Tongue Tie, Nosebleeds, Reading Skills – PediaCast 370
- This week we answer more of your questions! Topics include tongue tie & breastfeeding, enlarged adenoids and frequent nosebleeds. Then Dr Colleen Carroll joins us with tips on stimulating a child’s interest in books and strategies for boosting their reading skills. We hope you can join us!
- Tongue Tie
- Enlarged Adenoids
- Nasal Voice
- Reading Skills
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike.
Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio.
It is Episode 370 for March 8th, 2017. We're calling this one "Tongue Tie, Nosebleeds, and Reading Skills". I want to welcome everyone to the program.
We're going to start out with some answers to listener questions for you this week. And I know some of you out there like, "It's about time. He asked for more questions at the beginning of the year and we get a string of interview shows after that. Where are our answers?"
Never fear, they're coming your way today. I have some of them today. And then, I have another round of them that I'll answer next time. because you guys always come through. When I ask for questions, you always send them in and we got some great ones. So, I'm really excited to get to them today and during our next program as well.
So that's coming your way. I'll still do an interview for your this week because I have lots of people reach out to me. And they're like, "Can you talk about this? Can we get this on the show?" And there always great topics. And they're ones that I know parents want to hear about, including the one today.
Dr. Colleen Carroll is going to join us during the second half of the program. She has a doctorate in education. And she's a reading coach for parents and has a lot of terrific tips and strategies for stimulating a child's interest in books and reading and really boosting their reading skills. When she approached and said, "Hey, can I talk about how do get kids to read and improve their reading?" I'm like, "Yeah, I want to do that." At the same your guys are sending me all your questions.
So we'll try to get everything. Stay tune for that conversation about reading coming up more toward the end of the program.
First though, answering your questions truly is my favorite part of doing this program, because I love empowering parents with information. And you, guys, always have such great questions. There are no silly questions. Really the heart of this program is to help parents understand. That's what we're really all about, really health literacy.
And our first listener question relates to tongue tied babies. What exactly is a tongue tie? How do you know if your child has one?
What problems can it cause, particularly with regard to breast feeding? But it can cause other problems, too. Tongue tie can be associated with kids not being able to get their tongue out of their mouth and can't stick their tongue out. Other kids, might be difficulty in ice cream cones. Some kids even have difficulty with language and speaking if their tongue is really tied down.
We're going to approach the question really as it relates to breastfeeding because that's what our listener was concerned about. But just keep in mind tongue tie can be a problem for older kids as well.
So, we're going to talk about what it is, what options do you have, what do you do about it, if anything. How do you know if you need to do something?
And as it turns out, that process of making a decision is often more important that the decision itself especially in healthcare. So we'll explore how you'll look at risk and benefits and make a decision in the context of tongue tie and breastfeeding but that same process of making a decision can really relate to so many other things.
And we've talked about this before on this program. It's been at least a year I think since we talked about risk-benefit analysis. And it's always an important consideration. So, that's coming your way.
We also have a question about adenoids, tonsils and adenoids. I know I didn't mention that in the title of today's program. Consider it a bonus topic. But listener has a mother-in-law who thinks her grandson's nasally voice could be the result of enlarged adenoids. Could that be? And if so, what should mom do about it, again, if anything?
Now, of course, we don't tell parents what to do on PediaCast. We talk about the topics in general. We talk about possibilities and risks and benefits, how you make that decision in partnerships with your child's doctor. So, we'll talk about all the different things that enlarged adenoids can do and when you might consider having them removed, and when it might be better just to leave them be, and why that is as we think about risk and benefits. But ultimately, we always encourage you to talk to your child's pediatric provider, have them take a look and evaluate and help you along the way. But we can talk about enlarged adenoids in general.
And then, our final listener question this is in regard to frequent nosebleeds. Now that I think about it but I should have pulled an ENT doctor into the studio today. And we're talking about tongue tie, adenoids and nosebleeds. But you're going to get the general pediatric perspective today. That's all I got for you. But that's why you're here, right?
So, I just realize it's all ear, nose, throat stuff. Okay, maybe next time. If there are any ear, nose, and throat doctors listening to this program today — and I know we have in the past — if I say anything out of line as we consider tongue tie, adenoids and nosebleeds, please write in and set me straight. I'll do my best to cover those topics.
And then, as I mentioned after our three listener questions on ENT topics, we have a great interviewee to present to you on the program. Dr. Colleen Carroll is going to talk tips and strategies for getting kids interested in books and boosting their reading skills. So lots coming your way this week.
Before we get started I do want to remind if you have a topic you'd like us to talk about, it's easy to get in touch. Just head over to PediaCast.org and click on the Contact link.
Also, I want to remind you, the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So, if you have a concern about your child's health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.
Let's take a quick break and I will be back to talk more about tongue tie, adenoids, nosebleeds and then reading skills. It's all coming up right after this.
Dr. Mike Patrick: Our first question this week comes from Rose in Baltimore, Maryland. And Rose's story is a little bit on the long side, which is fine. There's nothing wrong with that, I enjoy long stories. But I intentionally left it long because I think, the whole story really has to be taken into account as we approach the answer. And just the frustration that Rose is experiencing is one I think will resonate with them, any of you. So, here's what Rose has to say.
"Hi, Dr. Mike, I'm a stay-at-home mom of a nine-month-old and has been listening for just over a year now. I have some questions about tongue ties and infants. When my daughter was born, the hospital had a couple lactation consultants on staff. Before we left, they checked and assisted me with her latch. They said all it well each time they stopped in. And when the time came for us to go home, we left with our little bundle.
"Once home, my daughter nursed all the time but had only gained an ounce at her first weigh-in. At her next weigh-in, she'd actually lost a couple of ounces. At that point, our pediatrician said it was possible she was still undergoing a normal minor drop in weight, post-birth and it will pick back up within a few days. He told us to come back soon to check the weight again. And if her weight continue to drop, then we begin supplementing with formula, pump breast milk or both.
"Between this appointments, after one particular rough afternoon feeding, I took advantage of a hospital's lactation services and my husband and I went to see the lactation consultants once again. When we weighed in upon arrival, I was dismayed to see she had dropped a few more ounces.
"The lactation consultant then did another evaluation and concluded my daughter had a posterior tongue tie. She told us there is only one dentist and one ear, nose and throat doctor in the whole city who did the procedure to fix it. And most pediatricians were uneducated about posterior tongue ties, so our child's doctor might not be on board.
"She explained that in-depth knowledge of tongue ties in babies went away along with midwives when women began birthing in hospitals and when formula feedings was in vogue. She shared that most pediatricians only learn about very obvious tongue ties in medical school, and not about once like our daughter had.
"We made appointments both with the ear, nose and throat doctor and our daughter's pediatrician and I began to pump and bottle feed her in the meantime, supplementing with formula as needed. When we visited the ear, nose and throat doctor, he would not put an exact term to what he was seeing. He did not mention the word posterior tongue tie or a degree of tongue tie but merely call it a bump and offer to do the procedure.
