September 14, 2018
My stepdaughter begins Speech Therapy treatment this week. I was wondering what we need to bring. We planned on bringing the ARK Therapeutic tools to be properly trained, but what else is necessary?
Expert's Answer:
This is a common question from parents as they prepare for their first appointment! Here is what we suggest bringing:
- If it is for feeding therapy, we suggest bringing some preferred and non-preferred foods along with the ARK tools they have.
- If it is for speech and language therapy, all you will need to bring with you to the appointment is the ARK tools. Please dress your child in comfortable clothes and have socks in case they go in the gym.
For additional information and commonly asked questions, see our Speech Therapy: What to Expect guide.
May 30, 2018
I have a 17 year old daughter with CRPS/AMPS and I am looking for an inpatient location to help her walk again. Do you take kids age 17? Thank you.
Expert's Answer:
Yes, Children’s Specialized Hospital is one of the few facilities in the country that offers a comprehensive, inpatient Chronic Pain Management Program for children 11-21 with chronic pain. During our 4 week program, our multidisciplinary team works with our patients to increase function, and promote coping skills to help her achieve her personalized goals.
For more information about the inpatient program or to schedule an evaluation with our team, please click here.
by Katherine Bentley, MD
April 04, 2018
I am in the process of getting state insurance for my children and wanted to know how insurance works if I do not have any at the moment?
Expert's Answer:
We suggest you see if you qualify for the Children's Specialized Hospital Benefit Fund until you are fully insured. This program helps make up the financial difference between the rehabilitation a child needs, and what his or her family’s insurance will cover. If eligible, the Children's Specialized Hospital Benefit Fund program can assist with high deductibles, coinsurances, and even copays.
January 23, 2018
My son is now 6 months old, and was born extremely prematurely at 23 weeks. He has been home from the NICU, now for 7 weeks. I want to get my child assessed to see if he needs PT/OT for developmental delays or if they would resolve in due course themselves - can it be done at this center?
Expert's Answer:
Yes, you’ve come to the right place! We have the most Developmental and Behavioral pediatricians in the country and offer PT/OT at 12 sites throughout NJ. You can easily schedule an appointment at www.childrens-specialized.org/request-an-appointment or call 800-244-5373 to have your son evaluated by one of our specialists.
Another very helpful option I would suggest is an Early Intervention Program. This is a resource for in-home evaluation to determine your child’s therapy needs. Early Intervention supports many children who were born prematurely, and can help you understand what additional services may be needed for your child. You can learn more about Children's Specialized Hospital's Early Intervention Program by calling 1-888-653-4463.
by Malia Beckwith, MD
January 04, 2018
I have a three year old child and I was wondering what age are they supposed to speak clearly and start to form sentences and how do I know if he has a learning disability or if I need to take him to see someone. I see that he has a very short attention span its really hard for me to get him to stay still and learn his name and abc's and 123's.
Expert's Answer:
At 36 months of age, we don't expect 100% intelligibility of speech, but unfamiliar adults should be able to understand at least 75% of a child's speech. The child should also be using 3-4 word sentences. This is a general guideline, however, and much growth happens between 36 and 47 months (I don not know the child's exact age).
It sounds like there may be a combination of language and behavioral concerns in this case. If there is even a mild delay in language, attention and learnings can be adversely effected. I would suggest making an appointment for a Speech and Language evaluation and to see a Developmental and Behavioral Pediatrician. These providers can determine if there are truly any areas of concern, and help formulate a plan of treatment.
by Malia Beckwith, MD
December 26, 2017
What’s test are given for ADHD testing and when does child need medication?
Expert's Answer:
An ADHD diagnosis is made when the child is found to meet DSM-5 criteria, which include features of inattention and/or hyperactivity. There are a variety of tools that can assist in making a diagnosis, but ultimately DSM-5 criteria must be met.
To make a diagnosis, the provider usually needs information about the child’s function in multiple settings. If truly ADHD, for example, we generally should see symptoms and dysfunction in both the home and school settings. Before initial evaluation appointments, we ask parents to request completion of the Vanderbilt Assessment Scale by the child’s teacher. This gives the examiner a sense of what is happening beyond the home setting.
The decision about medication should be made after careful discussion between a child’s parent/ guardian and their medical provider. Every case is different, as some children are better able to compensate and use in school accommodations to be successful despite their ADHD. However, if dysfunction is causing significant distress in the home and school settings, leaving the ADHD untreated may result in profound long term consequences to a child’s self esteem.
