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General Clinic Recommendations

Susan R. Johnson MD, FAAP 2/6/2014

RECOMMENDATIONS:

I. To strengthen childrens sensory integration/processing pathways so they can better coordinate their body when moving, still their body when sitting or standing, easily focus and pay attention when learning, and decrease their stress and anxieties:

1) For treatment of unresolved cranial compressions, which often occur during children's birth and can disrupt the development of their sensory processing pathways, have your child see a specialized osteopathic physician who has been trained by Dr. James Jealous and who gives non-manipulative, Biodynamic Cranial Osteopathic treatments. I sometimes recommend a specialized physician who is board certified in Atlas Orthogonist and Functional Neurology. The key is to find the one that your child most connects and relaxes with during the treatments so the treatments are the most effective. These treatments help to resolve cranial compression(s), especially over the cerebellum brain tissue and brain stem at the base of the skull, and help to deeply relax the autonomic nervous system so balance, proprioceptive and bilateral integration pathways can more completely develop. In my opinion these treatments are far superior to most cranial-sacral treatments. These treatments also correct any eye winking, eye tracking and/or eye converging challenges. You can read more about Biodynamic osteopathic treatments and locate the names of other practitioners in your state by going to the web site, www.jamesjealous.com. Please set up a phone time to speak with me one week after your child has had at least 3 cranial treatments to discuss the progress your child is making.

Signs and symptoms for having unresolved cranial compressions which also cause blockages in the development of tactile, balance, eye tracking and proprioceptive pathways:

Birth history risk factors:

  • (born prematurely, prolonged labor (>12 hrs.), fast delivery, c-section birth, pitocin used to induce labor (especially after the water had broken), use of vacuum suction forceps, torticollis at birth, a fractured clavicle (collar bone), bruising on head, overlapping sutures (skull plates) and/or excessive molding of cranium (skull).
    Tactile hypersensitivity or hyposensitivity (pressure seeking)
  • Constant crying (colic), reflux (GERD)
  • Difficulty breast-feeding, latching-on, maintaining a good suck.
  • Picky eater, because child is sensitive to food textures or can't coordinate chewing
  • Developmental milestones are delayed or too early (delays in creeping flat on stomach, crawling on hands and knees, and/or sitting. Having an unusual crawl pattern (backward crab crawl or wounded leg crawl with dragging of one leg or a history of walking early or very late).
  • Did not like tummy time as an infant or wanted to be held all the time.
  • Prolonged bed wetting (after age 6 years), grinding of teeth, head banging
  • Prolonged sucking of thumb, fingers and/or a pacifier
  • Asymmetry of facial planes/skull, overcrowding of teeth, jaw and bite asymmetry (underbite, overbite, or a collapsed arch)
  • Tightly contracted back neck muscles that restrict passive flexion, extension, and side to side head movements. These tightly contracted back neck muscles along the spinal column also make it hard for the child to fully flex their head when bending over at the waist, and they may not be able to
  • even touch their toes without having to bend their knees.
  • Difficulty creeping flat on abdomen (drags feet, has to lift head or pelvis)
  • Retained Asymmetric tonic neck reflex, Moro (startle) reflex, Palmar reflex,
  • Galant Reflex, and/or persistent tongue thrust impacting speech articulation.
  • Asymmetry of shoulder blades, hip bones and/or arches of feet due to asymmetry in contraction of back neck muscles that are stabilizing head movement, since there is a compression at the base of the skull.
  • Eye tracking and eye converging challenges because of poor functioning of the one or more cranial nerves that control the muscles that move the eye.
  • Unable to wink with left and/or right eye by age 4 years (compression is usually interfering with the ability of the 3rd cranial nerves on either side to raise the eye lids in one or both eyes, when both eyes are closed).
  • Persistently dilated pupils (>30% of color portion of eyes)in indoor light, frequent nightmares because of being predominately in the fight/flight, sympathetic portion of the autonomic nervous system.
  • Needs parent next to child in order for child to fall asleep or stay asleep.

