Learning disorders: Know the signs, how to help

Many children who have learning disorders, also known as learning disabilities, struggle for a long time before being diagnosed. This can affect a child's self-esteem and motivation. Understand how to identify signs that might signal learning disorders and what you can do to help your child cope.

What are some common types of learning disorders?

A learning disorder is a disorder that affects a person's ability to acquire and use academic skills, such as reading and calculating. Learning disorders aren't the same as mental or physical disabilities, and don't reflect a child's intelligence. Instead, learning disorders affect a child's ability to complete a task or use certain skills, particularly in school.

The most common learning disorders include:

• Dyslexia. Dyslexia is a learning disorder characterized by difficulty reading, spelling and recalling known words.
• Dyscalculia. Dyscalculia is a learning disorder related to math concepts. Signs include difficulty solving even simple math problems or sequencing information or events.
• Nonverbal learning disability. This learning disorder is characterized by difficulty with nonverbal cues, such as coordination and body language.

Some children might have more than one learning disorder.

What causes learning disorders?

Factors that might influence the development of learning disorders include:

• Genetics. Some learning disorders, such as reading and math disorders, are hereditary.
• Medical conditions. Poor growth in the uterus (severe intrauterine growth restriction), exposure to alcohol or drugs before being born, and low birth weight are risk factors that have been linked with learning disorders. Head injuries might also play a role in the development of learning disorders.
• Environmental exposure. Exposure to high levels of lead has been linked to an increased risk of learning disorders.

What are the signs of learning disorders?

Identifying a learning disorder can be difficult. Your child might have a learning disorder if he or she:

• Experiences a delay in achieving a developmental milestone, while most other aspects of his or her development are normal
• Has difficulty understanding and following instructions
• Has trouble remembering what someone just told him or her
• Lacks coordination in walking, sports or skills such as holding a pencil
• Easily loses or misplaces homework, school books or other items
• Has difficulty understanding the concept of time
• Resists doing homework or activities that involve reading, writing or math, or consistently can't complete homework assignments without significant help
• Acts out or shows defiance, hostility or excessive emotional reactions at school or while doing academic activities, such as homework or reading

Seeking help for learning disorders

Early intervention is essential for a child who has a learning disorder. Learning disorders can snowball. For example, a child who doesn't learn to add in elementary school won't be able to tackle algebra in high school. Children who have learning disorders can experience performance anxiety, depression and low self-esteem — and lose motivation. Some children also might act out in an effort to distract attention from the real issue.

If you or your child's teacher thinks your child might have a learning disorder, consider having him or her evaluated by a child psychologist or neuropsychologist. Many schools also offer tests to identify learning disorders.

First, your child will likely undergo tests to rule out vision or hearing problems or other medical conditions. A psychologist or learning specialist will then use tests, as well as talk with you and your child and look at your child's school history, to determine if your child has a learning disorder. In many cases, further assessment is needed to make a diagnosis.

Keep in mind that some children are naturally slower learners and might need time to develop reading, writing and math skills. Others, however, have disorders that affect their ability to learn.

Treatment options

If your child has a learning disorder, your child's doctor or school might recommend:

• Extra help. A reading specialist, math tutor or other trained professional can teach your child techniques to improve his or her academic skills. Tutors can also teach children organizational and study skills.
• Individualized education program (IEP). Your child's school might develop an IEP for your child to create a plan for how he or she can best learn in school. Find out if your state has legislation regarding IEPs.
• Therapy. Depending on the learning disorder, some children might benefit from therapy. For example, speech therapy can help children who have language disabilities. Occupational therapy might help improve the motor skills of a child who has writing problems.
• Medication. Your child's doctor might recommend medication to lessen the toll of a learning disorder. If your child has depression or severe anxiety, certain medications might help. Talk to your child's doctor about the risks and benefits.
• Complementary and alternative medicine. Some research shows that complementary and alternative treatments, such as music therapy, can benefit children who have learning disorders. Further research is needed, however.

Before your child's treatment begins, you and your child's doctor, teachers or therapists will set goals for your child. If, over time, little progress is made, your child's diagnosis or treatment plans might need to be reconsidered.

While learning disorders can cause long-term problems, there's hope. Early intervention and treatment can fully remediate some learning disorders. Family and teachers can also help children who have persistent difficulties achieve success in school, as well as in other areas of life.

