What is a breast bud? The breast bud is the first stage of development of breast tissue. They are present in both male and female newborns due to the maternal hormone estrogen. Some babies even leak some real milk from their breasts. This is can be termed “witch's milk.” This term may seem sinister and may have come from the shock that parents felt witnessing this happen. Today we know this phenomenon is a normal reaction to maternal hormones, shared with the baby during pregnancy.

What are night terrors? Night terrors are awakenings from sleep, typically in the first half of the night, that are different from nightmares. Children with night terrors are unaware of their surroundings during an episode. They often appear frightened and are inconsolable for a few minutes. When the episode breaks, the return to sleep is rapid, and there is no recall of the events the following morning.

What is pervasive developmental delay? Pervasive developmental disorder refers to persons with impaired communication and social interaction. These children also manifest repetitive or ritualized behaviors, may have an extreme focus of interest and are often intolerant to change. The disorders included are autistic disorder, Rett’s syndrome, childhood disintegrative disorder and pervasive developmental delay not otherwise specified.

What is pica? Pica is the eating of substances that have no nutritional value. Common examples include paper, soil and wood. It usually begins in the first two years of life and can have an associated increased risk of lead toxicity.

What is separation anxiety? Separation anxiety occurs when a parent or caregiver leaves a young child at daycare or at a babysitter and can even occur when a parent just leaves a child’s room. The basis of separation anxiety is probably formed around six months of age when an infant learns that even though a parent can’t be seen, it doesn’t mean that parent doesn’t exist. A baby doesn’t know whether a parent has left for good or will be right back. Being unsure of whether you’re gone forever or not, your infant or toddler will do anything and everything to prevent your departure.

What is stranger anxiety? Stranger anxiety occurs when young children and infants are distressed when they are around people who are unfamiliar to them. Infants can experience stranger anxiety as young as six months of age but most babies begin to experience it around eight to nine months of age. As infants approach this age, they begin to show strong preferences for the people who they know the best--their parents. They realize their relationship with their parents is different from other people they meet. They become more discriminating about whom they will let hold them and play with them. Stranger anxiety peaks around 12 to 18 months.

What is stuttering? Stuttering occurs when children know what they want to say but the words don’t come out smoothly. Instead, children will repeat certain syllables, words or phrases. They may prolong them or even skip syllables. Many children have problems with stuttering between two and four years old. Usually it is gone by five years of age. If stuttering becomes a social problem, speech therapy is helpful.

Is stuttering ever normal? It is actually quite common. It is estimated that more than three million Americans stutter. Stuttering affects individuals of all ages but occurs most frequently in young children between the ages of 2 and 4 who are developing language. Boys are three times more likely to stutter than girls. Most children, however, outgrow their stuttering, and it is estimated that less than one percent of adults stutter.

When do babies walk? Most babies are walking by 14 to 16 months, but the range of normal is quite large. Some babies take their first steps at nine months, while late bloomers can wait until they're 17 or 18 months. See your provider if your child is not taking steps by 18 months.

When do babies talk? Usually by six months of age an infant babbles or produces repetitive syllables such as "ba, ba, ba" or "da, da, da." Babbling soon turns into a type of nonsense speech called jargon that often has the tone and cadence of human speech but does not contain real words.

By the end of their first year, most children have mastered the ability to say a few simple words. By 18 months of age most children can say 8 to 10 words and, by age 2, are putting words together in crude sentences such as "more milk." At ages 3, 4, and 5 a child's vocabulary rapidly increases, and he or she begins to master the rules of language.

My little guy said “mama” before he said “dada” should I worry? The sounds that make up mama and dada are actually a few of the easiest for infants learning language to pronounce. The ah sound is frequently the first sound a baby makes. The consonant sounds that are easiest to make are the ones that are made entirely with the lips—m, p and b. When infants start saying mama and dada they probably are just making sounds and should not be thought of as producing language. In fact, the sound mama is usually produced before the sound papa. Soon we, as parents, assign a meaning to these babbles. It is interesting to note that these sounds are replicated for mother and father in many languages.

In the 1950s, American anthropologist George P. Murdoch examined the words for mother and father in 470 languages from all over the globe. He found that the word for mother contained a syllable of the form ma, me or mo in 52 percent of the languages in his sample, and the words for father contained the syllable pa, po, ta or to in 55 percent of his languages.

What are the "terrible twos"? The terrible twos are a rite of passage, although not all children experience this stage while they are two. It is a time of your children doing the opposite of what you want them to do. They become very oppositional. They also have trouble making up their minds. You may give them many choices but all you may hear is “no, no, no.”

The terrible twos can begin as early as 15 months and persist beyond the age of two. In fact, some parents insist that they last until your children move out of the house.

Should my five-year-old still be taking a nap? Studies have shown that 57 percent of four year olds and 27 percent of five year olds still take naps. And of course, 100 percent of parents need naps.

What are tantrums? Temper tantrums include a wide range of behaviors in response to frustration. Behaviors can range from whining and crying to hitting and throwing things. They happen most often between the ages of two and three. They occur equally in boys and girls.

There are a few main reasons that children have tantrums:

• Seeking attention
• Being tired or hungry
• Being frustrated when they can’t do something or have something they want

What is meant by my child’s temperament? Temperament is a set of traits that children are born with. They help organize a child's response to the world. Children’s temperaments determine the way children learn about the world around them. A child’s temperament molds his or her personality.
These traits appear to be relatively stable from birth.

