All normal children have times when they may appear hyperactive, running around endlessly, yelling and seemingly out of control, and yet, at other times they may seem inattentive and “spaced out”. This may be normal childhood behavior for some, but for others, these behaviors may be so severe that it disrupts their lives.

Attention deficit/hyperactivity disorder (AD/HD) is a diagnosis given to children who consistently display behaviors associated with impulsivity, hyperactivity and distractibility. The diagnostic criteria requires that these behaviors be excessive, long term, appear before age seven, present for at least six months and disrupt at least two areas of a child’s life (i.e. home and school).

AD/HD is one of the most common conditions of childhood. It affects four to twelve percent of school aged children. According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, the official clinical diagnosis is attention deficit hyperactivity disorder. This diagnosis in turn is divided into three categories: combined type, predominantly inattentive type, and predominately hyperactive/impulsive type. Many people use the term attention deficit hyperactivity disorder and attention deficit disorder interchangeably.

If you suspect your child may have AD/HD, observe your child closely during activities where he is expected to pay attention; children with AD/HD often have difficulty paying attention to detail or when spoken to and make careless mistakes. Observe your child when you expect him to sit for a while or think before acting; children with AD/HD often have difficulty staying on task, following instructions and tend to be restless, fidgety, loquacious or impulsive. Talk to your child’s teacher. Learn about your child’s behavior at school, their academic performance and learning abilities. If you suspect your child has AD/HD, talk to your child’s pediatrician, a clinical psychologist or a psychiatrist.

There is no single medical test for the diagnosis of AD/HD. However, reliable diagnostic criteria and tools have been developed. In order to make an accurate diagnosis, families, teachers and health care providers must work as a team. To evaluate your child, your child’s doctor may ask you and other informants to fill out rating scales about your child. These rating scales will help determine what type of AD/HD your child may have.

The exact cause of AD/HD is not known. Common myths regarding the cause of AD/HD are: poor parenting, lack of discipline, poor teachers, excessive TV viewing, food allergies and excessive sugar. One popular theory regarding the cause of AD/HD is that refined sugar and food additives cause hyperactive and inattentive behavior in children. The National Institutes of Health concluded that refined sugars and food additives may affect five percent of children with AD/HD. AD/HD is more likely caused by abnormal neurotransmitter activity in the brain. There is evidence that AD/HD may have a genetic component.

Clinical studies have shown that the most effective treatment for AD/HD involves both pharmacologic treatments and therapy. Medications are used to normalize neurotransmitter activity in the brain. Pharmacologic treatments include stimulants (Ritalin, Concerta, Adderall, etc.) and non stimulant (Strattera) medications. These can be prescribed by your child’s pediatrician or psychiatrist. Therapy includes behavior therapy and cognitive therapy. These services are aimed at helping the child with behavior modification and with the emotions that arise from having AD/HD. Therapy can be sought from a clinical psychologist or a psychiatrist.

Parents can help their child succeed by establishing routines for daily activities, limiting distractions, assisting their child with organizational and study skills, praising, complementing and providing positive feedback when they put forth their best effort. Identify what your child is good at doing and build on it. Help them with the use of agendas and keep “to-do” lists. Keep rules and instructions clear and brief. Give them a sense of responsibility; this will help boost their self esteem. Allow your child to have downtime and allow them to expel extra energy through physical activity. Remember to work closely with your child’s teacher and doctor. Most of all, tell your child that you love and support them unconditionally.

1. How does a parent know if their infant or child is developing a food allergy or a reaction to something in the environment?

Environmental allergies can manifest themselves as watery eyes, runny nose, nasal congestion, sneezing and cough. Food allergies can evidence themselves through vomiting, diarrhea, abdominal pain, rash or hives, and in severe cases, shortness of breath and difficulty breathing (anaphylaxis). If parents suspect their child has allergies, charting the child’s food intake and activities along with symptoms experienced may shed some light as to possible allergens. If you suspect environmental allergies, a positive response to a trial dose of antihistamines may be all that is needed to confirm the diagnosis. Also, discuss your concerns with your child’s doctor, since many common allergies can be diagnosed with simple blood tests, in addition to skin testing.

