Vision, Hearing, OrthodonticsIs Your Child Ready for a First Check-up?

Is my baby healthy? It’s a parent’s first question and remains a primary concern for a lifetime. From the moment of birth, a child’s well being is assessed by doctors and parents alike. Fortunately, health and hygiene advances have given us new tools to identify and treat problems. Early detection can lead to the prevention and cure of long-term conditions, so getting your child on the right timetable for medical screening and intervention is essential. Health experts conclude that there are various schedules for various procedures. Some require a level of physical maturity and an ability to follow simple directions, while others can be performed on sleeping newborns.

It’s important to know when your child is ready for treatment. Is a child ever too young? Here are some recommendations from the experts:

Hearing "One of the most exciting innovations on the medical front is the otoacoustic emission test (OAE), a hearing screening test for newborns," says Rigmor Spang, M.D., chief of inpatient pediatrics at Lenox Hill Hospital. Since New York State adopted a policy of universal newborn hearing screening in 2000, all of our youngest children have the benefit of early testing and treatment. The OAE is a quick non-invasive test that consists of a small rubber probe inserted into the baby’s ear. A soft clicking sound is emitted. In a normal ear the sound will echo; the test detects this echo. In rare cases, foreign substances lodged in the ear at birth may influence the test. If a baby fails the OAE, a Physiological Auditory Brainstem Response (ABR) evaluation will be recommended. This test, which is similar to an EKG, is performed on a sleeping baby and gives an indication of the degree of hearing loss. "The earlier we can identify a hearing problem, the better the potential outcome for speech and language development," says Deborah Lee, M.S., coordinator of The Cochlear Implants Center at Manhattan Eye, Ear and Throat Hospital. "Today, newborns can be fitted for hearing aids shortly after birth, and cochlear implants can be performed on deaf infants as young as 12 months old to restore hearing." As children mature, parents should continually monitor them for any indication of hearing problems, suggests Dr. Spang. Is your baby chattering or cooing? If you speak in a low voice, does he respond? Lee recommends consulting the developmental hearing guidelines published by the American Speech-Language-Hearing Association (ASHA). "An infant should startle to a loud noise, and turn to a sound," she says. "Trust your instinct as a parent. If you suspect your child has a hearing problem, see a specialist as soon as possible." Formal hearing screenings, consisting of a tone test, start at age 3, during annual pediatric visits. Even at this age, not all children have the concentration level to sit through the test and identify the sounds. Parents may be asked to subjectively evaluate their child. Any perceived speech delay or articulation problem should be professionally diagnosed. Manhattan Eye, Ear and Throat Hospital employs Conditioned Play Audiometry — hearing tests designed for young children that are play oriented and easy to administer to a fussy toddler. When a child hears a tone, they must put a block or toy in a box. "These tests are engaging and fun," says Lee. "They make a child comfortable. We can get critical information and assess problems without the child even realizing he is undergoing a medical evaluation." If test results reveal any degree of hearing loss, the child will undergo further examinations to determine its cause and establish a suitable course of treatment.

Vision Newborns undergo a simple vision-screening test to determine whether the baby can fixate on an object and to rule out any congenital abnormalities like cataracts or cross-eyes. Low birth weight, premature babies who have been exposed to oxygen are more prone to serious retinal disease and should be seen by an ophthalmologist immediately. "The ideal time for a child to see a pediatric eye specialist is age 1 to 1-and-a-half," says Dr. Joseph Bistricer, an optometrist at Sterling Vision. "Many optic muscles become fortified before age 2. If we detect subtle problems at this time, we will have better results with early treatments." It is particularly important to ascertain whether both eyes are working together. If vision is not maximized in both eyes before the age of 6 or 7, a permanent condition called amblyopia, known as lazy eye, can result. This condition is preventable with early treatment, which may require a patch or vision training. It is difficult to ascertain whether a very young child has 20/20 vision (his sight is normal for him). Near- or far-sightedness does not generally manifest itself until ages 2-and-a-half to 3. Up until that age, doctors and parents should subjectively assess the child’s vision based on behavior. Symptoms of problems may include headaches, rubbing eyes frequently or teary, watery eyes. At age 3, eye exams are included in annual pediatric check-ups. A child is generally mature enough, at this age, to either identify pictures or point to letters in different directions. Vision problems in children may often require corrective eyeglasses. Special durable materials are available, designed to withstand a kid’s typical wear and tear. Children ages 6-10 sometimes require reading prescriptions because the focusing system of the eye is not fully developed. In some cases, this condition will improve as the child gets older. "Mature children can begin to use contact lenses if they are comfortable inserting them and will follow the strict cleansing guidelines necessary for maintenance," says Dr. Bistricer. Corrective laser surgery is not appropriate for children because the eyesight must be stable for several years before undergoing such surgery. You can help take care of your child’s vision by making sure they have a bright reading light and do not hold reading materials too closely. While reading or using the computer, it is important to give eyes a periodic break, approximately every 15 minutes. "Problems with visualization skills may be the underlying cause of learning disabilities — from ADD to dyslexia," says Dr. Henry Ettinger, optometrist and director of the New York’s Vision Improvement Program (VIP). VIP is a 10-week intensive course that aims to enhance a child’s ability to absorb and process visual information. The program is geared for children ages 5 and up. "We teach skills to improve a child’s learning ability. At that age, they are ready to participate in the goal-oriented activities the program embodies," says Dr. Ettinger. "It’s like riding a bike: Once the skills are embedded, they will be present for life."