"When we pressed for exact terms on what he was seeing, he said something about not getting too caught up in the labels. He also told us that many pediatricians were not aware of posterior tongue ties for the same reasons the lactation consultant gave. He said tongue ties were often the undiagnosed cause of latch issue. He seemed kind and professional became highly recommended. But his lack of specificity about our daughter's own tongue tie gave us pause.
"Sure enough, when we met with our pediatrician, she examined our baby's frenulum and did not see a tongue tie during her evaluation. She said some babies struggle with nursing and it may take this kid sometime to get it down, and that was likely the problem. She said frenulotomies are common recommendations from lactation consultants these days when babies struggle with nursing. But the procedure was almost unheard of ten years ago, and she did not think it necessary.
"In the end, we went with our gut and the pediatrician and did not have the procedure done. When went back to a lactation consultant for other strategies to help my daughter nurse, I did not receive much help because it was her belief that we needed surgical intervention. When I was there, I also encountered other moms of young babies who'd received the same advise we had and had already made appointments for the recommended procedure for their babies.
"As time passed, I continued to pump. Then my daughter's experience worsening colic and I became desperate to get her to latch. I eventually paid out of the pocket to see a different lactation consultant, but she also believe that many pediatricians had missed out on important information about tongue ties back in medical school. She was very accommodating.
"She did not provide a specific diagnosis for our daughter but merely helped me create an alternative plan to get my baby to latch, as a I had requested.
"By this time, my daughter was very attached to the bottle and was going to an extremely fussy state to boot. The latching plan was difficult and time consuming, but I was committed. We kept with it. And I felt like I began to see an improvement. Then a family emergency occurred. I no longer had the time or emotional energy to devote to the scheduled pumping, supplementing, and getting a very angry baby to attach, all the while attending to her other needs and dealing with everything else that was going on.
"Fast forward to today, and my daughter is a happy nine-month-old and I exclusively pumped breast milk. Things are much easier these days as my supply is established, so I can go longer periods without pumping and she is no longer colicky. However, when I think about the future, I doubt whether this method would be sustainable if we have a second child with the same problem and demeanor. And I wonder at times if we made the right choice. I'm not sure I'd make it again the second time around.
"I'm wondering if you have encountered this controversy and what you think about it. Is it possible this is an issue that really has been overlooked or is it a fad?
"Is there any research available that parents in similar situations should take into account when they receive contrasting opinions from professionals as we did? Are there negative consequences of getting a procedure like a frenulotomy done on a baby so young? What is required of pediatricians in terms on keeping current with the new or, as suggested in this case, old information they might have missed out on during their initial formal training?
"I'll truly any input you might share. Thank you so much for your time. Sincerely, Rose."
Well, thanks for the story, Rose, and all the questions associated with it. It sure does sound like a frustrating experience. And as I mentioned it probably resonates with many listeners out there who have similar stories. Maybe not in regard to tongue tie, but just with getting different opinions and not quite sure what to do and then looking back at the whole thing and wondering, "Should we have done something different?" So, that's something that a lot of people deal with when they encounter medical issues.
And so, I want to begin, first, let's just cover tongue tie. And then, we'll talk about the going through that risk-benefit and trying to figure out what to do. We've done that before in this program but I think this is a great opportunity to reinforce these principles.
So, the first thing, you've mentioned frenulum. I think everyone can sort of picture, if you look at the bottom of the tongue where the tongue is connected to the floor of the mouth, there some tissue there. And if that tissue is really tight and firm and what this ear, nose and throat doctor would call a bump, it can sort of tether down the tongue making it more difficult for the tongue to raise in the way the babies need it to raise when they latch and when they nurse.
And that's what we would call a posterior tongue tie. So, you look in there and there's just a bump or a flap of tissue that's very firm and does inhibit movement of the tongue to some degree.
And then, an anterior tongue tie, so anterior just means more forward and posterior means more back or deep in the mouth. So an anterior tongue tie would be that frenulum or that flap of tissue that connects the bottom of the tongue to the floor of the mouth. It comes farther forward so you can really see that tissue and see it tethering the tongue to the roof of the mouth.
Now, the anterior tongue ties are pretty obvious and you can see those underneath the tongue because that tissue is coming forward. And a posterior tongue tie can be a little bit more difficult to figure out that what's going on because there's not much tissue to see, just a little bump. And most babies aren't really cooperative with opening their mouth wide and lifting their tongue up so that you can get a good look. So it can be a hard thing to appreciate.
Then, a frenulotomy which Rose also mentioned is just a procedure of releasing that tissue so that the tongue is not tethered anymore. So you basically make an incision in that frenulum which frees up the tongue.
The pediatricians learn about this during their training. Most formal medical training in medical school just forms a base of core knowledge. Where you really learn to practice medicine is during your residency training, where you're seeing patients day in and day out, just lots and lots and lots and lots and lots and then lots more patients.
That's what we call the practice of medicine because you really are practicing as you see all these folks, and you start to form patterns in your brain. And you're taking the experiences of your mentors that are teaching you into account. And also, looking at that research and what the evidence would suggest. And it's how medical training continues as we come across problems and we look things up.
We're required to do continuing medical education on a regular basis. So, here on the state of Ohio, physicians need to document that they've done 50 hours of Category 1 Continuing Medical Education training every year. There's a lot of training that goes on, but we can choose what kind of Continuing Medical Education we want to do.
And I would encourage folks to listen to PediaCast CME where we do offer free Category 1 Continuing Medical Education for healthcare providers over at PediaCastCME.org.
But my point is you might not come across tongue ties as you're doing this because there's so many things competing for our interest. So that gives you a little bit of an idea of tongue ties and the training that's involved in how we learn about tongue ties.
Now, as we think about the research, here's what we can go into a little bit of a problem. It ends up being that there was a study recently that looked into a large group of kids with tongue ties and another large group of babies who did not have tongue ties. And then, just look to see that they have latching breastfeeding problems.
And latching and breastfeeding problems was more common in the kids with the tongue ties. So about 25% of the kids with tongue ties had difficulty breastfeeding. So about quarter of them. But that means that 75% of them did just fine, that they did not have any problem with breastfeeding despite the fact that they also have a tongue that was a little more tethered down.
And compare that to babies who did not have tongue ties — so they had just have normal freely moving tongues — and only about 3% of those kids that had a problem with nursing, with latching.
So it is more common to have problems with tongue tie, but it's also not a universal problem. There are plenty of tongue tied babies who did do just fine latching and nursing. So there's more of an association, there's more to it that just tongue tie equals difficulty.
And a lot of pediatricians have seen kids who have their tongue tie fixed, and yeah, it made a huge difference. And it helped eliminate latching and nursing problems and everything was great afterwards. And you do hear that story.
And a lot of other kids have their tongue tie fixed and it doesn't eliminate any problem at all. They have just as much problem as they did before. And there's not really a good way to predict which of those kids are going to do well after the procedure and which ones aren't.
Now, if there was no risk to the procedure, you would say, "Okay, fine." Maybe it will little help. 25% of kids with tongue tie do have nursing problem. We know breast milk is best. We want to maintain mental sanity and have our kids or babies latch and nurse well because it's really stressful when that is not happening.