2. What are the best ways to treat allergies?

The best treatment for allergies is to avoid the offending agent. If this is not possible, medications are always an option. Treatments include topical steroid nasal sprays, both sedating and non-sedating antihistamines and leukotriene inhibitors. Nasal sprays work by decreasing inflammation in the nose. Antihistamines work by decreasing the effects of histamine on the respiratory tissues and leukotriene inhibitors work by decreasing inflammation in the respiratory tract. Each treatment can play a significant role in decreasing allergy symptoms. Determining which treatment is best for each person depends on the allergens and the individual’s response to the medications.

3. What breakfast foods do you recommend for kids?

Foods rich in whole grains and protein such as oatmeal, yogurt and eggs, for example, are excellent choices for breakfast. A good breakfast will give your child a head start to their day, providing the necessary substrates to fuel their minds and bodies. Avoid foods high in simple sugars such as some breakfast cereals, as these will only raise your child’s blood sugar and make them feel tired and less energetic later in the day.

4. What type of diet is recommended for children?

Children should be taught early on to make healthy food choices and to eat well-balanced meals. Moderation is the key. In general, parents should avoid giving their children foods that are high in salt, fat –especially saturated and hydrogenated fats — and simple sugars. Foods that are freshly prepared, as opposed to processed foods, will help limit the intake of these ingredients. Limit fast food as well, since these are heavy in salt and fat.

5. What type of vitamins do you recommend for children?

Most healthy children eating well-balanced diets do not need to take vitamins. There is no proof that consuming more than the recommended daily allowance of nutrients is beneficial. On the contrary, consuming excessive amounts of vitamins A, D, E and K can actually be harmful. If you are not sure whether your child may need vitamins, discuss this with your pediatrician. Depending on your child’s nutritional needs, you may select a multivitamin with or without minerals. Children’s vitamins can now be obtained in liquid, hard and soft chewable, and gum form with a variety of tastes to choose from.

6. Besides basic immunizations for school, what other vaccines should parents be aware of?

Parents should be aware that there are vaccines available to prevent other severe diseases such as meningitis, genital warts, cervical cancer and profuse diarrhea. Meningitis is an infection of the tissues surrounding the brain. It is usually fatal and serious neurological deficits can occur. Pneumoccocal bacteria are known to infect the ears, sinuses, lungs, blood and brain. Parents should know that they can have their child vaccinated against pneumoccocal disease. The pneumoccocal conjugate vaccine does not prevent all types of pneumoccocal disease, but may prevent their child from getting meningitis due to the more common types of pneumoccocal bacteria. In addition, there is a meningococcal conjugate vaccine available that can prevent meningitis caused by meningococcal bacteria. Like the pneumacoccal vaccine, the meningococcal vaccine does not protect against all meningococcal bacteria, but will protect against the most common types of infections. The pneumoccocal conjugate vaccine is administered to children in one to four doses depending on the age it is first given. The meningococcal conjugate vaccine is administered to adolescents in one dose. There is another vaccine available for young ladies that will protect against certain types of human papilloma virus, or HPV. When administered, this vaccine could protect against 90 percent of genital warts and 70 percent of cervical cancers caused by the HPV types found in the vaccine. The HPV vaccine is administered in three doses over a six-month period. The rotavirus causes significant vomiting and diarrhea in hundreds of infants yearly, causing severe dehydration and requiring hospitalization. The rotavirus vaccine is an oral vaccine administered in three doses in the first six months of life.

7. What should one look for when selecting a pediatrician?

When selecting a pediatrician, parents should take into account not only the pediatrician, but the office and its staff. Ask questions pertaining to the following: office hours, scheduling of sick visits, scheduling of well visits, how calls are handled during office hours, how after-hours calls are handled and if there are any charges for after-hours services provided. Ask if you can schedule a time to meet with the pediatrician prior to your first appointment. During this visit, take the time to observe the surroundings and friendliness of the office staff. Ask the physician if they have hospital privileges, where these privileges are held and how they handle hospital admissions. What is acceptable to a parent depends on their expectations and needs.

8. What are the five most common issues you are treating your patients for? Do you see any trends developing with any of these issues?

