Pain in the Ear | NIH News in Health

October 2018

Fending off Ear Infections

Being up all night with a child crying from the pain of an ear infection can be a nightmare. But it’s not uncommon. Most children in developed countries get at least one ear infection by the age of five.

Most ear infections happen in the middle ear, the part of the ear behind the eardrum. The middle ear is connected to the upper part of the throat by the eustachian tube. It normally lets fresh air into your middle ear and lets fluid drain out.

After a cold or other infection, the virus or bacteria that caused the illness can spread to the middle ear. When this happens, the eustachian tube can swell up or become blocked with mucus. This can trap the germs and cause an ear infection. The trapped germs can cause more swelling and fluid buildup. That’s what causes the pain of an ear infection.

Why do so many young children get ear infections? “In younger kids, the eustachian tube, as well as the immune systemThe system that protects your body from invading viruses, bacteria, and other microscopic threats., are still developing. Some kids might also have an underactive immune system that can’t fight the infection,” explains Dr. Michael Hoa, an ear, nose, and throat specialist and researcher at NIH.

In older children and adults, the eustachian tube is large and slanted to drain fluid from the middle ear. In younger children, this tube is narrower and more level, so it’s more likely to get blocked.

If the pain won’t go away or your child has fluid coming out of their ear, you should visit a doctor. Ear infections can also make a child fussy, cause a fever, or create trouble hearing.

Many ear infections don’t need to be treated. They often clear up on their own.

“There is a huge push not to overprescribe antibiotics,” Hoa says. Bacteria can become resistant to the effects of these drugs. So doctors try not to give them, except for severe cases.

When drugs are necessary, it’s important that they be taken for the full time your doctor tells you. But it’s not always easy to get young children to take medications.

A recent NIH-funded study tested whether antibiotics could be taken for less than the standard 10–day treatment. Unfortunately, the shortened treatment didn’t work as well and had no benefits.

NIH-funded researchers are now looking for better ways to treat an ear infection. One group is testing injectable gels to deliver medication right into the ear canal.

One major cause of ear infections is a type of bacteria called Haemophilus influenzae, or H. influenzae. These bacteria can cluster together to make a biofilm, a thin, slimy coating that your body has a hard time getting rid of. Even antibiotics can be ineffective against them. Ear infections that keep coming back often involve biofilms.

A vaccine introduced in 1987 already prevents ear infections caused by one strain of H. influenzae. Researchers are working on developing vaccines to protect against other strains. They’re also looking at what specific nutrients H. influenzae needs to grow the biofilms. Restricting those nutrients may be a new way to fight these bacteria.

If your child has repeated ear infections or trouble hearing, your doctor may suggest draining your child’s ear with small tubes to help maintain a healthy environment.

Ear infections aren’t contagious. But there are things you can do to lower your chances of getting one. See the Wise Choices box for tips on preventing ear infections.

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Caring for Concussions | NIH News in Health

August 2018






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A study found that many people treated for a concussion may not receive follow-up care that could improve their health.

A concussion is a mild brain injury. It results from a bump, blow, or jolt to the head. Most people recover quickly from a concussion, but some have symptoms for weeks or months. 

A concussion may give you a headache and make you feel confused, tired, or dizzy. You may have nausea and may vomit. You may feel groggy and have a hard time thinking and remembering. Your vision may be blurry. You may also have trouble sleeping or mood changes. Getting treatment is important for recovery from any brain injury.

A research team wanted to find out if people were getting follow-up care after a concussion. Their study included more than 800 people diagnosed with a concussion in an emergency department. They asked patients if they received educational materials about concussions when leaving the hospital, if the hospital called to check up on them, and if they’d seen a health care provider since going home.

About 42% said they’d received educational materials when leaving the hospital. Only 27% received a follow-up call from the hospital. Within 3 months of their injury, only 44% had seen a health care provider. People with severe symptoms were more likely to seek care. But only about half of people with at least 3 significant and persistent concussion symptoms sought care within 3 months of the injury.

“Even in the best trauma centers in the country, patients with concussion are not getting the follow-up care they desperately need,” says researcher Dr. Geoffrey Manley of the University of California, San Francisco. “For too many patients, concussion is being treated as a minor injury.

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Care and Connection | NIH News in Health

August 2018






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Loneliness Affects All Ages

Human beings are social creatures. Feeling like we’re part of a community helps us thrive. But we sometimes have a hard time making and keeping the relationships that sustain us. Many Americans report feeling lonely for long periods of time. Connections with others are important for your health.

Social isolation and loneliness can both cause problems. “Isolation is about whether other people are physically there or not. Being lonely is about not feeling connected to others. You can feel lonely in a room full of people,” explains Dr. Steve Cole, an NIH-funded researcher at the University of California, Los Angeles, who studies loneliness.

