Can lead paint lead to learning disabilities, and, if so, what kind?

Lead paint has been implicated in learning difficulties. It does take some time to build up in children's systems. The learning difficulties are often school-related problems. Many times they show up as learning difficulties. There are many county public health programs, which have screening efforts where they will come out and evaluate your homes. We have had some cases in the Midwest recently. If you are concerned, you can ask your pediatrician to get a blood lead level on your child. Early detection is key to avoiding the complications of lead poisoning.

What types of chronic health disorders are most common in children?

Probably the most common health disorders in children are things like diabetes, asthma, and various forms of cancer. Obviously, cancer has more specific implications for survival and more complications related to the types of treatments that affect both lifestyle as well as daily functioning for children. I suspect diabetes is probably the most common.

Do most children outgrow asthma?

Many children with asthma do outgrow it to some extent. It probably depends on the type of asthma. I am not a medical doctor, so I am unable to clarify what types are related to change over time for kids.

My son is nine and has a lot of anxiety issues. Is medicine recommended?

Not necessarily. Medicine for anxiety is very helpful but for children, we need to look at causes in their environment. There are many useful non-medical treatments for anxiety difficulties. These involve various forms of relaxation training and counseling. This is to assist with coping with anxieties.

What is your opinion of the claims many are making that children are too readily diagnosed with ADD/ADHD and prescribed Ritalin?

I have to agree with guest #6 that, in many instances, people seem to rush to judgment, if you will, about the diagnosis of ADHD. Again, many children who seem to have attention problems can have them for a variety of reasons. If work assignments are too difficult for them, if they are anxious, if there are other stress problems in the background, these children may appear inattentive. However, medication directed at ADHD, for these problems, is not helpful and may be harmful. What children need is probably a thorough assessment of their functioning both at school, home, and with their peers before we assume that medication or the diagnosis of ADHD is appropriate. I believe the big problem with this diagnosis is that it is something that all of us seem to do at times, namely we are inattentive. There are many reasons for our inattentiveness. Children, in school, are often in a very difficult situation of having to perform and when they don't perform, an easy scapegoat seems to be that they are inattentive. I am certainly not implying that ADHD doesn't exist, but a more thorough assessment of the child's functioning involving school personnel, parents, as well as medical personnel will probably result in the best outcome for the child.

What type of psychological therapy do you recommend for a child going through a chronic illness if any?

Guest #2 asked an important question: probably the most useful information for most children is developing some form of a support system both at home and school and trying to maintain activities and a normalization of activities. Therapy, per se, usually tries to deal with social isolation factors that many chronic illnesses impose. Knowledge of the health problems and depending on the child's age, their own knowledge of these issues, is often very helpful. We need to assist children in becoming partners in their health care process. This often gives them a sense of control again over the chronic illness.

What is your opinion of inclusion, pros and cons?

I would need more information about inclusion for what.

What do you tell classmates about a child who has cancer?

Children need to have information about life-threatening illnesses. Often when kids leave school having a diagnosis of cancer, it is very difficult to talk about this with the class. However, it is very useful to present information to them to make it easy for the child to discuss some of these things if they are comfortable with such questions. Today, many forms of cancers are curable, and children need to hear things like that. Many children also wonder about things like is cancer contagious. For young children, the knowledge about the chronic disease becomes a helpful and important issue.

My son has juvenile diabetes. We are having a difficult time finding appropriate yet fun items for school lunch. Any suggestions?

Contact a dietician, and certainly your local physician could provide you with more appropriate suggestions.

How should children explain their health problems to their peers?

Children need help with this since many kids assume negative things often about disabilities or health problems. Parents can help children explain their health difficulty or their disability, which is very important to maintaining good social interactions. When children have a reasonable explanation for their disability or health problem, it often empowers them to move forward in a social situation with their peers. This is probably the most helpful thing a parent can do for a child, namely to assist him in having ready information about health difficulties for peers and others.

How does a parent confront their child to describe the seriousness of the child's new cancer diagnosis?

Discussion of cancer with children is a main concern for many health care professionals. Depending on the child's age, they need to know what the process is and often times the nurse or physician-oncologist can be very helpful in providing the parent with some ideas and the right words. Probably the most important point is not to keep secrets from a child since most children can read emotions in other people's faces about such serious illnesses. An open discussion with a child over time and obviously at their developmental level is probably the best approach and many of us think is a very therapeutic way to handle serious illnesses.

My teenage daughter has sickle cell anemia. She misses school often when she is in crisis and is having difficulty fitting in with the kids at her high school. Any suggestions?

Sickle cell is a very troubling disease for young adolescents. Many of their peers do not seem to understand the pain and discomfort that is often quite variable. Here, many times, information for her friends with her full knowledge, that is, about the disease can be quite helpful. Often times adolescents are quite embarrassed about "being different", and sickle cell has a way of promoting this feeling of isolation. Again, information that she can share and then secondly, we have often found that an individual buddy, or peer, who can be supportive and assist in social situations, can be a helpful friend. Again, this has to be orchestrated with the full knowledge of the young adolescent.

How do you help a child deal with chemotherapy and all that comes with the treatment?

The question on chemotherapy is, for many of us in pediatric medicine, one of the most difficult times in working with families. We know that treatments need to be accomplished, but many times the so-called side effects are not only devastating but also frightening. They change the way the child looks, they change the way the child behaves, and they can be scary for siblings as well as all relatives. Again, family participation and extended family involved in this process at the hospital is often quite helpful. It is useful to ask families what kind of information they need and what kinds of activities we can provide to support the child. Unfortunately, there are no simple ways to make this a smooth process but, on many of our inpatient units at UHIC hospitals, we have children's groups where the children who are undergoing chemo often assist each other. This is not to be underestimated in its impact and usefulness for kids. Our child life therapists can provide families with different ways to approach children but the children themselves can provide insights to each other, which we find quite helpful in smoothing things over. It has been my observation that many times the children are doing better with the chemo from a psychological standpoint than the parents, and this points out to us that we need to help parents in maintaining good emotional control, which can help the children as well.