If questioning the diagnosis of ADHD, the best first step is to discuss with your child’s primary care provider. The provider will help to determine if a specialist is needed to help with diagnosis of treatment. You can then schedule an evaluation with one of Children's Specialized Hospital's Developmental and Behavioral specialists at www.childrens-specialized.org/request-an-appointment.
by Malia Beckwith, MD
December 20, 2017
My daughter is 10 and sometimes has trouble controlling her emotions. Sometimes these meltdowns have apparent reasons (e.g. she worried about a school assignment) but other times they seem without reason and she can't express why she's upset. I've learned that the best thing I can do is remove her from the situation and give her time to calm down. She does well in school and seems to, for the most part, be better able to control herself in that setting. Should I be concerned?
Expert's Answer:
It sounds like your daughter may be struggling with anxiety. Anxiety can manifest differently in children than it does in adults. They may have meltdowns or can be more irritable, and unable to verbalize feelings or worry or fear. It sounds like she is focused on her achievement and wants to do well. I am very happy these meltdowns are not happening at school, but think that she could benefit from working with a psychologist on her anxiety and emotional regulation through cognitive behavior therapy.
It will empower her to be able to verbalize her emotions more effectively, before she reaches the point of a meltdown. This skill is something we all need. I do not think that you should be "concerned" but this is an opportunity to help her learn a valuable skill for the future.
by Malia Beckwith, MD
November 20, 2017
Do you have bilingual counselors (Spanish/English) for individual and group therapy? Also, do you have a sliding scales or take insurance?
Expert's Answer:
Thank you for contacting us regarding psychology services. Yes, we do have limited bilingual therapists available and we do take many forms of insurance. For additional questions regarding bilingual services or payment options within psychology, please contact our Mental Health Access Coordinator at 888-CHILDREN ext. 8878.
by Richard Leit, PhD
November 09, 2017
Hi My Son is 2 year's 3 months old. He is having speech delay and he is getting therapy from Early intervention. We recently noticing that he is getting upset easily and throwing the objects he has around him etc. Its hard manage him during the phase some times he fighting with person who is trying to calm him down. We are worried about this behavioral change.. any suggestions on this much appreciated.
Expert's Answer:
What you are experiencing is not an unusual problem for children with speech/language disorders. As the child is growing, and may be progressing with receptive language skills (what they understand), they may become more frustrated that they are not able to verbally express themselves resulting in tantrums. Sometimes providing an alternative means of communication (sign, picture communication) can help decrease this frustration, and allows you to continue to work on verbal skill acquisition. I would, however, recommend an evaluation by a Developmental Behavioral Pediatrician to help you with behavior management strategies, and to make sure all of your child’s needs are being addressed. I would also recommend discussing behavioral concerns with your Early Intervention Case Manager. Through Early Intervention, sometimes a behavioral intervention, Applied Behavior Analysis (ABA), can be implemented to help teach more appropriate behaviors which promote participation and learning.
by Malia Beckwith, MD
November 08, 2017
When my son started kindergarten he started to show some behavioral problems, he was then referred to the child study team, evaluated and diagnosed with ADHD. At the time he was moved to a behavioral class, each year he has met his goals and slowly integrated into general education classes. He was started on Methylphenidate last year and it has improved his concentration, impulse control, motivation among many other things. My son is 10 y/o now, in 5th grade and he just started his first year, in a new school district, in Gen Ed full time with in-class support. The first couple months went well but some problematic behaviors are starting to appear. At that time his special education teacher recommended going back to a behavioral class. After speaking with the child study team she has since changed her mind. When the behaviors started to emerge a couple weeks ago, I started looking at some of his old assessments from kindergarten. His academic achievements have all been on or near grade level, at times both above and below. As part of his Psycho-Educational Eval he took the WPPSI-III, He scored Verbal 112 Performance 100 Processing 102 FSIQ 103 In his sub-tests I noticed that, Matrix Reasoning he got a scaled score of 7 /16th percentile and his Coding he got a scaled score of 8 /25th percentile. 1) Are these results reliable since the test was taken when he was 5yrs 11mo and potentially in a poor mental state? a) If they are reliable, are these two low scores something that should be further evaluated or reevaluated? 