Loneliness not only feels bad, it may also be harmful to your health. People who feel lonely are at higher risk of many diseases. These include heart disease, high blood pressure, and Alzheimer’s disease. Loneliness may also increase the risk of death for older adults.

Some of the increased risk of disease may come from changes in behavior. People who feel isolated may not have friends or family encouraging them to eat right, exercise, or see a doctor. New research suggests that loneliness can also directly harm our health.

“Lonely people have differences in their biology that make them more vulnerable to disease,” Cole explains. He and colleagues have studied how loneliness affects the immune system, your body’s disease fighting system. They found that loneliness may alter the tendency of cells in the immune system to promote inflammationHeat, swelling, and redness caused by the body’s protective response to injury or infection.. Inflammation is necessary to help our bodies heal from injury. But when it goes on too long, it may raise the risk of chronic diseases.

People who feel lonely may also have weakened immune cells that have trouble fighting off viruses. “So that leaves lonely people more vulnerable to a variety of infectious diseases,” Cole adds.

People often associate loneliness with getting older. But you can feel lonely at any age. A recent survey found that young Americans are more likely to feel lonely than older adults. Some research suggests that social media tools and resources are preventing younger people from connecting in real life, Cole says. However, more studies are needed to know whether this is true.

It can be hard for people to talk about loneliness, Cole explains. They may feel like something is wrong with them, even though feeling lonely happens to almost everyone at some point.

NIH-funded researchers are looking into ways to help people break the cycle of loneliness. Studies have shown that feelings of loneliness can be reduced by helping others, Cole says. Caregiving and volunteering to help others may therefore help people to feel less lonely.

Having a sense of purpose in life may be another way to fight the effects of loneliness. Research has found that having a strong sense of mission in life is linked to healthier immune cells. “And when you start to pursue a goal that’s important to you, you almost always have to cooperate with others to do that,” Cole says. “That helps bring people together.”

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Bionic Movements | NIH News in Health

Connecting Mind and Machine

When you lose the use of a limb, even the simplest of daily tasks can turn into a challenge. High-tech devices can help restore independence. New technologies are even making it possible to connect the mind to an artificial limb. These artificial limbs are called bionic prosthetic devicesDevices that replace a body part..

“To get back some of that lost function, you need some sort of assistive tool or technology to either enhance recovery or restore the capability of the anatomy that’s missing now,” says Dr. Nick Langhals, who oversees NIH-supported prosthetic engineering research.

This fast-moving research aims to improve people’s lives by restoring both movement and feeling.

Prosthetic Control

Traditional prosthetic devices use a body-powered harness to control a hand device. These are easy to use. With a shrug of your shoulder, the prosthetic hand or hook opens. With the release of your shoulder, the prosthesis closes. Through the feel of the cable tension across your shoulders, you know whether the prosthesis is open or closed without looking at it.

Newer, motorized hands are not as easy to learn how to use. To close the device, you contract the remaining muscles in your arm. An electrical sensor placed over those muscles detects the contraction and tells the hand to close. Since the original muscles that controlled the hand are gone, the remaining muscles must be retrained. Learning how to open and close a prosthetic hand in this way takes some time. And you still need to watch the device to know what it’s doing.

To make motorized hands more intuitive to use, researchers are developing ways to detect the electrical signals in your brain and nervesSpecial tissues that carry signals between your brain and other parts of your body. to help control advanced bionic prosthetics. This can be done many ways, such as by implanting tiny sensors in the parts of the brain that control movement or by attaching small electrodesTools that are used to carry electricity to or from different parts of the body. to the amputated nerves. Either way, the patients simply think about moving their hand and computers translate it into the movements of a bionic prosthetic hand.

Two-Way Communication

To regain a sense of wholeness, a person with a bionic limb needs to do more than control the device. They also need to “feel” what it’s doing. New bionic devices can send sensation from the device back to the brain. This allows a person with a bionic device to feel like they are using their own limb.

“The most important thing about the research that we’re doing is this sense of wholeness,” says Dr. Paul Marasco, a biomedical engineering researcher at Cleveland Clinic.

One way to help a person feel their prosthetic hand is to move the remaining sensory nerves from the amputated hand to the skin of the upper arm. You can then use small robots to press on the skin of the upper arm when the hand is touching something.

Marasco’s team devised a similar system to restore the feeling of movement, too. The bionic hand sends signals to a computerized control system outside of the body. The computer then tells a small robot worn on the arm to send vibrations to the arm muscle. These vibrations deep in the muscle create an illusion of movement that tells the brain when the hand is closing or opening.

Marasco’s team tested this feedback system with several people who had a hand prosthesis. The study participants were able to operate the bionic hand and know what position it was in just as well as with their natural hand. With this feedback system, they didn’t have to look at the bionic hand to know when it was open or closed, or when it was reaching for an object.

