Problems at School

Dear Lisa,

MY SON IS 5 YEARS OLD. HE IS COMPLETELY DIFFERENT FROM BEFORE THE SCHOOL STARTED. I THINK HE IS STRESSED, BUT ONE THING...........HE KEEPS TRIPPING, CAN’T KEEP HIS BALANCE AND HE SHAKES A LOT. I DONT KNOW IF IT IS STREES, OR I SHOULD TAKE HIM TO THE DOCTOR. IT IS BEING GOING ON FOR A WHILE AND ALL HIS BLOOD TESTS ARE FINE.

"STRESSED AT SCHOOL"

Dear "STRESSED AT SCHOOL",

A child who suddenly begins to lose his balance, shakes and trips needs an evaluation by a Physician. Although losing your balance and tripping can be due to something as simple as ill-fitting footwear, it can also be a sign of a neurological problem. Since the reasons for this type of behavior are many, a comprehensive evaluation by your Physician is necessary and a referral to a neurologist may be recommended.

First it would be important to know if these symptoms occur all of the time or only at school. Since it seems that your son’s symptoms are new and seem to have coincided with entering a new school, it would be a good idea to talk to his teacher about your concerns. Your son’s teacher is a great resource and she should be able to tell you if there are any symptoms that she notices during the day.

It also would be a good idea to check his footwear. Sneakers in particular can present a problem with tripping in children. The rubber soles of sneakers are less flexible than the leather soles found in shoes. The rubber’s high coefficient of friction results in an increased frequency of tripping on certain types of floor surfaces. (1)

If your son is wearing new sneakers to school, take notice if the tripping occurs only at school or only on a certain type of floor. See if your son trips when he walks at home barefoot, or when wearing a different pair of shoes, not sneakers. If he is tripping regardless of the type of shoe he is wearing then an evaluation by his Physician can rule out other problems. Children who are tripping and losing their balance should have their hips, leg length, coordination,muscle tone and vision evaluated.

Ophthalmologic or vision problems can also cause a child to trip. Children who can not see correctly can experience tripping, bumping into objects, over-reaching objects and difficulty catching a small ball. (2) Other signs of vision problems include squinting, frequent blinking, head tilting, rubbing the eyes, eye strain, tired eyes and blurred vision. If your son is experiencing any of these problems he may need an evaluation by a Pediatric Ophthalmologist.

Children can tremble or shiver because they are cold or nervous. (3) Involuntary shaking outside of these scenarios or involuntary jerking of the extremities is abnormal and should also be evaluated by a Physician. If your son’s shaking is intermittent or only occurs certain times during the day it would be a good idea to keep a record and bring it to the Doctor’s visit. In the record, take note of the time of day, the duration of symptoms, the parts of the body involved, the relation to eating and activity, his attention span, eye symptoms and associated findings such as dizziness or pain. You may need to videotape your child’s symptoms so that your doctor can witness an event.

You mentioned that your son may be stressed. Did you ask him if there is something in school that is bothering him? Since his symptoms started when he entered school, it may be necessary to rule out a social problem that he is encountering in the classroom. You can start by sitting down and talking to him about his feelings, fears, and problems at school. It would be important to find out if there is someone in particular teasing him or picking on him in school.

Teasing is common among children and is an important part of their social life. It commonly occurs during school, especially during non-structured time such as recess, changing classes or at lunch. (4) Teasing under normal circumstances can be a part of normal play and may be a healthy way that children show interest in each other. (4) What is more important than the teasing itself is how a child reacts to the teasing. If a child feels intimidated or threatened or if a child can’t see the joking in the teasing, problems can arise. In some cases innocent teasing can escalate into taunting and bullying. It is common for children who are bullied to develop anxiety, sleep disturbances, depression and somatic complaints such as headaches or bellyaches. (4)

Signs that a child is being bullied include; a change in a child’s behavior, academic performance that is worsening, absenteeism or not wanting to go to school, avoiding activities that a child previously enjoyed and a pattern of health complaints. (4) A talk with your child and his teacher can help you decipher if his new symptoms of being “stressed out” are due to interactions that he is having with other children. It is important that you share the information that you find with your Pediatrician so that he can guide you with his care.

I hope you find a resulution to your son's problems soon.

References:
(1)Schwartz M, Charney E, Curry T, Ludwig S. Pediatric Primary Care. A Problem Oriented Approach. 2nd Ed. Littleton, Mass:Year Book Medical Publishers, Inc. 1990:67.
(2)Chow M, Durand B, Feldman M, Mills M. Handbook of Pediatric Primary Care. Albany, New York:Delmar Publishers Inc. 1984:658.
(3)Bellack J, Bamford P. Nursing Assessment A multidimensional approach. Belmont, CA:Wadsworth Inc.1984:285.
(4)Vessey J, Carlson K, David j. Helping Children Who are Being Teased and Bullied. Nursing Spectrum.2003.15(2):22-24.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice Website