Is Your Child Ready to Learn?

When most of us think about helping kids succeed in school, we zero in on things like reading to them early and often, and making sure that schools are safe and staffed by talented teachers.

The vision of pediatrician Irwin Redlener, M.D., goes further. As a professor at Columbia University's Mailman School of Public Health, Dr. Redlener knows that being physically and mentally healthy is essential for getting a good education. So 25 years ago he teamed with musician Paul Simon to found Children's Health Fund, a national organization dedicated to providing quality health care for kids who don't have access to it. "Undiagnosed, untreated medical problems can profoundly affect a child's ability to learn," says Dr. Redlener, a Parents advisor. If your daughter's frequent ear infections prevent her from hearing her teacher, she's going to have trouble understanding the addition lesson. If your son's classmate can't focus because he was coughing all night from asthma, he won't remember the spelling words no matter how hard he studied. "My goal is to raise awareness of the connection between health and education," says Dr. Redlener. The key is to prevent or properly manage physical and psychological problems, and catch developmental delays early.

We believe that every parent can take a page from his playbook, so Parents has partnered with Children's Health Fund to get the word out. (See "Give Every Child a Chance," on page 3.) By making sure you know what to expect at the next checkup -- and which red flags to wave if the doctor doesn't address one of your concerns -- you will give your child a firm foundation for school success. Ask yourself these questions:

How well can my child see?

Kids with vision problems lose interest in learning, explains pediatrician Lisa Gwynn, D.O., medical director of Children's Health Fund in Miami-Dade County, Florida. "They can't follow what's going on in class, so they zone out, fall behind, or misbehave. Often, they're labeled problem learners or misdiagnosed with a learning disability."

Between 5 and 10 percent of preschoolers and 25 percent of school-age children have a vision problem, says the American Optometric Association. Yet less than a third have their vision tested before they start school.

Teachers witness these problems every day. Aileen Umholtz, an elementary-school teacher in Easton, Pennsylvania, recalls a third-grader who never paid attention during lessons and was "totally lost" when he had to complete assignments on his own. "He thought he just wasn't smart, and he stopped trying." All that changed when he was finally fitted for glasses. "Suddenly, school was exciting. He started participating in class, he handed in homework on time -- in every way, he was a happier kid," she says.

What your doctor should look for By age 3 or 4, when your child can read an eye chart, he should be screened yearly for nearsightedness, farsightedness, astigmatism (the eyeball is not perfectly round, resulting in distorted vision), color blindness, and strabismus (eye misalignment). If he can't read yet, he may be shown shapes or pictures of animals.

When to speak up Does your child hold books and toys very close to his eyes, turn or tilt his head to one side, or cover one eye when reading? Does he sit unusually close to the TV or computer screen? Squint even though the light is not bright or complain of headaches? Ask for a referral to an ophthalmologist or an optometrist.

Could she have a hearing problem?

Hearing is vital to speech and language development but problems are often undetected or misinterpreted. They range from mild impairment to profound loss, and a child can suffer regardless of how serious the problem is. "If kids are only hearing every other word, they don't pick up on social cues and miss out on social interactions with their parents, friends, and the world at large," says Denise Roeder, a kindergarten teacher in New York City.

Two or three kids out of every 1,000 suffer from a severe hearing loss, according to the American Academy of Pediatrics. Congenital problems are usually identified before a baby leaves the hospital, but others can develop throughout childhood as a result of head injury, genetic factors, diseases such as measles, antibiotics taken for serious infections including meningitis, even exposure to very loud noise. Temporary hearing loss, which can last three or more months, can occur when repeated ear infections lead to fluid buildup.

What your doctor should look for The pediatrician will examine your child's ears for infection, but she should also have a yearly audiometric screening by age 3 (4 at the latest). During this test, your child will wear headphones and be asked to raise her hand to indicate in which ear she hears tones. If she fails the exam, ask for a referral to a pediatric audiologist or to a pediatric ear, nose, and throat specialist (ENT) for a more comprehensive evaluation.