“We fool their brains into believing that the prosthesis is actually part of their body,” Marasco says. This advancement directly taps into the way that the brain senses movement, which helps improve the two-way communication between prosthetic device and mind.

Wearable Robots

Research teams are also trying to help people who have lost the use of their legs. By wearing a robotic device called an exoskeleton, some people with leg paralysis have been able to regain the ability to walk.

A group led by Dr. Thomas Bulea, a biomedical engineer at the NIH Clinical Center, created a wearable exoskeleton for children with cerebral palsy. Cerebral palsy is a brain disorder that makes it hard to stand up straight, balance, and walk. The motorized, robotic exoskeleton changes the way the children walk by helping them straighten their knees at key points during the walking cycle. While the exoskeleton can make walking easier, children must be able to navigate at least small distances on their own to use it.

“The ultimate goal really is to have a person wear this outside of our lab, or even outside of the clinical setting,” Bulea explains. “To do that you have to have a really robust control system that makes sure that the robot is behaving properly in all different kinds of environments.”

The team is now writing software so that the robotic device can be worn while navigating bumps in the terrain and other real-world conditions.

Finding the Right Device

“What I try to emphasize to people is that there are a lot of potential tools and technologies at our disposal to try and make people better, and they should explore them and consider embracing them,” Langhals says.

Many types of prosthetic devices are now in development. If you’d like to find a clinical study to help test one, you can search for one in clinicaltrials.gov, a database of both NIH-supported and other studies around the world.

If you’re interested in taking part in a study, talk with your doctor about the possible risks and benefits. See the Ask Your Doctor box for questions to ask.

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Shape Your Family’s Habits | NIH News in Health

Helping Kids Make Healthy Choices

Many things can influence a child, including friends, teachers, and the things they see when they sit in front of the TV or computer. If you’re a parent, know that your everyday behavior plays a big part in shaping your child’s behavior, too. With your help, kids can learn to develop healthy eating and physical activity habits that last throughout their lives.

Healthy eating and physical activity are essential for children of any age. “They can have many health benefits for children, including promoting heart health and improving mood,” says Dr. Voula Osganian, a child obesity specialist at NIH.

Getting active and eating right may also prevent excess weight and childhood obesity, a growing concern in this country. Today, nearly 1 in 3 children in the United States is overweight or obese. “If someone develops obesity as a child or adolescent, there’s a very high likelihood that they’ll remain obese or overweight as an adult,” Osganian explains. “But studies also show that if you start eating healthy and being active early, you tend to maintain those habits over time.”

Although most of us know that it’s a good idea to eat healthy food and move more, it isn’t always easy to do. Children aren’t likely to change their diet and activity habits on their own. It’s up to you to make it easier for your family to make healthy choices.

“Parents are very important in terms of arranging an environment and setting a model for healthy or unhealthy behavior,” says Dr. Leonard H. Epstein, an expert
on childhood obesity at the University of Buffalo. “Parents bring foods into the house. They control how much time a child can watch TV. They control what kinds of social activities are paired with foods. And kids learn a huge amount about eating and physical activity from watching and imitating their parents.”

Epstein’s research shows how important parents can be. In NIH-funded work, his team assigned obese children, ages 8 to 12, to different types of weight loss programs. All the groups were taught about healthy diet, behaviors, and exercise. For some groups, positive feedback and encouragement for weight loss and behavior changes were given only to the child. Other groups focused on both the child and an obese parent. Comparison groups received little feedback.

The researchers found that when obese parents and children worked together, both were more successful at losing weight and making healthy changes. “Our studies suggest that getting the whole family working together really benefits the child,” Epstein says. “Even after 10 years, when these kids were 18 to 22 years old, the ones who had the parent working with them had lost more weight and maintained more weight loss than the ones treated by themselves, and obviously more than the comparison groups.”

Over time, most parents gradually began to regain their lost weight, the researchers found. But after 10 years, more than 40% of the kids who worked with their parents had maintained a weight reduction of at least 20%. “The finding suggests that even if the parents go back to their old behaviors, many of the kids will not,” says Epstein.

While it’s never too late to start making healthy changes in your family, research suggests that the earlier your kids learn healthy behaviors, the better.

Dr. Julie Lumeng, a pediatrician at the University of Michigan, focuses her NIH-funded research on the factors that affect eating behaviors in young children—especially preschoolers and infants. That’s an ideal time to start exposing your children to a variety of healthy foods, such as fruits and vegetables, so they develop a liking for them.

Getting young ones to accept fruits and vegetables can be a challenge, but some parents give up too quickly if a child rejects a new food. Research suggests that the more times you offer a food, the more likely a child will be to warm up to it. “Kids typically have to taste a new food 9 to 15 times to begin to like it,” Lumeng says.

If your child doesn’t like a new food right away, stay positive and keep trying over time. Encouraging kids to take just one bite of a new food can help. But avoid creating conflicts and stress over it.