My son has Juvenile Rheumatoid Arthritis. The other kids pick on him because he is not athletic. He wants to feel like he is a part of recess too.

Juvenile rheumatoid arthritis is probably one of the more misunderstood diseases for young children. The joint pain, the frequent absences, the very nature of the inflammatory process promotes tremendous amount of social isolation for the child. One thing we have just developed is a computerized, self-administered, training program for kids with juvenile rheumatoid arthritis that teaches them how to cope with their pain and provides information on what to tell their peers. However, athletic participation, certainly for young boys, is a major issue and is always not a likely possibility for such children. We like to look for other ways of participation with athletic teams and not to downplay the importance of being a trainer or some participation without great athletic outcome. We often talk to coaches and see if they can make alternatives for allowing kids to participate. One of the important things is providing that child with some pain control and some effort that he/she, usually he, has control over his disease. We can do this through some counseling and behavioral training which is quite helpful. We are optimistic that this will help children with a lot of these pain problems that they can take care of themselves.

My 14 year old son has Gynecomastia. He wants to participate in sports but is embarrassed in the locker room and doesn't want to be teased. What can he do?

This is a tough question because gynecomastia essentially refers to breast development, or seemingly breast development, in males. Children are, for all of the appropriate obvious reasons, are quite sensitive to this. I think that the best approach is an individualized effort to assist the child in understanding what is going on. 14 is a tough time. Allowing him to have more privacy rather than always undressing in front of peers may help. I don't have a simple answer to this embarrassment, but coaches and athletic people need to be informed of this issue and be involved. I know it sounds like we are orchestrating too much, but we have a responsibility to ask peers to behave in a more appropriate fashion to people just because they have differences. An individual counseling approach is often needed, and your local physician might recommend a supportive counselor outside of school.

Our son (age 7) has cerebral palsy. He does well (i.e. good supported walking, louder talking, better bladder control) when motivated. Is his need for motivation typical of regular 7 year olds or cerebral palsy students? We were wondering as several teachers have remarked to us about the extreme difference in his behavior with or without motivation.

I need a little more information about the child with cerebral palsy. What do you mean by extreme difference in his behavior with/without motivation?

With motivation, our son will be attentive, show his teachers he can read and count, etc. Without motivation, he will not. Also, with motivation, he will initiate the supported walking steps, without motivation, he has trouble balancing.

Thank you for the clarification. It seems like the issue that you may be raising relates to his ability to focus in addition to motivation. Since these behaviors occur in several situations, I would wonder if we might try to get him to focus more specifically and, if he is able, to verbally rehearse or repeat what is required. It is not important whether he is completely understandable - he may or may not have communication difficulties - but the idea is to get him to focus and verbally rehearse what he needs to do. Many times we find this technique to assist all children as well as adults in becoming more attentive and focused on the activity.

What can be done for children with recurrent abdominal pain?

Questions that seem to trouble all parents and often many pediatricians are children with recurrent abdominal pain. Many times, children show physical distress as a result of psychological stressors from school or home or with their peers. These children are often referred to as having multiple pains. A thorough physical exam often reveals negative findings, but parents need ways of coping and distracting the child from this pattern of recurrent pains. We have often found that a highly structured but supportive set of directions about when to say they should stay home, do they have a fever, are they ill, is helpful. We try to define illness behavior as something that is not as much fun. Often this works wonders for helping children get back to school quickly.

What about persistent bed-wetting? What could this indicate?

There is a good question. Bed-wetting, depending on the age of the child and its frequency, can indicate several different concerns or issues. Young children who are not yet toilet trained - that is under the age of 2 1/2 - often do have nighttime accidents. However, after a child has been toilet trained, and they begin to wet frequently, an examination by a family doctor is most important to be sure there is no medical cause. Again, if the results are negative from a medical standpoint, a conservative approach often involves reducing fluids after 6 o'clock and also encouraging the child to void or use the bathroom before he goes to bed. Also, one can set the alarm for an hour or two later after bedtime, and wake the child to assist him/her to empty their bladder. This is a conservative approach and usually takes care of most problems. If it persists despite usual reductions of fluid, certainly more medical consultation is probably needed.

He is on Depakote to control seizures. Is this a side effect of Depakote, or do some children with cerebral palsy have difficulty with the ability to focus?

The answer is it is kind of variable and depends on the child. I do not want to sound like a non-answer, but in most cases, Depakote would not necessarily reduce attention. Since you raise the issue of seizures, it may be that some of the inattention could be related to the seizure pattern. This should be reviewed with your physician/neurologist to get further opinion. It is a very good question and needs to be explored further from a medical standpoint to help sort this out.

Do you have any information to share regarding weight loss in autistic teenagers?

Probably the most important question is what kind of communication skills does the person have, and can we use a more behavioral approach in setting up a dietary plan. Often times, it is useful to develop some form of reward system for compliance with a dietary program rather than using only a verbal set of reminders. We have often suggested that teens try to get control of this through using their own desire for "looking better" but also promoting this through more physical activity. Often times, when working with teens who have difficulties similar to autism, the question again becomes whether we can get them to focus, whether we have the right set of rewards that will peak and maintain their interest.