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Cold medicines for kids: What's the risk?

Over-the-counter cough and cold medicines are the best way to help a child who has a cold feel better — right? Think again. Cough and cold medicines aren't recommended for children younger than age 2, and the jury is still out on whether cough and cold medicines are appropriate for older kids. So how can you treat a child's cold? Here's practical advice from Jay L. Hoecker, M.D., an emeritus pediatrics specialist at Mayo Clinic, Rochester, Minn.

What's the concern about cough and cold medicines for kids?

Over-the-counter cough and cold medicines don't effectively treat the underlying cause of a child's cold, and won't cure a child's cold or make it go away any sooner. These medications also have potentially serious side effects, including rapid heart rate and convulsions. The Food and Drug Administration (FDA) discourages use of cough and cold medicines for children younger than age 2.

Are cough and cold medicines a problem for children older than age 2?

FDA experts are studying the safety of cough and cold medicines for children older than age 2. In the meantime, remember that cough and cold medicines won't make a cold go away any sooner — and side effects are still possible. If you give cough or cold medicines to an older child, carefully follow the label directions. Don't give your child two medicines with the same active ingredient, such as an antihistamine, decongestant or pain reliever. Too much of a single ingredient could lead to an accidental overdose.

What about antibiotics?

Antibiotics may be used to combat bacterial infections but have no effect on viruses, which cause colds. If your child has a cold, antibiotics won't help. It's also important to remember that the more your child uses antibiotics, the more likely he or she is to get sick with an antibiotic-resistant infection in the future.

Can any medications help treat the common cold?

An over-the-counter pain reliever — such as acetaminophen (Tylenol, others) or ibuprofen (Advil, Motrin, others) — can reduce a fever and ease the pain of a sore throat or headache. Remember, though, low-grade fevers help fight infection and don't necessarily need treatment.

If you give your child a pain reliever, follow the dosing guidelines carefully. Don't give ibuprofen to a child younger than age 6 months, and don't give aspirin to anyone age 18 or younger. Aspirin has been associated with Reye's syndrome, a rare but potentially fatal illness.

If you want to give your child an herbal or alternative remedy, consult your child's doctor first.

How can I help my child feel better?

There's no cure for the common cold, but you can help your child feel better while he or she is toughing it out. Consider these tips:

• Offer fluids. Liquids such as water, juice and broth can help loosen congestion. Chicken soup — which can have a mild anti-inflammatory effect — is another good choice.
• Encourage coughing. Coughing can help clear mucus from your child's airway.
• Use a suction bulb for a baby or young child. This device draws mucus out of the nose. Squeeze the bulb part of the syringe, gently place the tip inside one nostril and slowly release the bulb.
• Moisten nasal passages. Run a cool-mist humidifier in your child's room. To prevent mold growth, change the water daily and follow the manufacturer's cleaning instructions. Steam from a hot shower may help, too.
• Use saline nasal drops. Over-the-counter saline nasal drops — or saline spray, for an older child — can loosen thick nasal mucus and make it easier for your child to breathe. For babies, follow up with a suction bulb.
• Soothe a sore throat. Ice cream or frozen fruit pops might feel good on a sore throat. Warm or cold beverages sometimes help, too. For an older child, gargling salt water or sucking on a piece of hard candy or a throat lozenge might offer additional relief. Remember that hard candy and lozenges — both choking hazards — aren't appropriate for younger children.
• Encourage rest. Consider keeping your child home from child care, school and other activities.

When should I contact the doctor?

Most colds simply need to run their course — which generally takes about five to seven days. It's important to take your child's signs and symptoms seriously, however. If you suspect something isn't right, consult your child's doctor. It's especially important to seek medical attention if your child:

• Has a high or persistent fever — or is younger than age 3 months and has any fever
• Has trouble drinking
• Isn't urinating as often as usual
• Has trouble breathing
• Has a persistent cough
• Has yellow or green eye discharge
• Has thick, green nasal discharge
• Seems to have ear or sinus pain

What's the best way to prevent the common cold?