2) Are these subtests related to working memory, and fine motor skills? When asked about some of the current problems he complains that he finds it difficult to write down his ideas, states that he has thoughts but when he attempts to write, they disappear. As well as he has trouble writing legibly at the same pace as his peers. When the are no time restrictions he is capable of neat handwriting but, with poor pencil grip, hand cramping, broken pencil tips and burns through erasers correcting errors. He says there's more to his struggles and frustration, but he is unable to explain and gets frustrated and emotional when trying to. He often says he is, or feels like a failure because he puts in maximal efforts but still cant achieve what his peers around him can. For example when prompted to write 3 paragraphs, he can only neatly write 3 sentences in the time allotted. If he rushes, he states that his handwriting is illegible and he doesn't write complete sentences or thought. 1) If the scores are correct, will the deficits provide an explanation for some of his complaints and struggles? a )To my understanding IQ doesn't vary much, so if these deficits are accurate, How much can be changed with motivation and effort? i) Would it be best to try to find ways to utilize areas of strengths to compensate for the weaker areas? Thank you in advance, I truly appreciate all the help I can get. Everyone who meets my son sees great potential, yet very few have been able to tap into it. We have an appointment with his CPNP to reevaluate his medication and discuss relevant topics, followed by an emergency Child Study Team meeting at the end of this month/beginning of next. In the past, small behaviors appeared then grew exponentially, bridges were burned and relationships were irreparable. In addition, this year's CST is less equipped and experienced than all previous years. I feel like we have climbed out of the valley and we are teetering on a cliff, a month is a long time to wait. My son is afraid his is going to accidentally have a melt down and be sent back to despite his best efforts and other achievements. This means the leg work is on me, so again I thank you very much for time and expertise. I look forward to your response.
Expert's Answer:
My first recommendation would be completion of a full CST re-evaluation, including psychological (cognitive) and educational re-evaluations. I think it is really hard to comment on the meaning of the scores provided, as testing was completed so long ago. Generally the CST will do a full re-evaluation every 3 years, so he is more than due. IQ scores do not change typically over time, but the accuracy of scores obtained at young ages can be somewhat questionable. We have to make sure there is not a specific learning disability that is further impacting his function.
I agree with meeting with his medication provider to determine if a tweak in dose may be helpful, but would also encourage you to speak with the school about having a Board Certified Behavior Analyst (BCBA) conduct an evaluation (a Functional Behavior Assessment or FBA) of your child in his current classroom setting, to better understand contributors to or functions of maladaptive behavior. This information can be used to create a more effective behavior management plan, that may allow him to stay in the current setting, rather than moving back to a more restrictive environment.
by Malia Beckwith, MD
My son, 13, will be starting High School in September. I had to fight the school system to get him an evaluation in 1st grade. They eventually classified him as "specific learning disability". For 7th grade the IEP team recommended he be placed into Reg. Ed. with in class support and accommodations. I was not really comfortable with this and asked that there be a stipulation placed that I could request he be placed back into Resource. It took 5 months of meetings to get them to place him back, and by that time he had failed one subject for the year and almost had to complete summer school because of misplacement. Now the IEP team is again suggesting Reg. Ed with in class supports even though he is barely a C now, so I presented to them a High School for Learning Disabilities that would be out of district. They are fighting me tooth and nail. I want to have a complete evaluation of my son to present that the School District is not equipped nor addressing all his learning disabilities, and that the Out of District HS would be best for him. He was diagnosed at Children's years ago with ADD. I highly suspect Auditory Processing Delay, Dyslexia. He has been having severe anxiety since last year over school. He has a terrible memory and poor fine motor skills as well. Can Children’s Hospital do a complete evaluation for me to present to his school district of his learning issues? Thank you so much!
Expert's Answer:
It sounds like you have gone through a lot in your pursuit of the best services for your child. After hearing this situation, I would suggest a Developmental evaluation so that a Developmental Pediatrician/APN can partner with you to determine how best to help your son.
by Malia Beckwith, MD
April 27, 2017
How do I go about getting a prescription refill for my daughter's ADHD medication?
Expert's Answer:
The easiest way for you to refill your daughter’s prescription is through our Patient and Family Portal! The Patient and Family Portal can be easily accessed on any smartphone, iPad, or laptop at my.childrens-specialized.org/PtAccess. Ask one of our registration representatives for a code at your next visit or email us at PortalHelpDesk@childrens-specialized.org. Once you set up your account you can conveniently request prescription refills, pay your bill, set up your child’s next appointment and much more!
by Malia Beckwith, MD
April 20, 2017
Hi, my daughter was diagnosed with Holoprosencephaly. I was informed it is in the Cerebral Palsy family. What is the life span and outcome of this disorder? She cannot walk or talk. She also has seizures.
