October 03, 2016

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 sucsccessful 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:

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 healthcare needs. We are proud to provide children with special healthcare needs, and even their siblings, outstanding family-centered healthcare.

Children’s Specialized Hospital is a family’s healthcare home base. We are your central resource for all of your child’s healthcare 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 healthcare team will provide a simpler approach to your child’s healthcare. 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. Click here to schedule your feeding evaluation.


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

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