ask the expert

the middle years

Quick Links:

Q: My son, who is now in 1st grade, has an adorable way of saying his “R’s” as almost a “W” sound (such as “wabbit” for “rabbit” and “owange” for “orange”). But as he gets older, I worry about him being afraid to speak up in class or being teased by peers. Will he just outgrow it? Should I correct him? I don’t want to give him a complex. What should I do to help?

Q: It’s the season of giving and I want to teach my 10-year-old about the value of giving back. But I don’t want to drag him to a soup kitchen. Any suggestions for easy and fun things he can do that will help him see how good it feels to do something for others?

Q: I suspect that my 5-year-old son may have learning disabilities, and I’m feeling overwhelmed. What is your advice on what a parent’s first steps should be?

Q: Our 6-year-old shows no interest in sports; she would rather read, draw or play. But I do want her to have a positive experience with sports and physical activity. Do I risk turning her off to sports and activity if I “force her” to do them? Any tips?

My son, who is now in 1st grade, has an adorable way of saying his “R’s” as almost a “W” sound (such as “wabbit” for “rabbit” and “owange” for “orange”). But as he gets older, I worry about him being afraid to speak up in class or being teased by peers. Will he just outgrow it? Should I correct him? I don’t want to give him a complex. What should I do to help?

It can be worrisome for a parent to see his or her child struggle with speech sounds. What was once an adorable trait can later turn into a lingering concern regarding the need for professional help. The “r” sound, or /r/, is one of the last speech sounds to develop for most children. In my experience, this occurs for two main reasons: First, your child can’t watch the way your tongue moves to produce an /r/ since it is made in the back of the mouth. This makes it more difficult than producing something like a “b” sound, which has lip movements that are easy to imitate. Second, more tongue control is required to produce an /r/ accurately, and children develop this control at a later age. Because /r/ is a later-developing sound, we don’t start to look for it in speech until around 3 to 4 years of age, and it may not be fully mastered until up to 7 to 8 years of age. However, if your child is 5 or more years old and still isn’t using /r/ in most words correctly, it is unlikely that this sound will develop without some direct instruction. Work with your child at home, focusing on how your jaw and lips are placed to make an accurate /r/. If your child’s /r/ does not seem to improve, it may be time to visit a speech-language pathologist. You can ask to be included in the therapy sessions, and the speech-language pathologist will provide you with strategies and practice you can then use at home. Once your child knows how to make a clear /r/, you can help him work on becoming more aware of this new sound. Practice 5-10 minutes a day with him, emphasize your own /r/ sound in words he says incorrectly, and give him a chance to imitate you (for example, “I’m confused. Did you mean ‘wabbit’ or ‘rabbit’?”). My clients love to correct me when I “accidentally” use incorrect /r/ sounds during therapy in order to increase their awareness of the sound. Games are a great way to engage children in practice without speech work feeling like a chore; try working on good /r/ sounds during a board game or by having a contest to see who can find the most items around the house that have an /r/ sound.

Melissa Reitz, M.A., CCC-SLP, is a speech-language pathologist at All for Kids Pediatric Therapy in Anchorage, and has been practicing for two years. For info, visit allforkidsalaska.com.

It’s the season of giving and I want to teach my 10-year-old about the value of giving back. But I don’t want to drag him to a soup kitchen. Any suggestions for easy and fun things he can do that will help him see how good it feels to do something for others?

Thanksgiving and Christmas are right around the corner, and it is a great time to start engaging children in the act of giving back. Some great ways to involve your son in the true spirit of the holidays are:

Donate money. When individuals are ringing the Salvation Army’s bell or collecting funds to purchase turkeys, have your child take a dollar from their own money and donate it. It is more powerful when the child uses their own money versus their parents’. Volunteer to work a kettle and your son can ring the bell for hours.

Toys-for-Tots. One of the fun activities that all kids do to get ready for Christmas is write their letter to Santa letting him know what toys they want this year. Before the letter is mailed off, have your child select a gift from that list they want to go to a child in need. Then go out with your child to select the toy and deliver it to a toy collection site.

Adopt-a-Family. Many organizations have a list of families who cannot afford a holiday meal. Have your son help with developing the menu, shopping for the items, contributing some of the money and – the fun part – helping deliver the package.

Distribute food. Local churches and organizations host events where they distribute food for the holidays. This is a great time to contribute food to the event and volunteer at the event.

Be a good neighbor. Bake cookies as a family and deliver them to neighbors, especially the elderly. Shovel a neighbor’s snowy driveway.

Trevor Storrs is the Executive Director of Alaska Children’s Trust. For info, visit alaskachildrenstrust.org.