And so, why not just do it? Why not just do the procedure, Fix the tongue tie? If it works, great. If didn't work, then at least we tried.
Well, the problem with that is it's surgical procedure. And what if something goes wrong with surgical procedure?
It might require sedation. There is the risk of bleeding into the airway because the tongue is right there by the airway. And so, if you have a bad bleeding episode during the procedure, bad things can happen. You might not heal properly. You may have trouble nursing afterwards because of pain. It might not heal correctly.
So there's all of these other variables that go along with surgical procedure, which are risks. Now, to be fair, they're not risks that happen very often. Most babies who have a surgical procedure like this, like release of a tongue tie, do just fine.
But there's a number of them, a subset who don't do fine and they have complications. And then, you have to ask yourself when that happens, "Did I do the right thing?" because, maybe it wouldn't helped at all and you just put your child through this procedure that is potentially dangerous.
And so, you really have to look at the risks and the benefits and what you risk tolerance is, with the realistic look at what those risks and benefits look like. To some degree, that's going to depend on where a family's priorities are. If you have a family that, "Breastfeeding, success in breastfeeding is really really important to me. And I want my child to have breast milk. Maybe I don't enjoy pumping. I really do want my baby to latch. This is really important to me." Or, "It's causing significant emotional stress in our family because of this problem."
And then, you look at, okay, the surgical procedure has some risks. It might not help. It costs money. It can be dangerous but those are minimized. So, for that family, getting the procedure done and trying it… And there was a waiting room at the lactation consultant she talked about, Rose, who that's the way that they went. That it was the risk was worth the benefit for them.
There's going to be other families that are like, "I can't take the stress. I also can't take the risk of the surgical procedure of my baby. And you know what, I'm just going to pump and feed with the bottle." And for that family, that's an okay decision.
There's going to be others and say, "This is just too much. I'm going to give up on breastfeeding. I've tried, I've gone to two different lactation consultants. We tried this. I'm gone to pediatrician. I really don't want the surgical procedure done, and we're going to switch to formula."
And you know what? That's okay, too. Breastmilk is absolutely best. It provides immune support. It's the right mix of fats for good baby brain growth. But are there millions and millions of babies who are now healthy adults who grow up drinking formula? There are.
Absolutely, I want to support breastfeeding moms. And, in fact, I just did a Continuing Medical Educational podcast on just that very topic over at PediaCastCME.org, Episode number 24. We actually had an internal medicine and pediatric physician. So, she is IM-Ped certified, so board certified Internal Medicine and Pediatrics. And she happens to be an advanced lactation consultant. And we spent an hour talking about how doctors can best support breastfeeding moms and the problems that the moms are likely to run into including tongue tie and what kind of advice that we can give the moms.
Obviously, there's times when we need to send breastfeeding moms who are having difficulty to lactation consultant who really know their business. But how can we help? How can we support? How can we help solve problems as primary care doctors and providers? And that's what that Continuing Medical Education podcast was all about.
By the way, for moms who are having difficulty breastfeeding or just want to learn about breastfeeding before your baby's born, it'd be a great podcast to listen to. Again, the target audience is providers, but it's one of those things where I think that it would be helpful for parents, too, especially if breastfeeding issues are important to you right now.
So, my point is just that I'm pro-breastfeeding. Don't get me wrong about that. But the art of medicine dictates that we really need to have that humanistic component and take each family as an individual and realize that there's also risks in all these stress and all these guilt when things aren't going well.
And when a family is seeing they're getting this opinion and that opinion, and seeing different lactation consultants and people are telling them different things and their pediatrician who they trust the most is telling them something else, and it just causes such grief, and pain and guilt. And so, sometimes, we need to say, "Look, that's also bad for your child's brain growth and for your family." And so, as we look really at the whole picture, we have to take all of them into account.
So, I do think that pediatricians know about tongue ties. We learn about them. We learn about both the anterior and posterior tongue ties. But we also learn about looking at risks and benefits and making decisions, and those decisions are going to be different from one family to another.
So, I hope that helps, Rose. It's a difficult topic for sure, and as I said, I think a lot of people can really understand your frustration because it may not be tongue tie but there lots of other topics and considerations and decisions that we've come up with in medicine, where the right course of action is not always clear.
Having said that once you do make a decision, don't look back. Look at the risks, look at the benefits. Maybe get a second opinion, but if you're getting third and a fourth opinion, you're just going to confuse yourself more. Find a medical pediatric provider you trust and let them walk through the risks and the benefits with you. Make a decision that's right for your family and go with it. That's the best advice I can give for those kind of situation.
Thanks again, Rose, for writing in. I really do appreciate it.
Dr. Mike Patrick: Next up we have Kelsey in Idaho. Kelsey says, "My son just turned five years old. He has always had a somewhat nasal quality to his voice. I hardly noticed it but my mother-in-law, who is a dental hygienist, pointed it our recently and told me I should get his adenoids checked.
"Do you really think this is an issue? He breathes quietly and does not snore. He does has seasonal allergy which sometimes cause congestion but his voice seems to always sound the same to me. I love listening to your podcast. Thank you — Kelsey."
Well, thanks for the question, Kelsey. So let's consider the adenoids. When we talk about adenoids, usually, they come after the word tonsils, right? We talk about tonsils and adenoids. The reason that one comes after the other is they're very similar sorts of tissue.
The adenoids are located a little bit further back and up compared to the tonsils. So they're sort of located where the back of the throat and the nose meet one another. Not really something that you can see if you open your mouth and look in the mirror. You're going to see the tonsils but the adenoids are little more out of the way back and up.
And their job like the tonsils is a part of immune system. So they greet foreign invaders with the immune systems and stop those invaders in their track before they can get to the lungs or the sinuses or the blood stream. So they have an important protection function, and they tend to get enlarged when they're doing their job, when they're fighting invaders, when we get sick, or if we have allergies.
And because allergy is still the body dealing with just the different sort of invader — it's still the immune system reacting to things like pollen, or dander, or molds rather than infectious organisms — the process is the same. The immune system revs up and the tonsils and adenoids become larger in response to the invasion of the microorganisms or the allergens. So the tonsils and adenoids have an important job protecting you.
Unfortunately, sometimes, they overreact and they get bigger than we'd like them to or they stay big long after their job is over. And in this case, they might cause some problems. And since voice quality, how your voice sounds is a reflection of sound waves resonating through the oral or nasal cavities, they can have an effect on your voice.
They can also obstruct the airway, which can lead to problems of breathing, especially breathing through the nose as we think about the adenoids. Sometimes, the obstruction interferes with sleep and we would call that obstructive sleep apnea.
And another issue with enlarged adenoids is they can push on the Eustachian tubes which connect the back of the throat where the nasal cavity comes in and the middle ear space. If bacteria goes up the Eustachian tubes into the middle ear and can't get back down because the adenoids are now compressing the Eustachian tubes, these enlarged adenoids, then that could result in frequent ear infections.