Expert's Answer:
Holoprosencephaly is a disorder that results from early abnormal development of the brain where the forebrain does not divide properly into two separate lobes. The severity of the deformity varies significantly from child to child. The life span and outcome of the disorder varies significantly and depends on the severity. In most cases, the babies do not survive to birth. With the least severe cases, the brain may be nearly normal and that individual may have a normal life expectancy.
Many children born with holoprosencephaly will have facial abnormalities involving the eyes, nose, and lip. Evaluation by a craniofacial specialist or team may be helpful. There may also be abnormalities in endocrine function so an evaluation by an endocrinologist may be necessary.
Much of the care for a child with holoprosencephaly involves providing the necessary support to allow her to maximize function and minimize deformity. An evaluation by a pediatric physiatrist would be helpful to thoroughly evaluate the degree of disability, guide therapy services (physical therapy/occupational therapy/speech therapy), and prescribe bracing and equipment to maximize mobility and ease of care, and treat movement disorders and abnormal tone. Optimizing seizure management by a neurologist specializing in epilepsy is also very important for your child’s health and development.
Children with holoprosencephaly will very often times have developmental delays and an evaluation by a neurodevelopmental pediatrician may be helpful in guiding therapy and school services. If your child is under three-years old, therapy services through the Early Intervention Program may be available.
Each child with holoprosencephaly is very unique and a comprehensive team of physicians and therapists can help children with this condition to reach her maximize potential. You can request an appointment online with a specialist here at Children’s Specialized Hospital or call 1-888-CHILDREN (244-5373).
by JenFu Cheng, MD
January 17, 2017
Where can we go or what shall we do to learn about proper holding techniques for a 15 year old with PDD?
Expert's Answer:
It sounds like you are seeking safe handling Applied Behavior Analysis (ABA) intervention. You can consult the Autism NJ website for a list of ABA providers and contact Perform Care (1-877-652-7624) for additional in-home behavioral support.
by Malia Beckwith, MD
January 09, 2017
Hello! My four year old son has been having behavioral issues for quite some time. We thought he would grow out of them, but they seem to be getting worse. He is very defiant against direction, won't listen when we try time outs, has sudden outbursts and will hit. He also won't sleep well- up very early in morning and will NOT go back to bed. We are very frustrated and at our wit's end (add exhausted to the list). I was recommended to reach out to you by his pediatrician. What type of doctor should i call to set up an appointment? I am just not sure if you deal with this? Thank you!
Expert's Answer:
You have come to the right place. I recommend that you obtain a Developmental and Behavioral Pediatrics Evaluation, as certainly more information and analysis is needed to determine the reason for these behaviors, and how to help them. Some common reasons for this kind of behavior include frustration due to limited communication skills (potential history of speech delay), attention seeking (behavior happens when your attention is directed elsewhere), task avoidance (behavior happens when demands are placed on him), or problems with self-regulation due to underlying developmental or behavioral disorder. While awaiting the Developmental Pediatrics Evaluation, I would also suggest seeking an evaluation with a Child Psychologist, who would provide behavioral therapy.
by Malia Beckwith, MD
January 03, 2017
My 7 year old has several "nervous ticks" which include nail-biting, fixing his hair, and leg-shaking. Most recently, he has has several behaviors that fall into the ADD/ADHD symptoms and that seem to be getting worse over time. Most notably, he has increasing difficulty remembering things, distraction, frequent daydreaming, struggle with following directions, trouble understanding consequences, excessive chatter, constant movement, frequent interruptions and he will act or speak without thinking. Notably, he has gotten to be more aggressive towards his brother. I don't want to medicate without a proper evaluation and diagnosis, but am afraid his pediatrician will be going that route to start. Would it make more sense to have my son evaluated by a psychologist, and avoid medications at this time? Would it make more sense to have him evaluated by a psychiatrist or neurologist instead?
