Pointers for Families

How can my child get help at school?

/ Dr. Alicia Pointer

There are lots of reasons a child may need extra help at school. Some have school-based needs from the first day. A teacher may raise concerns about learning or behavior. A student could have a new diagnosis that interferes with daily activities. No matter the reason, there are basics that can help families start on this journey.

School-based services can be complicated and ever-changing. As a pediatrician, I still sometimes struggled with getting kids what they needed in school. Having a plan and understanding some of the terms can give families a little more confidence.

Where to start?

How the process begins will differ depending on each family and child. For some children, their needs are known before they even start school. Other students’ needs may not be known until they struggle. In any case, the first place to start is information gathering and presenting. Get as much information as you can and put it all in one place.

Talk to your doctor

The doctor’s office is one good place to start. For many school services, children need a diagnosis to qualify. If your child does not yet have a documented diagnosis, the doctor can help with that. Sometimes the doctor can make a diagnosis that day. Often, they will have questions for you and/or your child’s teacher or specialists. And they may decide to make a referral. To save time, bring any info you have to the visit- report cards, prior testing or school evaluations, teacher’s notes, names of specialists, etc.

If your child already has a diagnosis or known reason for needing services, the doctor can help with information gathering. They can give you a list of diagnoses, prior test results, medications, durable medical equipment and even ideas for services that may be helpful. As a doctor, I would put all of this info in a letter that the parents could bring to the school. This was easier for the parent and school than sifting through years of paperwork.

Talk to the teachers

Many parents start with talking to the teacher. At the beginning of the year, ask the teacher the best way to reach them: email? phone? a note in your child’s folder? Don’t wait for parent-teacher conferences. Teachers can let you know how your child is learning. They can also tell you what has worked or hasn’t worked so you know what to ask for. And they notice parts of your child’s day-to-day that other people might miss. Is your child unsteady in a crowded hallway? Are they squinting at the board? Teachers want the same thing you do- to see your child succeed in class.

Talk to the school

Okay, you’ve talked to your child’s doctor. Maybe you’ve talked to the teacher. You’ve decided your child needs support at school. The next step is to go to the school or district. Your child’s teacher, school counselor, nurse or principal may be able to help you depending on what your child needs.

Don’t hesitate to contact the school district, especially if this is a long-term issue that will span grades. Every district has a Department for Special Education. Many also have a department for “student services” or “student support.” You can find these on your school district’s website, or your school’s counseling office can give you the phone number.

Be Specific

When you talk to the school district, be very specific. Tell them what problems your child is having in school (or what problems they would have without support). This could include getting around the school, hearing/seeing the teacher, learning, staying safe and healthy in school, etc. The school district is interested in how your child does in a school setting. If your child has a specific diagnosis or has results of testing or studies, let them know. It may help to provide the district with any letters or information you have from the doctor, teachers, prior schools, testing, etc. Remember to keep a copy for yourself!

I almost always recommend writing a dated letter to the school district with your concerns and needs. Keep a copy of the letter for yourself. If you talk to the district on the phone, ask them what the next step is and take notes of who you talked with and when.

If there is something specific that your child needs, let the school district know 1) What school-based problem needs solving- e.g. “My child will not be able to carry their books around school or take the stairs” 2) Why (if you know why)- “They have cerebral palsy which causes poor balance” and 3) The solution- “They need an elevator pass, longer time between classes and someone to carry their backpack.” The people at the school district want your child to do well in school. However, they are not doctors so something that may be obvious to you may need to be stated clearly.

If you don’t know what your child needs, it is still important to be specific. E.g. “My child is in 3rd grade and reads below a 1st grade level. When the teacher asks a question, my child knows the answer but doesn’t understand when it is written down. This started in first grade. My doctor did a vision test and it was normal.”

School evaluations

If your child does not have a diagnosis, sometimes a school evaluation can be helpful. You can ask the school for an evaluation as part of the IEP process (see below for more information about IEPs). An evaluation is usually done at the school by an outside expert. It can include observations, teacher and parent questionnaires and tests that your child completes. These tests may look at how your child learns, how your child speaks or moves, and your child’s social/emotional development. The school cannot usually make a diagnosis. However, the results may help your doctor make one. They can guide the school to which services your child needs.