2a) If available in your area (usually at a Waldorf or Waldorf-methods school), have your child do at least one cycle of Therapeutic Eurythmy movement therapy (Highly specialized Tai Chi and Qigong-like movements for children and adults) either twice a week for 7 weeks or once a week for 14 weeks to strengthen eye tracking, eye convergence, balance, proprioception, and bilateral integration pathways. Therapeutic Eurythmy also helps to relax the autonomic nervous system. I usually have children do 2 to 3 biodynamic cranial sessions before starting Therapeutic Eurythmy to help resolve any cranial compressions so the eurythmy movements imprint more deeply in the brain. Sometimes children need more than just 1 cycle of 14 sessions to open their pathways. I sometimes recommend a one hour follow-up session to reassess movement and/or reading pathways after the first cycle to determine if a 2nd cycle is needed. Therapeutic Eurythmy is done one on one with your child and in my opinion is more effective than Brain Gym, HANDLE exercises, Smart Moves, gymnastics and even occupational therapy, though I do recommend occupational therapy (if done with a therapist that specializes in working with children that have sensory integration dysfunction) for very young children (ages 2 to 4) or older children whose balance and proprioception need strengthening before they can do Therapeutic Eurythmy (see my referral sheet). Check this website, www.Therapeuticeurythmy.org/directory/ for eurythmy therapists.

Frequently prescribed Therapeutic Eurythmy movements:

  • Allergy sequence (T, S, R, M with the Curative Ah) for strengthening the immune system, rhythmic system and metabolism. Curative Ah helps to calm the autonomic nervous system and helps children to fall asleep more easily.
  • S helps with incarnation, strengthens the sense of the body in 3 dimensional space and strengthens bilateral integration as well.
  • Dexterity E (a) for strengthening incarnation into the body while also strengthening tactile, balance, proprioceptive and bilateral integration pathways. .
  • Finger rod, 7 fold rod and Waterfall Rod exercise. Finger rod exercises strengthen fine finger movements and also help integrate the vertical midline. 7 fold rod exercises help children better locate their body in 3-dimensional space while integrating the vertical and horizontal midlines. The Waterfall rod exercise is also incarnating and works on the awareness of backspace. .
  • I-Ah-O, for grounding thinking in the head with feeling in the heart, and connecting these forces to the will forces in the metabolism and movement of the extremities, .
  • Hope U (oo) for strengthening balance and a sense of the backspace. This is also a soul exercise, along with Ah Veneration, and Love E (a). .
  • Slow 3 fold walking, forwards and backwards (with simultaneous arm movements in the older child) to strengthen balance, proprioception, and bilateral integration pathways. .
  • S with o legs, L with x legs, Ah-E (a) and concentration exercises with jumps and stomps to bring your child more deeply into the lower extremities and help your child to integrate both the horizontal and vertical midlines by strengthening bilateral integration and proprioception.
  • Love E (a) and B for helping to strengthen the soul and physical boundaries and so your child is not so overwhelmed by sense impressions. .
  • Walk Star form with feet while simultaneously doing the vowel forms with arms and hands to strengthen balance, proprioception, and bilateral integration. .
  • Concentration exercises with upper and lower extremities moving simultaneously while moving and counting, forwards and backwards. .
  • Bedwetting Fto help resolve enuresis in older children (>5 years of age).

2b) Therapeutic or Parelli Natural Horsemanship riding lessons (mostly bareback) are also wonderful for strengthening proprioception and balance. Check web sites for Therapeutic Horseback riding and/or www.Parelli.com and www.ParelliNaturalHorse Training.com.

2c) Have your child participate in Extra lesson movement work with EXTRA Lesson trained movement therapists that usually work at Waldorf and Waldorf-method Schools. This movement work is done once or twice a week to strengthen eye tracking, eye convergence, balance, proprioception, and bilateral integration pathways. I usually start with a course of Therapeutic Eurythmy movement therapy and then add or substitute bareback horseback riding (if available) and/or Extra Lesson work or other movement programs (whatever is available). The loving relationship of your child to the movement therapist is extremely important for extra lesson work and for any other movement therapy or educational experience in which your child participates. The therapist needs to be in and to stay in the present moment, when working with your child, and the therapist needs to care deeply for your child and enjoy the movement or teaching work that he or she is doing with your child. This is what will help your child to relax and enable him or her to imprint the movement and learning. Anytime your child experiences excessive stress when moving or learning, she or he will go into the fight/flight portion of the autonomic nervous system, and the movements and learning will not fully imprint in his or her mind (in other words the therapy will not be very effective).