Expert's Answer:
As you allude to in your question, obtaining a proper evaluation and diagnosis is essential before embarking on a plan of care. Working with your Pediatrician in obtaining the proper evaluations to rule out any specific medical conditions contributing to your child’s current symptoms and coordinating his ongoing care is important in developing an integrated treatment plan. A good place to start would be to have a psychological evaluation to assess for ADHD and any co-morbid conditions ( such as learning disabilities, anxiety and mood disorders). As part of the evaluation, information about home, school and social functioning (including screening questionnaires, rating scales or more specific testing) will be obtained with specific diagnoses and recommended treatment interventions. Depending on the results of this evaluation, recommendations including psychoeducation, school accommodations, therapy or referral to additional specialists such as Neurology, Psychiatry or a Behavioral Developmental pediatrician for further assessment or treatment may be made.
by Elvira Downs, MD
December 01, 2016
My 6 year old has had motor and some verbal tics for 2 years on and off. He is a very funny, smart, athletic boy who, as he gets older, is becoming more aware of these tics and is exhibiting some anxiety related to doing them in front of others. He has been teased by a classmate as well which has seemingly sparked his most recent verbal tics. We are not sure how to help him.
Expert's Answer:
Tics in fact are quite common in childhood. Tics are a Neuropsychiatric disorder that involves an irresistible urge that must be expressed motorically and/or verbally. While there is some ability to control the tics, urges can be quite persistent. As a first step it would be important to see a medical professional who specializes in tics/movement disorders (Neurologist/Psychiatrist) to obtain a definitive diagnosis and then outline a treatment plan which can include educational and therapeutic interventions and even pharmacological interventions depending on the severity and functional impairment.
Finding a therapist who is familiar with treating children with tic Disorders is important to help both you and your child by providing educational materials and teaching techniques to help the child control tics and/or anxiety which can exacerbate the tics. This would also help him in managing the issues with his peers. There are also educational materials for teachers and schools to use to educate peers in the classroom about the disorder. An important resource would be New Jersey Center for Tourette Syndrome for professional referrals for medical diagnosis, treatment and psychological services. A useful website is the American Academy of Child and Adolescent Psychiatry for additional information.
by Elvira Downs, MD
November 28, 2016
As a loving and concerned Mom of a vibrant 8- year-old boy, I have had my suspicions that he is suffering from ADD. However, for some time, I have tried to suppress this feeling, with hopes that I was wrong. His third grade teacher has expressed some concern that he may be suffering from a learning disability. I truly do not feel that he has a learning disability, but rather a lack of focus and inattentiveness that is hindering him succeeding in some of his studies. The teacher suggested that I have him tested in school to see if there is indeed a learning disability; however, I am hesitant to do this, as he is very conscious of being singled out. I am just looking to get to the root of his issue and help & support him in every way possible – all while NOT letting him know that there may be something wrong, or bringing unnecessary attention to him in school. Should I take him to see his pediatrician for diagnosis, or bring him to a specialist? And secondly, would one of your physicians be able to diagnose him with ADD, as well as determine if there is a learning disability?
Expert's Answer:
Unfortunately 3rd grade seems to be the year when many bright children with ADHD or a learning disability start to suffer academically. There are increasing expectations for self-organization from children during this grade, while the child also encounters increasing academic challenges. Attention deficit hyperactivity disorder- inattentive type (previously known as attention deficit disorder, or ADD) can be diagnosed by the general pediatrician if the pediatrician feels comfortable with their ability to make this diagnosis.
Many pediatricians will make the diagnosis of ADHD, and provide treatment through medication; however, some prefer the child be evaluated by a specialist, such as a developmental and behavioral pediatrician or a child neurologist. The diagnosis generally requires evidence of significant impairment in attention in at least 2 settings (home and school), resulting in performance deficits. I would suggest you start by speaking with your son’s pediatrician to determine next steps. The pediatrician may ask you to complete behavioral rating scales, and ask your son’s teacher to also complete these scales in order to help with the diagnosis.
Learning disabilities are a separate area of challenge, which may accompany ADHD. Examples include specific learning disorders, with deficits isolated to reading, written expression, or mathematics. The diagnosis of a learning disability requires completion of extensive cognitive and academic achievement testing. This type of evaluation is often completed by your School District’s Child Study Team, who will also determine through this process if your child qualifies for any special education services.
As you have long held concerns about the possibility of ADHD-inattentive type for your son, I would start with a medical evaluation to see if this diagnosis is appropriate. I recommend discussing with your pediatrician, to determine if referral to a specialist is needed. If so, our providers through CSH are able to make this diagnosis. If your son continues to struggle, despite his attention challenges being addressed, I would then encourage you to seek a Child Study Team evaluation through the District.
by Malia Beckwith, MD
October 10, 2016
My son was diagnosed with ADHD but I have concerns about him having Autism.