So, what do we do then for enlarged adenoids and really tonsils too for that matter? Do we simply remove them because they're big and they're staying big? No, not necessarily.
Remember, they're serving an important purpose and taking them out involves some risks. It is after all a surgical procedure. So there's the risk of sedation and infection and bleeding, which can be particularly problematic deep inside the airway.
On the other hand, these risks are minimized with good drugs and good surgical techniques and good after care. But there are risks just the same and it represents — I should mention this, too — a significant cost. You have to take that into account as well when you have a surgical procedure.
So, how do you decide? Like so many things, it's a theme of today's program. Like so many things we talked about, you have to consider the risks and the benefits of both sides of your decision.
As I think about risks and benefits, if my child has significant obstructive sleep apnea, verified by a sleep study, and his lack of sleep is interfering with his life — he's tired during the day, he has difficulty paying attention, perhaps, he's irritable all the time — and I really think these symptoms do stem from his lack of his sleep and he has big tonsils and adenoids, and we've documented he has obstructive sleep apnea and no other apparent cause of his sleep disturbance, then does the benefit outweigh the surgical risk?
And for me as a parent, it probably does. It's probably useful to get the tonsils and adenoids out and the kid whose having daytime symptoms because of their documented obstructive sleep apnea.
Another situation, my baby daughter is having recurrent ear infections and she's been on multiple rounds of antibiotics and they keep coming back. And each time she gets one she has a fever for several days and she's irritable and doesn't eat well, and maybe she's losing some weight. I'm missing work because all of these infections and she's going to get ear tubes anyway. And we know the enlarged adenoids are causing Eustachian tubes compression and dysfunction. Then, in that case, does the benefit of removing them when you're putting the tubes in outweigh the additional surgical risk that you get for taking out the adenoids?
And again, for me, this really comes down to your risk tolerance and someone walking through this journey with you and helping you make this decisions, looking at both sides of the coin. As a parent, for me, if it was my daughter, it probably would make sense to take her adenoids out when we put ear tubes in.
Now, what about voice quality? In a kid who doesn't know his voice sounds maybe a little more nasally, living with a mom or dad who hadn't even really noticed, he's not being made fun of because of his voice and it's not causing him distress or affecting his life in anyway, then in that case, is it worth the surgical risk simply to have his voice sound a little less nasally when that's really not impacting his life?
For me, again as a parent, probably not, especially given the fact that as he gets older the oral cavity's going to grow, his adenoids will likely get smaller, and it will also really get sorted out on its own account.
On the other hand, if I have a older child with a noticeable voice change, and it's causing him distress. Maybe he wants to audition for The Voice or star in the spring musical next year. If the voice change is interfering with the quality of his life and his tonsils and adenoids are quite large and legitimately thought to be the cause, then in that case, is it my decision going to be different? Yeah, it might be different.
So it's important to look at the entire picture and take all of the risks and benefits of your decision into account. Of course, grandma means well. And she could be right, that the enlarged adenoids are making his voice sound a little more nasal. But again, does the risk of adenoid removal justify the outcome that you're trying to achieve? That's a decision that you and your child's doctor should arrive at together.
By the way, Kelsey, be sure to bring up your concern with your child's doctor regardless of which way you'd lean based on my discussion. See if your doctor has a concern with the amount of voice nasalness. Make sure his examination is normal because there are other things that can affect voice quality — things like cleft palate, sinus infections, allergies, vocal chord nodules, vocal chord dysfunction.
So, absolutely, bring up your concerns, that's always a good plan. And then, walk through the cause and the risks and the benefits of possible interventions. Walk through those risks and benefits together with your doctor.
So hope that helps, Kelsey. And as always, thanks for asking the question.
Our next question comes from Libby in Columbus, Ohio. So Libby's a little closer to home. Libby says, "Hello. I am curious about when to worry about a bloody nose. My daughter has always been susceptible to bloody noses. They're understandably worse in the winter when he air is dryer, but she gets them year-round. They're spontaneous. They don't seem to be precipitated by manual manipulation such as rubbing or picking and usually resolve in about five minutes.
"Blood tests a few years ago ruled out any blood dyscrasia but the nosebleed persists and caused her and me some distress. Do we need to re-address this with her pediatrician?"
Well, thanks for the question, Libby. Always appreciate you writing in. I have two observations right out of the gate before we talk about nosebleeds. The first is I commend you for the use of the word dyscrasias. So blood dyscrasias, very nice. For those of scratching your heads, blood dyscrasia is just a fancy way of saying a problem with blood cells or the manner in which those blood cells function.
So with regard to bleeding, when you do have frequent bloody noses, particularly when they're profused and difficult to get them to stop, then we do worry. Are there enough platelets present? Are those platelets functioning correctly since they're so important in blood clotting? Are there any other disorders present which could account for profused hard-to-stop bleeding, things like hemophilia or Von Willebrand disease?
A lot of times when kids do have nosebleed, it's a significant problem, especially if they're profused, frequent, difficult to stop. Then we will look at the bloodwork to make sure that everything with bleeding and clotting mechanisms are working correctly. So that's the reason for blood dyscrasia discussion as we think about nosebleeds.
Second, the answer to the question, do we need to re-address this with her pediatrician? The answer to that question if it goes through your mind is always yes. Always, bring up your concerns, every time, even if the answer turns out to be the same answer that it was before and consists of a lot of reassurance and a reminder of the previous answer, and maybe a more in-depth explanation of the reasoning behind the answer. That's okay. It doesn't always have to… I think sometimes families feel like, "If we bring it up again, then they're going to do a big workup or a big treatment plan." Or, maybe you're expecting that.
So, if you are expecting that, stop. Don't expect it. Just voice your concerns and don't feel like it's a waste of time, of your time, or of your doctor's time because there's a lot to be said for reassurance and peace of mind even if your rehash the same issues a second, third, or fourth time.
On the other hand, maybe you will have new information that your doctor teases out. Maybe there is something a little different about it this time. Maybe the fact that it's happening again, those raise a red flag for your doctor. Maybe there's a new concern that does require a different approach.
And this doesn't just occur with recurrent nosebleeds but really with anything that you've seen your doctor. They've given you some reassurance but you're not quite sure, you have more questions. Absolutely, if you're thinking I need to bring it up again, bring it up again.
Even if the result is the same in reassurance, it's okay. We want to, as providers, we want to hear that kind of feedback and we want to be able to explain things to you. Lot of times, we don't explain everything because there are lots of parents out there who don't want to hear it. They just want the answer. But there are others that really it's going to nag at of them until they understand. And so, that's important to — and the communication really — bring that up with your doctor.
Okay, with those two observations made, the importance of checking blood dyscrasias when there's profused difficult-to-stop bleeding. And if you have a concern, always bring it up with your doctor.
So with those observations made, let's talk about nosebleeds. And as you pointed out, Libby, they tend to be more common in the winter when the air, at least here in the Midwest and in other northern regions, is drier than other times of the year. So the nasal passages have lots and lots of tiny blood vessels that serve as kind of like a heating element to warm the air as it enters the nose. And those little blood vessels can get brittle and dried out when there's a lack of moisture in the air, which can lead to a nosebleed from a disrupted blood vessel.
