St-ut-ter-ing in children

Stuttering is fairly common in children and more boys stutter than girls. This speech disorder scars the confidence of children and the sooner speech therapy is resorted to better it is for the confidence of the child. Dr. Asha Agarwal, eminent speech therapist working at Sir Ganga Ram Hospital writes----

The first time when I met Madhukar, he had come to my clinic with his mother. He was tugging at her sari while she talked to me and I saw a six-year-old boy with a thick mop of unruly black hair and sad eyes. His mother shared that Madhukar didn’t like to go to school these days. She was quick to clarify that he was a good student who usually got ‘A’ in all his written work at school. But, he had become a loner, refrained from meeting with his friends and was reluctant to participate in oral tests at school. Whenever Madhukar would open his mouth to answer, normally he would take a second longer to speak the word which gave an opportunity to his teacher to correct and his fellow classmates to sneer.

Like Madhukar, hundreds of children lose confidence in their capabilities because of stuttering that hampers their development. Learning to speak is a liberating experience for a child as it allows him to express his feelings. But speech becomes a deterrent to his development when each time he opens his mouth he fears that someone is going to correct him or people will make fun of him. Stammering usually gets detected in children by the time they turn 3 to 4 years old, because this is the time when they develop a vocabulary of words. But, I have come across episodes of stuttering in a two-year-old child. Initially stuttering is episodic; it comes and goes.

Contrary to myths, one cannot outgrow stuttering. In fact, if it does not get cured it can leave psychological scars in the child’s mind. Children with stuttering begin to lose confidence and resort to gestures to communicate. Studies have time and again reiterated that stuttering runs in families.

Boys stutter more than Girls. In 30 years of my experience as speech counsellor, I have seen thousands of cases and ratio of boys to girls is 70-30. However, girls stutter at an earlier age than boys. Emotions and stammering connect. Often, children who speak normally might stammer if they are agitated, afraid or under stress.

How speech therapy helps

Speech therapy helps in lowering the stutter by using various techniques to develop fluent speech that reduce anxiety levels of children, which helps them to talk more fluently and confidently.

• Relaxation – To co-ordinate breathing and reduce oral pressure.
• Phonation – co-ordinate breathing with articulators with soft contacts
• Automatic speech – to practice technique effortlessly
• Reading – short stories in simple sentences with voice continuity.
• Reading and Narration
• Conversation in close-set with strangers.
• Telephonic conversation
• Conversation in different situation like public gathering, presentation etc.
• Maintenance and follow up
• Parents involvement

Coming back to Madhukar, he regained his confidence when he learned to speak without stammering. Sometimes he does stammer when he is too angry and for these moments his mother hands him a glass of water to cool off. He looks forward to go to school and has huge gang of friends.

Raise confident kids

Self –confidence is a feeling of trust in one’s abilities, qualities, judgment, and value. Some children seem to be born with coyness and a lack of self-confidence. Dr Arti Anand, consultant psychologist with Sir Ganga Ram Hospital says, “A shy child will hesitate to make new friends and clings to the mother when she meets new people or in new situations. She will not talk to people who come at home.” Regardless of the cause, you can help your child build a healthy level of self-confidence. It helps your child to develop mentally and emotionally.

Positive parenting means responsibility of a parent to help a child grow with self-confidence. Dr Anand points out, “Such children become back benchers and resist to respond to teachers because they are afraid of any spot light shining on them.”