Expert's Answer:
The number of children with ADHD in individuals with autism spectrum disorder (ASD) is estimated to be 30 to 50 percent, depending on the study examined. Clinically, we do often see ADHD symptoms in individuals with ASD, but it is important to remember that the key feature of ASD is social impairment- which may be accompanied by in attention and hyperactivity.
In the situation presented, where there may be co-occurring disorders, I would suggest a multidisciplinary team evaluation. This team consists of a psychologist, developmental pediatrician, and therapy providers who work together to determine the most appropriate diagnosis of the child. This type of evaluation can be scheduled through Children's Specialized Hospital. If you are considering an autism-team evaluation for your son, call 1-888-CHILDREN, extension 2493.
by Malia Beckwith, MD
October 10, 2016
My son is 22 months old. He had an un-diagnosed Arachnoid cyst on his spine which caused loss of movement in his lower body. (C6/7 - T2). The cyst has been successfully removed and now nearly 7 weeks after the operation he is still in hospital in London, United Kingdom, unable to walk or sit up. My family would be extremely grateful if you could provide any information of any programs you may be able to offer us at your facility.
Expert's Answer:
Thank you for contacting us. It sounds as if your son would benefit from our inpatient Spinal Cord rehabilitation program, offered at our inpatient hospital in New Brunswick, NJ. The program at Children’s Specialized Hospital provides intensive and comprehensive rehabilitation services for infants, children, and adolescents with acquired, traumatic, and congenital spinal cord dysfunction. I encourage you to watch the spinal cord video in this video library to learn about our unique program and reach out to your son's current care team about his rehabilitative needs.
There are many challenges of caring for children from different countries. You can find more information about our admission process.
by Michele Fantasia, MD
My 6 year old daughter cannot help herself fidgeting, wiggling, not standing still. She cannot seem to "turn off" her brain at night, she has low self-esteem, get frustrated easily. But she is meeting all the educational markers so far (she just started 1st grade). I am looking for help with making her successful in school and in life. Would coming to your office be a step in the right direction?
Expert's Answer:
You are describing common symptoms of attention deficit hyperactivity disorder (ADHD). This disorder can certainly hurt function academically, but many bright children are able to meet expectations for several years before academics suffer. However, ADHD also hurts socialization and self-esteem, and this is the most concerning factor for your daughter currently. I would recommend an evaluation by a developmental pediatrician in order to clarify diagnosis and strategies to improve function. Request an appointment here.
Additional resources you may want to visit:
by Malia Beckwith, MD
October 03, 2016
My son has just changed daycares due to lack of structure at the other school, they let him do whatever he wanted. In the new school they say he is out of control, banging his head on the walls and not listening or playing with other children. He is 2 1/2. Is there concern for a autistic evaluation?
Expert's Answer:
Certainly a change to a new school setting can be stressful for any child, and exacerbate new behaviors. However, the behaviors you describe may be concerning for autism, or another developmental/behavioral disorder. It is always best to error on the side of caution and seek an evaluation, especially when recommended by the school. If these behaviors are simply related to challenges with adjustment, they should dissipate over the next few weeks. If not, you will be glad you have started the process of determining how best to help your little one.
Start here with general information about our autism program including assessments and evaluations. This page explains the different types of assessments, as well as our unique team evaluations approach.
If you are considering an autism-team evaluation for your child, call 1-888-CHILDREN, extension 2493.
by Malia Beckwith, MD
October 03, 2016
Hi my son was recently diagnosed with cerebral palsy I'm wondering if there is any info someone can email me on cerebral palsy? Thank you
Expert's Answer:
Thank you for reaching out to our team! As a pediatric physiatrist, I work with children who have cerebral palsy (CP) on a daily basis. What is a pediatric physiatrist? We specialize in the rehabilitation care and medical management of children with cerebral palsy and other conditions including brain injuries, spinal cord injuries, neuromuscular disorders, and musculoskeletal. We understand how cognitive and physical disabilities affect growth and development. Our team works with patients and their families to develop and direct an individualized treatment program. We see patients in the outpatient and inpatient settings and in schools throughout New Jersey.