“Trying a new food can be exciting and also stressful in general,” Lumeng says. “Several studies show that kids are more likely to try a new food if they’re eating in a setting that’s relaxing and pleasant.”

Children under the age of three tend to stop eating on their own when they’re full. “But after age three,” Lumeng says, “the more you put on their plate, the more they’ll eat.” So make sure to give your kids child-size portions.

Take opportunities to teach young children about feelings of fullness. “If your child asks for another helping, instead of saying, ‘No, honey, you’ve had enough,’ try saying something like, ‘You must really be hungry tonight,’ to raise their awareness of their feelings,” Lumeng suggests. “Or when they stop eating, say, ‘Oh, you must feel full now,’ to help teach about hunger and feeling satisfied.”

Several studies show that parents can effectively influence healthy behaviors by talking in a positive way or avoiding certain situations altogether. “Instead of telling your children, ‘No, you can’t have any more cookies,’ just keep cookies out of the house altogether,” says Lumeng.

When you bring unhealthy food and sugary drinks into the house, “parents essentially become the food police,” adds Epstein. “It’s easier to create an environment in the home where there’s limited access to unhealthy foods and lots of access to healthy foods.”

Experts recommend that most kids get at least an hour of moderate to vigorous physical activity each day. Parents can help by limiting TV and computer time to no more than one or two hours per day.

“Small changes in the home environment can also have a huge effect on physical activity,” says Epstein. You can make sports equipment like balls and jump ropes more accessible by putting them next to the door. Walking fast, bicycling, jumping rope, and playing basketball, soccer, or hopscotch are all good ways for kids to be active.

When it comes to food and physical activity, what you say and do around your children can have a lasting effect. Work together as a family to make healthy habits easy and fun.

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See, Hear, Speak | NIH News in Health

Are Kids’ Senses Ready for School?

When setting off for kindergarten or first grade, a child may feel prepared with a backpack loaded with crayons, pencils, and paper. But a good start in the classroom depends on more than just school supplies. Healthy hearing, vision, speech, and language are key to success at school. If a child has problems in these areas, the sooner they’re spotted, the better they can be treated.

Sometimes problems with senses, speech, or language fly under the radar. A child with a lazy eye or a little hearing loss might get along just fine at home or in daycare. But when children get to school, minor difficulties may start to catch up with them. They may have trouble focusing and flourishing in the classroom. NIH-funded scientists are searching for better ways to recognize and treat these types of problems as early as possible.

Nearly all newborns are screened for hearing loss before leaving the hospital. For newborns diagnosed with hearing loss, interventions such as hearing aids or cochlear implants should begin no later than 6 months of age. When interventions begin early, children with hearing loss can develop language skills that help them communicate.

Hearing problems can also arise in older kids. “Some children are born with normal hearing and develop hearing loss later for various reasons,” says Dr. Mary Pat Moeller, who studies childhood deafness and language development at Boys Town National Research Hospital in Nebraska. Head injuries, meningitis, and chronic fluid behind the eardrum from repeated bouts of ear infections are just a few conditions that can lead to later hearing loss.

“We rely on normal hearing to pick up concepts and learn new words,” Moeller says. But a noisy classroom can be tough for kids who can’t hear well. “Children with undetected hearing loss may look like they have attention deficits. They may miss what they’ve been told because they’re just not hearing clearly,” she says.

Screening for hearing loss in school-age kids is a familiar process. Children wear headphones and raise their hands as they hear a series of tones. Some 5% to 10% of school-age children don’t pass these tests. Kids with hearing loss can be fitted with hearing aids or benefit from cochlear implants or assistive devices. For example, teachers can wear microphones that send their voices directly to the children’s ears. Even children with minimal hearing loss can benefit from this type of technology.

Children learn language by listening to others and engaging in conversations. But kids with hearing loss can miss out on some of this experience. Moeller and her colleagues are studying how children with hearing loss develop language. Results from this NIH-funded research point to several factors that can help. These include the quality and fit of hearing aids, how often kids get speech and language training, and how often parents have conversations with their children.

A different source of language problems is a disorder called specific language impairment, or developmental language disorder. This condition affects an estimated 7% of children in kindergarten. Kids with specific language impairment have trouble learning new words and engaging in conversation. They might produce grammatically incorrect sentences like “What he want for dinner?” or they might have a small vocabulary.

“Both of those are fundamental to being able to communicate with the teacher, to understanding what the teacher is saying to them, and to forming social relationships with their peers,” says Dr. Mabel Rice, an NIH-funded researcher who studies childhood language disorders at the University of Kansas.

For example, a child with specific language impairment might not understand that “It’s time to put your things away now” means “Put your things away.” Children who don’t understand complicated sentences can seem like they’re disobedient, Rice says. More complicated grammar is also good for making friends. Saying “I would like it if you’d come play with me” might attract more playmates than “Come over here.”