When to speak up "One of the first signs of hearing loss is speech delay," says Dr. Gwynn. "Most children will say single words by 15 months and two-word sentences like 'Mama bye-bye' by age 2. By 3, strangers should be able to understand what she's saying." Other red flags: Does she seem to ignore you when you call her name, or blast the volume on the TV? Is it hard for her to understand others? Does she tell you her ear hurts or that she hears noises in her ears? A specialist can determine the extent of hearing loss and work with you and the school to develop an intervention plan.

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.

Could she have asthma?

Asthma is an inflammatory disease of the tiny airways in the lungs; it causes wheezing and coughing. It's the most common chronic disease of childhood and usually begins to develop before age 5. In 85 percent of children, asthma is triggered by one or more allergens. The other 15 percent of cases are typically aggravated by a virus, secondhand smoke, cold or dry air, or exercise. In either case, symptoms are the same, and they truly impact a child's performance. "Kids who are up all night coughing may be exhausted when they get to school, or too tired to even get there," says Jacqueline Eghrari-Sabet, M.D., a pediatric allergist in Gaithersburg, Maryland.

What your doctor should look for A good medical history offers several clues. Since the tendency to develop asthma runs in families, he should ask if anyone else has the disease or if your child had eczema when she was a baby (often a sign that asthma may develop later). He'll also ask about any possible triggers: Does your child cough or wheeze during exercise or when she laughs, cries, or has a cold? Do symptoms usually get worse around the same time every year? If the doctor suspects asthma, he may prescribe an anti-inflammatory and/or bronchodilator medications: one "controller" drug to take daily to keep attacks at bay and another "rescue" medication to be taken at the moment an attack begins.

When to speak up Not every child with asthma will wheeze. Some may have only a chronic nighttime cough or develop a bad one every time they get a cold or run around outside in cold weather. So if your physician doesn't take a complete history, this is the time to report past allergic reactions, recurrent bronchitis, or your child's complaints that her chest hurts or she's too tired to play with other kids. If previously prescribed medication isn't helping, say so -- and ask for a referral to an allergist.

• Learn more about managing asthma and allergies.

Give Every Child a Chance

Children's Health Fund's bright-blue mobile health clinics roll into more than 25 underserved communities around the country. Picture your doctor's office on wheels, complete with X-ray equipment, and offering medical screenings, checkups, and dental and mental-health care as well as treatment for acute and chronic diseases to youngsters who otherwise might rarely see a doctor. Join Children's Health Fund in helping make sure all kids are healthy and ready to learn this year. Visit childrenshealthfund.org to add your voice to the "Every Child a Chance" campaign and download a checkup checklist too. Your support will give Children's Health Fund a larger voice to advocate for children and bring health care to more kids who need it.

• Go to childrenshealthfund.org

One Checkup, a Lifetime of Benefits

Juan Robles was only 13 when he and his five siblings moved from Honduras to New York City's South Bronx. He knew no one. He spoke no English. But he had a soccer coach who took an interest in him and suggested that his mother take the family to the nearby health clinic run by Children's Health Fund. Over the years, Robles and his siblings visited the clinic for medical and dental checkups, eye tests, vaccinations, and everything else that a family needs to stay healthy. That's where he met Alan Shapiro, M.D., who heads both the clinic and the "big blue bus" that rolls through New York City, serving the 11,000 families who rarely see a doctor, let alone receive the top-notch personal health care that Children's Health Fund provides.

"Dr. Shapiro inspired me to study hard and to follow my dreams," says Robles, who went on to become a doctor himself and graduated from Albert Einstein College of Medicine in the Bronx. Dr. Robles is in his second year of a residency in community health care and, not surprisingly, he knows he wants to work for Children's Health Fund. "If I can touch the life of even one child, that would mean the world to me," he says.

Originally published in the September 2013 issue of Parents magazine.

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