How can I help my child focus?

It is common to hear from parents that their child is having problems focusing. There are several factors to take into account as to why their child may have difficulty. Often children are not getting enough sleep or proper nutrition. Other times the difficulty may stem from not being developmentally ready to handle the work expected of them at school. This occurs frequently when a child is one of the youngest in their class and often needs an extra year of development to “catch up” with their peers. It is best for a child with focus issues to be fully examined to rule out any medical causes for their attention issue such as sleep apnea or absence seizures. In addition, a child may need to be evaluated by a psychologist and undergo psychoeducational testing.

The following are ways parents can help their child focus.

1) Sleep- A proper amount of sleep each night is important for a child’s brain to function at it’s best. The following hours of sleep are a general guideline:

Preschoolers 3-5 yo 10-13 hours

Gradeschoolers 6-12 yo 9-12 hours

Teens 13-18 yo 8-10 hours

2) Nutrition- Neurotransmitters, the chemicals released by brain cells to communicate with each other, are essential to maintain proper attention and focus. A diet rich in proteins such as lean meats, fish, eggs, beans, nuts, soy, and low-fat dairy products, complex carbohydrates such as whole grains, and a variety of fruits and vegetables are essential to the process of making neurotransmitters.

The goal is to encourage your child to fill half their plate with fruits or vegetables, one-fourth with a protein, and one-fourth with complex carbohydrates.

Zinc: helps to regulate the neurotransmitter dopamine. Zinc levels have been found to be low in some children with focusing issues. Foods high in zinc include beef, spinach, pumpkin seeds, and shrimp.

Iron: is a key cofactor in the making of neurotransmitters. Supplemental iron can be dangerous if too much is taken. Iron levels need to be checked before starting a supplement. Eating iron-rich foods such as red meat, red beans, dark chocolate, and leafy greens can increase iron levels without the risk.

Vitamin C: helps to make neurotransmitters like dopamine and norepinephrine. Foods such as oranges, red peppers, and kale are high in Vitamin C.,

Vitamin B: Deficiencies in B vitamins, particularly B6, can cause irritability and fatigue in children Adequate B6 levels can increase alertness and decrease anxiety-like symptoms. Foods high in B6 include wild-caught tuna, bananas, spinach, and salmon.

Magnesium: Magnesium is also used to make the neurotransmitters involved in attention. Magnesium is known to have a calming effect on the brain. Magnesium can be found in foods including dark leafy greens, nuts, seeds, and beans.

It is also possible to take a daily supplement if nutritional goals are not met in a child’s dietary intake. However, supplements can become dangerous if taken in excess, so it is best to always check your child’s levels of each vitamin before you start a supplement.

3) Behavior Therapy- Often children with focus issues benefit from behavior therapy. This strategy aims to reward desired behaviors and helps to eliminate undesired behaviors. It should be the first line of treatment for children under 5 years old and should be considered for all children. Cognitive behavior therapy uses strategies to eliminate irrational or negative thought patterns.

4) Exercise increases the neurotransmitter dopamine and therefore helps maintain attention. Yoga and mindfulness are especially effective in doing this. In addition “Green time” 20 minutes a day also helps with attention fatigue so it’s important to get outside each day.

5) A medical food that provides omega-3 that is able to pass the blood brain barrier has shown significant improvement in focusing in some children. It is available by prescription.

Treatment for each child should be individualized. With the proper balance of sleep, nutrition, behavior therapy and exercise each child can begin to focus better. It is important to monitor symptoms to see what works and adjust accordingly.

Is my child speaking enough?

A common concern I hear from parents is whether or not their child is developing speech appropriately. In this blog I will discuss the development of speech, common milestones to expect and what to to do if a speech or language delay is suspected.

Voice is the sound made from the vibration of air passing from the lungs through the vocal cords in our larynx. Speech is the coordination of muscles of the jaw, tongue, lips and vocal tract to make sounds that we recognize as language. Language is a set of rules that allow the expression of ideas in a meaningful way.

The first 3 years of life is critical for acquiring speech and language skills. Therefore the developing, maturing brain of your child thrives in a world that is rich with sounds, sights, and consistent exposure to the speech and language of others.

Infants learns that a cry will bring food and comfort. Newborns also begin to recognize the voice of their mother or primary caretaker. Most babies recognize the basic sounds of their native language by 6 months.

Children develop speech and language at different rates. However, they follow a natural progression for learning the skills of language. Milestones help determine if a child is on track or if he or she may need extra help due to hearing loss or a speech or language disorder.

Birth to 3 months

Recognizes your voice and quiets down if crying

Reacts to loud sounds with a startle reflex

Vocalizes with coos, cries, or fusses

Makes noise and smiles when spoken to

Responds to sound of rattle

4 to 6 months

Looks or turns toward a new sound

Responds to “no” and changes in tone of voice

Enjoys rattles and other toys that make sound

Vocalizes back when talked to

Begins to repeat sounds: “ooh,” “aah,” and “ba-ba”

7 to 11 months

Responds to his or her own name, ringing sounds, or someone’s voice even when not loud

Knows words for common things: “cup” or “shoe” and recognizes, “bye-bye”

Babbles: "ba-ba-ba," "ma-ma" or "da-da"

Tries to communicate by actions or gestures

Looks at things or pictures when someone talks about them

Begins to respond to requests: “come here”

Enjoys games like peek-a-boo and pat-a-cake

Makes babbling sounds, even when alone

Imitates simple words and sounds; may use a few single words or baby signs meaningfully

12 to 17 months

Understands simple commands: “put the ball in the box” or “put the car on the table”

Enjoys being read to

Follows one-step commands when shown by a gesture

Shakes head to respond yes or no

Imitates simple words

Uses four to six words or more

Says more words as each month passes

18 to 23 months

Understands the meaning of action words: clap, sit or jump

Points to some body parts when asked

Understands and answers simple “yes-no” questions: “Are you hungry?”

