Treatment

The earlier the treatment, the better the opportunity to reverse the vision loss. Amblyopia can be treated between the ages of two and six, but the success rate decreases with age. The best results from treatment occur between six months and two years.

Glasses are commonly prescribed to improve focusing or misalignment of the eyes. Surgery may be performed on the eye muscles to straighten the eyes if other means have not been successful.

Eye exercises may be recommended either before or after surgery to correct faulty visual habits associated with strabismus and to teach comfortable use of the eyes. The correction may be followed by patching or covering one eye for a few weeks to as long as a year. The better-seeing eye is patched, forcing the "lazy" one to work, thereby strengthening its vision.

Eye drops or ointment may be used to blur the vision of the good eye in order to force the weaker one to work, although this is generally a less successful approach than eye patching.

Although true amblyopia cannot be cured after the age of six, treatment for older children still can usually improve vision. Treatment of amblyopia after the age of six requires more effort and includes vision therapy. If not treated early enough, an amblyopic eye may never develop good vision and may even become functionally blind.

lead poisoning Lead poisoning is one of the most common and preventable childhood health problems today, affecting more than one million children under age six. More than one-fifth of African-American children living in housing built before 1946 have elevated blood lead levels. Alarmingly, even very small exposures can produce subtle but dangerous health effects in young children.

Lead is a neurotoxin, which means that it will impair both physical and mental function and development. For many years, people assumed that children would have to ingest large amounts of lead before being harmed, but today experts believe even small exposures (such as raising and lowering a window painted with lead paint in the presence of a child) can result in subtle developmental and intellectual delays.

Youngsters ingest lead by licking or eating flakes of old paint containing lead, or by drinking water flowing through pipes contaminated with lead, solder, or brass fittings. Babies who drink reconstituted formula made with water flowing through lead pipes can ingest an alarming percentage of tainted water.

Lead poisoning causes most damage to the brain, nerves, red blood cells, and digestive system. A cumulative poison, it remains in the kidneys for seven years and in the bones for more than 30 years. Several studies have also shown that high levels of lead in the blood can interfere with a child's growth; poisoning during critical periods of bone and brain cell growth can seriously interfere with a child's development.

Lead poisoning in children is particularly serious because it does not take much to harm a child— and the potential damage to the child's developing neurological system is much more serious. Furthermore, the danger of lead poisoning is especially great with young children, who tend to put everything into their mouths, including contaminated lead dust and flecks from old lead paint. Worst of all, there may be no symptoms of lead poisoning for a very long time until the damage has already been done. Because its effects vary wildly from one child to another, it is almost impossible to predict how an individual child will fare.

Lead Prevention

The most effective way to protect children from lead poisoning is to prevent lead from building up in blood, tissues, and bones. The Centers for Disease Control and Prevention (CDC) recommends testing every child at 12 months of age, and if resources allow, at 24 months. Screening should start at six months if the child is at risk of lead exposure (for example, if the child lives in an older home built before 1960 which has peeling or chipping paint). Decisions about further testing should be based on previous blood lead test results, and the child's risk of lead exposure. In some states, more frequent lead screening is required by law. The CDC in 1991 identified a number of reasons for testing a child for lead poisoning, including:

• child lives or regularly visits a house built before 1960 being renovated or that has peeling, chipped paint

• sibling or classmate is being treated for lead poisoning

• child lives with someone whose hobby includes exposure to lead, such as making pottery or stained glass, working in auto repair or bridge or highway construction

• child lives near industry likely to release lead

• child received treatment for foreign object in ear, nose, or stomach

• child often swallows nonfood items

• any child under six with unexplained developmental delays, hearing problem, irritability, severe attention deficit, violent tantrums, or unexplained anemia

The test will identify how many micrograms of lead are found in one deciliter of the child's blood. Based on what is known today, children should have under 10 micrograms per deciliter (10 mcg/dl) of blood lead concentration. If higher levels are found, there are certain steps that can be taken.

At 10-19 mcg/dl, a child has mild lead poisoning and should be retested in a few months. The home and all the places where the child spends time should be checked for lead sources, and identified lead hazards should be controlled. Frequent wet cleaning and hand-washing will help reduce lead dust. Good nutrition can help the child fight lead.

A blood lead level between 20 and 44 means the child has moderate lead poisoning. Sources of lead in the child's environment must be removed, and the child may need chelation therapy to remove lead from the body. Chelation therapy means the child is given a drug capable of binding lead and reducing its acute toxicity. All drugs have potential side effects and must be used with caution.

A blood lead concentration of 45-69 is severe lead poisoning. A child with this concentration needs both medical treatment and lead removed from the environment.