So if your child is prone to nosebleeds in the winter, extra moisture in the nose may be helpful. You can do that by putting a humidifier in the bedroom. And it's a good idea just to run the humidifier all day. In that way, when they go to bed at night, their room is nice and moist and they're breathing in that moist air all night long.
But if you start the humidifier at bedtime, it may be a couple of hours or more before the room is really humid. So just keep the humidifier going in the winter around the clock and then make the bedroom a nice, moist, environment for him to sleep in.
But don't forget to also wash out the humidifier frequently. You don't want anything growing in there and aerosolizing into the room.
And then the other key is Vaseline. So if you just take a little swab of Vaseline, put it on your finger or a Q-tip, rub it up inside the nose gently, that can help the moisturize the mucous membranes as well. If you use your finger, just wash your hands before and after you apply the Vaseline.
And then, you do want to make sure that your kids aren't, especially in the winter time when their nose is more likely to be dry, make sure they're not rubbing. Now, for some kids, they sleep kind of restlessly and are very active sleepers and then they move their face across their pillow kind of hard, they get a nosebleed in the middle of the night. Not a lot you can do about that other than the moisture. But if you see them rubbing their nose or picking their nose, then you do want to remind them that that can be contributing to those nosebleeds and they need to stop.
And by the way, in terms of picking the nose, all kids pick their nose. It's only a matter of which finger they used and whether you see them doing it or not. So I wouldn't discount nose picking as a contributing factor just because you don't see your child picking their nose and they tell you that they don't pick their nose. Yeah, maybe.
So, as Libby alluded to, the things that she's thought about, nose picking and the dry air, those are all things to think about. So good job on that Libby.
Keep this in mind. This is another important thing with nosebleeds, is they often occur in clusters. And that sometimes causes parents some anguish because it's like my kids keep getting these nosebleeds and what they mean by that is they've had eight nosebleeds in the last two days. But each of those nosebleeds, it's just a little bit of blood and it's pretty easy to stop. They just keep getting them.
And the reason that happens is because when you have the nosebleed, the way that it stops is you form a little clot, and the clot can be fragile, especially if the air is dry. And anything that disrupts that clot is going to make the nose start bleeding again. And so, you have a situation where they'll have several nosebleeds in one day in a span of two or three days. And it's really not until you've gone a few days without a nosebleed that your nasal passages are back to normal.
And so, what's more concerning is when you have a couple of nosebleeds every month and they're spaced out kinds of nosebleeds. So, things have a chance to heal, it's just something's happening again. And that's happening throughout the year and not just in the dry season, and/or they're difficult to stop or they are really profused types of nosebleed. That's more of a concern.
Whereas the little nosebleeds, that you are able to get them to stop, they just keep happening several times a day for a few days. That's more normal until, again, you've gone a few days without a nosebleed and then things are healing and they should stop.
Now, there are some significant things other than bleeding disorders that can cause more significant nosebleed, things like trauma. And sometimes, kids get hit in the nose and don't tell you about it. So trauma is always something to at least keep in the back of your mind.
And you can also have some abnormalities of blood vessels where it's a bigger blood vessel and maybe a brittle large blood vessel because it's a larger one.
And you can also have what we can call an arteriovenous malformation where kind of an artery and a vein come together without a capillary bed in between them. And sometimes, those can bleed profusely.
So, again, if you have trouble getting it to stop or it's profused, you do want someone to look to make there's not been recent trauma, that there's not some blood vessel that can be cauterized, and of course, that there's not a bleeding disorder going on. So, you do want to talk to your doctor about these things and have your child seen if nosebleeds aren't going away.
So, how do you stop them? So these mild nosebleeds that's in the wintertime, they're happening frequently during the dry season, one right after another because we think the clots getting dislodged. What's the proper way to stop a nosebleed? I think it's an important thing for parents to know.
And the first thing that you want to do is pinch your child's nose at the fleshy part of the nostrils. So, not up on the bridge but at the fleshy part.
And there are two reasons you want to do this. One, if the capillary is lower down, you're applying pressure to the capillary by squeezing the nostrils close, so you're applying pressure. The second thing that you're doing when you're squeeze though is — it may not be direct pressure — you want the blood to go toward the point where you pushing. So that it then backs up and applies pressure to the point where it's bleeding, just in case that is a little further up out of your reach from where you can pinch the nose together.
And for this reason, it's important that your child hold his or her head down — so chin on chest sort of thing — and not tilt their head back. And the reason for this is blood flows toward gravity. So, if you lean your head back blood is going to flow backward into where the nose and the throat connect, and your child 's likely to just swallow that blood. And you're not really applying pressure. It can still flow that way. And you swallowing blood can end up leading to nausea and vomiting.
But with your head down, then the blood's going to flow toward the location that you're pinching. And it's going to back up from there as you apply pressure and it backs up because it has nowhere to go. And it backs up to the point where it's bleeding and applies pressure that way or you're applying pressure yourself by squeezing that fleshy part of the nose.
Squeeze the nose, chin on chest, and wait five minutes. And I mean a full five minutes. Set a timer. Five minutes can seem like an eternity with kids, and especially kid who wants to get away. There's an inverse relation relationship between how long five minutes seems in the age of your child.
So if your son or daughter is struggling to get away, as you have them put their head down and you squeeze their nose, try some distraction techniques. You know, sing, count their toes, let them look at a book, or play on your smart phone or tablet. While their heads down anyway, they can look at something.
So, you really you're going to have use your imagination, get creative to get through that five minutes of nose pinch and head down with chin toward the chest. And then, once the five minutes is up, slowly let go. Don't bother the nose, don't rub it with a tissue, no big sniffing, just let it be. The clot's going to be fragile at first, so you just want to leave it alone.
If blood flow returns, so you see blood now flowing back out of the nostril, then just repeat that technique. Another five minutes, nostrils pinched, head down, lots of destruction, full five minutes, slowly release and leave it alone.
And nearly, every time a couple rounds of that is going do the job if you're really doing it right. But if there is a problem that might not help. If you really do have a blood dyscrasia, there's abnormal blood vessel, there had been trauma, then it might start flowing again. And if it does, do it the third time.
But if you get to after three of this five-minute episodes — so now, you've been dealing with this bloody nose for 15 minutes and it really is not stopping — at that point time, it's get some help. Call your doctor or start heading into an urgent care that sees kids or an emergency department. Because, 15 minutes of bleeding when you really are doing this every 5 minutes, it increases the likelihood that there is some serious issue that needs to be corrected and you really do want to get this bleeding to stop.
Now, a lot of kids, by the time mom and dad get to the ER or the urgent care with the child, the bleeding has stopped, and that frustrates lots of parents. But we still say if you're home and it's been 15 minutes and it's still bleeding — 15 minutes, so three of those 5-minute episodes we described — then, start heading in even if your experience is it stops. It's still a good idea to have someone and take a look.
