by, for instance, requiring surveillance cameras.

Keeping daycare workers, directors, and owners accountable for distracted behaviors and the harms they cause to children is of utmost importance to society at large. Harming children physically, cognitively and emotionally has terrible long-term social costs, from delinquency to addiction to incarceration.

Communities ought to honestly address the problem of distracted daycare, not minimize, deny, and cover it up. Parents, lawmakers and child welfare professionals should regularly broach the issue with the daycare business community. In the end, as Mister Rogers would remind us, open discussion of the problem and cooperative efforts to resolve it will make us all better neighbors!

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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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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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Can Children Get Type 2 Diabetes?

Diabetes is a condition that affects the body’s blood glucose levels. There are two main types of diabetes that are diagnosed in children and adults: type 1 and type 2. In type 1 diabetes, the pancreas can’t make enough insulin, which is a hormone that helps spread glucose (sugar) into the body’s cells to produce energy. Those diagnosed with type 1 diabetes are most often born with the condition.

Type 2 diabetes is diagnosed when the pancreas creates enough insulin, but the body won’t use it. This is referred to as insulin resistance. Diabetes affects the way the body makes and uses insulin. That means rising levels of blood glucose and, ironically, a body starved for energy.

In the United States, over 30 million Americans suffer from diabetes. In 2017, 18,000 children below the age of 20 were diagnosed with type 1 diabetes, and over 5,000 children were found to have type 2 diabetes. November is Diabetes Awareness Month–the perfect time to learn about a disease that affects so many people of all ages every day. If you believe your child is at risk of being diagnosed with diabetes here is what you need to know.

Child Risk Factors for Type 2 Diabetes

Once referred to as adult-onset diabetes, type 2 diabetes has become a more common diagnosis in children. This is because of rising levels of childhood obesity over the past twenty years. Most cases of childhood diabetes are diagnosed in puberty, though children can get it as young as 8 years old. There has also been an increase in mothers who are diagnosed with gestational diabetes during pregnancy. Gestational diabetes increases the risk for developing diabetes later in life in both the mother and her baby.

Children, most often girls, are also at an increased risk for developing type 2 diabetes if they have a family history for either diabetes or obesity. If your child is of African American, Hispanic, Asian American, Pacific Islander, or Native American descent, he/she also has a higher chance of developing type 2 diabetes as a child.

Obesity is linked with insulin resistance, the leading cause of type 2 diabetes. Childhood obesity affects around 12.7 million children and teenagers in the United States. As the childhood obesity epidemic grows, so do the number of children who become insulin resistant and go on to be diagnosed with type 2 diabetes.

Can Diabetes Type 2 Be Prevented?

Children with prediabetes are at risk for developing type 2 diabetes. In prediabetes, blood glucose rises to levels approaching type 2 diabetes. If your child has prediabetes, the doctor may make recommendations to help lower your child’s blood glucose levels. Following the doctor’s recommendations may prevent your child from developing type 2 diabetes.

Encouraging children to eat healthier foods can help prevent the development of diabetes. Eating a diet low in carbohydrates with adequate protein and healthy fats, can reduce the risk of excess weight gain. Such a diet should also result in weight loss in children who have gained too much weight. Obesity is a major cause of type 2 diabetes development.

Another common type 2 diabetes prevention tactic is getting regular exercise sessions of around 30 minutes each, five days a week. Participating in physical activities can prevent not only diabetes, but many other serious health complications and diseases like, for instance, cancer. Limiting TV and video game time and encouraging children to be active reduces their risk for being diagnosed with type 2 diabetes.

Healthy Activities Prevent Type 2 Diabetes

Here are some fun activities that can help prevent diabetes type 2 in children:

  • School sports like baseball, lacrosse, and soccer
  • Walking the family dog
  • Physical chores like shoveling snow and raking leaves
  • Walking or bike-riding to school
  • Physical family activities like hiking or sledding
  • Daily runs or walks
  • Dance or gymnastics class
  • Karate

Signs & Symptoms of Type 2 Diabetes

In the beginning stages of type 2 diabetes, signs and symptoms of the disease are uncommon. Only as time passes do the symptoms begin to appear. Some of the most common symptoms include:

  • Extreme Thirst
  • Frequent Hunger
  • Unexplained Weight Loss
  • Dry Mouth
  • Frequent Urination
  • Itchy Skin
  • Blurred Vision
  • Numbness or Tingling in Hands or Feet
  • Heavy Breathing
  • Slow Healing of Sores and Cuts
  • Darkened Skin in Armpits and Neck

Complications of Type 2 Diabetes

A diagnosis of type 2 diabetes can lead to complications that come on faster in children than in adults. Diabetes is the leading cause of vision loss and blindness from a group of eye conditions called diabetic eye disease. These conditions include diabetic retinopathy, diabetic macular edema, glaucoma, and cataracts, and affect most major portions of the eye. Other complications of diabetes can include coronary artery disease, stroke, heart attack, kidney failure, and sudden death.