I suspect that my 5-year-old son may have learning disabilities, and I’m feeling overwhelmed. What is your advice on what a parent’s first steps should be?

Great question! Learning disabilities (LDs) are fairly common in children, with about 15 percent of children in the US having a diagnosed LD (healthychildren.org). Children with LDs are capable of learning and even excelling in academics with the right diagnosis and supportive services. If your child is in preschool or kindergarten, the first step would be to discuss your concerns with their teacher. Your child’s teacher should be able to help you determine your child’s strengths and pinpoint the areas of learning that are most challenging for your child. If your child is enrolled in your local school district, you and your child’s teacher can request that your child be tested for LDs through the school district. After speaking to your child’s teacher, your next step would be to speak to your child’s pediatric medical provider. If you haven’t established care with a medical provider, I would recommend looking for a pediatric provider who is a part of a group that qualifies as a Patient Centered Medical Home (PCMH). In a PCMH, your child will benefit from care coordination which will make it easier for you to access any community services that your child might need such as speech therapy or additional academic testing. Your child’s pediatric medical provider will evaluate your child for symptoms that can have an effect on learning such as hearing, vision and attention problems. If none of these issues are thought to be the cause of the learning difficulties, your child’s provider will likely refer you to another professional who can administer testing that will rule out specific learning disabilities such as a reading, writing and math disorders. Typically, your child’s medical provider or the professional who administers the academic testing (usually a psychologist, neuropsychologist or developmental pediatrician) will give you a letter or a full report that includes specific recommendations about how to help your child to be successful in school. Give a copy of the report to your child’s teacher to move forward with the recommendations. Finally, your last step is to regularly praise your child for their strengths and continue to be a loving, nurturing and supportive parent. After completing these steps, give yourself a big ol’ pat on the back for being a tuned-in, supportive and loving parent! You deserve it!

Jessica Adams is a Licensed Clinical Social Worker who works as a Behavioral Health Provider at Alaska Center for Pediatrics. For more information, visit akpeds.com.

Our 6-year-old shows no interest in sports; she would rather read, draw or play. But I do want her to have a positive experience with sports and physical activity. Do I risk turning her off to sports and activity if I “force her” to do them? Any tips?

I would say let her read, draw and play! Sports can have a positive place in a child’s life but so can play. There are many ways to be active and it doesn’t have to be through “traditional sports.” Activities like hiking, biking or just being outside can be just as beneficial if not more so than traditional sports like basketball or soccer. The benefits reach far beyond just the physical. Specifically, I am talking about nature-based play. We can all remember the focus, creativity and freedom that playing in nature brought to our lives and that is what we want for our kids. You don’t need to have special equipment to use nature; it doesn’t take a coach to learn how to organize it and it doesn’t cost money if you don’t want it to. You can be 200 miles from the road in the Brooks Range or in your own backyard, nature works. It’s important to remember that even in our world of structure, rules and guidelines, free unrestricted play is crucial to the development of our children. As a parent myself, I do feel pressure to have my kids in activities. There is no perfect formula for raising kids but I do know they need play. My goal as a parent is to try to strike a balance between structure and play. In the words of Robert Frost, “When I see birches bend to left and right … I like to think some boy’s been swinging them.”

Sam Braband is the Outdoor Recreation Manager for the University of Alaska Fairbanks. His favorite activities include family adventures with his wife and three kids, climbing, skiing, and dragon hunting in the backyard. uaf.edu/draw

My 6-year-old daughter often has nightmares. She gets very upset and then comes into our bed for comfort. What might be causing these nightmares and what is the best way to help her cope?

Nightmares are common with young children. It is important to listen to and reassure your child. Try to return your daughter to her bedroom; encourage her to stay in her bed, and help her feel safe in her space. Because of the frequent disruptions to your own sleep, you may be tempted to allow her to just stay in your bed until morning, but if the layout of your home allows, it is better to arrange your bedrooms in a way where you will be able to hear her and you are easily accessible to her. A nightlight and/or a security object like a special blanket or doll can be helpful in calming fears.

With nightmares being a normal part of development, it may be difficult for a parent to differentiate between an unpleasant dream versus night terrors which is an actual sleep disorder. In general, when a child wakes from a nightmare, they tend to be fairly easy to console; however, when a child wakes from a night terror it is often with a blood-curdling scream, and they are confused, agitated and difficult to calm for several minutes. Nightmares and night terrors can be just as scary for you as they are for your child, but don’t fret – there are treatments available and most children outgrow it by puberty.

If you suspect that your child may be having night terrors, you should follow up with your pediatrician who can refer you to a sleep specialist and/or sleep clinic.