For parents and children alike, simple preventive measures can go a long way toward preventing the common cold. To help your child stay healthy:

• Keep it clean. Teach your child to wash his or her hands thoroughly and often. When soap and water aren't available, provide an alcohol-based hand sanitizer or hand wipes. Keep toys and common household surfaces clean, too.
• Cover up. Teach everyone in the household to cough or sneeze into a tissue — and then toss it. If you can't reach a tissue in time, cough or sneeze into the crook of your arm.
• Don't share. Avoid sharing utensils, drinking glasses, washcloths, towels and other items that might harbor germs with anyone who has a cold or fever.
• Steer clear of colds. Avoid close, prolonged contact with anyone who has a cold or other communicable infection.

It's also important for your child to eat a healthy diet, get plenty of sleep and stay current on his or her vaccinations — including a yearly flu vaccine.

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Iron deficiency in children: Prevention tips for parents

Why is iron important for children?

Iron is a nutrient that's essential to your child's growth and development. Iron helps move oxygen from the lungs to the rest of the body and helps muscles store and use oxygen. If your child's diet lacks iron, he or she may develop a condition called iron deficiency. Iron deficiency in children can occur at many levels, from depleted iron stores to anemia — a condition in which blood lacks adequate healthy red blood cells. Red blood cells carry oxygen to the body's tissues, providing energy and giving skin a healthy color. Untreated iron deficiency in children can cause physical and mental delays in areas such as walking and talking.

How much iron do children need?

Babies are born with iron stored in their bodies, but a steady amount of additional iron is needed to fuel a child's growth and development. Here's a guide to iron needs at certain ages:

Age group	Recommended amount of iron a day
7 to 12 months	11 milligrams
1 to 3 years	7 milligrams
4 to 8 years	10 milligrams
9 to 13 years	8 milligrams
14 to 18 years, girls	15 milligrams
14 to 18 years, boys	11 milligrams

What are the risk factors for iron deficiency in children?

Infants and children at highest risk of iron deficiency include:

• Babies who are born prematurely — more than three weeks before their due date — or have a low birth weight
• Babies who drink cow's milk before age 1
• Breast-fed babies who aren't given complementary foods containing iron after age 6 months
• Babies who drink formula that isn't fortified with iron
• Children ages 1 to 5 who drink more than 24 ounces (710 milliliters) of cow's milk, goat's milk or soy milk a day
• Children who have certain health conditions, such as chronic infections or restricted diets

Adolescent girls also are at higher risk of iron deficiency because their bodies lose iron during menstruation.

What are the signs and symptoms of iron deficiency in children?

Too little iron can impair your child's ability to function. However, most signs and symptoms of iron deficiency in children don't appear until iron deficiency anemia occurs. Signs and symptoms of iron deficiency anemia include:

• Fatigue or weakness
• Pale skin
• Poor appetite
• Shortness of breath
• Irritability
• Inflammation of the tongue
• Difficulty maintaining body temperature
• Increased likelihood of infections
• Irregular heartbeat
• Behavioral problems
• Unusual cravings for non-nutritive substances, such as ice, dirt or pure starch

How can iron deficiency in children be prevented?

Take steps to prevent iron deficiency in your child by paying attention to his or her diet. For example:

• Breast-feed or use iron-fortified formula. Breast-feeding until your child is age 1 is recommended. Iron from breast milk is more easily absorbed than is the iron found in formula. If breast-feeding isn't possible, use iron-fortified infant formula. Cow's milk isn't a good source of iron for babies and isn't recommended for children younger than age 1.
• Encourage a balanced diet. When you begin serving your baby solids — typically between ages 4 months and 6 months — feed him or her foods with added iron, such as single-grain, iron-fortified baby cereal. For older children, good sources of iron include egg yolks, red meat, chicken, fish, beans and dark green leafy vegetables. Limit foods that are high in calories and low in vitamins and minerals, such as soda and potato chips.
• Enhance absorption. Vitamin C helps promote the absorption of dietary iron. Although citrus juice isn't generally recommended for children younger than age 1, you can help your child absorb iron by offering other foods rich in vitamin C — such as melon, strawberries, apricots, kiwi, broccoli, tomatoes and potatoes.
• Consider iron supplements. If your baby was born prematurely or with a low birth weight or you're breast-feeding after age 6 months and your baby isn't eating two or more servings a day of iron-rich foods, such as fortified cereal or pureed meat, talk to your child's doctor about oral iron supplements.

Should I have my child screened for iron deficiency?