Your child can be evaluated by the school even if they are also being evaluated by a specialist or their own doctor. Sometimes the school testing provides a different kind of information.

The meeting

Some services can be provided very easily. Often, just talking to a teacher, counselor or nurse can get a child the help or support they need.

However, sometimes the school and family will need to sit down together to make a clear plan for support moving forward. Parents may hear about different types of plans for their child including an IEP (Individualized Education Plan) or 504 Plan. The following sites explain 504 Plans and IEPs and how they are similar and different.

IEP vs 504 at Understood.org

What is an IEP? at Additude Magazine

504 Plans at Kidshealth.org

No matter what type of plan your child has, there are a few things to know before the meeting:

You can make changes to what the school suggests. The first meeting is the easiest time to ask for what your child needs and tell the school what changes you want. However, you can also revisit the plan later if it isn’t working.
Don’t be afraid to be creative. You may have ideas that the school hasn’t thought of. There is no real limit on what can be in the plan if you and the school agree.
If you don’t understand something, ASK. There are a lot of new words, acronyms and abbreviations. Parents are not expected to understand all of it.
Remember to bring copies of everything even if you’ve already given it to the school.

My best advice for the meeting itself is: bring someone with you. As someone who has been through a meeting, I know how much it can feel like you are in a different country where everyone is speaking a language you don’t know. Many school districts allow you to request a parent peer who has been through this before. They know the acronyms and how the system works. If not, bring a friend. Some doctor’s offices have care coordinators or social workers who can attend with you.

Through this process, you will deal with experts in medicine and experts in education. Remember, you are the expert in your child!

It's possible to have joyful mealtimes even with a picky eater!

How do I feed my picky eater?

/ Dr. Alicia Pointer

“My child will hardly eat ANYTHING!” This is one of the most common concerns I hear from families. In every family I’ve met, no matter their culture, food is a way to care for and connect with each other. So when kids don’t eat, it’s stressful for everyone. However, with patience, creativity and a little bit of letting go, there are ways to make mealtimes joyful again.

Is it just picky eating?

If your child is having troubles with eating, check in with your child’s doctor to make sure everything is okay. Picky eating is very common even in healthy kids. But changes in eating can sometimes be a medical problem. Some signs it might be more than picky eating are: tooth or mouth pain; gagging or choking; sudden changes in eating habits; belly pain, nausea or vomiting; diarrhea or constipation; or trouble with food textures.

Once a picky eater, ~~always~~ for a while, a picky eater

Your child’s picky eating is not your fault. Just like kids have different personalities, siblings raised the same way can have very different eating attitudes. Picky eating is a normal stage that starts around 2-3 years old. But some kids are picky eaters for years (and we all know some adults who are, too). Dealing with picky eating can be a long process. Sometimes a child will eat a new food at one meal just to reject it again at the next. Don’t get discouraged!

There is no quick “cure” for picky eating. But there are tips that will help increase the number of foods your child eats and ease your family’s mealtime frustration.

Make new foods, but keep the old…

The most important thing about picky eating is to keep offering a variety of foods. Otherwise kids can become more and more limited in what they’ll eat. “Offering” means 1) put it on or next to their plate but 2) don’t force it (more on this later). Don’t stop offering something just because they have refused it in the past. Some toddlers can see a food on their plate 5-10 times before they’ll eat it.

Tips for offering new or non-preferred foods:

Offer new foods next to things they already like. New foods are less intimidating when there are familiar foods on the plate, too.
Offer things similar to foods they already eat. For example, if they like apples, try other crunchy foods; if they like hamburgers, try turkey burgers, etc.
Kids are most open to new things when they’re hungry, not if they’ve had a big snack or drink right before. For this reason, breakfast can be a great time for new foods.

Enjoy family meals again

Meals are a great way to bond as a family. But picky eating can make everyone stressed. When meals become power struggles, kids may be less likely to try new foods. And they may be less likely to enjoy them- food tastes worse when everyone is grumpy. Even with a picky eater, your family can find a way to add joy back to its meals.

