Healthy Kids. Supported Families. Strong Communities.

Category: School-age

How can my child get help at school?

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

What is an IEP? at Additude Magazine

504 Plans at

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!

How do I feed my picky eater?

“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!).

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

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.


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 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.