Is he overly stressed?
Little kids don't get stressed, right? Wrong. They worry about whether they'll have someone to play with at recess. They worry about the fact that their parents are worried about the car needing a new transmission. They worry whether that big argument their parents had the other night means they're getting divorced. Even happy events -- the birth of a new baby, a move to a bigger house -- can loom large.
"Most kids have a little bit of stress," explains Rachel Busman, Psy.D., a clinical psychologist in the Anxiety and Mood Disorders Center at New York City's Child Mind Institute. "But too much triggers the release of stress hormones that flood the brain, interfering with a child's ability to concentrate, retain information, and perform."
What your doctor should look for Rare is the 6-year-old who will announce, "I feel really stressed today, Mom." Recognizing that something's wrong and figuring out what to do frequently means connecting the dots. Your doctor will ask if your child is sleeping and eating well and if he's happy and enjoying school, activities, and friends. She'll also want to know if you've noticed any changes in his behavior: Is he unusually clingy? Does he say he hates school, when before he used to race to the bus?
When to speak up "Pediatricians are time-crunched and have 15 to 20 minutes on average to devote to a well-child checkup," explains Dr. Redlener. "The more in-depth questions needed to discuss a child's mental health often get short shrift." So report any concerns or changes you've noticed in your child. "Headaches, stomachaches, nail biting, bedwetting, and hair-pulling can all be stress-related," says Dr. Busman. It's worth mentioning if your child is doing poorly in school, that your family recently moved, Grandma is sick, or you or a spouse were laid off.
What does she eat?
When a child is hungry, her head may hurt and her memory may be fuzzy. Her hunger probably gets in the way of good sleep, so she's too tired to follow what the teacher is saying and too irritable to care how her actions might be affecting the other kids.
But children who are overweight or obese -- as are one third of all kids in the U.S. -- are equally at risk for poor school performance. Not only do high-calorie, low-nutrient foods make kids fat, they don't sufficiently feed their brain. And of course children who are carrying too much weight are more likely to develop serious health problems, including type 2 diabetes and high blood pressure, says Isabel Pino, M.D., Children's Health Fund medical director in West Virginia.
A growing body of research links obesity with poorer academic performance beginning as early as first grade. Last year, a study conducted at the University of Missouri, in Columbia, tracked more than 6,250 kindergartners through fifth-graders. The researchers found that children who started school obese and remained obese performed worse on math tests than those who were never obese.
What your doctor should look for Expect him to check height and weight and explain where your child falls on the normal growth chart for her age. He'll also calculate body mass index (BMI), a mathematical formula for determining body fat and her risk of obesity (or alternatively, if she's sliding toward a possible eating disorder). He'll also ask about her diet, eating habits, and exercise.
When to speak up Worried that your child is gaining too much weight? Ask for advice about any rapid or dramatic weight gain or loss. If you're concerned that she's a picky eater, discuss ways to help her gain in a healthy way. Also mention if your child skips breakfast or never has milk or vegetables; she may be missing out on important nutrients. Note any problems too. Does she feel sick after consuming milk or dairy products? Is she constipated?
How's he sleeping?
"Many parents don't realize that a significant part of learning actually occurs while a child is sleeping," says Judith Owens, M.D., M.P.H., director of sleep medicine at Children's National Medical Center, in Washington, D.C. "It's during two critical periods -- what is called deep sleep and rapid eye movement (REM) sleep -- that the brain grows new connections and consolidates the day's memories."
Research shows that kids who don't get enough sleep are lethargic, have trouble paying attention, and their grades suffer. They also have more behavior problems. Easily distracted and often argumentative, tired kids are frequently overactive (to help themselves stay awake) and may be misdiagnosed with ADHD. School-age kids ought to be able to stay awake and alert all day. "Most 5- to 11-year-olds should get ten to 11 hours of sleep," says Dr. Owens, a Parents advisor. But most don't.
What your doctor should look for She may ask questions about your child's sleep habits: Does he stick to a set bedtime routine every day? How much time does he spend playing computer games or watching TV? Does his bedroom resemble an electronics store? All of this has been linked to insufficient and poor-quality sleep. "If your child has a cold or it's allergy season, a little snoring is common," says Dr. Owens, who is also president of the American Sleep Apnea Association. But loud or frequent snoring, breathing pauses, choking, or gasping during sleep could be a symptom of sleep apnea, which is a potentially serious condition that disrupts breathing and affects 2 to 4 percent of children. Kids with enlarged tonsils and adenoids, asthma, gastrointestinal reflux disease (GERD), and obesity are at particular risk for sleep apnea.
When to speak up Be sure to mention any sleep problems (difficulty falling or staying asleep, snoring, restless sleep with sweating, or mouth breathing) that persist more than a few weeks or seem to be getting worse.