Iron deficiency and iron deficiency anemia are typically diagnosed through blood tests. Some experts recommend that all infants be screened for iron deficiency anemia starting between ages 9 months and 12 months and again 6 months later. Others recommend screening only infants ages 6 months to 12 months who have an increased risk of developing iron deficiency anemia. Ask your child's doctor about his or her screening recommendations, especially if you're concerned about iron deficiency. Be prepared to provide details about your child's diet. Depending on the circumstances and possible screening results, the doctor might recommend an oral iron supplement or a daily multivitamin.

Iron deficiency in children can be prevented. To keep your child's growth and development on track, pay attention to how much iron your child is getting through his or her diet and talk to your child's doctor about the need for screenings and iron supplements.

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Healthy snacks for kids: 10 child-friendly tips

Snacking is a major pastime for many kids — and that's not necessarily bad. Nutritious snacking can help your child curb hunger throughout the day, as well as provide energy and important nutrients. Find out how to make healthy snacks for kids.

No. 1: Keep junk food out of the house

Your child won't clamor for cookies, candy bars or chips if you don't keep them on hand. Set a good example by choosing healthy snacks yourself.

No. 2: Go for the grain

Whole-grain foods — such as whole-grain pretzels or tortillas and high-fiber, whole-grain cereals — provide energy with some staying power.

No. 3: Mix and match

Serve baby carrots or other raw veggies with fat-free ranch dressing or hummus. Dip graham cracker sticks or fresh fruit in fat-free yogurt. Spread peanut butter on celery, apples or bananas.

No. 4: Broaden the menu

Offer out-of-the-usual fare, such as pineapple, cranberries, red or yellow peppers, mangoes, tangelos or roasted soy nuts.

No. 5: Revisit breakfast

Serve breakfast foods — such as scrambled eggs and whole-grain toast — as healthy snacks for kids in the afternoon.

No. 6: Sweeten it up

Healthy snacks for kids don't have to be bland. To satisfy your child's sweet tooth, offer fat-free pudding, frozen yogurt or frozen fruit bars. Make smoothies with skim milk, fat-free yogurt, and fresh or frozen fruit.

No. 7: Have fun

Use a cookie cutter to make shapes out of low-fat cheese slices, whole-grain bread or whole-grain tortillas. Make fruit kebabs or show your child how to eat diced fruit with chopsticks. Make a tower out of whole-grain crackers, spell words with pretzel sticks, or make funny faces on a plate using different types of fruit.

No. 8: Promote independence

Keep a selection of ready-to-eat veggies in the refrigerator. Leave fresh fruit in a bowl on the counter. Store low-sugar, whole-grain cereal and fruit canned or packaged in its own juice in an easily accessible cabinet.

No. 9: Don't be fooled by labeling gimmicks

Foods marketed as low-fat or fat-free can still be high in calories and sodium. Likewise, foods touted as cholesterol-free can still be high in fat, saturated fat and sugar. Check nutrition labels to find out the whole story.

No. 10: Designate a snacking zone

Restrict snacking to certain areas, such as the kitchen. You'll save your child countless calories from mindless munching in front of the TV. If your child needs to snack on the go, offer string cheese, yogurt sticks, cereal bars, a banana or other drip-free items.

Teaching your child to make healthy snack choices now will help set the stage for a lifetime of healthy eating. Start today!

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Children's nutrition: 10 tips for picky eaters

No. 1: Respect your child's appetite — or lack of one

If your child isn't hungry, don't force a meal or snack. Likewise, don't bribe or force your child to eat certain foods or clean his or her plate. This might only ignite — or reinforce — a power struggle over food. In addition, your child might come to associate mealtime with anxiety and frustration. Serve small portions to avoid overwhelming your child and give him or her the opportunity to independently ask for more.

No. 2: Stick to the routine

Serve meals and snacks at about the same times every day. Provide juice or milk with the food, and offer water between meals and snacks. Allowing your child to fill up on juice or milk throughout the day might decrease his or her appetite for meals.

No. 3: Be patient with new foods

Young children often touch or smell new foods, and may even put tiny bits in their mouths and then take them back out again. Your child might need repeated exposure to a new food before he or she takes the first bite. Encourage your child by talking about a food's color, shape, aroma and texture — not whether it tastes good. Serve new foods along with your child's favorite foods.