In the past, parents were sometimes blamed for a child’s language disability. They might have been faulted for not reading enough to their children. But research suggests that specific language impairment has other roots. The disorder tends to run in families, which hints that genesStretches of DNA, a substance you inherit from your parents, that define characteristics such as how likely you are to get certain diseases. play a role. Rice led a study of over 300 people, including children with specific language impairment and their families. The scientists identified a gene that’s also linked to dyslexia and other learning disabilities. The finding might eventually lead to better understanding and treatment of these disorders.

Kids don’t usually grow out of specific language impairment. Their language improves, but they can continue to struggle with subtleties even after they enter the workforce. “It is very important to identify these kids, particularly at school entry or before school entry,” Rice says. Many school districts screen children for specific language impairment before kindergarten. Language therapy can help children catch up.

Poor vision can also cause trouble in school, and the problems may go unnoticed. Vision problems are common in preschoolers, but kids don’t always tell others about their symptoms. Children might even think it’s normal to see double or for things to be blurry. But poor eyesight can cause headaches and hinder reading. Some children with vision problems might seem to have attention difficulties, since eyestrain and headaches can make it hard to stay on task.

The most common cause of vision impairment in children is amblyopia, or lazy eye. It often arises if the eyes point in different directions, or if one eye produces a better image than the other. The brain starts to shut down signals from the weaker eye. Treatment encourages use of the weaker eye, sometimes by putting a patch over the other eye. NIH-funded research has found that treatment for amblyopia is more effective if begun when a child is young.

Some children are nearsighted, with problems focusing on faraway objects like the chalkboard. It’s less common for youngsters to be farsighted, with trouble focusing on up-close items. Both can be corrected with eyeglasses or contact lenses.

To catch problems early, NIH funded a study of thousands of preschoolers to find the best ways to screen for impaired vision. “How often screening is done and what screening is done varies widely from state to state,” says Dr. Marjean Kulp, a vision researcher at Ohio State University.

The study evaluated different tests and identified a few that could best detect vision problems—even when performed by people who aren’t vision specialists.

Screenings only identify potential problems, and they don’t catch everything. Children should have regular exams by an eye care professional.

Early detection and treatment of hearing, vision, and language problems can give kids a better learning experience.

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Positive Parenting | NIH News in Health

Building Healthy Relationships With Your Kids

Parents have an important job. Raising kids is both rewarding and challenging. You’re likely to get a lot of advice along the way, from doctors, family, friends, and even strangers. But every parent and child is unique. Being sensitive and responsive to your kids can help you build positive, healthy relationships together.

“Being a sensitive parent and responding to your kids cuts across all areas of parenting,” says Arizona State University’s Dr. Keith Crnic, a parent-child relationship expert. “What it means is recognizing what your child needs in the moment and providing that in an effective way.”

This can be especially critical for infants and toddlers, he adds. Strong emotional bonds often develop through sensitive, responsive, and consistent parenting in the first years of life. For instance, holding your baby lovingly and responding to their cries helps build strong bonds.

Building Bonds

Strong emotional bonds help children learn how to manage their own feelings and behaviors and develop self-confidence. They help create a safe base from which they can explore, learn, and relate to others.

Experts call this type of strong connection between children and their caregivers “secure attachment.” Securely attached children are more likely to be able to cope with challenges like poverty, family instability, parental stress, and depression.

A recent analysis shows that about 6 out of 10 children in the U.S. develop secure attachments to their parents. The 4 out of 10 kids who lack such bonds may avoid their parents when they are upset or resist their parents if they cause them more distress. Studies suggest that this can make kids more prone to serious behavior problems. Researchers have been testing programs to help parents develop behaviors that encourage secure attachment.

Being Available

Modern life is full of things that can influence your ability to be sensitive and responsive to your child. These include competing priorities, extra work, lack of sleep, and things like mobile devices. Some experts are concerned about the effects that distracted parenting may have on emotional bonding and children’s language development, social interaction, and safety.

If parents are inconsistently available, kids can get distressed and feel hurt, rejected, or ignored. They may have more emotional outbursts and feel alone. They may even stop trying to compete for their parents’ attention and start to lose emotional connections to their parents.

“There are times when kids really do need your attention and want your recognition,” Crnic explains. Parents need to communicate that their kids are valuable and important, and children need to know that parents care what they’re doing, he says.

It can be tough to respond with sensitivity during tantrums, arguments, or other challenging times with your kids. “If parents respond by being irritable or aggressive themselves, children can mimic that behavior, and a negative cycle then continues to escalate,” explains Dr. Carol Metzler, who studies parenting at the Oregon Research Institute.

According to Crnic, kids start to regulate their own emotions and behavior around age 3. Up until then, they depend more on you to help them regulate their emotions, whether to calm them or help get them excited.