Road to confidence

1. Be proud parents. Be proud of your kids and show that pride. Be proud of what your child is and express that pride. Knowing that you’re proud of her, she will always refrain herself from going on a wrong path and will never hurt your expectations. This will definitely build her self-esteem.
2. Trust her! Trust, as we all know is “earned”. You must start building trust between you and your children. Nothing builds confidence in human beings like trust. Though it is not always easy for a parent to feel sure of their children’s abilities, start with small and realistic steps that are agreed upon and carried out.
3. Praise her. Appreciation works more than criticism. Parents often speak without thinking. Statements such as, “You’ll never get it right,” or “Don’t be so stupid,” may seem harmless when spoken, but they send a negative message to your child that contributes to a low self-image. Dr. Anand advises, “Build your child’s self-confidence by providing frequent, genuine statements of praise. Tell your children they are special, that you love them even when they fail.”
4. Perfect role model. Children learn a great deal by watching the role models in their lives. Parents are the first and the most important role models. Do not put yourself or your spouse down in front of your children. Be the perfect role model for your little angel.
5. Help them to choose right. Give your child choices. Being able to make decisions is something that your child will have to do all throughout life. Such decision-making skills will give your child confidence in her ability to make her own choices, as she gets older.
6. Admire your toddler. Respect your child's interests, even if they seem boring to you - take a genuine interest in your child's friends, and what's happening at school, and comment to show you're listening. “All the children should be given a chance to participate in plays, sports etc. Teachers should be polite and kind while expressing a failure rather than shouting and screaming at them,” suggests Dr. Anand.
7. Self-dependent kids. Don’t do things for your child that he or she can do alone. Children need to learn to take care of themselves and they learn this through hands-on experience. By knowing appropriate developmental stages of your toddler, you can identify which tasks he or she can safely do without your help. In the end, this will help build self-confidence.

My ear hurts.....

It can be difficult to tell, but if your child has a cough or runny nose and then suddenly develops a fever for three to five days, it may be caused by an ear infection. Ear infections are among the most common illnesses of early childhood. Three out of four children have had at least one ear infection by age 3, according to the National Institute on Deafness and Other Communication Disorders. Dr KD Gupta, Consultant ENT Surgeon with Sir Gangaram Hospital discloses, “The ear cavity internally opens into the upper part of the mouth cavity - one on each side by a tube like structure. This tube allows ventilation of the ear cavity. In young children the tube is short, wide and straight and this allows easy spread of infection from nose, nasopharynx (upper part of mouth cavity). This is the reason that young children are prone to ear infections.”

However he is quick to mention that children most affected are between 3 to 7 years of age. This is because babies are often fed improperly (whether breast fed or bottle fed). Dr. Gupta even points out, “ During feeding a baby's head should be raised. If babies are fed lying flat, milk regurgitates easily from the mouth into the ear and an infection sets in.”

Symptoms

Ear infections can be hard to detect, especially if your child is too young to say, "My ear hurts." Children with ear infections may:

• Tug or pull at their ears
• Cry more than usual
• Have trouble sleeping
• Fail to respond to sounds
• Be unusually irritable
• Develop a fever
• Develop fluid that drains from the ears
• Have headaches

Treatment options

Your child's treatment decision depends on several factors including:

• Your child's age
• History of previous infections
• Whether your child has any underlying medical problems

Most ear infections safely clear up on their own without any antibiotics.

“By 7-10 years of your baby the Eustachian tube (the tube mentioned earlier) becomes larger, narrower and less straight. Hence there is a less chance of ear infections,” Dr Gupta adds.

Normally, treating the pain, steam inhalation and allowing the body time to heal itself suffice. Curing the infection may need a dose of antibiotics. When giving antibiotics to young kids, follow the dosage, schedule and your doctor’s advice strictly.

Watch out

Dr. K.D. Gupta warns that recurrent infections can impact hearing. He says, “Children with persistent ear infections do run the risk of hearing loss. If a child turns the volume of TV high and does not respond properly are warning signs for parents warranting an evaluation of the ears of the child by an ENT specialist.”

Prevention

• Protect your child from secondhand smoke. Keep your child at bay from smoke. Stay in smoke-free environment.
• Breast-feed your baby for at least six months. Breast milk contains antibodies that offer protection from ear infections.
• Ask your child's doctor about the pneumococcal vaccine (Prevnar). Studies indicate that it slightly reduces the risk of ear infections as well.
• Try to limit the use of any group childcare. Children in childcare settings can easily spread germs to each other.
• Washing your hands often. Hand-washing stops infection from spreading by killing germs.

Fighting tooth and nail

Accidents happen without notice! Same with dental emergencies, but if you are updated on ways to handle an emergency situation, it can spell the difference between a ‘lost’ and reclaimed ‘tooth’.

