YOUR HOME FOR QUALITY PEDIATRIC CARE • SPRING 2022
Welcome to The PediaMag.................. 2 MENTAL HEALTH COVID’s “Devastating Impact”......... 4 BREASTFEEDING AND VACCINATION Shots Protect Moms & Babies......... 6 ALLERGIES Spring Allergies............................... 8 FOOD Sustainable Foods........................... 10
FEEDING DIFFICULTIES When Your Child Won’t Eat............... 12 SCHOOL CONCERNS What to do when you worry about school................................... 14
Publication Provided by:
Welcome
Welcome to The PediaMag March comes in like a lion and goes out like a lamb. Or maybe this year March is taking turns daily with lion weather and lamb weather. However, one thing that doesn’t change is spring allergies. In this issue of The PediaMag, Dr. Russell Traister gives us a good reminder on how we can best handle our and our children’s springtime allergies. We also have an abundance of valuable information about how to get your children to eat and to make good healthy food choices thanks to occupational therapist Amy Zurasky and nutritionist Jennifer Yoon. And what about school? Do you find yourself worrying about the struggles your child has been having at school this year? Dr. Bethany Ziss has some advice for parents to help their children get the help at school that they need. And as always, we bring you updated COVID-19 information regarding masks, and how our kids are holding up with all of the changes. At AHN Pediatrics, we are here to give you the best possible pediatric care. If you have any questions about anything you read in The PediaMag, please talk to your pediatrician!
About Us: Pediatric Alliance was formed in 1996 when eight individual practices joined together to provide quality health care throughout Southwestern Pennsylvania. Over the years, Pediatric Alliance grew to be the largest physician-owned group pediatric practice in the area. In 2019, Pediatric Alliance joined with Allegheny Health Network to allow expansion of resources in order to stay abreast of the latest technology and advances in health care. Our board-certified pediatricians offer primary care to children and adolescents in 18 offices in the Pittsburgh and Erie areas including 14 primary care offices and 4 specialty offices - Allergy, Endocrinology, Developmental Pediatrics, and Dermatology. We are proud to offer personalized, patient-centered care to patients from birth to 21 years of age. We strive to meet your family’s pediatric needs, provide convenient access to care, and build strong relationships with families to maximize your child’s health. To learn more about AHN PediatricsPediatric Alliance, visit our website at www.ahnpediatrics.org.
AHN Pediatrics-Pediatric Alliance 1100 Washington Ave., Suite 219 Carnegie, PA 15106 www.ahnpediatrics.org
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The PediaMag is published quarterly, copyright 2020. All rights reserved. Publisher AHN PediatricsPediatric Alliance
AHN Pediatrics • Spring 2022 • www.ahnpediatrics.org
Editor Rebecca Scalise
Art Director Brent Cashman
New & Expectant Parent Classes Increase your knowledge and confidence as you prepare for the birth of your baby. Receive helpful tips to calm a baby, ease fussiness, and much more! Advanced registration is required for these complimentary classes. Make sure to register early to reserve your space. www.AHNPediatrics.org
All classes are free and conducted online via Zoom. Login information is provided upon confirmation of registration. Visit www.AHNPediatrics.org for class schedules and registration.
BABY BASICS
BREASTFEEDING 101
Expectant parents can meet with a physician and receive basic information about the care of their newborn and what to expect while they are in the hospital.
Learn all about the how-to’s and benefits of breastfeeding, both short-term and long-term, for Mom, Dad, and baby. Be aware of some challenges you may experience breastfeeding to be prepared for your journey and make decisions about your baby’s feeding.
JOURNEY TO TABLE FOOD
BREASTFEEDING: REWARDS AND REALITIES
Starting solids can be scary! There is so much information about what to feed baby, when to feed baby, and how to feed baby, that it can be overwhelming. This fun and informative discussion will help you understand the role of complimentary foods in your baby’s first year of life and navigate the best feeding choices for your baby and family.
Expectant moms and their partners can meet with a Board-Certified Lactation Consultant and gain knowledge on how to successfully initiate breastfeeding from day one.