“They’re watching you to see how you do it and listening to how you talk to them about it,” he explains. “Parents need to be good self-regulators. You’re not only trying to regulate your own emotions in the moment, but helping your child learn to manage their emotions and behavior.”

As kids become better at managing their feelings and behavior, it’s important to help them develop coping skills, like active problem solving. Such skills can help them feel confident in handling what comes their way.

“When parents engage positively with their children, teaching them the behaviors and skills that they need to cope with the world, children learn to follow rules and regulate their own feelings,” Metzler says.

“As parents, we try really hard to protect our kids from the experience of bad things,” Crnic explains. “But if you protect them all the time and they are not in situations where they deal with difficult or adverse circumstances, they aren’t able to develop healthy coping skills.”

He encourages you to allow your kids to have more of those experiences and then help them learn how to solve the problems that emerge. Talk through the situation and their feelings. Then work with them to find solutions to put into practice.

Meeting Needs

As children grow up, it’s important to remember that giving them what they need doesn’t mean giving them everything they want. “These two things are very different,” Crnic explains. “Really hone in on exactly what’s going on with your kid in the moment. This is an incredibly important parenting skill and it’s linked to so many great outcomes for kids.”

Think about where a child is in life and what skills they need to learn at that time. Perhaps they need help managing emotions, learning how to behave in a certain situation, thinking through a new task, or relating to friends.

“You want to help kids become confident,” Crnic says. “You don’t want to aim too high where they can’t get there or too low where they have already mastered the skill.” Another way to boost confidence while strengthening your relationship is to let your kid take the lead.

“Make some time to spend with your child that isn’t highly directive, where your child leads the play,” advises Dr. John Bates, who studies children’s behavior problems at Indiana University Bloomington. “Kids come to expect it and they love it, and it really improves the relationship.”

Bates also encourages parents to focus on their child’s actual needs instead of sticking to any specific parenting principles. It’s never too late to start building a healthier, more positive relationship with your child, even if things have gotten strained and stressful.

“Most importantly, make sure that your child knows that you love them and are on their side,” Metzler says. “For older children, let them know that you are genuinely committed to building a stronger relationship with them and helping them be successful.”

By being a sensitive and responsive parent, you can help set your kids on a positive path, teach them self-control, reduce the likelihood of troublesome behaviors, and build a warm, caring parent-child relationship.

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Multiple Sclerosis: An Overview | NIH MedlinePlus the Magazine

 

What is MS?

Multiple sclerosis, or MS, is a chronic disease that affects the central nervous system (the brain and spinal cord). A patient’s clinical course is difficult to predict.

It damages myelin, a substance that wraps around nerve fibers and helps protect them.

Damaged myelin exposes our nerve fiber and disrupts key communication between our nervous system and brain. This creates pain, coordination issues, vision problems, and more.

MS is considered to be an autoimmune disease, in which your immune system mistakenly attacks healthy cells in your body.

Know the symptoms

Multiple sclerosis signs and symptoms appear in many ways. They can range from minimal to disabling, depending on how much nerve damage there is and which nerves are affected.

The majority of MS patients are mildly affected, but in the worst cases, MS can make a person unable to write, speak, or walk.

MS symptoms usually appear in people between ages 20 and 40 and can include the following:

  • Blurred or double vision
  • Red-green color distortion or blindness in one eye
  • Severe tiredness
  • Muscle weakness in hands or feet
  • Problems with coordination or balance
  • Difficulty walking or standing
  • Partial or complete paralysis
  • Numbness or prickling “pins and needles” sensations
  • Speech problems
  • Tremors or dizziness
  • Hearing loss
  • Depression
  • Memory loss or difficulty concentrating

Check with a health care provider if you experience any or some of these symptoms and suspect it may be MS.

Treatment

Some people with MS do well without therapy, and in some cases, medications can have serious side effects. Some have major risks, which requires close monitoring. Unfortunately, MS can worsen slowly enough that patients are not always aware of it, and this can happen in the absence of new lesions in the brain or spinal cord.

SOURCES: National Institute of Neurological Disorders and Stroke; Opens new window National Multiple Sclerosis Society: Definition of MS Opens new window

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It’s a Kid’s Job | NIH News in Health

 

Playing Helps Kids Learn and Grow

What would childhood be without time to play? Play, it turns out, is essential to growing up healthy. Research shows that active, creative play benefits just about every aspect of child development.

“Play is behavior that looks as if it has no purpose,” says NIH psychologist Dr. Stephen Suomi. “It looks like fun, but it actually prepares [kids] for a complex social world.” Evidence suggests that play can help boost brain function, increase fitness, improve coordination, and teach cooperation.

Suomi notes that all mammals—from mice to humans—engage in some sort of play. His research focuses on rhesus monkeys. While he’s cautious about drawing parallels between monkeys and people, his studies offer some general insights into the benefits of play.