They are enduring characteristics. Some children are quiet while others are noisy. Some children are docile while others are more aggressive. The following are temperament traits that can shape a child:

• Activity. Is your child always in motion or is your child still?
• Rhythmicity. Is your child tied to a schedule or do things happen seemingly at random?
• Approach/withdrawal. Is your child shy or does your child run into the arms of anyone?
• Adaptability. Does your child adapt to changes in routines does you child resist changes?
• Intensity. Does your child react strongly to different situations or does your child react calmly?
• Mood. Is your child always negative or always positive?
• Attention span. Does your child give up or keep on trying?
• Distractibility. Is your child easily distracted or can your child shut out distractions?
• Sensory threshold. Is your child over sensitive to light, noise and touch or is your child not bothered by these stimuli?

What is ADHD? ADHD stands for Attention Deficit/Hyperactivity Disorder. It is a common behavioral disorder that affects between five and ten percent of all children. Boys are about three times more likely than girls to be have it. Children with ADHD act impulsively, are distracted easily, can be hyperactive and have trouble focusing. They have trouble following through with instructions because they can't sit still, pay attention or attend to details.

What causes ADHD? Nobody knows. However, ADHD is a medical condition that is caused by changes in the way the brain works. We think these changes are related to two chemicals in the brain—dopamine and norepinephrine. These two chemicals help the nerve cells in the brain communicate.

Does ADHD run in families? It seems that the apple doesn’t fall far from the tree when it comes to ADHD. Parents with ADHD have a greater chance of having children with ADHD.

Do food additives, immunizations or too much sugar cause ADHD? Definitely not.

Can you outgrow ADHD? We see children with the hyperactive form of ADHD become less hyperactive as they get older. They often develop coping mechanisms to help them deal with the symptoms of their ADHD.

Is there a simple test to diagnose ADHD? No, unfortunately, ADHD can’t be diagnosed with a simple blood test or written survey. Accurate diagnosis is made only by a trained clinician after an extensive evaluation that involves ruling out other possible causes for the symptoms involved, a thorough physical examination, and a series of interviews with the parent, child and review of information from teachers or other adult caregivers.

ADHD is a boy thing, right? Boys are diagnosed about three times as often with ADHD compared with girls.

What is the difference between ADHD and ADD? This condition has been known for more than a hundred years, but it hasn't always been called the same thing. In the past, different labels have been used for what we now call attention-deficit/hyperactivity disorder (AD/HD).

Why the change? The American Psychiatric Association publishes the official guidelines for naming such disorders. Each update attempts to reflect new knowledge and be more specific and accurate. In 1994 it was concluded that the different types of attention deficit, with or without hyperactivity, are all part of the same major condition. There are three types of this one condition called ADHD – inattentive, hyperactive/impulsive, and combined.

Some continue to use the older term ADD, which typically means the individual has the inattentive type of ADHD, without hyperactivity.

Is medication always necessary to treat someone with ADHD? Medication has been proven time and again to offer the greatest benefit for those with ADHD, but it should not be the only support offered. There is a role for counseling for parenting in management of children with ADHD. Individual or group therapy for ADHD is of limited value, but may be more helpful in dealing with symptoms of depression or anxiety. Children with ADHD will also benefit from implementing classroom accommodations and providing special education services if a learning disability is also present.

What types of school support can be provided? Students with ADHD may qualify for what is called a “Section 504” plan. Federal law mandates that students with a physical or mental disability that significantly limits major life activities, such as receiving an education or learning be provided with accommodations when requested. The 504 plan can include such things as seating near the teacher, modifying assignment length, help with organization, allowing un-timed tests and many other options.

A child with ADHD who also has a documented learning disability may qualify for an IEP – and Individual Education Plan, which clearly describes the specific learning disability and educational support services the school will provide.

Requests for both a 504 plan and an IEP should be made in writing to the school, who must then respond within a reasonable amount of time to complete assessment and plan development and implementation.

How do I get an ADHD evaluation for my child? Contact your primary care provider at Partners in Pediatrics. A staff member will give you a set of educational materials as well as questionnaires and forms that need to be completed prior to meeting with the provider. Typically two appointments are needed to complete the process.

What is autism? Autism is a developmental disability. It is generally evident before age three.

All children with autism demonstrate deficits in

• Social interaction
• Verbal and nonverbal communication

In addition, they often have repetitive behaviors or interests. They may have unusual responses to sensory stimuli, such as certain sounds or the way objects look or feel. These symptoms present in each individual differently, and range from mild to severe defecits.

What is Asperger Syndrome? Asperger syndrome (AS) is a neurologic disorder that is part of a group of disorders labeled "autistic spectrum disorders."

Asperger syndrome is characterized by:

• Poor social interactions
• Obsessions
• Odd speech patterns
• Peculiar mannerisms

Children with Asperger Syndrome often use few facial expressions and have difficulty reading the body language of others. They may have repetitive routines and may have an unusual sensitivity to certain stimuli, such as visual or auditory stimuli. In general, people with Asperger Syndrome function in everyday life, but may be somewhat socially immature and may be seen by others as odd or eccentric.

What is pervasive developmental delay? Pervasive developmental delays (PDD) are also known as “autism spectrum disorders.” They range from a severe form, autistic disorder, to milder forms such as Asperger Syndrome.

If a child has symptoms that are suspicious for any of these disorders, but does not meet the specific criteria for formal diagnosis, they are said to have pervasive developmental disorder not otherwise specified (PDD-NOS).

Other rare, very severe disorders that are included in the autism spectrum disorders are Rett syndrome and childhood disintegrative disorder.