AHN Pediatrics • Spring 2022 • www.ahnpediatrics.org
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Mental Health
COVID’s “Devastating Impact” By Dr. Ned Ketyer Previously posted at www.ThePediaBlog.com on February 17, 2022
Ever since the American Academy of Pediatrics declared a national emergency in children’s mental health in October, evidence has been piling up that the pandemic is making things much worse. A recent study from Canada showed that mental health care services for anxiety, depression, psychotic disorders, and substance use in children and teenagers all increased since the start of the pandemic. Rising rates of despair in children might just be the tip of the iceberg. Lei Lei Wu discovered: “Given the chronic and cumulative nature of distress on mental health and well-being, the impact of the pandemic on
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the mental health of children and adolescents is likely not yet fully realized,” [study author Dr. Natasha] Saunders and colleagues emphasized. In an accompanying editorial in JAMA Pediatrics, Dr. Tami Benton and colleagues sound the alarm for an urgent and sustained response to the mental health crisis in the United States and elsewhere: The immediate effect of the COVID-19 pandemic on children and adolescents has been significant, but the long-term effect will be more devastating without urgent action. Globally, 2.2 billion children have been or will be directly or indirectly affected by the COVID-19 pandemic and its sequelae. Saunders
The pandemic has exacerbated these challenges by increasing fear, grief, isolation and economic hardships. Some children spent months out of school, and their access to health care and social services has been even more limited. Child psychologist Julie Kaplow fears the number of bereaved children across the nation will only grow larger: Nearly two years into the pandemic, we are now facing a silent epidemic of grief in children, or what I refer to here as “psychological long COVID.” Across the nation, over 167,000 children experienced the death of at least one parent or caregiver to COVID, including 2,887 youth in Louisiana. The majority of these losses have taken place among Black and Hispanic families, many of whom were facing health disparities and higher death rates even prior to the pandemic, making them even more vulnerable to mental and behavioral health issues.
and colleagues and other researchers have sounded the alarm. We cannot wait to respond to the distress and escalating mental health and suicide crisis. Prioritizing children’s and adolescents’ mental health demands a transformational societal and systems solution that protects the future. Surgeon General Vivek Murthy, M.D. has been sounding alarms of his own about widespread mental health challenges affecting America’s youths. Melissa Jenco reports on some of the reasons why the crisis has become so severe: Dr. Murthy noted increases could be due in part to more willingness to discuss mental health, but he also cited growing use of digital media, drug and alcohol use, limited access to care and societal challenges like income inequality, racism, gun violence and climate change.
Dr. Kaplow looks for “red flags” that impair daily functioning, indicating the need for a clinical evaluation and possible therapy: In younger children, this may involve difficulties eating or sleeping or separation anxiety, such as refusing to leave a caregiver’s side. For older children or adolescents, this may involve constant tearfulness, extreme social withdrawal or excessive risk-taking behaviors. Other red flags include signs of post-traumatic stress such as nightmares, avoiding reminders of the person who died, hypervigilance or appearing numb. Finally, any expression of a wish to die would require immediate attention from a trained clinician. Kelly Livingston followed Dr. Murthy to a senate hearing, where the surgeon general said that vastly expanding access to highquality, affordable, and culturally competent mental health services will be required in order to repair the devastating harm caused by the pandemic: “Our obligation to act is not just medical, it’s moral,” Murthy said. “It’s not only about saving lives, it’s about listening to our kids who are concerned about the state of the world that they are set to inherit. It’s about our opportunity to rebuild a world that we want to give them, a world that fundamentally refocuses our priorities on people and community and builds a culture of kindness, inclusion, and respect.”
Dr. Ned Ketyer is the AHN Social Media Medical Advisor and the editor of The PediaBlog which will be 10 years old in August 2022. He started his medical practice in 1990 and was a founding member of Pediatric Alliance, P.C in 1996. Dr. Ketyer retired from practice in 2017.