Active, vigorous social play during development helps to sculpt the monkey brain. The brain grows larger. Connections between brain areas may strengthen. Play also helps monkey youngsters learn how to fit into their social group, which may range from 30 to 200 monkeys in 3 or 4 extended families.

Both monkeys and humans live in highly complex social structures, Suomi says. “Through play, rhesus monkeys learn to negotiate, to deal with strangers, to lose gracefully, to stop before things get out of hand, and to follow rules,” he says. These lessons prepare monkey youngsters for life after they leave their mothers.

Play may have similar effects in the human brain. Play can help lay a foundation for learning the skills we need for social interactions. If human youngsters lack playtime, says Dr. Roberta Golinkoff, an infant language expert at the University of Delaware, “social skills will likely suffer. You will lack the ability to inhibit impulses, to switch tasks easily, and to play on your own.” Play helps young children master their emotions and make their own decisions. It also teaches flexibility, motivation, and confidence.

Kids don’t need expensive toys to get a lot out of playtime. “Parents are children’s most enriching plaything,” says Golinkoff. Playing and talking to babies and children are vital for their language development. Golinkoff says that kids who talk with their parents tend to acquire a vocabulary that will later help them in school. Let kids guide the conversation. When you take over the conversation, you may shut it down.

Unstructured, creative, physical play also lets children burn calories and develop all kinds of strengths, such as learning how the world works. In free play, children choose the games, make the rules, learn to negotiate, and release stress. Free play often involves fantasy. If children, say, want to learn about being a fireman, they can imagine and act out what a fireman does. And if something scary happens, free play can help defuse emotions by working them out.

“Sports are a kind of play,” Golinkoff says, “but it’s not the kids calling the shots.” It’s important to engage in a variety of activities, including physical play, social play, and solitary play. “The key is that in free play, kids are making the decisions,” says Golinkoff. You can’t learn to make decisions if you’re always told what to do.

Some experts fear that free play is becoming endangered. In the last two decades, children have lost an average of eight hours of free play per week. As media screens draw kids indoors, hours of sitting raise the risk for obesity and related diseases. When it comes to video games and other media, parents should monitor content, especially violent content, and limit the amount of time children sit.

There’s also been a national trend toward eliminating school recess. “Thousands of children have lost recess altogether,” says child development expert Dr. Kathryn Hirsh-Pasek of Temple University. “Lack of recess has important consequences for young children who concentrate better when they come inside after a break from the schoolwork.”

Many kids, especially those in low-income areas, lack access to safe places to play. This makes their school recess time even more precious. In response to these changes, some educators are now insisting that preschool and elementary school children have regular periods of active, free play with other children. The type of learning that happens during playtime is not always possible in the classroom. School recess is also important because of the growing number of obese children in the United States. Running around during recess can help kids stay at a healthy weight.

Play also may offer advantages within the classroom. In an NIH-funded study, Hirsh-Pasek, Golinkoff, and their colleagues found a link between preschoolers’ math skills and their ability to copy models of two- and three-dimensional building-block constructions. Play with building blocks—and block play alongside adults—can help build children’s spatial skills so they can get an early start toward the later study of science, technology, engineering, or math.

“In a way, a child is becoming a young scientist, checking out how the world works,” says Hirsh-Pasek. ”We never outgrow our need to play.” Older children, including teens, also need to play and daydream, which helps their problem-solving and creative imagination. Adults, too, need their breaks, physical activity, and social interaction.

Play can also be important for medical care. At the NIH Clinical Center in Bethesda, Maryland, “Recreation therapy services are seen as essential to the patients’ recovery,” says Donna Gregory, chief of recreational therapy. She and her team tailor activities for both children and adults. Games can get patients moving, even for just minutes at a time, which improves their functioning.

Medical play helps children cope with invasive procedures. A 2-year-old can be distracted with blowing bubbles; older kids can place their teddy bear in the MRI machine or give their doll a shot before they themselves get an injection. It gives kids a sense of control and supports their understanding in an age-appropriate, meaningful way.

Without play and recreation, people can become isolated and depressed. “There’s therapeutic value in helping patients maintain what’s important to them,” says Gregory. “When you are physically and socially active, it gives life meaning.”

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Keeping Up in School? | NIH News in Health

Identifying Learning Problems

Reading, writing, and math are the building blocks of learning. Mastering these subjects early on can affect many areas of life, including school, work, and even overall health. It’s normal to make mistakes and even struggle a little when learning new things. But repeated, long-lasting problems may be a sign of a learning disability.

Learning disabilities aren’t related to how smart a child is. They’re caused by differences in the brain that are present from birth, or shortly after. These differences affect how the brain handles information and can create difficulties with reading, writing, and math.