A.J. Vedrode, RPSGT, RST is a mother of five living in Fairbanks and Anchorage. She is the Technical Director at Alaska Sleep Clinic and has been working in sleep medicine for 15+ years. alaskasleep.com

My 8-year-old daughter loves to perform on the piano, but is always unnerved prior to a performance. How can I help her overcome her fear?

For most students like your daughter, nervousness can be greatly reduced by incorporating “recital rehearsals” into their home practice. These mini recitals in front of a relaxed, positive family audience can mentally prepare your daughter for a fun and successful performance. Once a recital piece has been learned and polished, have her play for you as you review these four parts of a recital:

Part 1 Announce her name and have her walk slowly to the piano.

Part 2 Have her take her position to perform. (For a pianist that means placing the piano bench in the correct position and placing her hands in position to begin.)

Part 3 She should take two deep breaths, to relax, before she starts. Your daughter needs to be aware that if her heart is beating fast, she will probably end up performing her piece much faster than planned.

Part 4 Once she has finished her piece, take a breath, stand up and face the audience. Once she has given the audience a chance to applaud, she should take a big “Thank You” bow before slowly walking back to her chair.

If you rehearse the recital this way at home you will give your daughter a routine she can use that will calm her nerves and build up her confidence. I tell my students that a recital is like a musical “show and tell.” Everyone wants a chance to share their favorite song. Having fun performing at home will allow your daughter to really enjoy the whole performance process without the pre-show anxiety.

Vince Spezialy has taught private music lessons in Anchorage for over 30 years and is the owner of the Anchorage Music and Dance Center. For information, visit anchoragemusicanddance.com

My 9-year-old wants to switch from glasses to contacts. Some of her classmates have them and she doesn’t want to be left out. Are contact lenses a good choice for kids this age? How do we know if she’s a good candidate?

The most important factors in the decision to fit your 9-year-old daughter with contact lenses are sufficient motivation of your child, the ability of your child to accept responsibility, and parental support in the fitting process. I have seen 9-year-olds that are totally ready for the contact lens fitting process, and I have seen older teens that lack responsibility and should not be fit.

It is helpful if your child enjoys an activity that is enhanced by wearing contact lenses. Sports, music, theater and outdoor activities including hunting and fishing may apply. The desire to avoid glasses may not be enough to motivate sufficiently for a successful fit.

Eye infections are a risk of wearing contacts, and children need to practice preventative eye care habits. Good hygiene, involving hand washing and use of proper solution is critical. She also must accept the wearing time limit imposed by the doctor. It is strongly recommended not to sleep in contacts. Soft lenses need to be disposed of at the appropriate time.

Even though contact lenses can correct most vision problems in children, it is necessary that a suitable lens design exists for her. The goals of wearing contacts are clear vision with good physical comfort. The fitting process will allow us to find a lens design to reach those goals.

Finally, there are two main types of contact lenses: soft lenses and gas permeable lenses. Today, the majority of new contact lens fits are soft lenses, but gas permeable lenses should also be considered. They may offer better vision, and while initial comfort is usually less, the long-term cost of lenses may be less.

Dr. Lynn J. Coon, of Valley Eye Associates, has been in practice in Wasilla since 1984. He enjoys taking care of people of all ages including fitting contact lenses for well-motivated, responsible children. For more information, visit valleyeyeassociatesak.com.

Is it healthy for children to be vegetarians? I am a vegetarian, but I have some concerns that my children (5 and 7) might not get enough nutrients.

To answer your question – yes, it is (very) healthy for your children to adopt a vegetarian diet. Your concerns regarding nutrients are warranted as a poorly implemented vegetarian diet can be lacking in vital nutrients necessary for your kiddos to thrive.

Planning is the key to ensuring your child’s diet provides adequate nutrients for proper growth and development. Children who follow a lacto-ovo vegetarian diet – allowing for dairy and eggs – receive abundant protein, iron, zinc and vitamin B12. Adequate, balanced vegetarian diets are high in vitamins, minerals and phytochemicals that keep kids healthy and lay the foundation for healthy lifestyle behaviors that decrease the risk for chronic disease as your children transition into adults.

Here are a few tips to help ensure an adequate, balanced, and nutritious vegetarian diet:

• Include whole grains, beans and lentils as excellent sources of protein, fiber and minerals.

• Ensure adequate calcium intake with three servings of dairy – milk, yogurt, cheese or keifer – daily.

• Offer nuts and seeds for essential fatty acids such as Omega-3 as well as fat-soluble vitamins such as vitamin E.