Dental/Orthodontia An important pre-requisite to a dental visit is teeth! The American Pediatric Dentistry Association recommends your child’s first visit to the dentist should coincide with the appearance of his first tooth or no later than his first birthday. The check-up will determine whether the shape of the tooth is normal and if there is good mineralization. Oral tissue, gums, lips and throat will also be examined. "Pediatric dentistry focuses on education and prevention, not drilling and filling," says Dr. Ann Lambert, a pediatric dentist at Park Avenue Pediatric Dentistry. "Parents learn techniques to establish good dental habits that will travel with the child through life. We teach proper dental hygiene — the importance of brushing new baby teeth regularly, and give parents nutritional guidelines." Certain behaviors, like thumb sucking or the use of pacifiers, can have a negative effect on growing teeth. Dentists also warn not to allow an infant to sleep with a bottle. Even nursing at night can create bacterial formation on teeth, which can result in a greater risk for cavities. "There are three factors that lead to cavities," says Dr. Rhonda Cavee, a pediatric dentist in Manhattan. "You need a tooth, bacteria and a food source. If prone to sweets or if a child has a higher bacterial level in their mouths, it might increase their tendency to have cavities," Dr. Cavee says. Dentists recommend regular bi-annual dental check-ups to screen for cavities and to clean teeth to prevent future problems. By age 2, fluoride treatments can be introduced. Today’s fluorides come in a wide variety of kid-pleasing flavors — from marshmallow to cherry cheesecake. "It’s better than Baskin Robbins!" says Dr. Lambert. If cavities are detected, treatment is scheduled. In extreme cases, very young children may require general anesthesia during this procedure. When the child is old enough to follow directions, usually by age 3, instruction in oral hygiene is introduced. Pediatric dentists undergo several years of special training to master techniques aimed at desensitizing a child’s fear and making them more comfortable. "I call my visits play dates with the dentist," says Dr. Lambert. "I use the Tell-Show-Do method: I tell a child exactly what’s going to happen. I show him my instruments. Then, I can do my examination. When I familiarize the child with the procedure that will occur, I cut down on the fear of the unknown." Parents should take care not to transfer their own fears to their child, advises Dr. Cavee. When permanent molars come in, around ages 6-7, tooth sealant can be applied to prevent cavities. A panoramic growth and development X-ray is performed at age 7, when the first permanent molars and incisors appear, to determine whether there may be a need for orthodontic treatment in the future. Orthodontists correct malocclusions — conditions that occur when teeth are not lined up properly. "Early intervention can identify and correct a small problem before it becomes a big problem," says Dr Sinh T. Ta, an orthodontist in Manhattan. She recommends a child see an orthodontist by age 7. Some common malocclusions, such as crowding or bite abnormalities, are easier to correct when a child is younger. Removable appliances like retainers can be employed to correct the problem as soon as possible. Retainers can also be used to put an end to adverse oral habits like thumb sucking or tongue thrusting. "Some of these habits may even have a negative effect on speech," Dr. Lambert says. "Conventional fixed braces are most commonly applied when permanent teeth predominate," says Clarence E. Shelton, D.D.S., an orthodontist in Manhattan. "This usually occurs between the ages of 9 and 11." Because braces straighten teeth gradually, treatment usually lasts one-and-a-half to two years, with visits scheduled every four to eight weeks for adjustments. A new generation of braces offers many options including colored braces, clear braces and Invisalign, a cutting edge product consisting of removable aligners that are virtually invisible. "Most children look forward to their visit to the orthodontist because they get to choose from a wide variety of colors," Dr. Ta says. Once children have braces, it is important to discuss proper care and maintenance. Kids need to brush more vigorously, avoid gum and candy, and cut food into smaller pieces. "Orthodontic treatment improves self-confidence and self image," says Dr. Shelton. It gives kids something to smile about!