No. 4: Make it fun

Serve broccoli and other veggies with a favorite dip or sauce. Cut foods into various shapes with cookie cutters. Offer breakfast foods for dinner. Serve a variety of brightly colored foods.

No. 5: Recruit your child's help

At the grocery store, ask your child to help you select fruits, vegetables and other healthy foods. Don't buy anything that you don't want your child to eat. At home, encourage your child to help you rinse veggies, stir batter or set the table.

No. 6: Set a good example

If you eat a variety of healthy foods, your child is more likely to follow suit.

No. 7: Be creative

Add chopped broccoli or green peppers to spaghetti sauce, top cereal with fruit slices, or mix grated zucchini and carrots into casseroles and soups.

No. 8: Minimize distractions

Turn off the television and other electronic gadgets during meals. This will help your child focus on eating. Keep in mind that television advertising might also encourage your child to desire sugary foods.

No. 9: Don't offer dessert as a reward

Withholding dessert sends the message that dessert is the best food, which might only increase your child's desire for sweets. You might select one or two nights a week as dessert nights, and skip dessert the rest of the week — or redefine dessert as fruit, yogurt or other healthy choices.

No. 10: Don't be a short-order cook

Preparing a separate meal for your child after he or she rejects the original meal might promote picky eating. Encourage your child to stay at the table for the designated mealtime — even if he or she doesn't eat. Keep serving your child healthy choices until they become familiar and preferred.

If you're concerned that picky eating is compromising your child's growth and development, consult your child's doctor. In addition, consider recording the types and amounts of food your child eats for three days. The big picture might help ease your worries. A food log can also help your child's doctor determine any problems. In the meantime, remember that your child's eating habits won't likely change overnight — but the small steps you take each day can help promote a lifetime of healthy eating.

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Tricks To Make Your Kid Eat..

End the Power Struggle

"Picky habits start when children test their limits, around age 2," Shu says. "Parents don't like rejection. They hear 'no' once or twice, they don't go back to that food."

But many preschoolers need to be offered new foods several times before they taste them. Serving a new food among five or six familiar choices can take the pressure off, says Boston pediatric nutritionist Linda Piette, RD, author of Just Two More Bites!

Trouble Eating

Some kids may still be mastering how to chew and swallow. Some may be inexperienced chewers.

"Many prefer meltable, crunchy carbohydrates because they're easy to eat and have a single texture," says pediatric psychologist Kay Toomey, PhD, of Greenwood Village, Colo.

Show your child what to do. "Banging a carrot on the table and talking about how hard it is teaches that the teeth will need to use pressure to break it apart," Toomey says, "versus yogurt, which is wet and smooth and can be just sucked down."

Not Hungry

Your child might be full from eating too many beverages or snacks.

"Kids carry around portable snack containers and boxes of juice, then they're not hungry for anything later," Shu says. 

Her advice: Serve fewer, healthier snacks. "If the child didn't finish lunch, give those leftover peas or carrots for a snack instead of pretzels or cookies."

An Emotional Reaction

If people are arguing at the table, your child may just want to get out of there. 

"Kids may try to make mealtime shorter," Shu says. "Alternately, they may try to get more attention by not eating, if they think enough attention isn't coming their way."

Rethink Your Meal Strategies

Between meals, analyze clues that may cause your child's pickiness.

Is the TV on? Adults tend to overeat when they're watching TV, but that's not true for picky children. Research shows that kids who watch television during meals can become overstimulated, making it harder for them to try new foods.

Is the whole family eating together? Children may be more likely to relax and try new flavors if everyone else is enjoying the same meal. "It makes a world of difference for our family," says Elizabeth Johnson Willard of St. Johnsbury, Vt., whose children shunned most meats, fruits, and vegetables when they were very young. "Seeing us try new foods helps encourage our children to do the same."

A child who eats alone may also sense your anxiety about their pickiness. "The parent hovers over every bite the child takes, which doesn't help," Piette says.

Are you setting a good example? Taste at least a little bit of everything that's served, and show a good attitude about it. "Kids are smart," Piette says. "They can tell by the look on your face."

Re-Do Dinner

When you introduce new foods, an offbeat tactic may help:

Let them eat cake . Don't offer dessert as a reward for eating vegetables. That sends the wrong message. If dessert is on the menu, consider serving it with the meal, instead of at the end.