• Unless you are jet-setting to Hawaii (or any other tropical island) frequently, chances are your kids are not getting enough sunlight for sufficient vitamin D here in Alaska. Check with your pediatrician about implementing a vitamin D supplement.

Involve your children with meal prep and planning! Try new vegetables together such as jicama or parsnips. Have them assist you in the kitchen by washing veggies or tearing lettuce for salads. Children are far more likely to try new foods when they are involved in the process. Rest assured, with a little planning, your children could enjoy a vegetarian diet abundant in nutrients. Exposing them now to a variety of plant-based meals and snacks sets the stage for healthy eating habits. And, could help you avoid the never-ending “Eat your veggies!” battle!

Tiffany Ricci, RDN, LD, is a registered dietitian and personal trainer. She is the owner of Creative Continuum, LLC: Creative Solutions for Healthy Living. For more information, visit tiffanyriccirdn.com.

My 7-year-old child is still wetting the bed. Should I start worrying? And what can I do to help him have an accident-free night?

Nighttime wetting is very distressful to the parent and child! The number of children who wet the bed at that age is still relatively high: 9 percent of boys and 6 percent of girls. Why is this happening? The bladder and brain may not be “talking” effectively, the kidneys may be making too much urine, or both. To address the latter, the child should take a water bottle and finish it before the end of the school day. By encouraging hydration during the day, restricting fluids two to three hours prior to bedtime is much easier to tolerate.

The communication problem between the bladder and brain is more difficult and often why certain children continue to wet into adolescence. There is no magic pill to wake the brain up when the bladder is full. The best surrogate is waking the child at set times or using a bed alarm. Nighttime waking and leading the child to the bathroom is the most effective therapy and has the highest success rate even after it is stopped. But, it takes a big commitment from the child and the parent. Even with a perfect routine, consistent dryness may take up to six to nine months. And you don’t have to buy a fancy alarm to benefit. Waking the child three hours after they go to bed and approximately two hours before waking in the morning can achieve the same goals. And the goal is to wake up! Not to have a dry night. Every time your child wakes up and goes to the bathroom is the victory, even if he or she has already wet the bed. We’re not trying to attain instant dryness, but instead encouraging the bladder and brain to talk to each other and dryness will come with time.

It is important for the parent to realize that medications to “dry up” or “increase the size” of the bladder do not address the root cause of the problem. And in most cases, the child will not stay dry after stopping the medication.

The most important thing I can impart is that a confident and motivated child will improve, and mom and dad are our most vital sources of confidence and motivation!

Laura Merriman, MD, is a pediatric urologist who sees patients in Anchorage and Soldotna. For information, visit alaskaurology.com.

My 8-year-old son is a reluctant reader. In fact, he says he hates to read. What are some ways I can help him enjoy reading and move toward a book-filled future?

You are not in a unique situation. Turning away from reading is very common at this age, especially for boys. Studies have shown it is very important to help children over this bump in the road to make sure they become lifelong readers and learners, an important key to their success in life. One of the first steps to take is to make sure that his reluctance doesn’t stem from vision problems. Sometimes a growing dislike of reading indicates a need for corrective lenses. So, if applicable, a trip to the optometrist might be helpful.

School, friends and extracurricular activities means his spare time can be as limited as yours. In this case, a book of short stories can work well. Titles that include cartoons in the stories, such as the Diary of a Wimpy Kid series (Kinney) are also fast reads. One secret every librarian knows is that kids this age love series. All you have to do is get him hooked.

Ten Series for Reluctant Readers

Secrets of Droon – Abott, Tony
My Weird School – Gutman, Dan
Diary of a Wimpy Kid – Kinney, Jeff
Big Nate – Pierce, Lincoln
Captain Underpants – Pilkey, Dav
Encyclopedia Brown – Sobol, Donald
Daniel Boom – Steinberg, Daniel
Geronimo Stilton – Stilton, Geronimo
The 39 Clues – Various authors
Choose Your Own Adventures – Various authors

With schoolwork he’s been introduced to a different style of reading for assignments, so you may have to re-introduce him to reading just for fun. Set the example by making sure he sees you reading for enjoyment. Even better, have fun reading together. Pick a time every day when you can share a book. Make it short, 20-30 minutes, about the time it takes to read a chapter or two. Choose a classic read-aloud like The Mouse and the Motorcycle (Cleary) or perhaps a factual book about something he’s interested in. As the comfort level grows you can even take turns reading aloud.

Most importantly, let him choose what he wants to read. It doesn’t have to be literature; the important thing is to keep him reading. Don’t forget the public library. It gives you the chance to sample a wide variety of choices for free and we love helping kids find the perfect book. Just ask us.