AHN Pediatrics • Spring 2022 • www.ahnpediatrics.org
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Breastfeeding and Vaccination
Shots Protect Moms & Babies By Dr. Ned Ketyer Previously posted at www.ThePediaBlog.com on March 1, 2022
“CDC recommends that women who are pregnant, are breastfeeding, are trying to get pregnant now, or might become pregnant in the future get vaccinated and stay up to date with COVID-19 vaccination.” Official CDC Health Advisory recommending “urgent action to help protect pregnant people and their fetuses/infants” from COVID-19.
example of nature’s brilliance: protecting the species’ most vulnerable members from microbial harm.
A couple of weeks ago [on The PediaBlog] Dr. Brian Donnelly alluded to breastmilk as “nature’s first vaccine” as antibodies in the mother’s body pass easily into her milk and then into her nursing baby providing life-saving immune protection. In the case of COVID-19, we now know that human milk contains enough SARS-CoV-2 antibodies for up to six months after the mother has been vaccinated to protect her infant from infection with this dangerous virus.
It was assumed that expectant mothers who received COVID-19 vaccines prior to giving birth would pass along protective antibodies against SARS-CoV-2. A new study published this month in the CDC Morbidity and Mortality Weekly Report reveals that babies born to mothers who are fully vaccinated receive excellent immunity. Their risk of hospitalization for respiratory failure and other complications is significantly lower compared with newborns and infants who didn’t receive maternal antibodies (ie. mothers who weren’t fully vaccinated), especially if the shots were given close to the baby’s birthday: Effectiveness of maternal completion of a 2-dose primary mRNA COVID-19 vaccination series during pregnancy against COVID-19 hospitalization among infants aged <6 months was 61%. Effectiveness of completion of the primary COVID-19 vaccine series early and later in pregnancy was 32% and 80%, respectively.
We also know that maternal antibodies are transferred to the baby before birth through the placenta and umbilical cord – another
Maternal antibodies continue to circulate and protect young infants from a variety of potentially dangerous viral and bacterial pathogens, and that protection can last for months after birth, and after babies stop breastfeeding.
David K. Li says the researchers surveyed 20 children’s hospitals in the U.S between July 2021 and January 2022: The results showed that 84 percent of the babies hospitalized with Covid had been born to unvaccinated mothers. The study included 43 infants admitted to an ICU with Covid, and found that 88 percent of them had mothers who did not get vaccinated before giving birth. “The bottom line is that maternal vaccination is a really important way to help protect these young ones,” [Dr. Dana] Meaney-Delman told reporters. We’ve said it before and we’ll say it again: The vaccines are safe, even during pregnancy. COVID-19 is not. Read more about COVID-19 vaccines and pregnancy on The PediaBlog here.
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Breastfeeding Support Line Breastfeeding Support Line 412-325-5616 412-325-5616
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Breastfeeding offers thethe best nutrition and protection for for your baby, butbut there Breastfeeding offers best nutrition and protection your baby, there areare many challenges that can arise in the early days of feeding your newborn many challenges that can arise in the early days of feeding your newborn and beyond. At At AHN Pediatrics, wewe areare dedicated to supporting families and beyond. AHN Pediatrics, dedicated to supporting families throughout their feeding journey to navigate thethe challenges and findfind thethe throughout their feeding journey to navigate challenges and feeding methods that fit the needs of the baby and thethe family. feeding methods that fit the needs of the baby and family. Offering extensive knowledge and training to support ourour mothers in their Offering extensive knowledge and training to support mothers in their breastfeeding journey. breastfeeding journey. OurOur Certified Lactation Consultants (IBCLC) and Breastfeeding Counselors (CBC) Certified Lactation Consultants (IBCLC) and Breastfeeding Counselors (CBC) offer telephone support, virtual Telehealth visits, or in-person consultations for for those offer telephone support, virtual Telehealth visits, or in-person consultations those patients who need additional support. patients who need additional support. IBCLC and CBC providers areare conveniently located throughout ourour IBCLC and CBC providers conveniently located throughout Greater Pittsburgh locations. Greater Pittsburgh locations.