Children at risk or already diagnosed with type 2 diabetes should receive an annual flu shot. The flu can increase the risk of diabetes-related complications. Any illness at all, in fact, can make diabetes more difficult to manage.

Children who are at risk for developing type 2 diabetes are also at risk for diabetes complications. For this reason, at-risk children should be screened for the disease on a regular basis. Early diagnosis means a chance to begin treatment as soon as possible. Early treatment of diabetes helps to prevent later complications from the disease.

Complications of Diabetes Treatment

Insulin therapy is often necessary to control type 2 diabetes. But as diabetic children and teens grow into young adults, the doctor may add further medication to their treatment plans. Some of these prescription drugs are known to have side effects far worse than the symptoms they are used to treat.

One such class of drugs is SGLT2 inhibitors. SGLT2 inhibitor medications regulate blood sugar levels by keeping the body from absorbing glucose back into the blood. Invokana is an example of an SGLT2 inhibitor. This drug has come under fire for increasing the risk of rare genital infections, lower-limb amputations, and ketoacidosis in adults over the age of 18 who use this medication.

Diabetes medications are often prescribed as part of an overall treatment plan. Ask your doctor about the possible side effects and complication of the various prescription drugs for diabetes. Having this information can help you decide see which medication is right for the child approaching adulthood.

What Can Parents Do?

A diagnosis of type 2 diabetes sounds scary. After all, diabetes, whether type 1 or type 2, cannot be cured. In spite of this fact, with proper management, most people with diabetes live a happy, healthy life. If your child or teen has been diagnosed with type 2 diabetes, you can help manage the disease by encouraging your child to engage in physical activity and eat healthy meals.

If you believe your child is at risk for type 2 diabetes, there’s so much you can do to avoid that dreaded diagnosis. You can help your child fit in more exercise and other healthy activities. You can make sure your child eats right and loses weight. Most of all, if you notice any possible symptoms of diabetes in your child, you’ll want to speak to your child’s pediatrician right away. Early diagnosis and treatment are the best way to keep your child’s life as normal and as healthy as possible

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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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14 DIY Projects to Get Your Kids Outside

A generation ago, it was common for American kids to play outside for hours at a time, coming in only when the streetlights came on or when it was time for dinner. Unfortunately, playing outside is no longer the norm. Today, children between the ages of 8 and 18 instead consume an average of 7 hours of indoor screen media daily. It can be a real struggle for parents to get them to put down their devices and go outside, but it’s not impossible. We’ve found some creative DIY projects that will have your youngsters running out the backdoor – and you running with them – to go have fun and play.

6 Benefits of Playing Outside

Being out of doors offers many benefits for children, both physical and emotional. Spending time playing outside:

  1. Improves physical health: Though it may seem to parents like their children never stop moving, kids today are much more sedentary than in past generations. Excessive screen time has been linked to obesity, anxiety, and depression. Playing outside in the fresh air and sun increases vitamin D levels in children, strengthening their bones and helping to prevent heart disease.
  2. Improves vision: Increasing the amount of time kids spend out of doors has been shown to reduce the risk for nearsightedness. Convincing children to be out and about is an easy way to keep them from needing glasses.
  3. Fosters independence: By and large, playing outside  typically comes with fewer rules than indoor play. Parents aren’t always within earshot, so kids sometimes have to settle disputes among themselves. They also have more freedom to run, climb, throw, explore, and be active in ways that might have landed them in trouble indoors. Free play encourages creativity and offers children a chance to make up their own minds about what they want to be doing.Boy runs with kite outside
  4. Lengthens attention span: Studies suggest that “green time” spent in natural environments may reduce Attention Deficit Hyperactivity Disorder (ADHD) symptoms in children. Sunlight, trees, plants, and the sounds of birds and insects can have a grounding and calming effect on children.
  5. Improves social skills: Taking part in unstructured play with other children teaches your child a lot about social skills and how to relate to others. For example, not everyone can have a turn on the swing at the same time. Outdoor play teaches kids how important it is to share in order to have fun with others.
  6. Reduces stress levels: Most people can agree that spending time out of doors, away from constructed environments, is relaxing. People often take vacations to national parks, beaches, wilderness resorts, and other natural environments to relax and relieve stress. Some people even take “forest baths,” which were found to lower blood pressure and levels of the stress hormone cortisol.