Emphasize style. Entice a picky eater to try a fruit salad by arranging it into a smiley face. Christen Cooper of Pleasantville, N.Y., realized that her then-3-year-old daughter would try almost anything served on her princess tea set.  

Show interest in their interests. Did your son's favorite character eat carrots and string beans? Offer the same foods. This trick worked for Leigh Steere of Boulder, Colo., whose son tried new foods when the recipes came from a Star Wars cookbook.

Encourage food play. Little fingers poking at dinner can help kids get used to food textures, which are sometimes bigger stumbling blocks than flavors for picky eaters. "Parents should be tolerant of the messiness," Piette says. "It does help. It's a sensory thing."

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The Basics of Anaphylaxis

What Is Anaphylaxis?

Anaphylaxis is a sudden, severe allergic reaction. It's a medical emergency.

Most people with allergies never experience anaphylaxis. But when it happens, it works like this:

Within minutes or hours of being exposed to your allergy trigger, your body starts a chain reaction that temporarily widens your blood vessels, which can lower your blood pressure. You may pass out. You may get hives and swelling, especially around your face and throat. You may have trouble breathing, talking, or swallowing.

What Causes Anaphylaxis?

The most common causes of anaphylaxis are:

• Foods, including peanuts and tree nuts (particularly almond, walnut, hazelnut, Brazil, and cashew nuts)
• Shellfish, especially shrimp and lobster
• Dairy products
• Eggs
• Insect stings, such as those from wasps, bees, ants
• Latex
• Medications

In some cases, anaphylaxis can also be caused by exercise, usually after eating certain foods that trigger your allergy.

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7 Ways to Protect Your Child's Oral Health

When the toddler came to her office, 4 of his 16 teeth were so decayed, they required dental crowns.

Although this case may sound shocking, it's not rare, says Beverly Largent, DMD, the Paducah, Ky., dentist who cared for the child. She tells parents it's crucial to care for baby teeth. "You need to brush from the first tooth," says Largent, past president of the American Academy of Pediatric Dentistry. 

In fact, tooth decay -- although largely preventable with good care -- is one of the most common chronic diseases of children ages 6 to 11 and teens ages 12 to 19. Tooth decay is five times more common than asthma and seven times more common than hay fever in children, according to the American Academy of Pediatrics. By kindergarten age, more than 40% of kids have tooth decay.

Neglecting baby teeth is not the only misstep parents can make when it comes to their child's early oral health.

Here's your 7-step game plan.

Start Oral Care Early

Your child should see a dentist by the time he or she is a year old, according to the American Academy of Pediatrics and the American Academy of Pediatric Dentistry.

Getting preventive care early saves money in the long run, according to a report published by the CDC. The report found that costs for dental care were nearly 40% lower over a five-year period for children who got dental care by age one compared to those who didn't go to the dentist until later.

Teach the Brush & Floss Habit

Dental visits are just part of the plan, of course. Tooth brushing is also crucial from the start.  "A lot of people think they don't have to brush baby teeth," Largent says. If your baby has even one tooth, it's time to start tooth brushing. "If there's just one tooth, you can use gauze."

Even before your baby has teeth, you can gently brush the gums, using water on a soft baby toothbrush, or clean them with a soft washcloth.

Once there are additional teeth, Largent tells parents to buy infant toothbrushes that are very soft. Brushing should be done twice daily using a fluoridated toothpaste.  

Flossing should begin when two teeth touch each other. Ask your dentist to show you the right flossing techniques and schedules, Largent says.

Also ask for your dentist's advice on when to start using mouthwash. "I advise parents to wait until the child can definitely spit the mouthwash out," says Mary Hayes, DDS, a pediatric dentist in Chicago and consumer advisor for the American Dental Association. "Mouthwash is a rinse and not a beverage."

So how long until Junior can be responsible for brushing his own teeth? "[Parents] have to clean the teeth until children are able to tie their shoes or write in cursive," says Largent.

During dental visits, ask your dentist if your child's teeth need fluoride protection or a dental sealant.

And remember, the most important time to brush and floss is just before bedtime. No food or drink, except water, should be permitted until the next morning. This allows clean teeth to re-mineralize during the night, from the minerals in the saliva and toothpaste.     