Cerebral palsy is a disorder of movement caused by an injury to the developing brain, before birth, during birth, or during the first 2-3 years of life. Children with cerebral palsy often have abnormal tightness in their muscles or involuntary movements. They often have weakness and problems with coordination. Children with cerebral palsy often develop orthopedic deformities. Though cerebral palsy is “defined” by the disorder of movement, children with cerebral palsy often have other health problems which may include problems with vision, hearing, learning, eating, and toileting. Also, cerebral palsy is a very broad diagnosis including children with a wide spectrum of severity and many different sub-types. That is why a team approach is essential in providing the best and most customized care for a child with cerebral palsy.
The main objectives are often to restore or improve physical function and maximize quality of life. Our physiatrists diagnose, develop treatment plans, prescribe medication, perform procedures/tests and lead a comprehensive rehabilitation team in creating and delivering effective individualized treatment programs. A program for child with cerebral palsy may include therapy (physical, occupational, speech, feeding), bracing, adaptive equipment (walkers, special chairs, wheelchairs, crutches, canes, communication devices/computers), medications, injections, and surgery. Coordination of care with schools and other entities is also essential.
Our Special Needs Primary Care pediatric practice may also be especially helpful in managing the unique needs of a child with cerebral palsy. Search our specialists and request an appointment.
Also, here are a few associations and advocacy groups that specialize in helping children with CP:
- Reaching for the Stars
- Cerebral Palsy Sports and Recreation Association
- Cerebral Palsy International Research Foundation
- American Academy for Cerebral Palsy and Developmental Medicine
by JenFu Cheng, MD
September 22, 2016
My 13 year old son is really anxious about starting middle school. So much so that if he just starts to think about his classes, his schedule, getting to class on time or even home work - he starts to hyperventilate. Almost like a panic attack. School hasn't even started yet and I have no idea what to do. Any advice for this stressed out mom?
Expert's Answer:
Back to school can be stressful for many children and even more so during a transition from elementary to middle, or middle to high school.
Starting a new school year can certainly be scary and overwhelming. But, some kids experience stress far beyond the typical feelings of nervousness. Approximately 13% of children and adolescents suffer from anxiety disorders, which can have a large impact on their academic and social functioning.
There are various potential causes of anxiety disorders, including:
- Genetic predisposition
- Environmental factors
- Temperament (shyness)
Fear and worry are common in children, especially at back to school time. But, it is important to distinguish normal, developmentally appropriate worries, fear, and shyness from anxiety disorders that significantly impair a child’s functioning.
The anxiety disorders commonly seen in children and their associated symptoms are:
- Generalized anxiety disorder: Chronic, excessive worry in a number of areas such as schoolwork, social interactions, family, health/safety, world events and natural disaster, with at least one associated somatic symptom. These children are often perfectionists, seek reassurance, and may struggle with more internal distress than is evident to parents or teachers.
- Separation anxiety disorder: Distress in anticipation of separation from home or significant attachment figures. These children worry excessively about their own or their parents’ safety and health when separated, have difficulty sleeping alone, experience nightmares with themes of separation, frequently have somatic complaints, and may exhibit school refusal.
- Social anxiety disorder: Feeling scared or uncomfortable in one or more social settings, or performance anxiety. These children may have difficulty answering questions in class, reading aloud, initiating conversations, talking with unfamiliar people, and attending parties and social events.
Although anxiety disorders are the most common class of psychiatric illness affecting children and adolescents, they often go undetected or untreated. It can be difficult to make an accurate diagnosis. At Children’s Specialized Hospital, we evaluate and treat the spectrum of anxiety disorders. Our expert staff includes child psychiatrists, advance practice psychiatric nurse practitioners, psychologists, social workers, and licensed clinical therapists. We conduct full, comprehensive diagnostic assessments with the development of a multimodal treatment plan to address not only the diagnosed anxiety, but other associated conditions.
Our clinical approach depends on the age of the child, the severity of the symptoms, and the family's participation in treatment. Parent guidance is typically the first step. This may be combined with cognitive behavioral therapy. Medication is considered when symptoms are severe enough to interfere with the child’s ability to function in school and significantly disrupt family life. We work closely with and coordinate with schools, as well as with referring pediatricians and primary care providers. We also offer psychotherapy to provide a safe, accepting environment for the child to explore his or her feelings of beliefs about self worth and self-efficacy.
Please consider calling our mental health screening dept. - they can help you find the most appropriate care for your son.
Best of luck!
by Elvira Downs, MD
September 22, 2016
My son and daughter in law just found out their baby will be born with Down Syndrome. We are all taking this news really hard. I want to reassure them that this child can have a happy and healthy life. What are some of the ways your hospital can help a child with Down Syndrome?