Free Classes for for New Parents! Free Classes New Parents! Breastfeeding: Rewards andand Realities Breastfeeding: Rewards Realities Breastfeeding 101101 Breastfeeding Baby Basics Baby Basics TheThe Journey to Table Foods Journey to Table Foods
Register online at at Register online http://pediatricalliance.com/class-registration/ http://pediatricalliance.com/class-registration/
Allergies
Spring Allergies By Russell Traister, MD, PhD
Though still thawing from a very cold winter and Punxsutawney Phil’s prediction of 6 more weeks of winter, spring is fast approaching. While spring can be an exciting time, with warmer weather and blooming trees and flowers, for allergy sufferers the arrival of spring can lead to unwanted increases in allergy symptoms. The primary cause of spring allergy symptoms is tree pollen. Unfortunately, year after year, spring tree pollen counts tend to be increasing, causing an increase in allergy symptoms. Allergy symptoms in the spring are no different than any other time of year, though they may be more severe. The hallmark symptoms of environmental allergies are itchy, watery eyes and nose. Itching is key as it is due to molecules such as histamine, which are released upon allergen exposure. In spring, ocular symptoms in kids can be particularly severe, sometimes requiring treatment with oral steroids for prompt resolution.
Treatment of allergy symptoms can involve multiple approaches. Avoidance of allergen triggers is ideal to prevent allergy symptoms, but given the widespread nature of tree pollen, that can be difficult to do in practice. Keeping house and car windows closed can help. Minimizing outdoor time can also help, but depending on individual situations, can also be difficult. More recent studies have shown that wearing masks can
also decrease allergen exposure, though eye symptoms might still be an issue. Eyeglasses or sunglasses can be somewhat, but not completely protective. Medications are the next treatment option. Intranasal steroids such as Flonase or Nasacort and antihistamines such as Zyrtec, Allegra, or Claritin are the most effective and both are available over the counter. Monteleukast is another option, available by prescription, though it is not effective for everyone. Allergy eye drops can also be beneficial. If symptoms persist despite medications, allergy shots are another option. Allergy shots are effective for about 80% of patients. After being tested for allergies, your positive test results can be used to mix your allergy serum. While allergy shots are effective, they are a big commitment, especially for the first 3-6 months. Administration of allergy shots requires building up the dose your body tolerates to what is known as the maintenance dose. This requires visiting your doctor’s office 1-2 times weekly, having your allergy shot(s) administered, and then waiting in the office for 20-30 minutes after your shot to ensure you do not have an allergic reaction. After about 6 months of build-up to your maintenance dose your shots can be spaced out and given on a monthly basis. This continues for 3-5 years, at which time a trial of stopping the shots can be attempted. It is also important to note that allergy shots do not take effect immediately and it may take 6-12 months of injections before clinical improvement is seen. In some patients, environmental allergies may also trigger exacerbation of underlying asthma. Allergy shots may be especially encouraged in those situations as shot administration has been shown to decrease asthma exacerbations. Regardless, choosing allergy shots is a personal decision and should be made in consultation with your allergist.
Dr. Traister is currently accepting new patients. He sees both pediatric and adult allergy patients at our specialty office in Bloomfield, at the Mellon Pavilion at West Penn Hospital, 4815 Liberty Ave., Suite 154. He also sees allergy patients at Dr. Petraglia’s office (adult primary care) at 455 Valley Brook Road, Suite 300, in McMurray.
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About Us:
Featured Office for Spring 2022 Featured OfAfRicCeAfD orIS Apring 2022 ARCADIA
How many providers/staff does your office have? 26 About Us: Where is your office located? 9795 Perry Highway, Suite 100 Wexford, PA 15090 How many providers/staff does your office have? 26 When did your office open? Pediatric Alliance Arcadia opened in February 2003. We Where is your office located? 9795 Perry Highway, Suite 100 Wexford, PA 15090 moved into this location in March 2015. When did your office open? Pediatric Alliance Arcadia opened in February 2003. We Does your office offer any special services? We offer Care Coordination, Lactation Support, moved into this location in March 2015. and Newborn Classes. Does your office offer any special services? We offer Care Coordination, Lactation Support, What is something unique about your office, something that your office does together or and Newborn Classes. celebrates? We wear different themed shirts every Friday, and we love celebrating birthWhat something unique about has youraoffice, that your office does together or days. is Everyone here at Arcadia sweet something tooth! celebrates? We wear different themed shirts every Friday, and we love celebrating birthFun Facts about your office: We are in a plaza that is shared with the Dog Stop. We get to days. Everyone here at Arcadia has a sweet tooth! see puppies walking by our windows all day long. Fun Facts about your office: We are in a plaza that is shared with the Dog Stop. We get to see puppies walking by our windows all day long.