Handling dental emergencies

1. Broken tooth
Seeing your child with a broken tooth can be a gut-wrenching sight. Keep patience and do the following—

• Carefully rinse the tooth in water. Make sure that you do not touch the root of the tooth with your hands. The root is the portion of the tooth embedded in the gum and not normally seen.
• Attempt to place the tooth back in its socket and secure with a wet wrap. If this is not possible or if you are afraid that your child might swallow the tooth, place it in a glass containing either saliva or milk.
  See your dentist immediately.

2. Chipped tooth
Check to see if your child is experiencing pain or sensitivity in the tooth. If so call your dentist to seek dental treatment immediately. In case your child is fine, contact your dentist to see whether or not your child should be seen. In most cases of chipped teeth, you can simply schedule a future appointment to replace the lost portion of the tooth with a porcelain veneer or with bonding material.

3. Bitten Tongue or Lip
Clean the area gently with a cloth and then apply cold compresses to reduce the swelling. If the bleeding does not stop, go to a hospital emergency room immediately.

4. Objects Caught Between the Teeth
Try to gently remove the object with dental floss and avoid damaging the gums. Do not use a sharp instrument. The best item to use is a plastic toothpick that has an angulated tip. If not successful in removing the object, visit your dentist.

5. Toothache
Rinse your mouth with warm water to clean out the area. Make sure there is no food or any other object lodged around the tooth. Use dental floss to clean the area thoroughly.
Never put aspirin or any other painkiller on the gums or around the painful tooth because it can burn the gums, thus causing more harm than good.

Preventing dental injuries

The best way to prevent a dental emergency is to properly protect your child. Increasingly, dentists are recommending that children engaged in sports wear mouth guards. Once only used in football and ice hockey, mouth guards are now being recommended for other sports as well. Most mouth guards are made of plastic and cover the lower teeth.

Not only do mouth guards protect teeth but they also protect lips, gums, and cheeks. Commonly there are two types of mouth guards:
Another way to reduce the risk of dental injury is to watch out for situations that commonly lead to injury. These are some of the more common:

• Trips and falls - Falling into furniture and down stairs often causes dental injury. This is most likely to occur when children are first learning to stand using furniture to maintain balance. If you have a baby childproof your home before he learns to walk.
• Water fountains - Often kids injure teeth by ramming them into the spout of water fountains as they drink. Sometimes kids behind them accidentally bump into them causing them to injure their teeth.
• Forks and Spoons - Believe it or not, some injuries are self-inflicted when people, not paying attention, crack or chip their teeth with spoons or forks as they eat.
• Bottle Caps - Tell your child to never open a bottle cap by teeth.

If you have young children at home make sure that your dentist has after hours coverage, which means there will be a qualified dentist available to take care of emergencies and keep the phone number handy.

Dr. Ramesh Mathur, Chairman Max International Dental Academy

Living with autism

Two-year-old Minal hardly spoke for her age. She is fond of symmetry, babbles few words, which her mother can comprehend and is a stickler for symmetry. Most of her waking hours are spent in stacking her toys in a specific fashion. When she is not stacking her toys, she is flapping her arms like a bird, and if she hears her name, she avoids eye contact. Minal is autistic.

Autism is greatly misunderstood. “It is a developmental disorder in young children that affects three important aspects--development skills,social skills, communication skills and these children have repetitive or restrictive activities”, says Dr. Raghuram Mallaiah, neonatolgoist at Fortis La Femme hospital, New Delhi. The symptoms of autism are present in the child from birth, but they become apparent between 18 months to 3 years—a time when social development begins to occur and language skills are learnt. “Diagnosing autism is difficult”, mentions Dr. Mallaiah. Not only, is it a complex condition to diagnose, but also there exists low awareness levels on this disorder. A number of children with autism may have normal IQ and the only problem that is apparent is their poor social skills and language development skills or repetitive and obsessive behaviour. Since genetic and blood screening is incapable in divulging autism, investigations by a trained psychologist only could offer clues on it.