Avoid "Baby Bottle Decay"

For years, pediatricians and dentists have been cautioning parents not to put an infant or older child down for a nap with a bottle of juice, formula, or milk.

Even so, says Largent, many parents don't realize this can wreak havoc with their child's oral health.

The sugary liquids in the bottle cling to baby's teeth, providing food for bacteria that live in the mouth. The bacteria produce acids that can trigger tooth decay. Left unchecked, dental disease can adversely affect a child's growth and learning, and can even affect speech.

If you must give your child a bottle to take to bed, make sure it contains only water, according to American Academy of Pediatrics guidelines.

Control the Sippy Cup Habit

Bottles taken to bed aren't the only beverage problem, says Hayes. The other? "Juice given during the day as a substitute for water and milk," Hayes says.

Often, that juice is in a sippy cup. It's meant as a transition cup when a child is being weaned from a bottle and learning to use a regular cup.

Parents mistakenly think juice is a healthy day-long choice for a beverage, say Hayes and Largent. But that's not the case.

Largent says she often sees children walking around all day drinking juices and other sugary beverages from a sippy cup, and that's hazardous to dental health. "Prolonged use of a sippy cup can cause decay on the back of the front teeth," if the beverages are sugary, she says.

Juice consumption has been linked to childhood obesity and the development of tooth decay, according to the American Academy of Pediatrics. In its current policy statement on preventive oral health, the organization advises parents to limit the intake of 100% fruit juice to no more than four ounces a day. Sugary drinks and foods should be limited to mealtimes.

"Pediatricians I know are telling parents to use juice as a treat," Hayes says.

Ditch the Binky by 2 or 3

Pacifiers used in the first year of life may actually help prevent sudden infant death syndrome, according to the American Academy of Pediatrics. They suggest using a pacifier when placing the infant to sleep but not to reinsert once baby has drifted off. Long-term use can be hazardous to dental health. Sucking too strongly on a pacifier, for instance, can affect how the top and bottom teeth line up (the "bite") or can affect the shape of the mouth.

Largent tells parents of her young patients: "Pacifiers are for infants, not for toddlers walking around with them in their mouths." She discourages long-term use of even the "orthodontically correct" pacifiers.

Largent says she prefers that pacifiers be dropped by age 2. The American Academy of Pediatrics suggests getting a professional evaluation if the pacifier habit continues beyond age 3.

Beware of Mouth-Unfriendly Medicines

Many medications that children take are flavored and sugary, says Hayes. If they stick on the teeth, the risk for tooth decay goes up.

Children on medications for chronic conditions such as asthma and heart problems often have a higher decay rate, she finds.

Antibiotics and some asthma medications can cause an overgrowth of candida (yeast), which can lead to a fungal infection called oral thrush. Suspect thrush if you see creamy, curd-like patches on the tongue or inside the mouth.

"If your child is on chronic medications, ask your child's dentist how often you should brush," Hayes says. You may be advised to help your child brush as often as four times a day.

Stand Firm on Oral Hygiene

Parents often tell Hayes that their children put up a fuss when it comes time to brush, floss, and rinse, so parents relent and don’t keep up with oral care at home as they should.

Hayes strongly advises these parents to let their children know they don't have a choice about taking care of their teeth and gums.

"It has to be done," Hayes says. But she understands that children can get cranky and difficult. She suggests these tips to coax reluctant brushers and flossers to get the job done -- or if they are too young, to allow their parents to help them do it.

• Plan to help your children longer than you may think necessary. "Children don't have the fine motor skills to brush their own teeth until about age 6," says Hayes. Flossing skills don't get good until later, probably age 10.
• Schedule the brushing and flossing and rinsing, if advised, at times when your child is not overly tired. You may get more cooperation from a child who isn't fatigued.
• Get your child involved in a way that's age-appropriate. For instance, you might let a child who is age 5 or older pick his own toothpaste at the store, from options you approve. You could buy two or three different kinds of toothpaste and let the child choose which one to use each time. You may offer him a choice of toothbrushes, including kid-friendly ones that are brightly colored or decorated.
• Figure out what motivates your child. A younger child may gladly brush for a sticker, for instance, or gold stars on a chart.

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Energy Drinks' Health Hazards For Adolescents

Many energy drinks have ingredients which can have a harmful effect on adolescent health, especially when mixed with alcohol, says a news report published in Pediatrics in Review.