FUN FACTS ABOUT ARCADIA PROVIDERS FUN FACTS ABOUT ARCADIA PROVIDERS
Dr. Tony Kovatch: Runs Marathons Dr. Pam Clair: Loves Cycling and Hikes Dr. Tony Kovatch: Runs Marathons Dr. Leslie Soloshatz: Got a puppy last summer because she became an empty-nester this Dr. Pam Clair: Loves Cycling and Hikes year. And she has never had a dog before!! Dr. Leslie Soloshatz: Got a puppy last summer because she became an empty-nester this Dr. Susie Saunders: has a twin, loves gardening, birdwatching (favorites are orioles, blueyear. And she has never had a dog before!! birds, and hummingbirds) and doing anything outdoors with her family. Dr. Susie Saunders: has a twin, loves gardening, birdwatching (favorites are orioles, blueDr. Bill Coppula: Loves spending time with his grandson, and donates hair to Locks of Love. birds, and hummingbirds) and doing anything outdoors with her family. Dr. Mike Petrosky: Loves playing baseball with his son and costume parties with his wife. VolDr. Bill Coppula: Loves spending time with his grandson, and donates hair to Locks of Love. unteers at the Woodlands. Dr. Mike Petrosky: Loves playing baseball with his son and costume parties with his wife. VolAlanna Ellis: Got married in August, loves baking, gardening, and cycling (Peloton) unteers at the Woodlands. Annette Lucas: Loves spending time with her family. Alanna Ellis: Got married in August, loves baking, gardening, and cycling (Peloton) Annette Lucas: Loves spending time with her family.
Food
Sustainable Foods By Jennifer Yoon RDN, LDN, IBCLC
The foods we choose have a powerful impact, positive or negative, not only on our health, but also on our planet. The way a food is grown, processed, and the journey to your table, all impact the earth. As the effects of climate change such as drought, severe weather, and rising temperatures are being realized, a change in the way we approach food systems must be made to reduce our impact on the environment, improve food availability, and protect our resources. The foods you choose to put on your table can make a big difference- even small changes can help in a big way. Sustainable eating puts the focus on foods that are produced in a way that is beneficial for the environment, supports local communities, and is humane to farmers, workers, and animals. Opting for sustainable foods whenever possible can help minimize greenhouse gas emissions, decrease food waste, and reduce
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exposure to harmful chemicals, additives, and preservatives that are abundant throughout the food supply. Some ways your family can choose more sustainable foods include: Eating Local: The less a food has to travel from where it is grown to where it is purchased, the less fuel is used and emissions produced. Though locally grown produce is limited in Western Pennsylvania in the colder months, choosing local as often as possible reduces food waste in transit, increases freshness, and supports local growers and economy. Choose Organic: Organic farming is more sustainable alternative when it comes to food production. The lack of pesticides and wider variety of plants enhances biodiversity and results in better soil quality and reduced pollution from fertilizer or pesticide run-off.