Causes
“Autism is multifactorial, but a larger number of evidences have begun to nudge towards the genetic link, as more than one child is born with autism in one family”, informs Dr. Mallaiah. There has been a good deal of debate if autism is linked to MMR vaccine. Dr. Mallaiah says, “ The evidence to support the link is very weak and the most likely explanation was the fact that MMR is given at 15 – 18 months, round about the time when autistic behaviour starts becoming apparent to parents. There have been large studies that have denied these associations. The medical fraternity on the whole would recommend all children to be vaccinated.”

Spectrum
Incidence of autism in developed countries where there is better awareness of the condition is said to be about 1-2/1000 children. These numbers include milder forms of autism too, says Dr. Mallaiah.

Earlier autism was dismissed in India. "From one in 10,000 children ten years ago, the prevalence is 3-4 per 1,000 live births now," says Mythili Chari, Founder-Director of the Institute for Remedial Intervention Service (IRIS) and member of the Expert Committee (Mental Retardation) under the Rehabilitation Council of India. Mythili adds wryly. "Those who dismissed it as a low-incidence disorder are now being forced to sit up and take notice.”

In India concrete steps towards autism happened with the Action of Autism—a society set up by Merry Barua in 1991. Parents can detect traits of autism in their children, if the child shows two or more of the following symptoms, says she.

1. Absence of warm and joyful expression
2. Does not respond to his/her name
3. Refrains from making eye contact
4. Babbles incoherent phrases, has unusual voice quality, tone and pitch.
5. Does not show and tell.
6. Indulges in repetitive behaviour.
7. Has a special fondness for symmetry

“Autism can’t be treated with medicines”, says Mythili. Dr. Malliah agrees, but, behavioural and speech therapy help moderate the severity of symptoms. “Children with autism do not benefit with learning by rote method. They need instructions based on applied behaviour analysis with a strong focus on structured teaching and experiential learning”, says Barua. Caring for a child with autism is resource intensive and often these children need to work upon the skills they possess. “However, these children might need special care and attention through out their lives”, says Dr. Mallaiah.

Societies for autism in New Delhi

Open Door
url: http://www.autism-india.org/afa_opendoor.html

School of Hope
CPWD Complex
Near Chinmay School
Vasant Vihar
New Delhi 110 057
tel: 26143853, 26151572
e-mail:tamana@mantramail.com

Action For Autism
Pocket 7 & 8
Jasola Vihar
New Delhi-110025
Tel: 91-11-65347422
Tel: 91-11-40540991, 40540992
Email: actionforautism@gmail.com
url: http://www.autism-india.org/index.html

Well-behaved kids

You can learn many things from children. How much patience you have, for instance.
Franklin P Jones

All children have episodes of bad behaviour, some more frequently, severely and others less. It’s just a fact of life! As parents you can’t escape scenarios when your child will act in annoying or hurtful ways and refuse to co-operate with your requests. It’s normal for parents to fly in rage at such instances, but rage does not help, instead complicates the matter further. A good understanding of normal problematic behaviour can help you respond appropriately and more sensitively to your child at a time when she needs you most.

There is a growing epidemic of bad manners among school children. Teachers are complaining that their students, some as young as seven, are speaking to them in the same familiar way they speak to their friends. Dr Arti Anand, consultant clinical psychologist with Sir Ganga Ram Hospital says, “Young children imbibe behaviour of parents. If parents behave badly, children are going to learn that.”

Tell-tale symptoms

• Using bad language
• Behaving aggressively or violently
• Destroying property
• Lying
• Stealing
• Refusing to cooperate with necessary tasks, such as getting dressed in the morning, going to bed at night or doing schoolwork.

Causes

Why my young one is becoming difficult these days? If the question bothers you, experts have answers. Children try to grab attention, wrest power and sometimes seek revenge through their bad behaviour. Rude behaviour is also a garb for lack of confidence and feelings of disappointment.