Understands “not now” and “no more”

Chooses things by size: “big” or “little”

Uses a vocabulary of 50 words

Asks for common foods by name

Makes animal sounds: "moo"

Starts to combine words into 2- to 3-word phrases to talk about and ask for things: "more milk"

Begins to use pronouns: "mine"

2 to 3 years

Knows some spatial concepts: "in" or "on"

Understands and uses more pronouns "you," "me" or "her"

Knows descriptive words , "big" or "happy"

Answers many simple questions

Follows two-step commands : “Get your shoes and come here.”

Uses three- to four-word sentences

Uses at least 100 words by 2 years of age

Uses question inflection to ask for something "My ball?

Begins to use plurals: "shoes" or "socks" and regular past tense verbs: "jumped"

Speech pronunciation is improving, but may still leave off ending sounds; strangers may only understand 50-75% of what is said

3 to 4 years

Answers simple questions: "What do you do when you are hungry?"

Groups objects into categories: foods or clothes

Recognizes colors

Uses 300 to 500 words by 3 years of age

Describes the use of objects "You eat with a fork"

Has fun with language; enjoys poems and recognizes language absurdities such as, "Is that an elephant on your head?"

Expresses ideas and feelings rather than just talking about the world around him

Uses verbs that end in "ing": "walking" or "talking"

Uses most speech sounds, may distort more difficult sounds: l, r, s, sh, ch, v, z, th

Uses consonants in the beginning, middle, and ends of words. Some of the more difficult consonants may be distorted, but tries to say them

Strangers are able to understand much of what is said

4 to 5 years

Answers "why" questions

Lists items that belong in a category (such as, animals or vehicles)

Understands more abstract spatial concepts (such as, "behind" or "next to")

Understands complex questions

Uses some irregular past tense verbs (such as, "ran" or "fell")

Describes how to do things (such as, painting a picture)

Speech is understandable, but makes mistakes pronouncing long, difficult, or complex words (such as, "hippopotamus")

Strangers understand 100% of what is said

5 years

Understands time sequences: what happened first, second, or third

Carries out a series of three directions

Understands rhyming

Engages in conversation

Produces sentences that can be eight or more words in length

Uses compound and complex sentences

Describes objects

Uses imagination to create stories

What should I do if my child’s speech or language appears to be delayed?

Your child may need to be evaluated by an audiologist and speech-language pathologist. Depending on the result of the evaluation, the speech-language pathologist may suggest activities you can do at home to stimulate your child’s development, group or individual therapy or further evaluation by a developmental psychologist.

Research is being conducted on developmental speech and language problems by the National Institute on Deafness and Other Communication Disorders. They have discovered a genetic link to specific language impairment, a disorder that delays children’s use of words and slows their mastery of language skills throughout their school years. Further research is exploring the role this genetic variant may also play in dyslexia, autism, and speech-sound disorders.

Vaccines and your child

I spend a fair amount of time during my day explaining the pros and cons of vaccines to parents. As a mother of three, vaccines not only affect my patients but also my own children. Therefore, I include in this blog why the pros outweigh the cons and why my children and patients fully vaccinate.

First let’s go over what is in a vaccine and why it is there.

The main ingredient in a vaccine is the antigen. This is what triggers the child’s body to make antibodies and memory cells to protect the child from the disease if they are exposed in the future.

Another component is an adjuvant. This decreases the amount of antigen needed to make the child’s body respond to the vaccine. The most common is aluminum salt. Breast milk and formula are other sources of aluminum salts.

The next component in some vaccines is a preservative. Most childhood vaccines no longer contain preservatives. It is usually present in multi-dose vaccines to prevent growth of bacteria and fungi. Most common are organic compounds found in our environment.

In addition stabilizers are proteins that protect vaccines from breaking down . They include albumin, sugars or amino acids.

Next, antibiotics keep vaccines from contamination. The antibiotics are non-penicillin containing such as streptomycin, polymyxin B, neomycin and gentamicin.

Lastly, residual amounts of yeast protein, cellular DNA and formaldehyde may be in some vaccines. If present, formaldehyde is in an amount much less than that naturally made in a child’s body or found in some foods such as an apple or pear.

Now that you understand what is in a vaccine and why it is there, it is important for you to know that the bacteria and viruses that vaccines protect children from still exist. Vaccines have protected our children from serious life-altering diseases such as encephalitis, meningitis and cancer. Side effects from vaccines are typically mild, the most common being redness and swelling at the site of injection. Serious side effects such as an allergic reaction to a vaccine component is rare.

Vaccines are given according to the age in which children are most susceptible to bacteria and viruses. Multiple vaccines can be given during a visit or if preferred by a parent the vaccines for each visit can be divided into two separate visits as long as the child is protected and doesn’t fall behind schedule. At the end of the day vaccines can provide us with the peace of mind needed to know we are doing what is most important to protect our children.