Expert's Answer:
A prenatal diagnosis of any congenital abnormality or condition is very hard for families. At Children's Specialized Hospital, we want you to know that there are a tremendous amount of resources that await the arrival of your very special grandchild. With the largest pediatric developmental team in the country, our Special Needs Primary Care pediatricians understand the complexities of raising a child with special health care needs. We are proud to provide children with special health care needs, and even their siblings, outstanding family-centered health care.
Children’s Specialized Hospital is a family’s health care home base. We are your central resource for all of your child’s health care needs. Our family-centered medical home treats children birth through 21-years-old, providing comprehensive and specialized primary care coordinating your child’s care from start to finish. Together, our health care team will provide a simpler approach to your child’s health care. Through this partnership, you will receive the best resources and information related to:
- Pediatric specialists providing coordinated care
- Information on health conditions and the latest treatments to better serve your child
- Home care and improved processes
- Equipment and quality service
- Support and respite services to protect and better your health
- Other key local resources specific to your area
We have Special Needs Primary Care centers at two of our locations - Hamilton and Mountainside.
by Matthew McDonald, MD
August 29, 2016
How do I get my 17 year old son, who is on the autism spectrum, to remember brush his teeth everyday, or take a shower? The constant reminders are getting old and I want him to become independent. I know he can do it, we just haven’t figured out the best routine.
Expert's Answer:
We have an APP for that! No, really, we do! And I commend you for looking for ways to ensure your son is independent. Thanks to our Kohl’s Autism Awareness Program, we offer the Healthier Me app - the first and only mobile app which promotes health, nutrition, fitness, and safety for children and teens with autism. Created by the Kohl’s Autism Awareness Program at Children’s Specialized Hospital, this free iOS app available in the Apple store and includes categories for children/teens with autism to track their own daily personal care, healthy eating, fitness and safety as well as access to important Kohl’s Autism Awareness and other autism resources. This useful tool helps a child reach reward milestones through positive actions and reinforcement – establishing good hygiene habits, healthy eating, watching out for food allergies, keeping active, and staying safe. Best of luck with your son!
by Malia Beckwith, MD
August 29, 2016
HELP! My 9 year old daughter is a horrible eater. She has three things she will eat – chicken nuggets, plain pasta and ice cream. This can’t be good for her and we’ve tried EVERYTHING to get her to eat! What can I do?
Expert's Answer:
I feel your frustration. We see many patients who only eat a small range of foods for many reason – taste, texture, difficulty swallowing. There is hope! Our comprehensive feeding program includes a team evaluation and treatment planning for feeding issues. Our team consists of a speech therapist, occupational therapist, registered dietician, and psychology staff. After the evaluation, the team provides the family with meal time strategies to improve the child's eating at home and makes therapeutic recommendations. To schedule your feeding evaluation, visit our Appointment Booking site here.
August 29, 2016
My son isn’t speaking as well as he should at 2 1/2. I can understand him, but no one else seems to understand what he is saying. Should we be concerned about his speech?
Expert's Answer:
A few general points first. There is a lot of normal variation in early child language development. First words may emerge from 8- 18 months– that’s quite a long time frame for a baby/toddler! The average vocabulary of an 18-month-old is approximately 50 words. By two years, or when the child has 50 single words, you can expect to see two word phrases emerging. For example: my ball, daddy gone etc.
It might be a good idea to actually keep a word diary of the word he is saying. And to see if you can see steady progress over time. The progress is important; possibly more important than the number of words he is starting out with. About 15% of otherwise typically developing 2 year olds are considered Late Talkers (that is they are two years old and do not have a minimal core vocabulary of 50-100 words and do not produce 2-3 word utterances). About half of these children who are considered late talkers will catch up by age three without intervention. The remaining late talkers are at risk for persisting delays and can benefit from intervention. Late talkers who are at greatest risk for persisting delays tend to have problems with understanding and expression, an existing family history of language or learning disability, reduced gesture or play skills, and more frequent or lasting occurrences of glue ear.
Our speech therapists are familiar with the developmental milestones that are normally attained at each stage in a child’s life. They provide age-appropriate activities to improve speech, communication, and feeding skills, and are adept at encouraging and motivating patients to reach their goals. I would encourage you to monitor your son’s progress and if he isn’t making steady gains – to contact our experts to schedule an evaluation.
by Malia Beckwith, MD