almonds require a lot of water to produce. Soy, Hemp, and Pea based dairy alternatives are the most sustainable and nutritionally complete. Drink from the Tap: Bottling and transporting liquids uses a lot of energy, plastics, and fuel. Drinking water in a reusable container reduces waste and carbon emissions. Choose Fairtrade Coffees and Teas: Coffee and tea are staple crops for many developing countries. Buying Fairtrade ensures the farmers get a fair price for the product and earn an adequate wage. To sell Fairtrade products, farmers have to improve soil and water quality, manage pests, avoid using harmful chemicals, manage waste, reduce their greenhouse gas emissions and protect biodiversity. In conclusion, the American Academy of Nutrition and Dietetics advises “Sustainable food production is incredibly important, not just for the sake of our planet, but also for our health and future as well. According the 2019 EAT-Lancet commission on healthy diets from sustainable food systems, a global shift toward more plant-based foods would help feed the world’s growing population a nutritious and sustainable diet. This plant-based eating style includes more legumes (beans, peas, lentils, peanuts), whole grains, vegetables, fruits and nuts, and less animal-based foods, especially red meat and processed meat. Limiting refined grains and added sugars is encouraged as well.”
Eat less meat: Raising livestock for meat uses a lot of resources. Despite using 77% of agricultural land, only 17% of global caloric consumption comes from animals. Raising livestock contributes to deforestation and disproportionate water usage. Meat consumption is responsible for releasing greenhouse gases such as methane, CO2, and nitrous oxide. The meat and dairy industry accounts for roughly 14.5% of global greenhouse gas emissions. Choose Plant Based Proteins: beans, lentils, and peas are some of the most sustainable foods due to the ease of growth, low water needs, and high yield. They are rich in protein, B12, manganese, selenium, zinc, and copper, as well as fiber. Swapping beans in for beef could potentially help achieve up to 74% of the reductions needed to meet the goals for the greenhouse gas emission targets in the United States by 2020. Choose Plant Based Dairy: As mentioned, raising cattle uses proportionately more resources than it yields. Almond milk is a popular substitute and though almond milk is better for the environment,
Jennifer Yoon, RDN, LDN, IBCLC is a Nutritionist and Certified Lactation Consultant and sees patients by appointment at AHN Pediatrics St. Clair.
AHN Pediatrics • Spring 2022 • www.ahnpediatrics.org
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Feeding Difficulties
When Your Child Won’t Eat By Amy L. Zuraski, MOT, OTR/L
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“Help! My child won’t eat ANYTHING!” is a statement that, unfortunately, is commonly heard in parent circles and pediatric offices alike. Recent studies indicate that 18-50% of typically developing children will present with feeding difficulties at some point during development. While most of us adults can eat mindlessly and without thought to the process, eating is one of the most challenging sensory motor tasks in which a young child will engage. Feeding difficulties can be rooted in several different causes, but if you find yourself with a picky eater, try these strategies: Provide structured meals and snacks: It is tempting with picky eaters to allow them to graze on snacks and beverages throughout the day, especially if you are concerned with weight gain or growth. Unfortunately, snacking can actually have the opposite effect. Children can fill up very quickly and “take the edge off” hunger, ultimately leading to overall decreased intake. Try presenting three designated meals plus 1-2 snacks per day.
Engage your child in the process: Take your child to the grocery store and allow him or her to select a food to try. Make grocery shopping a game (i.e. “Can you find a vegetable that is purple? Can you find a fruit that is round?”). Encourage your child to interact with foods by assisting with simple meal preparation as developmentally appropriated or by serving foods to family members. Children are more interested in trying a new food if they have some ownership in the process. Make small changes with food: Children generally like familiarity and routine, so use this principle with food as well! Make small changes with the foods your child is already comfortable eating. For instance, if your child eats Honey Nut Cheerios, try a different flavor such as Apple Cinnamon Cheerios. Present a favorite condiment like peanut butter with a new “dipper” such as apple slices, pretzels or graham cracker sticks. If your child likes French fries, offer sweet potato fries or tater tots. Reframe the way you talk about food: Avoid labeling foods as “good foods” or “bad foods,” as all foods provide some type of nutrient to our bodies. When presenting a new food, talk about the characteristics of the food such as the color, shape or texture. Try to link these characteristics to foods your child currently likes (i.e. “Look! This raspberry is red just like the strawberries you eat!”). Avoid telling your child that he or she will not like a food. Restructure your language to remind your child that he or she is still learning about that new food. Praise any interaction with a new or nonpreferred food such as touching, smelling or licking.