Kids Playing Soccer Outside in the backyard

14 DIY Backyard Projects

Kids who enjoy video games or electronic toys might be surprised to find that there are do-it-yourself outdoor projects that offer high-level challenges and rewards. Some of the activities below are competitive and require strategy. Others will appeal to kids who like adventure games or making music. Also: how cool is it that instead of growing virtual plants in a game, kids can do it in real life in their own backyard. Here are 14 fun DIY backyard games and projects that kids of all ages can enjoy with family and friends:

  1. Make a music wall: Hang musical instruments (think pots and pans, spoons, and old pieces of metal) for your kids to play with on one of the walls of your house or on a fence bordering your backyard. The children can choose what they want to play and – depending on how close the neighbors are – volume might not be as much of an issue out of doors. If the neighbors are close, consider inviting them over to join the symphony orchestra!
  2. Build a fire pit – Gathering around a campfire is a great way to encourage conversation and family bonding. To build a fire pit, just pick a spot a safe distance from the house, dig a hole, and line it with rocks or bricks. Working together will help make it a special place for telling stories and roasting marshmallows, but be sure to supervise children at all times.
  3. Plant a garden: Planting a vegetable garden is a great way to get messy with your kids outside, as well as teaching children patience. Digging into the dirt represents sensory play which is so important for brain development. Kids get to watch the fruits of their own labor grow, and after the harvest, they get to enjoy eating what they’ve grown. Kids are also more likely to try vegetables they’ve grown themselves.
  4. Create a Ninja Warrior-inspired obstacle course: A backyard ninja obstacle course is a great way to get your kids outside and keep them active. No longer will they have to sit and watch people on television dominating obstacle courses – they get to compete themselves! There are dozens of different obstacles you can create and include, from ramps and rock-climbing walls to teeter-totters, cargo nets, balance beams, and monkey bars. To help you get started, here are DIY backyard obstacle course instructions.Children playing with all sorts of things in the backyard
  5. Make an old-fashioned tire swing: All kids love a good tire swing. If you have any old tires lying around, or access to one, a tire swing is a DIY project that will engage kids for a long time.
  6. Make a reading nook: Providing a fun place for your kids to read outside not only gets them out into the fresh air, but also encourages them to open the pages of a book rather than stare at a screen. The possibilities for your reading nook are endless. Each one can be designed to fit your child’s personality and interests. Here’s a cute one with toadstools.
  7. Create a sand and water table: Using some simple materials, you can create a sand and water table that will occupy kids for hours and can be used to teach impromptu science lessons. With PVC piping, funnels, and water, you and your children can create an intricate pipe design that is fun to play with. When you’re not using the table for water play, fill it with sand for a raised sandbox – perfect for making sand castles, digging, and other fun activities.
  8. DIY passing practice wall: Do your kids love sports? Are you looking for ways to strengthen your kids’ gross and fine motor skills? If so, build your own passing practice wall with targets of various shapes and sizes for kids to practice their aim.  Here is an easy model to follow.
  9. Giant Connect Four: A friendly game of Connect Four becomes even more fun when you play it outside on a massive board with giant pieces. It is the perfect way to load up on some Vitamin D and learn strategy, too. Check out these instructions for making your own.
  10. DIY cornhole: Both little kids and big kids enjoy the game of cornhole – an outdoor version of bean bag toss made with large wooden boards. If your kids are older, this is a fun DIY project as they can design and paint the cornhole boards to match their interests. Here are instructions from the DIY Network.
  11. Outdoor movie theater – You can give an old sheet or painter’s tarp new life and recreate the magic of drive-in movie theaters with this awesome outdoor movie screen project. Just add popcorn and comfortable seating, and don’t forget to invite the neighbors!
  12. Pallet daybed – You can make your backyard even cozier with a DIY pallet daybed. Kids and adults alike will love to read, lounge, nap, and hang out in your new favorite spot. Add wheels to make the daybed mobile, or you can turn it into a swing.
  13. Outdoor chess: For chess-loving families, consider turning part of your backyard into a DIY chessboard. For example, by laying pavers strategically, you can turn a section of your yard into a game board. See DIY Network’s chessboard patio instructions.
  14. DIY outdoor Yahtzee: The game of Yahtzee involves only dice, a score pad, and a pencil. Using large wooden blocks and a permanent marker, you can easily make your own set of dice for backyard Yahtzee. Here are simple DIY instructions.

Unstructured Play

It’s hard to overstate how important it is for children to spend time playing outside. When they look back on their childhood later in life, your kids probably won’t remember passing a particular level of a video game. But they will reflect fondly on adventures, discoveries, and unstructured time spent playing in the backyard.

Little Girl does handstand in backyard

Depending on how adventurous and physically active your children are, they might get some bumps and bruises while climbing trees, swinging, or navigating obstacle courses. It’s always a good idea to establish safety rules and to have a basic first aid kit on hand for minor emergencies. But actually, the benefits of playing out of doors can’t help but make kids more physically fit, more independent, and provide an outlet for stress. Whether you use the ideas here or brainstorm your own, backyard projects are sure to provide you and your children with hours of creativity, togetherness, and fun.

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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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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

Found what you just read useful? Why not consider sending a donation to our Kars4Kids youth and educational programs. Or help us just by sharing!