So, that's nosebleeds in a nut shell, Libby. It sounds like your doctor looked and checked for blood disorder. It's reassuring that it mostly happens in the wintertime. Moisturize the nasal passages with the humidifier in the bedroom, general application of Vaseline.
Appropriate treatment of allergies, some kids rub their nose a lot because their allergies aren't being treated well. And so, they can rub their nose and get nosebleeds. Other kids if they don't need the allergy medicine, using it when you don't need it can also dry things out and make kids more prone to nosebleeds. So allergy medicines kind of go both ways depending on whether you really have allergies there or not.
So talk to your doctor about that, about whether you need allergy medicines or you don't need allergy medicines because either one of those scenarios could be contributing to nosebleeds. Again, it's very important to keep your kids from rubbing and picking their nose which can be hard to do. And it can be difficult to elicit the truth about that.
All right, so hopefully that helps. And you understand nosebleeds a little bit better, Libby. As I mentioned, if you have a concern, definitely ask your doctor. Even after listening to this, talk to your doctor. They may have a different take on it or they may find something on the exam that changes their mind a little bit. Always an important thing to do.
And as always, Libby. Thanks so much for writing in.
Don't forget if you have a question, it's easy to get in touch with me. I would love to answer your question, get your comments, your topic suggestion on the program. Just head over to PediaCast.org and click on the Contact link. It just says up on the top there that the tabs of different pages, one of them says contact Dr. Mike. And just click that, fill up the form. I do read each and every one of those that comes through. And we'll try to get your questions or your comments on the program.
Dr. Mike Patrick: Dr. Colleen Caroll holds a doctorate of education and is a seasoned reading coach, with 20 years of experience helping moms and dads make a difference in the lives of their children, with strategies designed to stimulate an interest and boost their ability to read. That's what she's here to talk about today — kids and readings.
So, let's give a warm PediaCast welcome to Dr. Colleen Caroll. Thanks so much for joining us today.
Dr. Colleen Caroll: Thank you so much for having me. It's a pleasure.
Dr. Mike Patrick: Yeah, really appreciate your stopping by.
So, at what age do you think that parents should really start thinking about their kids and reading?
Dr. Colleen Carroll: Well, I always like to say that parents should really start at birth because children need to hear stories right and immediately they come into this world. And one of the most relaxing and thought provoking even from young children — there's research on this — is that reading and modeling read-aloud to even young young baby is very soothing and calming to them and helps establish a lifelong desire or interest in reading.
And as they get older, it's something they get used to. We want to establish those healthy habits absolutely and immediately.
Also, we use a different voice when we read aloud to children, and especially when we read aloud to babies. And that voice is soothing and enjoyable. And so, if we show babies and toddlers that we value reading right from get-go, then sets them up for a lifetime of success.
Dr. Mike Patrick: Yeah. What about reading even while they're in the womb?
Dr. Colleen Carroll: Actually, yes. People say that's a practice that is not a bad a idea to start. And a lot of new moms love that, or moms and dads. Even those dads read to moms who are pregnant. And there's some research that says that babies in the womb can tell that voice inflection, can tell that different soothing voice and actually enjoy it.
So, there's certainly really nothing wrong with that. It's a great practice to get established. And one of the nice things about it, too, is that helps parents really start to build the collection of books that they love for children. So, that once the child is born, they've vetted several different titles that they're going to enjoy reading to the child in young years.
Dr. Mike Patrick: Now, as babies grow up to be toddlers, at what point do you start really engaging them with the books themselves? So, you're not only reading to them but really encouraging them to hold the books and turn the pages and play and explore.
Dr. Colleen Carroll: Once they can. Every child grows a little differently, but once a child is sitting up and is able to grab things or can point, then I would start immediately. So reading allowed should be a habit that parents are doing every single day. Before bedtime is always good, when the child is in the bathtub.
And if a child is able to sit up or hold the book or point to the characters in the books, a parent might ask, "So where is the dog?" when the children are really young and they're starting to identify animals. And the child could point to the dog or point to the cat. And as the child gets a little bit older and starts maybe recognize letters you can say, "So where is the word cat?" or "Where is the C in the word CAT?"
So it's really if they're really able to do it, I'll say yes, I'm involved immediately. And you start to know that when you try.
All right, so sometimes, holding a book is a challenge but you can hold the book and they can do the pointing. Or you can hold the book or they might be able to try to turn the page. It's going to be a little sticky in the beginning, turn the pages hard but we want to get there tactile skills to page turning comfortable nice and early. So start when you feel they're ready.
Dr. Mike Patrick: When my daughter was around this age, we would do what you're suggesting and go to the books and point to pictures and such. And she would get to the point that even before she could read, she could tell the story and came pretty close to what the words in the book were saying.
Dr. Colleen Carroll: Yes, that's a great point. There is something really effective about re-reading books, reading books more than once because that memorization is what helps kids get comfortable with books. They really like to sort of have the comfort of knowing what's going to happen next. There's nothing wrong with re-reading stories. In fact, it builds a healthy fluency for kids. So if they memorized the story, they start to be able to make better word-prints connection. And they love that.
And so, when they memorize some of their favorite stories, it really means that they're learning to love literacy and literature. And that's just one of the steps that's invaluable. We don't want to skip that. So re-reading and helping kids memorize stories is really, it's a fantastic way to get building their love of reading.
Dr. Mike Patrick: How do you cross that bridge from looking at the pictures and telling the story to really getting kids to pay attention to the words and to start to learn reading?
Dr. Colleen Carroll: Well, again, I think every child learns when he's ready at a different time. But what I say is start early. We want to have a long entrance ramp for kids into the world of literacy. So some parents are thinking, "Oh, they shouldn't be learning to read till kindergarten or maybe pre-K." And that's because we learned in school, or build on our learning to read in school, there is this, I think, this idea that kids start reading at age five.
But that's not really true. What is true is the sooner we introduced the fact that letters have meaning, or they represent a sound. And that sound, when you put them together represents words and words say things. As soon as kids start to get that concept, the better they will be to understanding that print actually tells the story. Or print is something that we can learn from.
So usually, between the ages of two, three, four years old, you can start to introduce letters in early books, very early reading books, where there just maybe a letter on the page and try it out. And if the child is really seeming like they're not ready for that, then you can always go back to picture books or plain just wordless books even.
If they're pulling out books or trying to introduce the letters and now, you're losing them, because they are just not ready for that mentally, then skip that. Wait another month or two. What we don't want to do is bore them and what we don't want to do is push them to something that they're not ready to do and have them be turned off from books.
But most of the time, they enjoy it. Young, early kids, they love to be able to read because it's fun for them. So no sense not trying it, even at two, three, four years old, somewhere in there.
Dr. Mike Patrick: Why is there so much variability in when kids begin to read? It's kind of like potty training. There's some kids that get it right away and others, it takes a little longer. Why do you think there's so much variability? And then, also speak to the idea that it's not necessarily a matter of smartness, right?