Have fun with food! Cut up food into fun shapes. Arrange it into a smiley face. Set a fancy table with candles, kid-made centerpiece and soothing music.
Raise kids who cook. Meal prep is a great time to bond over food. Kids are more eager to try something they helped make. Even toddlers can help with stirring or pouring.
Eat together. Turn off the TV and use this time to connect. Tell your favorite jokes. Talk about foods you loved or hated when you were a kid. When kids see their parents enjoying foods, they’re more likely to try them, too.

Don’t force it

This is really hard. We do all we can to make sure our kids get what they need, including nutrition. But, the goal is not to get your child to eat those 5 green beans on their plate. The goal is to raise children who will try a variety of foods to keep them healthy throughout their lives. Choking down those green beans won’t add much in terms of nutrition and it might make your kid hate green beans even more.

Food waste is such a frustrating part of picky eating. Once you bought the food, nobody wants it to go to waste. Frozen foods are one way to avoid food waste. Frozen veg are usually more affordable than fresh and can taste better than canned. Plus, you can defrost a small amount. If your kid loves it, defrost more. If they hate it, save it for another meal days, weeks or months later. Even foods like rice, cooked meats or canned beans can be frozen for later.

Get creative!

Sometimes it helps to get a little creative when it comes to picky eaters.

Let the choosy eater choose. Walk through the store together and let your child pick out a new food to try. Bonus points if it’s a new food for you, too!
Change up the prep. Some kids love peppers raw but not cooked or like potatoes roasted but not mashed. (When I asked my picky-eater son his opinion on this article, this was his only advice. He said “tell people about really crispy carrots or broccoli with honey.”)
Use dips and dressings as needed. You’d be amazed what kids will eat if it is topped with ranch, ketchup or peanut butter.
Let them play with their food. Toddlers who poke and smoosh their food may be more likely to try new foods and learn names of foods faster. Kids with sensory issues may need to touch, sniff and even lick their food multiple times before they’ll eat it.

Give yourself a break

Changing eating habits is a process that takes time. It’s okay to be flexible when it comes to your child’s eating. If your doctor isn’t worried, you don’t need to be either. Most kids, even very picky eaters, still manage to grow well and get the nutrition they need. If they don’t drink milk, maybe they get calcium from yogurt or cheese. If they don’t eat meat, they might get protein from eggs or peanut butter. Many children’s cereals are even fortified with calcium, vitamins and iron.

If you focus on continuing to offer a variety of foods and enjoying mealtimes together, your family will be making happy food memories. And then, when your child thinks about veggies, they might just smile (or at least not cringe!).

Practicing at home can make a doctor's visit go smoothly for anxious kids.

Does going to the doctor’s have to be so hard?

/ Dr. Alicia Pointer

A family brings their six year old for a vaccine. When it’s time for the shot, the little boy panics. He says “no, I’m not going to!” then cries and runs away. His mother catches him, but he thrashes as she brings him back. Is this one of my pediatric patients? No. This was my son last year. This year, however, things went differently. He was still nervous, but there was no screaming, no running. He was even able to say “Okay, I’m ready” when the time came. How? Prep, patience and simple strategies.

For some kids and families like ours, the doctor’s office is a struggle. This can happen for a lot of reasons. Many children are afraid of needles. Some kids get sensory overload and feel overwhelmed by new feelings, sight and sounds. A child may have a past trauma or bad medical experience, and the doctor’s office triggers scary memories and feelings. Whatever the cause, there are ways to make the doctor’s a little less painful.

Prepare

The first step to easier visits starts before you get to the office. Kids feel more secure when they know what to expect. Explain to your child at their level what will happen. Does the blood pressure cuff bother them? Say the nurse will put a band on their arm that will squeeze like a hug. Is the ear exam a challenge? Tell them the doctor will shine a flashlight in their ear and it might tickle.

Should you tell kids about shots ahead of time? Most kids do better when they are not surprised and can mentally prepare. For others, knowing before just builds anxiety. You know your kid best. Use simple positive language, e.g. “You may need a vaccine to stay healthy. It is a quick pinch and helps protect you and other people from getting sick.”