Eat together as a family: As much as possible, try to eat meals together at the table with your child. Ideally, meals should be conducted in an environment free from distractions such as television and tablets. Use this time to model appropriate meal time behaviors and to engage in conversation with your child. Play with food: While this may not be considered proper table etiquette for adults, children learn by interacting with their environment, and this includes food! Allow your child to engage in messy play with new and novel foods (i.e. finger paint with yogurt, build a face with vegetables, etc.). Repeated and playful exposure to the feeling and smell of foods will increase the likelihood that your child will be willing to taste something new.
While frustrating, some amount of picky eating is expected during development, especially during the toddler years as children begin to develop autonomy and personal preferences. Picky eating becomes more concerning and may warrant the need for intervention if your child is avoiding an entire food group or food texture, losing or not gaining weight as expected for his or her age, gagging or choking on foods or drinks, eating less than 20 foods, or consistently eliminating and not re-introducing foods he or she once ate. Fortunately, there are trained specialists such as occupational therapists, speech therapists, and dieticians who can help your picky eater. A feeding specialist can thoroughly evaluate your child’s skills to determine the underlying cause or causes of picky eating. Talk with your pediatrician regarding appropriate services to address your feeding concerns.
* AHN Pediatrics now provides Occupational Therapy services two days a week in our Greentree offices. If your child is in need of these services, talk to your pediatrician. **Amy L. Zuraski, MOT, OTR/L is an occupational therapist and the Regional Manager of Pediatric Therapy Services for Allegheny Health Network.
AHN Pediatrics • Spring 2022 • www.ahnpediatrics.org
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School Concerns
What to do when you worry about school Dr. Bethany Ziss
Your kindergartener gets a brightly colored “AIMSWEB” report showing skills below the basic level. Your first grader still does not pronounce the “R” sound clearly. Your second grader is reversing letters in writing. Your third grader is spending hours on homework and doesn’t seem to understand the directions. Some children have delays that are identified very early on, and enter school already receiving services. But often concerns emerge in the early grades. It can be challenging to know where to go when you have worries about your child’s academic progress. And while everyone knows what a grade of A or D means in high school, young children often come home with reports using terms such as “progressing” or “mastered” which are a lot less clear. The first step with any concern about academic skills or progress should be your child’s teacher. She or he should be receptive to an e-mail or to schedule a meeting. You can go over report cards, test scores and your observations from home, and your child’s teacher can
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share observations as well as expectations for your child’s grade level. Sometimes worries can be eliminated at this step. For example, some speech sound errors are not concerning in the youngest grades if a child’s speech is otherwise understandable. Some letter reversals are also common as children are learning to read and write. If concerns persist, there are several steps to getting children additional evaluation and support. Public schools provide academic intervention through a program called Title 1, and this is sometimes also available for children attending private schools. This is not considered special education. Typically, the school gives a computerized assessment to all the children several times a year. DIBELS, Aimsweb and STAR are three commonly used tests. Children who score below a cut-off are entitled to additional help in reading, math or both, usually in a small group setting. Title 1 support is sometimes also given to children where there is some concern about academic progress even if they do not score in the concerning range on the test.