Seven steps towards better-behaved children

1. Explain limits. When your child doesn't understand what you expect, explain your reasons. Make polite requests for changing misbehaviour, and be specific and concise. Say, "Please play with the ball outside, not inside, because something might get broken."
2. Provide a reminder. When your child forgets a rule, tell him the rule again. Explain what happens if the rule is not followed. After you have reminded her of this rule, place her in the stroller if she breaks the rule again.
3. Take your time. If you find yourself angry or frustrated with your child, "take time." Take a deep breath, count to 20, or give yourself five minutes away from your child to cool down before you respond.
4. Aggression hurts. Never strike your child in anger. This teaches your child that aggression is okay. Dr Arti points out, “ Sometimes the teenagers become aggressive and out of control if their demands are not met. Again if parents do not spend quality time with their children or are unable to communicate with them, children tend to be frustrated and aggressive.”
5. Time out. Learn to use the "time out" method to help your child regain self-control. Give your child some time alone, not as a punishment, but as an opportunity to recover from a bout of misbehaviour. Try to discuss the behaviour problem constructively with your child.
6. Take a break. Allow for some breaks in routine to reduce boredom. This gives children a chance to experience fun and variety, and still lets them return to the security of familiar routines afterwards.
7. Just ignore. Ignoring misbehavior is an effective way to deal with fighting between siblings and misbehavior that is directed at getting attention. Children do need attention. Children, who do not get enough positive attention will settle for negative attention, e.g. yelling, brought on by misbehavior.

As parents we strive to give our children what we didn’t have in our growing years. Sometimes in this struggle, children miss out on what we had in our growing years—time of parents. Children are malleable and inculcating good behaviour is not difficult after all, but like all episodes of parenting it is going to test your patience. Amen!

Scouting for summer camps

Summer vacations are here. With schools closed and long summer days outstretched before us, parents are in look out of activities and engagements to keep their children busy, and what better way to do that than to enroll them in a summer camp. Normally, schools offer summer camp for their students, but the neighbourhood children are also welcome to enroll. While some schools like Excelsior American School allow students to invite their friends and cousins to enroll in the summer camp. Arti Anand, psychologist Sir Ganga Ram Hospital says, “Summer camps provide an opportunity to children to engage their minds in creative and active pursuits away from the indoctrination of TV. They learn new things which makes them confident” Normally, children believe summer vacation is for watching and re-watching runs and re-runs of their favourite shows and to fiddle with their cool videogames. “Normally children stay indoor these days. By enrolling in an active sport like horse riding or skating they get the much-needed reprieve from TV and the necessary exercise”, says she.

Namita, spokesperson for Alpine school says, “The whole philosophy behind summer camps is to keep children busy by engaging them in creative pursuits without encumbering them with the burden of studies.”

Shopping for summer camps

Many playschools in conjunction with various hobby classes spring summer camps in these months to cash on the trend. They may be a viable option as they are in the neighbourhood, still if you are deciding on summer camp, it is advisable to talk to your children and explore their areas of interests.

• Activity—the kind of activity in the camp should be in sync with the interest of the child. Gitanjali Dogra, manager with Amadeus school Gurgaon, says, “Amadeus school offers sporty activities like horse riding and skating, and have facilities of swimming pool for children and parents alike.”
• Counsellor—As goes with any group-based activity a moderator or counsellor is assigned to a group. The group should be large enough to foster interaction and small enough to be monitored. Ideally, seven to eight members in a group suffice.
• Duration—Summer vacations are meant for unwinding and relaxing. A camp engaging children for a duration longer than three-four hours and more than four weeks thwarts the purpose and begins to double up as day-care.
• Transport—You got to find about the pick-up and drop facilities. Alpine school offers free transport on their bus route, informs Namita.
• Meals—Will the children get some refreshments at the camp or will they need to carry their own?
• Amount of activities—Any camp that boasts of doing too many activities will not do justice to even one.
• Cost— Summer camps come at a tag of Rs. 500 per week to Rs. 1500 per week.
• Flexibility—Will the programme allow you to enroll for a week or two or you have to enroll for a month?

Before scouting for summer camps it is a good idea to have a heart-to-heart talk with children on what they wish to do. After all, children should be interested in the array of activities that are on offer in the summer camp to make most of it.