JT (Jayne) Isch has a master’s degree in information science and has worked as a youth services librarian for 20 years. A recent newcomer from the Pierce County Library System in Washington State, she is currently a youth services librarian at the Z.J. Loussac Library.

I try to teach my 10-year-old to have good posture, but it doesn’t always work. Why is good posture so important? Are there any health risks associated with bad posture?

First, it is important to recognize that posture is important because of the fact that in many aspects of life, structure determines function. We can’t roll a square wheel, just like we can’t expect to be healthy with a crooked spine and poor posture. That is why it is so important for our children to develop good posture habits early. Speaking simply, posture is actually the window to a person’s spine. By assessing the posture of a person and comparing it with the presence or absence of symptoms of organ dysfunction, we can get an accurate clue as to what may be happening with their underlying spinal structure and have a better idea as to whether or not their body is working in accordance with the way it is designed.

As much as we want to help our children to have good posture, unfortunately there are often underlying problems that may need to be overcome first. A child isn’t necessarily “lazy” if they are slouching; it is often an outward sign of an inward spinal imbalance. What that means is that if a child has experienced an insult or injury to their spine, then poor posture and compromised health, or some type of organ dysfunction, is a common result. Any shift in a spinal segment that impacts the health of the nervous system is called a spinal subluxation. This is the injury that a chiropractor works to detect and correct. If a subluxation is left uncorrected, research demonstrates that the effects of continued injury, and the stress from gravity and time will effectively make the posture, spine, organ functioning and overall health of the child much worse.

The bigger concern, however, is that a deviation in the spine will compromise the function of the nervous system at that level. The nervous system is responsible for organizing, regulating and coordinating every function of every single cell, tissue and organ in our body at all times – every day. It needs to be working at 100-percent efficiency all the time for us to be healthy and it can be highly impacted by postural and structural changes. Although many people hope that children will “grow out” of a problem like poor posture, if it is associated with spinal subluxations then underlying issues are likely to create compensations that cover up the original concern. These compensations accumulate as the child develops and will affect their overall health throughout their lifetime as more symptoms develop.

Actively participating in chiropractic care is highly encouraged for the whole family as it results in good posture, a healthy spinal structure and a higher quality of living.

Dr. Jessica Dachowski is a board-certified Diplomate in Clinic Chiropractic Pediatrics. At Whole Family Chiropractic, she specializes in caring for the specific needs and healthcare challenges of young children, pregnant mothers and their families.

For more information, visit wfcalaska.com.

My child is 9 years old and her new permanent teeth have a yellowish tint to them. I make sure she brushes and she even uses whitening toothpaste sometimes. Is there something wrong or something else we can/should be doing?

This question is one that is often asked in my office, and the answer, the majority of the time, is quite simple. Now, there are many causes of dark or yellow teeth in children. Discoloration can be caused by poor oral hygiene (i.e., lack of brushing), infections or certain medications. A prolonged illness that induced a high fever also can affect the color of teeth. However, in healthy teeth, the teeth that appear more yellow are generally normal and are expected. Primary teeth, or baby teeth, also when healthy, are bright white in color. Hence the nickname “milk teeth.” When our permanent teeth make their appearance right beside those glowing white baby teeth, the difference in color or appearance can be very alarming.

Again, in most cases, there is nothing to worry about. Our teeth, both baby and permanent, have three layers to them: Enamel (the outer, visible, layer); Dentin (the middle layer); and Cementum (the innermost layer). In each of these layers, there are three things that are different in comparison to baby teeth. In permanent teeth, the enamel is more transparent, the dentin, which is naturally dark grey/yellowish in color, is much thicker and darker, and the dentin is surrounding a very large pulp (i.e., the blood supply), to a still growing and developing tooth. So, starting in the middle of the tooth, with a larger, deep, red pulp, followed by a much larger, thicker, grey/yellow in color, dentin then cover it all in a more transparent enamel and there you have it: A permanent tooth that appears darker and more yellow in color – very normal. As more of the permanent teeth start to come in, you can re-evaluate the color and see then how they look. My bet is that the color will not appear nearly as grey/yellow as they first did when next to the baby teeth. If they do, this, too, can be very normal for your child. Once your child is older, preferably young adulthood, whitening toothpaste and possibly whitening agents can be considered. However, if you do feel that your child’s teeth, permanent or baby, are darker than normal, you may want to schedule an appointment with your child’s dentist just to be sure.

Dr. Christopher Coplin is a general dentist at the Alaska Dentistry for Kids, LLC in Anchorage and licensed by the State of Alaska. For the last 11 yrs, he has focused on and limited his practice to serving the needs of infants, children and those with special needs. For information, visit alaskadentistryforkids.com.