“Typically, in the first few years of elementary school, some children, in spite of adequate instruction, have a hard time and can’t master the skills of reading and writing as efficiently as their peers,” says Dr. Benedetto Vitiello, a child mental health expert at NIH. “So the issue is usually brought up as a learning problem.”

In general, the earlier a learning disability is recognized and addressed, the greater the likelihood for success in school and later in life. “Initial screening and then ongoing monitoring of children’s performance is important for being able to tell quickly when they start to struggle,” explains Dr. Brett Miller, a reading and writing disabilities expert at NIH. “If you’re not actively looking for it, you can miss opportunities to intervene early.”

Each learning disability has its own signs. A child with a reading disability may be a poor speller or have trouble reading quickly or recognizing common words. A child with a writing disability may write very slowly, have poor handwriting, or have trouble expressing ideas in writing and organizing text. A math disability can make it hard for a child to understand basic math concepts (like multiplication), make change in cash transactions, or do math-related word problems.

Learning difficulties can affect more than school performance. If not addressed, they can also affect health. A learning disability can make it hard to understand written health information, follow a doctor’s directions, or take the proper amount of medication at the right times. Learning disabilities can also lead to a poor understanding of the benefits of healthy behaviors, such as exercise, and of health risks, such as obesity. This lack of knowledge can result in unhealthy behaviors and increased risk of disease.

Not all struggling learners have a disability. Many factors affect a person’s ability to learn. Some students may learn more slowly or need more practice than their classmates. Poor vision or hearing can cause a child to miss what’s being taught. Poor nutrition or exposure to toxins early in life can also contribute to learning difficulties.

If a child is struggling in school, parents or teachers can request an evaluation for a learning disability. The U.S. Individuals with Disabilities Education Improvement Act requires that public schools provide free special education support to children, including children with specific learning disabilities, who need such services. To qualify for these services, a child must be evaluated by the school and meet specific federal and state requirements. An evaluation may include a medical exam, a discussion of family history, and intellectual and school performance testing.

Many people with learning disabilities can develop strategies to cope with their disorder. A teacher or other learning specialist can help kids learn skills that build on their strengths to counter-balance their weaknesses. Educators may provide special teaching methods, make changes to the classroom, or use technologies that can assist a child’s learning needs.

A child with a learning disability may also struggle with low self-esteem, lack of confidence, and frustration. In the case of a math learning disability, math anxiety may play a role in worsening math abilities. A counselor can help children use coping skills and build healthy attitudes about their ability to learn.

“If appropriate interventionsActions taken to prevent or treat a disorder or to improve health in other ways. are provided, many of these challenges can be minimized,” explains Dr. Kathy Mann Koepke, a math learning disability expert at NIH. “Parents and teachers should be aware that their own words and behavior around learning and doing math are implicitly learned by the young people around them and may lessen or worsen math anxiety.”

“We often talk about these conditions in isolation, but some people have more than one challenge,” Miller says. Sometimes children with learning disabilities have another learning disorder or other condition, such as attention deficit hyperactivity disorder (ADHD).

“ADHD can be confused with a learning problem,” Vitiello says. ADHD makes it difficult for a child to pay attention, stay focused, organize information, and finish tasks. This can interfere with schoolwork, home life, and friendships. But ADHD is not considered a learning disability. It requires its own treatments, which may include behavior therapy and medications.

“Parents play an important role in treatment, especially for children in elementary school,” Vitiello says. Medications and behavioral interventions are often delivered
at home. Teachers can usually advise parents on how to help kids at home, such as by scheduling appropriate amounts of time for learning-related activities. Parents can also help by minimizing distractions and encouraging kids to stay on task, such as when doing homework. Effective intervention requires consistency and a partnership between school and home.

Many complex factors can contribute to development of learning disabilities. Learning disorders tend to run in families. Home, family, and daily life also
have a strong effect on a child’s ability to learn starting from a very early age. Parents can help their children develop skills and build knowledge during the first few
years of life that will support later learning.

“Early exposure to a rich environment is important for brain development,” Mann Koepke says. Engage your child in different learning activities from the start. Before they’re even speaking, kids are learning. “Even if it’s just listening and watching as you talk about what you’re doing in your daily tasks,” she says.

Point out and talk with children about the names, colors, shapes, sizes, and numbers of objects in their environment. Try to use comparison words like “more than” or “less than.” This will help teach your child about the relationships between things, which is important for learning math concepts, says Mann Koepke. Even basic things, like getting enough sleep and eating a healthy diet, can help children’s brain development and their ability to learn.

NIH is continuing to invest in research centers that study learning challenges and their treatments, with a special focus on understudied and high-risk groups.

Although there are no “cures,” early interventions offer essential learning tools and strategies to help lessen the effects of learning disabilities. With support from caregivers, educators, and health providers, people with learning disabilities can be successful at school, work, and in their personal lives.

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