A blood lead level over 70 is an acute medical emergency. The child may stay in the hospital for treatment and not be released until he or she can return to a lead-free safe home.

While many products contain lead, it is most often associated with paint; until about 1960, all house paint contained some. Lead was added to paint because it helped the paint dry quicker and gave it a shiny, hard finish. In fact, the more lead in a can of paint, the better and more expensive the product—some paints were as much as 50 percent lead.

By the late 1970s the government began to regulate the amount of lead in paint, but nothing was done about the lead-filled paint already on the walls in millions of older homes throughout the United States. It is this lead-based paint (often found in inner-city homes) that causes most of the lead poisoning in children. More than three-fourths of American homes built before 1980 still contain lead paint, and 14 million housing units have high levels of lead in dust or chipping paint— 3.8 million housing young children. If a house was built before 1950, it is almost guaranteed that its paint contains the toxic substance; if it was built between 1950 and 1978, there is a 50 percent chance of lead paint.

The average blood lead level in the general population has been gradually dropping over the past 20 years since lead was eliminated from gasoline, but an estimated seven million tons of lead remain in the soil.

Symptoms

Lead poisoning is usually a chronic problem, building up in the body over a period of time. When a child eats lead, the body absorbs about 10 to 15 percent of the metal, and the rest is slowly excreted. Most of the absorbed lead is stored in the child's bones, with smaller amounts deposited in bone marrow, soft tissues, and red blood cells. If the lead poisoning continues, it will accumulate to toxic levels.

Lead is excreted very slowly from the body, so it builds up in tissues and bones and may not even produce detectable physical effects, although it can still cause mental impairment. If they do appear, early symptoms include listlessness, irritability, loss of appetite and weight, constipation, and a bluish line in the gums, followed by clumsiness, vomiting and stomach cramps, and a general "wasting."

If untreated, the toxic lead levels in a child's body can lead to serious cognitive complications as well, including mental retardation. Babies exposed to high levels of lead before birth reveal impaired attention span, hearing and language ability, and intelligence. After birth, the affected infants may be able to recover, but only if they are no longer exposed to lead. If lead exposure continues, their cognitive performance will continue to be affected for at least the first five years of life.

In addition, some researchers suggest that there may be an association between exposure to lead pre- and postnatally and hyperactivity, behavior disorders, and attention deficit hyperactivity DISORDER.

While lead poisoning is almost always a chronic problem, it is possible—albeit extremely rare—to suffer from an acute case of lead poisoning, when a large amount of lead is taken in by the body over a short period of time. Acute poisoning symptoms include metallic taste in the mouth, abdominal pain, vomiting, diarrhea, collapse, and coma. Large amounts directly affect the nervous system and cause headache, convulsions, coma and, sometimes, death.

Treatment

According to the CDC, unless widespread screening has revealed no lead problems, a baby should be tested at 12 months of age and again at two years, even without symptoms. This is because symptoms may be subtle or nonexistent.

Lead screening includes a simple blood test that determines the level of lead in the blood. A child with elevated blood lead levels, or enough absorbed lead in the body to show symptoms, will probably require hospitalization. Treatment usually includes the administration of medicines (called chelating agents) to help the body rid itself of lead. In mild cases, the chelating agent penicil-lamine may be used alone; otherwise, it may be used in combination with edetate calcium disodium and dimercaprol. Chelation therapy has its risks, however, and must be properly monitored to avoid kidney damage. In acute cases, stomach pumping may be necessary.

What Else Parents Can Do

When renovating an older home, consumers should call an expert to ascertain whether or not there is a lead problem and, if so, how to handle the situation. Because children who live near factories that melt metal may also have a lead poisoning problem, parents who live near a factory can find out if lead is being released from the stacks by checking the Environmental Protection Agency's (EPA) Toxics Release Inventory available at public libraries.

To temporarily reduce lead paint and dust, floors, windowsills, and window wells should be cleaned at least twice a week with a trisodium phosphate

LEAD POISONING GUIDE

The following recommendations have been provided by the U.S. Centers for Disease Control:

Lead Levels

Complications

Treatment

0-9 mcg/dl*

None

Annual checks until age six

10-14 mcg/dl

Borderline (possible test inaccuracy);

Nutrition, housecleaning

risk for mild developmental delays

15-19 mcg/dl

Risk for IQ decrease; no symptoms usually noticed

Test for iron deficiency

20-44 mcg/dl

Risk of IQ impairment increases

Eliminate lead; drug treatment

possible

45-69 mcg/dl

Colic, anemia, learning disabilities

Remove from home until lead

is removed; drug treatment

70 mcg/dl

Vomiting, anemia, critical illness

Immediate hospitalization;

lead removal

*mcg/dl = micrograms per deciliter of blood lead removal

*mcg/dl = micrograms per deciliter of blood detergent available at hardware stores. Sponges used for this purpose should not be used for anything else. Cribs and playpens should be moved away from chipped or peeling paint, mantels, win-dowsills, and doors. Baby furniture that may be decorated with lead paint should be stripped or removed. The child's hands, face, bottle nipples, and toys should be washed often. Children and pregnant women should not be in the area while removing lead paint. Because the seams of imported canned foods may be soldered with lead, which can leach into the contents, they should be avoided.