Dr. Colleen Carroll: Absolutely not. Exactly. I'm glad you said that. Parents do worry that if they're trying to get their child to read at home and their child is just not getting it, they're worried that there's a reading disability. They are worried that maybe their intellect isn't as high as they like it to be. They're worried that reading is not going to be something they're good at. That seems to make sense but it's actually not the case.
So just like everything else that you mentioned, potty training, we would never say that a child who didn't potty train early wasn't smart. It's just that you know what, they're not ready for it yet, emotionally or physically or what have you. It's the same thing with reading. Like anything, reading is a skill that needs to be built upon and that needs to be learned and crafted and honed over time.
So a child who doesn't take a soccer ball really well automatically in the beginning could still be a phenomenal soccer player. They just need some practice. And same thing with reading. It's something that we practice to get good at. So, don't fear and just keep practicing and read aloud.
And what's really critical is modeling, particularly for children who may be a little bit slower to learn to read or slower to understand concepts, or friends are slower to read. Parent read-aloud is one of the most important things you can really do, if you just focus on that. All children will come along in their own time.
Dr. Mike Patrick: Yeah. Are there particular strategies that parents can use to really encourage kids to read and boost their reading skills? Is there a certain plan that parents ought to follow?
Dr. Colleen Carroll: Sure. Well, what I try to tell parents is look, we don't expect you to be reading teachers. You didn't get to college to get a multi-year degree in how to teach kids, really how to be a reading teacher. But that doesn't mean that you can't do miraculous work at home to help your child be a reader. It's just going to look different than what a reading teacher, let's say, at a school does.
So because of that, there are some things, and these are the things I'll tell you now that I think if parents did these things, the child would just skyrocket with reading.
As I mentioned earlier, modeling. So reading allowed every night from both fiction books and non-fiction. This is a pretty critical points here, because stories are fun to read. They kind of have a beginning, a middle, and an end. And the end is interesting and that fiction stories are what a lot of people gravitate to. But the non-fiction books are also really important, because non-fiction or books about true things — like books about dinosaurs, for example, and snakes, and kids love all animals — they're also modeling for kids reading in the real world. So an adult, we do more non-fiction reading most of us than actual fiction reading.
So that's an important strategy that we start with kids right away, is getting them comfortable with those stories and the real world stuff, so that they can grow in their background knowledge and vocabulary.
Also, asking a child's questions about what they're reading. So as you read aloud, you can stop and predict to get to a really good point in the story and say, "Hey, what do you think is going to happen next and why do you think so?" Not just so, what's going to happen next but what makes you think so? Because that will get the child thinking about what he's already heard, or he's reading also what is already read and being able to really synthesize the information. That'd be great for the brain also.
Just so you know, I have two e-books out on my website. One's called Chaos to Comprehension and it's about getting kids to learn how to comprehend, if they're really struggling with that. Another one is From Frustration to Fluency, and it's about modeling for fluency. And a quick tip on that is whenever you're reading aloud, parents who are reading aloud to their kids, they're really modeling not only how to be a good reader but how to use voice inflection, when to stop at punctuation, when to use a question mark. Your voice goes up, right?
So that's an important strategy also that parents can use to boost reading skills. And it make kids love reading because it's fun.
Dr. Mike Patrick: Yeah, yeah, absolutely. What about the kids who are sort of reluctant to get involved in this process where they'd rather be playing with their Legos or playing video games? And maybe you didn't start right from the beginning. How can you sort of encourage them to enjoy reading?
Dr. Colleen Carroll: Well, I definitely believe that it's never too late. It does get harder as they get older if it wasn't a focus for you earlier on as a parent, but it's never too late. So I've got lots of good strategies for that. First of all, I really do focus on, part of my work is working with family to kids who are already sort of addicted to video games, or addicted to screentime. And I help parents set parameters around screentime so that they can have other healthy pursuits take place, such as reading, that don't now because the child is on the screen too often.
So that's definitely a large piece of my work. So once we get control over managing screentime in the home, then what I suggest to those parents of reluctant readers are several kinds of books that may not feel so book-y. So for example, graphic novels are really popular now, and they're not the cartoons of yesteryear. There really are good literature in a graphic novel sort of cartoon type of format.
And there's lots of series out there that if you just Google graphic novel for your age group or you ask the local librarian, they'll be able to point you in the direction of them. And they're so popular, particularly with the boys reluctant readers.
Also, any book in a series. So once your child gets hooked on a particular series, and there's so many of them out there also that are really popular these day. But once they read one, they tend to stay within the series because they don't have to re-learn the characters. They don't have to re-learn the setting. They can just kind of keep going with the story that never seems to end.
So series can be really popular. Two other strategies are the youth humor. So lots of books that are fun out there will get kids more interested in the drama. So if there and then, drama type stories for kids who are really reluctant. If we can lighten up the reading by making it funny and giving them opportunities that will make them laugh, they tend to gravitate to that more.
And finally, they'd be using audio books and e-readers, a little bit of technology. I tend to shy away from recommending that too much, particularly for kids who are already kind of screen addicted. But if really, for some kids that they're so hooked on screens, that the only way they're going to read is maybe read on an e-reader, like a Kindle or a Nook, then I say by all means, don't avoid it. Just better doing that than playing Minecraft.
And it's a lot like, let's say, you're going on vacation. Well, rather than having to carry three or four books, you can bring one e-reader and have several books downloaded on it. So it can be a unique tool like that.
Dr. Mike Patrick: Great, great suggestions. How do you tell if a kid is reluctant because they don't have an interest or because there really is a reading or a learning problem? And you had talked about some kids just take a little bit longer than others to get reading and sort of get into it. How do you know that there really is a problem there?
Dr. Colleen Carroll: Well, that is very tricky. That signs that children are either not enjoying reading or because there's a comprehension or fluency issue or something more serious such as dyslexia or another type of reading problem, children will avoid. So they will be consistently avoiding reading and doing anything else but.
So if you see constantly avoidance, you know there's something going on, because while kids will develop into a being a reader at different times, most kids even they are developing more slowly will still enjoy looking at picture books, will still enjoy looking at books. So if they're really avoiding it, that's a good sign that something else might be going on.
Also, if they get angry or fearful or anxious, one of those three things or combination of those, when you bring up reading, there's something going on. So a child that shows anxiety, let's say over reading, they get stressed out. They get nervous. There might be some avoidance tendencies. They seem fearful or they tend to snap at you over asking them to read or if they want to read. Those are really good signs that there's something more going on than just "Ah, I don't like to read."
Now, if you're really concerned about a reading problem, the best thing to do is have an expert test your child. That can be done in the school or it can be done privately. But the only real way to determine if there's a dyslexia issue going on or another deep-seated reading issue is to go through a battery of test that can be a strong determinant of the actual problem.
Dr. Mike Patrick: And sometimes parents have to really be an advocate for their kid to get that testing done.
Dr. Colleen Carroll: For sure, for sure. Because what happens in schools is, we don't want to label kids too early. And we recognize that there are so many different reasons why a child might not be reading early on. And so, we don't want also over-test them. So what schools will do is kind of postpone assuming that there's a reading problem and way to see if they've tried everything else, to ensure that the child is really just not maybe a slow-to-mature reader, or we need to find just another way to hook him or her.
