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Learning disabilities are a common concern that parents bring to pediatricians. I'll be discussing those on today's Scope.

I have a lot of parents coming to me to see if their child has a learning disability. Usually it's dyslexia, which is a reading disability. But sometimes is dyscalculia, which is a math disability, or dyspraxia, which is a developmental disorder that affects motor skills like writing. Parents normally notice that their child is struggling in only one subject and does fine in others, or they notice that their child is writing letters, words, or numbers backwards. The teachers may be the first to recognize if there is a problem and tell the parents to have their child see their pediatrician for an evaluation.

Now, here's where it gets tricky. Yes, most of us can identify if there is a learning disability. However, we as general pediatricians are not the ones who can do a full evaluation and diagnosis. Even behavioral and developmental pediatricians are not usually qualified. Why? Because there is a lot that goes into determining if this is truly a learning disability or if there are other reasons for the difficulty in a particular area. We as pediatricians are the right place to start the process though. Schools also. School psychologists can actually do a lot of the testing to start the process, and that is what most of us recommend. While schools start doing the initial learning evaluations, pediatricians do full physical exams to rule out other medical reasons, such as ruling in or out movement disorders, ADHD, anxiety, depression, or speech issues.

The final evaluation and where the actual diagnosis is made is with a neuropsychologist. These are specialists who will do a huge evaluation with a lot of specialized tests, including IQ tests, standardized tests in reading, math, language skills, things like that, to get a good idea of how the brain itself is working, or not working, and be able to come up with the exact diagnosis specific for the child. This can be a long process, but it is necessary to get the correct diagnosis.

Once a child has been diagnosed with a learning disability, the next step is to notify the school and have them come up with an IEP or individualized education plan. This is a written contract stating what the child's disability is and what the school is able to do to help the child learn successfully. It's drafted with the parents, teachers, and school psychologists all involved and goes off of the results from the neuropsychology report. This IEP should follow the child all the way through graduation. It should be reevaluated every six months to make sure that the child's needs are being met and that there are not new issues coming up.

There are no medications to help with learning disabilities. As pediatricians, we can help direct you to resources that can help your child. Our relationship with your child will not change. And we too, like the schools can adapt if your child has problems with learning.

What your child needs most is encouragement and a lot of positive reinforcement when they get something right. Let them know that this is something that they can totally be successful with. Let them know some of the famous people that have had dyslexia, such as Keanu Reeves, Albert Einstein, Steven Spielberg, even Ozzy Osborne. They've all been successful. Henry Winkler had both dyslexia and math problems. Even Ben Franklin was thought to have a math learning disability.

Having a learning disability will make things harder, but not impossible. And often those who have a learning disability in one area often have exceptional abilities in other areas. Encourage your child to focus on what they are good at while they work hard things out that don't come easy. Remind them that they are not defined by their learning disability only by their abilities.

When you are expecting a baby, you have so many hopes for the future of your child. What if you learn that your child will have physical or developmental disabilities? I'll discuss your pediatrician's role in your child's care on today's Scope.

Often parents will ask me if I'm able to take care of a future sibling of one of my patients. The answer always is of course. Some parents will then get a little more quiet and say, "But my baby isn't normal." And I'm like, "Are any of us normal?" Seriously, if you've ever studied embryology and seen all the things that can go wrong during development, it's amazing any of us come out okay. When it comes to seeing new babies who may have some physical or developmental challenges, I honestly tell them I would be honored to be their new child's pediatrician.

When I was five, we moved to a house where the neighbors behind us had a son my age. His older sister had Down syndrome. In the five years that we lived at that house, his sister became one of my best friends. We would play school together, go to the pool together. She actually became a swimmer on the Special Olympics team. We did all sorts of things that friends do. Our families have kept in contact this whole time. And I've been so proud to see all she's accomplished.

I learned early on that just because someone has an extra chromosome and has some differences as a result, they're still an amazing person. They still have so much to offer. I mean, I was the asthmatic kid, allergic to everything. And I was in the school nurse's office all the time. So I also felt like I was a bit defective. We all are a little off in our own ways.