Children should be given calcium, iron, and protein, with plenty of milk, breads, low-fat foods, and green leafy vegetables, because these diminish lead's effects in the body. In addition, parents should limit the amount of dirt tracked in the home and avoid storing acidic food (such as orange juice and tomatoes) in ceramic or crystal containers that may contain lead glaze. Pregnant women should not drink out of ceramic mugs.

The home's water lead level should be tested; it should not exceed 15 parts per billion. Water should never be boiled to eliminate lead; boiling only concentrates lead. Cold water should be allowed to run only for a few minutes before using, and parents should never cook with hot water from the tap (especially when making baby food) since lead leaches more quickly into hot water. A water-treatment device to remove lead from tap water might be a good investment. If the soil tests high in lead, it should be covered with clean soil and seed or sod.

learning disability A neurobiological disorder in which a child's brain works, or is structured, differently, affecting one or more of the basic processes involved in understanding or using spoken or written language. Such a disability may result in a problem with listening, thinking, speaking, reading, writing, spelling, or doing mathematical calculations. Experts believe that children with learning disabilities have a problem with the way the brain handles information that hinders the normal learning process.

Learning disabilities affect one in seven children and represent a national problem of enormous proportions. Every year 120,000 more students are diagnosed with learning disabilities, a diagnosis now shared by 2.4 million schoolchildren in the United States. Many thousands more are never properly diagnosed or treated, or they do not get treatment because they are not considered eligible for services.

All children learn in highly individual ways. Children with learning disabilities simply process information differently, but they are generally of normal or above-average intelligence. The most common learning disability is a problem with language and reading.

Sometimes overlooked, learning disabilities are often not easily recognized, accepted, or considered serious once detected. The impact of the disability, which can be hereditary, ranges from relatively mild to severe. Learning disabilities can affect many parts of a child's life: school or work, daily routines, friendships, and family life. Some children have many overlapping learning disabilities, while others may have a single, isolated learning problem that has little impact on other areas of their lives.

Learning disabilities are not the same as mental retardation, autism, deafness, blindness, or behavioral disorders, nor are learning disabilities caused by poverty, environmental factors, or cultural differences. Learning disabilities are not curable, but individuals can learn to compensate for and even overcome areas of weakness. Attention deficits and hyperactivity sometimes appear with learning disabilities, but not always. Common learning disabilities include:

dyslexia A language-based disability in which a person has trouble understanding words, sentences, or paragraphs

• Dyscalculia A mathematical disability in which a person has a very difficult time solving arithmetic problems and grasping math concepts

• Dysgraphia A writing disability in which a person finds it hard to form letters correctly or write within a defined space

• Auditory and visual processing disabilities Sensory disabilities in which a person has difficulty understanding language despite normal hearing and vision

More than one in six children will encounter a problem learning to read during the first three years in school, according to the U.S. Department of Education. Currently, more than 2.8 million school-age children receive special education services as students with learning disabilities, which represents about five percent of all children in public schools. However, these statistics do not include the thousands of students who attend private and religious schools, nor does it include the scores of students who may have serious problems with learning but who may not meet the criteria established by school districts to receive special education services.

Symptoms

The earlier a learning disability is detected, the better chance a child will have of succeeding in school and in life. parents are encouraged to understand the warning signs of a learning disability from as early as preschool, since the first years in school are especially crucial for a young child.

There is no one indication of learning disabilities. Although most children have an occasional problem with learning or behavior, a consistent pattern of the following problems may suggest the need for further testing:

Preschool:

if the child has problems

• learning the alphabet

• rhyming words

• connecting sounds and letters

• counting or learning numbers

• being understood when speaking to a stranger

• using scissors, crayons, or paint

• reacting too much or too little to touch

• using words or using phrases

• pronunciation

• walking up and down stairs

• talking (identified as a "late talker")

• remembering names of colors

Elementary School:

Does the child have trouble with:

• learning new vocabulary

• speaking in full sentences

• understanding conversation rules

• retelling stories

• remembering information

• playing with peers

• moving from one activity to another

• expressing thoughts

• holding a pencil

• handwriting

• handling math problems

• following directions

• remembering routines

• reading comprehension

• drawing or copying shapes

• deciding what information presented in class is important

• modulating voice

• neatness and organization

• meeting deadlines

• playing age-appropriate board games

Adulthood:

Does the adult have trouble with:

• remembering new information

• organization

• reading comprehension

• getting along with peers or coworkers

• finding or keeping a job

• sense of direction

• understanding subtle jokes

• making appropriate remarks

• self-expression

• following directions

• reading, writing, spelling, and math

• using proper grammar

• meeting deadlines

Symptoms may appear in only one skill area, such as reading or writing, in many people with learning disabilities. The following is a brief outline of warning signs for possible learning disabilities in specific skill areas:

Attention:

• has short attention span

• has difficulty conforming to routines

• is easily distracted

Auditory:

• does not respond to sounds of spoken language

• consistently misunderstands what is being said

• is overly sensitive to sound

• has trouble differentiating simultaneous sounds

Language:

• can explain things orally but not in writing

• has trouble telling or understanding jokes or stories

• misinterprets language

• does not understand what is said

• responds in an inappropriate manner, unrelated to what is said

• responds only partially to what is said Math:

• has problems with arithmetic, math language, and math concepts

• reverses numbers

• has problems with time, sequencing, or problem solving

Memory:

• learns information presented one way but not another

• has trouble memorizing information

• is unable to repeat what has just been said

Movement:

• performs similar tasks differently each day

• has trouble dialing phone numbers or holding a pencil

• has poor coordination, is clumsy; poor motor planning

• is unaware of physical surroundings

• has a tendency to self-injury

Organization:

• has trouble following a schedule

• has trouble learning about time

• has difficulty organizing belongings

Reading:

• has poor reading ability or poor comprehension

• may misread information

• has problems with syntax or grammar

• confuses or reverses similar letters or numbers

• has problems reading addresses, small print, and/or columns

Social:

• has trouble with social skills

• misinterprets nonverbal social cues

• experiences social isolation

• does not use appropriate eye contact Thinking Skills:

• acquires new skills slowly

• has trouble following directions

• confuses right/left, up/down, under/over, behind/between

• gets lost in large buildings

• seems unaware of time or sequence of events

Writing:

• has problems writing down ideas

• has problems organizing thoughts on paper

• reverses or omits letters, words, or phrases when writing

• has problems with sentence structure, writing mechanics

• may spell the same word differently in a single paper

• may read well but not write well (or vice versa)

What Is Not LD

It is also important to understand what is not included in the LD category. For example, while attention deficit disorder (ADD) and attention deficit hyperactivity disorder (ADHD) are not learning disabilities themselves, there is a 20 percent probability that a child with ADD or ADHD also has one or more learning disabilities. other conditions that are not considered to be learning disabilities themselves include autism, blindness and deafness, emotional problems, hyperactivity, illiteracy, mental retardation, "slow learner," or physical disability.

Diagnosis

"Learning disabilities" is a broad term that covers a range of possible causes, symptoms, and treatments. Partly because learning disabilities can show up in so many forms, it is difficult to diagnose or to pinpoint the causes.

Not all learning problems are necessarily learning disabilities; many children are simply slow to develop certain skills. Because children show natural differences in their rate of development, sometimes what seems to be a learning disability may simply be a delay in maturation. To be diagnosed as a learning disability, problems must occur either in developmental speech and language disorders, academic skills disorders, or other coordination disorders and learning handicaps. Each of these categories includes a number of more specific disorders.

Developmental Speech and Language Disorders

Speech and language problems are often the earliest indicators of a learning disability. Children with developmental speech and language disorders have trouble producing speech sounds, using spoken language to communicate, or understanding what other people say. Depending on the problem, the specific diagnosis may be:

• Developmental articulation disorder

• Developmental expressive language disorder

• Developmental receptive language disorder

With a developmental articulation disorder, children may have trouble controlling their rate of speech, or they may lag behind their friends in learning to make speech sounds. These disorders are common, appearing in at least 10 percent of children younger than age eight. Fortunately, articulation disorders can often be outgrown or successfully treated with speech therapy.

Some children with developmental expressive language disorder have problems expressing themselves in speech, such as calling objects by the wrong names, speaking only in two-word phrases, or not being able to answer simple questions.

Some have trouble understanding certain aspects of speech; this is developmental receptive language disorder. This explains the toddler who does not respond to his name or the worker who consistently cannot follow simple directions. While hearing is normal, these individuals cannot make sense of certain sounds, words, or sentences. Because using and understanding speech are strongly related, many people with receptive language disorders also have an expressive language disability.

Of course, some misuse of sounds, words, or grammar is a normal part of learning to speak. It is only when these problems persist that there is any cause for concern.

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