But if a parent at home is finding that they're seeing so many symptoms, and they really, really want the test, then they really should speak up and speak to the people that matter such as the classroom teacher, maybe the reading teacher. Certainly, the building principal if they're feeling like they're not getting anywhere. Most schools have a school psychologist. So there's different avenues that you can go to but make sure your voice is heard.
Dr. Mike Patrick: I think it can be easier, too, for some parents to say, "Well, they're good with other things and other areas," And sort of ignore the issue and say, "You know, it's okay to keep playing the video games," and maybe even, "I'll play the video games with you." And to some degree, that's great time with your kid, but there can be some additional problems that stem from reading difficulty if we ignore the issue. What are some of those issues that can pop up?
Dr. Colleen Carroll: Well, let me put it this way. A child who doesn't like to read and isn't really encouraged to love to read as a youngster, it's very rare that he or she is going to suddenly develop that love in high school, college, or beyond. So the importance of developing at a young age is really significant.
Also, if you're not at least a proficient reader, it's very easy to fall behind in school because everything we do in school today including math revolves around reading. So math word problems is a perfect example. You can be good at math word problems if you can't start discerning what you're reading and know the vocabulary.
Also, everything that we focus on, every content area in school, has its own vocabulary. Math, science, technology, all those sort of non-reading type of subjects that people think, they all have very specific important and high level academic vocabulary. That, if you're not a reader, you're not be able to grasp those words and you're not going to be able to be successful. So for education purposes, it's critical.
Also, what winds up happening, if children don't read at an early age and at least at proficient level — and what I mean by that is keeping up with the on-grade level work — then they wind up developing coping mechanisms around not reading that make it really hard to tell that they're not a reader.
Kids get really good at doing all kinds of wily things to get out of reading when they're a non-reader or they don't like to read or when reading frustrates them. And these coping mechanisms may work for the moment and they may fool teachers, and they may fool parents but they don't help them later on in life. So, they're not going to help them in college, for example.
So if the child is avoiding or copying other kids or memorizing things that you or other people say and using what they've memorized to get through, let's say, a class, that may work for the moment and they fool some people, but it's going to hurt them later on.
Dr. Mike Patrick: Yeah, good.
Dr. Colleen Carroll: And just a final…
Dr. Mike Patrick: Yup.
Dr. Colleen Carroll: And the problem is lifelong interrupted learning. So when they go out in the workforce, there's always going to be necessity to read. Even very labor intensive jobs, my plumber and my electrician, for example, I chat with them and they come over to work at my house. They're always pulling out manuals. And they always are reading blue prints, and they're always reading directions. Everything that comes in box has lots and lots of directions. I have to pull those out and read it.
And I often chat with them and say, "You know, your job is pretty reading intensive." And they'd agree that even though their job is so manual, they have so much reading to do. And a lot of people don't think about that.
Dr. Mike Patrick: Excellent points.
For the parents who are running into difficulty and they just want some coaching on how to get their kids interested and motivated and boost reading skills — and you've mentioned you have a couple of e-books available — tell us more about your program, Innovative Reading.
Dr. Colleen Carroll: Sure. I'd love to. So on my website, InnovativeReading.com, I have a blog that is consistently updated weekly with brand new writings that I do. Within every blog article that I post has a free download of cheatsheet or a checklist or some place I'm sending you to for lots of information. And these blog articles and free downloads are full of great strategies and tips that parents can easily do at home that make reading fun and interactive and help kids stay off screens and stay off the video games.
And so I invite all a parents to sign up for that because it's free and it's consistent, and there's all kinds of stuff that you can do or pursue. So that would be to go to my website at InnovativeReading.com and just put your name in where it says Get My Free Download, and you'll be on my email newsletter list.
I have also two e-books on my website that are super user-friendly. They're more like e-workbooks. So once you open and buy that, they are about $14 each, I think. They're about 30 pages. You can print them right off on your computer. It gives you excellent, sort of in-depth. It's for the parent who kind of wants to be a little bit hands-on.
But the feedback from parents is if they follow even some of the strategies, they see kids just take off in their comprehension or their fluency depending on which e-workbook you buy.
Finally, I'm putting out a teleseminar coming out in the end of March. So, if you get on my e-newsletter, my free teleseminar will be a 90-minute call where we'll walk through, one, my really big step. I had a whole system coming up called Stop Nagging and Get Your Child Off Screentime and Learn to Love Books. But the free teleseminar is going to be one my best strategies, 90-minutes in-depth, roll-up-your-sleeves, let's really talk about how you can boost your child's interest to around a level of a passion in order to start to enjoy reading.
And I invite all parents to sign up on my website so I can send you information for when the date is chosen and you can be one of the first people to sign up, to get on that free call.
Dr. Mike Patrick: Great. Again, folks can find this information at InnovativeReading.com. And we'll put a link in the Show Notes for this episode, 370, over at PediaCast.org, so parents can find it easily.
Dr. Colleen Carroll, parent reading coach and also the brains behind Innovative Reading, thanks so much joining us today.
Dr. Colleen Carroll: It was a pleasure. I appreciate it. Have a great one.
Dr. Mike Patrick: Wow, that was a big show this week. I want to thank all of you for taking time out of your day and making PediaCast a part of it.
Also, thanks to our guest, Dr. Colleen Carroll, parent reading coach with Innovative Reading. Really appreciate her sharing some tips and strategies for helping kids get interested in books and boosting their reading skills.
Don't forget, you can find us in all sorts of places. Wherever you found us, we're also in iTunes, Google Play. You do want to check their podcast directories, not their music directories. We're on iHeart Radio, Stitcher, TuneIn, most mobile podcasting apps for iOS and Android.
We're also on social media — Facebook, Twitter, Google+, and Pinterest — and appreciate you connecting with us on those places and sharing our content with your own online audience or your connections on social, so that other parents can find the program and maybe ask questions if they have to and suggest topics which will benefit the entire audience. They might be thinking of something that we aren't thinking about but we can certainly use and learn more from.
So, please share the show, really do appreciate that. In addition to the social media spaces, we also really appreciate it when you talk us up face to face with your family, friends, neighbors, co-workers, babysitters, daycare workers, grandparents, anyone who has kids or who takes care of children.
And that does include your child's doctor. Whoever your pediatric provider is for your kiddos, make sure you let them know you found an evidence-based pediatric podcast. Target audience is moms and dads. But we do have a lot of providers in the audience as well.
And we have a show for them, PediaCastCME — Continuing Medical Education. It's at PediaCastCME.org, but it's also in iTunes, Google Play, iHeart Radio, all those places we mentioned, both shows are available. And pediatric providers can claim free Category 1 Continuing Medical Education Credit for listening to those programs.
And again, one of those programs, one of the recent ones was on breastfeeding. And I think a lot of parents might be interested in that one as we had an advanced lactation consultant in the studio talking with us. You'll find that over at PediaCastCME.org.
All right, thanks again for stopping by. And, until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.
Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.