(Favor for all pediatricians: please don’t promise that there won’t be shots or that shots won’t hurt. If your child needs them, they may not trust you the next time, and future visits will be harder if they expect the worst. If you decide not to tell them ahead of time, it’s better to just say “I don’t know”.)

Practice

Practice parts of the exam at home. “Pretend I’m the doctor, now I’m going to feel your tummy!” Pick a time when your child is relaxed; try to make it fun. When kids know what’s going to happen, they feel like they have some control. Plus, when they realize, “Oh, I remember this, I did this with daddy,” they have extra confidence and reassurance.

For older kids, practice what strategies they’re going to use for the more difficult parts of the exam. If kids practice a calming strategy in a safe and controlled setting, they are more likely to use when they need it.

Calming strategies

For overall anxiety about the visit, focused breathing is a good strategy to try. Even very young kids can do breathing exercises such as pretending to blow out a candle or putting their hand on their belly and feeling it move up and down. Older kids can try breathing in for 3 seconds, holding for 4 seconds and breathing out for 5 seconds.

Distraction works well for scary parts of the visit. This can be looking at a book, singing a song together, watching a video, playing a game or listening to music.

Don’t forget the power of touch. Hugging your child on your lap, holding their hand or rubbing their back can make a big difference in their anxiety. If your child is very sensitive to touch, tell the doctor this, too.

Be an advocate

Don’t be afraid to speak up. There are usually things that your doctor’s office can do to help. If there are parts of the exam that are especially challenging, maybe they can be done later in the visit after your child warms up (or they may not need to be done at all). If the texture of the gown annoys your child, can they do the exam without it? If your child wants to stay on your lap instead of the exam table, that’s probably fine.

If your child has a fear of needles, let the office know. There are creams and sprays that can lessen the pain of a vaccine. They usually need to be applied up to 30 minutes ahead of time, so ask before your visit. Tell the doctor some of the positive or soothing language you’ve been using at home so they can use the same words.

Finish on a high note

Give your child something to look forward to at the end of the visit. Maybe it’s playing a game together, having a special treat, calling a favorite relative, getting a library book or extra TV time. Whatever it is, do it no matter how the doctor’s visit goes. This is important because 1) if the beginning of the visit doesn’t go well, they still have something to look forward to during the rest of it and 2) it creates a positive feeling for the next doctor’s visit even if this one doesn’t go perfectly.

After the visit is done, try to frame the visit in a positive light and find a way to praise your child for a part they did well.

How do I start a reading routine?

/ Dr. Alicia Pointer

I love books. One of my favorite parts of my job as a pediatrician is giving out books. And reading with my kids is one of my favorite parts of being a parent. I won’t say books can fix everything, but I rarely find a part of parenting that isn’t improved by books.

Sleep trouble? Reading can be part of a bedtime routine. Behavior issues? A few minutes snuggled up reading is positive one-on-one time. Potty training? Ask my kids about “poop stories.” Boredom? Check. Unsure how to bring up a tough topic? Yup. Jitters over starting something new? Struggling with feeling different? Dealing with a loss? There’s a book for that. And of course, there are other benefits of reading. Books can reflect children’s own experiences and give them insight into the experiences of others. Reading can help improve language skills, vocabulary and school performance. It can teach kids how to cook, draw and create online virtual worlds. Reading has the potential to bring kids comfort, joy and adventure.

Of course, there are many other times parents joyfully connect with their children, whether through cooking, worshipping, shooting hoops or singing. There are infinite ways families enrich their children’s lives with their own meaningful traditions. If you would like reading to be one of those but are not sure when or where to start, any time is the right time.

Babies

It is never too early to start reading together (just like it’s never too late!) Newborns recognize and are soothed by their mother’s voice even before they are born. And while infants don’t understand the story, early reading can help their language development. Plus, as a parent, I found it broke up the boredom that can come from spending all day with a newborn.

Babies tend to like simple books about other babies and animals. Once babies are 6-12 months old, they start to grab at, chew and throw books. That’s great! It’s normal baby curiosity and experimentation (and teething). At this age, it can be tough to get through a whole book or even a whole page. That’s okay. “Reading” to your baby may mean pointing at a picture of a cow and making moo sounds. Or saying “where’s the baby?” as you close and open the book to the same baby picture. Or even asking “Is this my hat?” as you balance a book on your head. All of this counts! You’re reading together!