The article - "Energy Drinks: What Teenagers (and Their Doctors) Should Know," - summarizes recent evidence regarding the content, benefits and risks of energy drinks which are consumed by teenagers.

Energy drinks are beverages with caffeine added to them. They are advertised as a means to enhance performance, boost the immune system, or create a "buzz".

The most popular energy drinks contain elevated, unregulated quantities of caffeine and other stimulants which give the caffeine an extra kick.

Caffeine is known to produce detrimental health effects in adolescents, including dehydration, digestive problems, obesity, anxiety, insomnia, and tachycardia.

Some energy drinks contain alcohol. Sometimes, people mix them with alcoholic drinks.

When energy drinks are mixed with alcohol, the potential dangers for adolescent health are much greater; there is also a risk of abuse.

The authors advise health care professionals to ask their adolescent patients whether they consume energy drinks. They should explain what the dangers of consuming both energy drinks alone or with alcohol are. Doctors should become aware of the signs and symptoms of energy drink consumption.

The authors say that teenagers are no strangers to energy drinks. Over the last 24 months, the media has heightened the awareness of doctors, lawmakers and parents.


About 66% of energy drink consumers are aged between 13 and 35.

Lead author Dr. Kwabena Blankson, a U.S. Air Force major and an adolescent medicine specialist at the Naval Medical Center in Portsmouth, Virginia, said regarding energy drinks:

"They contain too much caffeine and other additives that we don't know enough about. Healthy eating, exercise and adequate sleep are better ways to get energy."

In 2010, nine students at Washington State University were admitted to the hospital. Doctors attributed their illness to fruit-flavored caffeinated alcoholic drinks. One of the students nearly died. Twenty-three students were hospitalized one month later in New Jersey after drinking the same combination as the Washington students.

Energy drinks mask the effects of consuming alcohol

When we mix energy drinks with alcohol, the "cocktail" can make us feel less drunk than we actually are. Many adolescents are not aware of this, the researchers explained. Consuming just one energy drink with alcohol may be equivalent to drinking a whole bottle of wine and several cups of coffee.

The average cup of coffee has approximately 100 milligrams of caffeine, compared to 160 milligrams in a 16-ounce energy drink.

According to Dr. Blankson, teenagers should consume a maximum of 100 milligrams of coffee per day. Other ingredients found in energy drinks increase caffeine's potency, such as guarana and ginseng.

According to a US government report issued in January 2013, twice as many people visited hospital emergency rooms because of energy drink consumption in 2011 compared to 2007. The majority of hospital visits were by teenagers and young adults, said the SAMHSA (Substance Abuse and Mental Health Services Administration) report.

Approximately 42% of emergency room cases in 2011 involved energy drinks mixed with either alcohol or medications, such as Ritalin or Adderall.

Believe it or not, the human body knows when and how much alcohol it is drinking and emits cues when the person should stop for the evening and get some rest. Some people try to overcome these cues by mixing energy drinks with alcohol.

A study carried out by Cecile Marczinski, a psychologist at Northern Kentucky University, found that combining energy drinks with alcohol removes our built-in checks that stop us from overindulging.

Marczinski said:

"Even with just alcohol alone, young, underage drinkers are bad at deciding how safe a driver they are, but I think this (mixing alcohol with energy drinks) would make that situation far worse."

Nine years ago, the French government banned the sale of Red Bull, a popular energy drink. The French Scientific Committee on Human Nutrition found that Red Bull had too much caffeine, it also raised concerns about the beverage's other ingredients, taurine, an amino acid which Red Bull promoters say can "kick-start" the metabolism, and glucuronolactone, acarbohydrate.

After an appeal, Europe's highest court upheld the French Red Bull ban.

In this latest report, the authors say that the readers should be able to:

• Understand how large the energy drink market is, as well as recognize the most common brands


• Realize that teenagers are great consumers of energy drinks, which they use as performance enhancers


• Know what the ingredients of energy drinks are, and how they may impact negatively on health


• Understand that energy drinks can cause obesity, high blood pressure, tachycardia and other medical problems in teenagers


• Understand how dangerous it is to mix energy drinks with alcohol


• Understand the relationship between alcohol tolerance/dependence and caffeine tolerance/dependence


• Understand how important it is to screen adolescents for energy drink consumption, and offer suitable counseling.

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