Acute otitis media, commonly known as ear infection, continues to be one of the most common diagnoses made in the office on a day-to-day basis. Although it is treated with common antibiotics, I am finding that more children are in need of multiple courses of antibiotics due to antibiotic resistance. Another common problem that I treat relates to skin infections and boils. Although common bacteria cause a lot of these infections, I am noticing an emergence of methicillin resistant staph aureas, or MRSA, which can be more difficult to treat. Streptococcus pharingitis, better known as strep throat, is another common occurrence. Although amoxicillin continues to be the drug of choice, I also have noticed an increase in amoxicillin-resistant strains. Reactive airway disease, or asthma, is a cause of significant morbidity in my pediatric population. Unfortunately, I continue to see children living in environments where they are constantly exposed to second-hand smoke, which is well known to aggravate their condition. Finally, diarrhea is also a common reason for office visits. Contrary to what most parents expect, most cases of diarrhea are not of an infectious nature, but rather are caused by excessive consumption of fruit juices. This is also known as toddler’s diarrhea.

Health Alert: Childhood Obesity

As a physician, I am very concerned about the increasing numbers of obese children, their lack of exercise and poor eating habits. The body mass index, or BMI, is a number calculated from an individual’s weight and height. It is used to screen for obesity. In children, the BMI is calculated and then referenced on a percentile curve. This is done because a child’s BMI may vary based on age and gender. A child with a BMI between the 85th and 95th percentile for their age and gender is considered at risk to become overweight. A child with a BMI above the 95th percentile is considered overweight and at risk for potential health problems. Less than the 5th percentile is considered underweight. If you would like to calculate your child’s BMI, you can log on to the following Web sites : www.cdc.gov/nccdphp/dnpa/bmi/ or www.kidsnutrition.org/bodycomp/bmiz2.html.

I sometimes find that other members of a child’s family model unhealthy behaviors. Therefore, this makes it somewhat difficult to address the problem of childhood obesity. Many parents will try to provoke change in their child, not realizing that this is a family affair. Kids are most successful in achieving dietary and behavior modifications when all family members are involved in the process.

Another factor that has been slowly contributing to the problem of childhood obesity is the amount of time children spend in front of a screen, whether it is the television, computer or electronic games. Without guidance, children will spend countless hours in front of a screen, robbing them of the opportunity to exercise their bodies and minds in other ways. I get looks of disbelief from children when I encourage parents to limit screen time to less than two hours per day. Exercise does not have to be a “painful” experience. A brisk, 30-minute walk every other day can have a positive effect on the body. If this seems overwhelming, I encourage my patients to start at a level that is comfortable for them. The important thing is getting started on a routine that includes exercise and smart food choices.

It is often hard for parents to understand how present obesity in children can correlate to future health problems. Childhood obesity puts children at risk for adult heart disease, stroke, diabetes, osteoarthritis, obstructive sleep apnea and gall bladder disease, as well as certain types of cancer, such as colon and postmenopausal breast cancer. Childhood obesity is preventable if doctors, parents and patients work together.

Jannette H. Rivera, M.D. is a board certified pediatrician in a very busy private practice in Clermont, FL. Dr. Rivera’s passion for the overall well being of children is illustrated by her annual mission trips to Central America.

As a mother, when I think of my children I can only pray that they will grow up to be God-fearing, well balanced, productive members of society. As a pediatrician, I find that most parents share the same prayer for their children. On a daily basis I address questions such as: can disciplining my child negatively affect their developing self esteem? Or what do I tell my child when they come home from school devastated by another child’s tease?

Indeed, those moments when your child is teased may affect your child emotionally but, their self esteem is affected by what they hear on a daily basis and not what they are told on a few encounters. What a child hears at home, especially from the mouths of those who are most important to them, plays a significant role as to how the child perceives himself. Unfortunately, many parents are afraid that one act of effective discipline may traumatize their child, when in reality it is the everyday exposure to negative expressions against them that can cause the most damage.

I have encountered loving parents that have referred to their child as ”below average”, ”behaving badly”, ”uncorrectable”, ”selfish”, ”antisocial”, ”a clown” or ”a whimp”, to mention just a few. These may seem relatively harmless words but over a period of time they may define a child’s self perception. As a result a child may never see himself moving beyond the limitations these words have set. Sometimes these words are spoken playfully but depending on the child they may be taken seriously. Many times these words may be spoken out of frustration. If you find yourself speaking negative words out of frustration, take time out to calm down and rethink your choice of words.