Toddlers

Reading to toddlers is where things start to get fun, until the hundredth time reading the same book. While toddlers may still like babies and animals, they also enjoy books that have rhymes and repetition. Toddlers are pretty tough, so stick with board books if you can. Kids this age may have a favorite book that they want read again and again. They may also be able to finish the last word of their favorite sentences or rhymes. So pause every once in awhile to give them a chance, or throw in a wrong word and see if they notice. (Note: to break up the monotony, “Is this my hat?”- still a hit.)

Some toddlers are always moving, so it can be hard to find calm time for reading. But parents usually know those few minutes in the day when their children are finally still, maybe around nap-time, during a snack or after their bath. Or throw a book in your bag to read waiting for an appointment or in line. Remember, reading together is supposed to be fun; if it’s stressful, put the book down and try again later.

School age

Just like it’s never too early to start reading to your child, it is never too late to read aloud. Once kids learn how to read, you can both gain a lot from reading out loud together. When kids hit school-age, reading can be relaxing way to re-connect and maybe sneak in some snuggles. It also helps kids develop interest in books when they are sharing them with someone they love. At the same time, “Is this my hat” stops working and you may have to try a little harder to make reading fun.

As I’ve said before, reading should be enjoyable for both of you. That means finding some time to read that doesn’t put pressure on your child to read to you. If your child is a reluctant reader or struggling to read, there will be other times to work on those skills. In fact, it is important for children who are reading behind grade level to read books that are just a small stretch for them to read independently and to BE READ books at their grade level. This allows them to work on their own reading at a steady pace while gaining the vocabulary, comprehension and joy in reading that come from hearing grade level stories.

At this age, kids’ interests will drive what books you read. Kids love having some control and independence so going to the library and letting them choose the book can be a big hit. Do they like unicorns? sports? video games? a super-hero movie? Chances are, there’s a book about it. And don’t limit yourselves to books. Maybe they’d like a graphic novel, magazine, book of jokes? Go for it. This time doesn’t have to feel educational to be worthwhile. The point is to enjoy reading and each other (with a focus on the latter).

Tweens and teens

Reading together with older kids can sometimes feel like a hard sell. But secretly, most adolescents still want their parents’ attention. So while they may not admit it, behind those eye rolls is appreciation that you are interested.

This age group takes a bit of creativity. Some kids will still be interested in reading aloud together. Some kids like being the one who reads, so try taking turns. Kids may want to choose the book themselves and can get a kick out of having their parents read potty humor or horror stories. But if you find a book you think your kid will love, try it out; they might be impressed.

Sometimes reading together means reading the same book separately. If there’s a genre, series or subject that your child is interested in, grab 2 copies of the same book. Or buy an extra copy of a book they’re already reading. You can each read separately and discuss, e.g. “Did you get to the part where ______?” “Who do you think is going to end up together?”

Maybe reading together at this age is saying “check out this magazine article I just read about [insert pop culture reference here].” Maybe it’s listening to an audiobook together in the car. All of this counts! You’re reading together!

What’s Your Back-up Plan?

/ Dr. Alicia Pointer

(If you are thinking about suicide or need emotional support, the Lifeline is available 24/7: 1-800-273-8255)

Lately, I’ve been seeing a lot of teenagers struggle emotionally. Many of these are kids who have never had issues with mood in the past. It’s a reminder that just because a kid HAS always handled things easily doesn’t mean that they WILL always handle things easily. It has also led to lots of conversations around strategies for dealing with stress, anxiety and depression.

At some point during these conversations, I ask “If those strategies don’t work, what’s your back-up plan?” or “If you’re feeling really badly, maybe even so badly you think about hurting yourself, what are you going to do?” And, most of the time, the answer I get is “I don’t know.”

What is a back-up plan?

If a teen is struggling with their mood, stress level or bad thoughts, their parents should talk to their pediatrician or find a therapist or counselor. They can help develop strategies for handling those tough feelings. A back-up plan is a plan for if you are feeling worried, sad, overwhelmed or out-of-control and your stress relief strategies aren’t working or you can’t use your strategies. It’s a way to reach out to other people so you don’t have to handle things alone. It’s knowing that asking other people for help is a smart, responsible way to help ourselves.