Parents are often overwhelmed when they have a new baby with special needs. And as their pediatrician, I serve as sort of a gatekeeper for all the specialists. My job is to take care of the well child visits, the usual colds and ear infections, and help manage some straightforward issues that most pediatricians are comfortable doing.

When a child needs a specialist, I know exactly who to refer them to. And the specialists and I coordinate together to make sure the child has all their healthcare needs addressed. It's called the medical home model. It's basically a community of doctors all working together, like a wheel with all the spokes of the wheel being the specialists, and the hubcap being the pediatrician. Depending on the needs of the child, the pediatrician also gets home health nursing involved or speech or physical therapists. Often we're the ones that fill out a lot of the paperwork for the insurance companies too and refill prescriptions for supplies if a child has a feeding tube or needs diapers long term.

Often one of the specialists is a pediatrician who has had additional training and certification in complex care management. That is someone I routinely refer my patients to, because they are an amazing resource and also help coordinate the specialists. They often try to make sure that a patient, if they are coming for a visit, have all of the specialists in the visit at once, so it's easier to make sure everyone is on the same page and can get extra help from dieticians, care manager nurses, and social workers if needed. Again, all part of the community of doctors caring for special needs kids.

Trust me, we as pediatricians love your kids as much as you do. And when they make certain milestones, we celebrate with you. I get so excited when I see my cerebral palsy kids walk into a clinic on their own. And I know that every child I see with Down syndrome means I'm guaranteed extra hugs that day. Special needs doesn't always mean limited, negative quality of life. Although their care will be certainly filled with challenges, it's our job as pediatricians to help you along your child's journey to reach their full potential.

Dr. Gellner: A lot of children have learning disabilities that can make school time tricky. What are learning disabilities, really, and how can you help your child? We'll discuss those on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: So, many kids struggle in school. Sometimes it's because they don't understand the material or they find it boring, so they don't care to learn it. Sometimes it's because they're acting up or they don't like their teacher, so they don't pay attention. And sometimes it's because they have chronic medical conditions and miss a lot of school. These aren't learning disabilities. These are barriers to learning.

A true learning disability is a disorder that affects the way the brain receives, processes, stores, and responds to information. Learning disabilities usually involve problems with reading, writing, math, and information processing. We don't know what causes most learning disabilities, but we do know that they tend to run in families, and can also be attributed to circumstances before or surrounding a child's birth, such as being born premature or if mom used drugs or alcohol during the pregnancy.

Cultural differences and poor parenting are not causes of learning disabilities. There are many types of learning disabilities, and there is a big range of how they affect individual kids.

There's a language disability where kids may have problems following directions or may mix up words. These kids have a hard time telling stories, because the words get all jumbled up in their brains.

There's visual processing disability where kids see words backwards, such as seeing "was" where the word is "saw" or switch the b's and d's around if they're older than first grade. It's normal until then. They may also write very slowly as well.

There's auditory processing disability where kids have trouble focusing on people talking to them or listening to important sounds, because they cannot distinguish those sounds from background noise. They also have a hard time following instructions.

Another common disability is fine motor disability. These kids have a hard time with buttons, zippers, or even holding a pencil.

To find out if your child has a learning disability, you will need to talk to their school, as the school psychologists are often the ones who do the screening evaluations. If your child is not yet in school, your pediatrician can help you find a developmental pediatrician who can do the more in-depth screening. If your child does meet the criteria for a learning disability, then the school and you will put together an Individualized Education Plan, or an IEP. This IEP outlines goals for your child to meet, what services they qualify for, and who will provide them, and frequently measures and updates how your child is making progress.

What can you do as the parent of a child who has a learning disability? A lot. First, your child will probably feel self-conscious about having a learning disability. Remind them of all the things they are good at and that everyone has different ways of learning. You can even tell them about famous people that had learning disabilities like Walt Disney, Tom Cruise, Whoopi Goldberg, and even Justin Timberlake.

Have them meet other children with learning disabilities, so they understand they're not alone. Make sure you have a nice quiet place for your child to do homework, and don't overload them with extracurricular activities. Most importantly, be an advocate for your child with their school, and remind your child that they may learn a little differently than other kids, but with the right help, they can achieve anything they set their mind to.

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