Sometimes this process is referred to as “RTI” or “response to intervention” because many children make good progress or “respond” to the support and do not need further evaluation or services. This program is also called MTSS, or Multi-tiered System of Supports. All students receive Tier 1 services, and Title 1 instruction is considered the second tier. Sometimes there are more significant concerns about skills, or children do not make expected progress after trying Title 1 services. Or there may be additional concerns about language, motor skills or behavior. In these cases, schools are required to evaluate children for an IEP, or individual education plan, to see if a child qualifies for special education services. An IEP is considered Tier 3 support because it is individualized to each child. The requirement to evaluate children and provide services if appropriate is part of a federal law, the IDEA, or Individuals with Disabilities Education Act. Children are entitled to a Free and Appropriate Public Education. Here, “appropriate” includes any needed services, accommodations and modifications. Nearly 20% of children receive special education services. Special education is a plan, not a place, and most children who get services are in a regular education class for most or all of the school day. Specific learning disabilities and speech and language impairments are the most common reasons for children to have an IEP. Children can receive speech therapy, work with a special education teacher in certain areas and modifications such as easier work or oral rather than written testing. Children can also get accommodations such as using audiobooks or help organizing their writing assignments. The request for an IEP evaluation needs to be made in writing. It can be a simple letter stating your child’s name and asking for an evaluation for a possible IEP. Sometimes the school will have a form for you to sign which counts as a written request. The evaluation is done by the district or by the Intermediate Unit, an agency in Pennsylvania that supports multiple school districts. The district or IU has 60 days to do the evaluation, not counting summer vacation. If the school thinks an evaluation is not necessary, it has to provide a written explanation. The district or IU can also evaluate children who are enrolled in private schools or homeschooling. The evaluation may include several different parts, depending on your child’s needs. A psychologist may do individual testing, including IQ test and achievement tests to measure academic skills. If there are concerns about attention or behavior in or out of the classroom, a psychologist may also observe your child in class and
other school settings. You and your child’s teacher may be asked to complete checklists describing your child’s abilities and challenges. A speech language pathologist or occupational therapist may also do evaluations. At the end of the evaluation, there is a team meeting of the school staff as well as the child’s family to discuss if the child qualifies for an IEP and what services will be provided. You are part of the IEP team and need to agree to the proposed plan. Older students can participate in their own meetings as well. Parents often ask about getting an evaluation outside school. These evaluations are available but may not be covered by insurance. In addition, schools are not required to follow the recommendations of an outside evaluation, although they are required to review any outside information you provide. A letter from your pediatrician or any outside specialists taking care of your child can provide useful information, but again, schools are not required to follow their recommendations. What to do if the school does not agree your child needs support or does not provide the support you think your child needs? You could agree together to monitor progress for awhile, perhaps one marking period. You could seek out a private evaluation. There is an appeals system including mediation and a legal step called Due Process. Very few families need to escalate concerns to this extent. Every state has a parent support organization which can provide information and support. In Pennsylvania, this is provided by the PEAL Center. (www.pealcenter.org) Their services are free and they can advise you on the process, your child’s rights and steps to take to get additional support if needed. They run trainings throughout the year. PATTAN, the Pennsylvania Training and Technical Assistance Network (www.pattan.net) also provides trainings and has information online about special education rules and regulations. Wrightslaw (www.wrightslaw.com) is a national site that provides a lot of free information as well. Your child’s pediatrician may be able to advise you through the process and also evaluate for medical or behavioral problems that may be affecting a child at school. Children spend a lot of time at school, and when school isn’t going well, it often seems like nothing is going well. I encourage families to nurture their child’s strengths and interests while also working on the challenges. Tutoring and homework are important for growth, and so are scouts, sports, dance and just running around in the park. Getting support, through school, and if needed, outside school, can often make a difference in identifying challenges and helping children succeed to be the best selves they can be.
Bethany Ziss, MD is a Developmental and Behavioral Pediatrician at AHN Pediatrics Multi-Specialty in Bloomfield at the Mellon Pavilion at West Penn Hospital. Dr. Ziss has a strong background in disability advocacy, and throughout her career she has worked to bring a neuro-diversity and disability community perspective to her clinical care.
AHN Pediatrics • Spring 2022 • www.ahnpediatrics.org
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MyChart
Now that Pediatric Alliance is part of Allegheny Health Network, we’re moving from Patient Portal to MyChart. MyChart is a secure online platform that gives you a quick and easy way to connect with our office: • Book appointments • View test results • Communicate with our care team • Request prescription refills • Review your child’s health history • Pay bills and view statements
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Follow these steps to register for MyChart now: 1. Visit mychart.ahn.org and click “Sign Up Now.” 2. O n the next screen, under “No activation code?” click “Sign Up Online” and follow the onscreen prompts. 3. Once you’re logged in, click “Profile” in the top right and then “My Family Access.” 4. Based on your child’s age, follow the instructions to get proxy access.
AHN Pediatrics • Spring 2022 • www.ahnpediatrics.org