Everyone should have a back-up plan. You never know if or when you are going to need it. But if you do, you want to have one ready. In the middle of a car accident is no time to install an airbag; in the middle of a crisis is not a great time to make a back-up plan. Most drivers will never need an airbag, but if we do, we’re glad it was installed before-hand!

(Some people know the term “crisis plan” from behavioral health. However, when people hear crisis plans, they tend to imagine something very formal and written that can only be used in a crisis. A back-up plan can be simple and easily changed and can be used whenever you want. )

How do you make a back-up plan?

A back-up plan will be different for everyone but each has a few key components. 1) When will you use it? 2) Who are you going to reach out to? 3) How are you going to reach out? 4) What’s your back-up to your back-up?

We discuss when to use the plan below, so we’ll start here with the “Who.” Some people already have an adult they feel comfortable talking to about tough issues. Some people feel more comfortable talking to someone they don’t know, like a confidential hotline. Some prefer to text. The most important thing is that you choose a method that you will actually use. If you choose an adult you know, it may be helpful to let them know ahead of time so they know how to help you. (It’s important that an adult is part of the back-up plan. Teen friends can be very helpful in stressful situations, but it is unfair to have friends take on this kind of responsibility. It can also put a strain on a friendship if they feel torn between keeping your feelings private and wanting to help you by sharing your situation with another adult.)

How are you going to reach this person? In-person? Call? Is their number memorized? Maybe you can discuss a code word with them ahead of time so they know to drop what they’re doing. If it’s a hotline, is it programmed into your phone? The National Suicide Prevention Lifeline is 1-800-273-TALK (8255).

And make sure you have a back-up to your back-up. If someone doesn’t answer the phone, what then? If you’re super-annoyed at your person and don’t want to talk to them, what will you do instead?

When do you use a back-up plan?

There is no down-side to using your plan. Don’t worry about not feeling “bad enough” to need it. If anything, the sooner you use your back-up plan, the better it usually works.

That being said, it can help to identify times when you might need it. Maybe there are triggers that are upsetting- a specific person, a reminder about a bad event, trouble with school/sports/work. When those triggers come up, you can use some of your other strategies right away and think about whether you need your back-up plan.

Most of the time, we know it’s time to use a back-up plan by how we feel. If you are thinking about hurting yourself, it’s time to use the back-up plan. If you are having thoughts that scare you, it’s time to use the back-up plan. Pay attention to your body and emotions. Are you feeling hot and tingly? Panicked? Tight all over? Hopeless? Low-energy? Heavy? Any of these may be signs to start using some of your stress-relief strategies and think about whether it is time to use your back-up plan.

Back-up plan examples

Back-up plans will be very individualized. They can be simple or more detailed. Remember, the best plan is the one that you’ll use. Here are a couple examples to get you started:

“ When I start to feel down, I’ll go for a run and listen to music. If that doesn’t work or if I have any scary thoughts, I will call my aunt. If she doesn’t answer, I’ll call the National Suicide Lifeline. Both phone numbers are in my cell phone.”

“If I start to panic, I’ll try a breathing exercise. If I can’t do that, I’ll hand my dad a piece of paper that says “panicked”. We’ve already talked about this and he knows that’s a sign that I am having a hard time and need extra help. If it’s during the school day, I will go to the school counselor. If those don’t work, I’ll text the Crisis Textline.”

Resources

National Suicide Lifeline 1-800-273-8225 : 24/7 Confidential Line. Anyone can call for emotional support whether or not you’re thinking about suicide)

Crisis TextlineText HOME to 741-741 : 24/7 Confidential Chat for any crisis or anyone who needs support)

The Trevor Project 1-866-488-7386 or Text START to 678-678 : Suicide prevention, crisis intervention and support for LGBTQ young people

Mental Health is Health: Website with resources, education and support for young people who want to take care of their own mental health or help a friend with mental health concerns

How can my child get help at school?

How do I feed my picky eater?

Does going to the doctor’s have to be so hard?

How do I start a reading routine?

What’s Your Back-up Plan?

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