Direct your correction at the child’s behavior and not the child himself. For example, a mother asks her 7 year old son to do a specific task because she really needs his help, but the child does not comply with his mother’s wishes. When she returns, the situation has only worsened. Instead of saying ”can’t you do anything right” or ”you are good for nothing” you may try saying ”mommy is very disappointed that you chose not to do what you were told.” The first response attacks the child’s ability as a person. The second response lets them know of your disapproval of the choice they made. When facing a situation that merits correction, focus on the child’s actions and avoid belittling the child. A child is more likely to believe that he can change his actions as opposed to believing he can change who he perceives himself to be.

As parents we are one of the most important people in our child’s life. Our words can help shape their self image, define their identity and form their character. As a result our words can influence who they will become and how successful they will be in life. There is always a positive way to say something. Make it a point to use words that will encourage and build up your child regardless of the situation. All it takes is a few minutes to stop and think.

All normal children have times when they may appear hyperactive, running around endlessly, yelling and seemingly out of control, and yet, at other times they may seem inattentive and “spaced out.” This may be normal childhood behavior for some, but for others, these behaviors may be so severe that it disrupts their lives.

Attention deficit/hyperactivity disorder (AD/HD) is a diagnosis given to children who consistently display behaviors associated with impulsivity, hyperactivity and distractibility. The diagnostic criteria requires that these behaviors be excessive, long term, appear before age seven, present for at least six months and disrupt at least two areas of a child’s life (i.e. home and school).

AD/HD is one of the most common conditions of childhood. It affects four to twelve percent of school aged children. According to the Diagnostic and Statistical Manual of Mental Disorders, fourth edition, the official clinical diagnosis is attention deficit hyperactivity disorder. This diagnosis in turn is divided into three categories: combined type, predominantly inattentive type, and predominately hyperactive/impulsive type. Many people use the term attention deficit hyperactivity disorder and attention deficit disorder interchangeably.

If you suspect your child may have AD/HD, observe your child closely during activities where he is expected to pay attention; children with AD/HD often have difficulty paying attention to detail or when spoken to and make careless mistakes. Observe your child when you expect him to sit for a while or think before acting; children with AD/HD often have difficulty staying on task, following instructions and tend to be restless, fidgety, loquacious or impulsive. Talk to your child’s teacher. Learn about your child’s behavior at school, their academic performance and learning abilities. If you suspect your child has AD/HD, talk to your child’s pediatrician, a clinical psychologist or a psychiatrist.

There is no single medical test for the diagnosis of AD/HD. However, reliable diagnostic criteria and tools have been developed. In order to make an accurate diagnosis, families, teachers and health care providers must work as a team. To evaluate your child, your child’s doctor may ask you and other informants to fill out rating scales about your child. These rating scales will help determine what type of AD/HD your child may have.

The exact cause of AD/HD is not known. Common myths regarding the cause of AD/HD are: poor parenting, lack of discipline, poor teachers, excessive TV viewing, food allergies and excessive sugar. One popular theory regarding the cause of AD/HD is that refined sugar and food additives cause hyperactive and inattentive behavior in children. The National Institutes of Health concluded that refined sugars and food additives may affect five percent of children with AD/HD. AD/HD is more likely caused by abnormal neurotransmitter activity in the brain. There is evidence that AD/HD may have a genetic component.

Clinical studies have shown that the most effective treatment for AD/HD involves both pharmacologic treatments and therapy. Medications are used to normalize neurotransmitter activity in the brain. Pharmacologic treatments include stimulants (Ritalin, Concerta, Adderall, etc.) and non stimulant (Strattera) medications. These can be prescribed by your child’s pediatrician or psychiatrist. Therapy includes behavior therapy and cognitive therapy. These services are aimed at helping the child with behavior modification and with the emotions that arise from having AD/HD. Therapy can be sought from a clinical psychologist or a psychiatrist.

Parents can help their child succeed by establishing routines for daily activities, limiting distractions, assisting their child with organizational and study skills, praising, complementing and providing positive feedback when they put forth their best effort. Identify what your child is good at doing and build on it. Help them with the use of agendas and keep “to-do” lists. Keep rules and instructions clear and brief. Give them a sense of responsibility; this will help boost their self esteem. Allow your child to have downtime and allow them to expel extra energy through physical activity. Remember to work closely with your child’s teacher and doctor. Most of all, tell your child that you love and support them unconditionally.