3) I recommend that children 6 years old or older and adults take 1 tsp/day of Arctic D cod liver oil by Nordic Naturals to provide 1000 IU of Vitamin D3, approx. 1000 IU of Vitamin A, and plenty of omega 3 fatty acids (especially DHA and EPA) for brain myelination and development. If children are ages 3 to 5 years then I recommend 1/2 tsp/day. If taking capsules containing the oil, make sure the concentrations of Vitamin A and Vitamin D 3 are fairly equivalent if these vitamins are added to the oil. Also make sure the capsules contain both DHA and EPA as omega 3 fatty acids. Children and adults will get a sandpaper like rash on their upper arms and/or back when they have omega 3 fatty acid deficiency. The skin should become silky along with any new growth of hair on the head, about 1 month after taking the oil. Be sure to have your child consume a few teaspoons of organic butter, Factor x butter (Weston Price recommended), and/or ghee (butter without the milk protein), during the same meal when taking the oil, since it helps the body absorb this oil. We need extra Vitamin D3 during the winter time in Northern California even if it is sunny outside since the low angle of the sun does not allow our body to make it easily. If your child does not like the oily taste then you can vigorously mix the oil with 4 to 5 Tbsps of organic grape juice before she or he drinks it.

4a) Continue to limit screen time (ie computer games, videos, television) to 2 hours/week, if at all, and avoid watching screens on school nights. Media over- stimulates and stresses the autonomic nervous system and therefore keeps the brain in fight/flight mode causing hyperactivity, impulsiveness, and attention problems. In addition, the pathways of the brain (ie. mind) can't develop properly or heal when the autonomic nervous system is stressed. Remember that 30 minutes of screen time often stresses the nervous system for 3 to 4 hours keeping children in fight/flight for several hours after turning off the screen. Playing outside in nature, especially in water or sand, is a great way to detox and relax the autonomic nervous system again.

We also convert our visual memories of the day from short term to long term memory during REM (rapid eye movement) sleep each night, and the visual input from screens will compete with and dilute out the visual information and visual experiences that your child has had during the day. In addition, if adults or children do not get enough sleep during the night then deep sleep is preserved but REM sleep is shortened (ie sacrificed) which also limits the conversion of short term memories from the day into long term memory. For example, if your child learned something new one day and did not get enough REM (ie rapid eye movement) sleep that night or watched a lot of media that day, then your child would more easily forget what was learned when he or she woke up the next morning.

4b) When children have adequate sleep they will awaken by themselves in the morning, have a hearty appetite for breakfast, and often have a bowel movement as well. Remember that getting enough sleep is key for learning (see 4a). In addition, deep sleep restores the brain's neurotransmitters and allows the liver to store sugar for the brain to use the next day. This helps prevent adrenal gland fatigue so the adrenal glands are not continually over-stimulated to secrete cortisol (a steroid and stress hormone that moves sugar into the bloodstream to provide more fuel for the brain). Cortisol oversecretion depletes vitamins and minerals and also suppresses the immune system so we become sick more easily. Usually we get reddish circles under our eyes from allergies and dark circles from adrenal fatigue.

5) Make sure that your child's hands, arms, feet, legs, and abdomen (lower back) are as warm as the skin over his or her heart. The brain can not adequately find an extremity if it is cool or cold. Children can't manipulate their fingers as easily if they are cold and can't feel the ground underneath their feet if their feet are cold. In general, being cold keeps children and adults in their stress portion of their autonomic nervous system. Children will use up their body's energy for developing their heart, lungs, brain etc. if they have to use that energy to keep their body and organs warm. The immune system also does not function as well when children or adults are cold. Magnesium deficiency can also cause our extremities to run cool.

6a) Play and do lots of proprioceptive strengthening games and movements that are noncompetitive, as well as chores, such as pushing a wheelbarrow, pulling weeds, digging with a shovel to plant flowers, carrying buckets full of water to water plants, etc. (See the handouts on proprioception that I gave you).

6b) Your child may also enjoy being squished in the Dog Pile game (where he or she is sandwiched in-between your bodies), being wrapped up like a burrito using a blanket or towel, and playing the Bear Hug game (where you sit in a chair as the sleepy big bear and give your child a big bear hug using your arms and legs). You can then pretend to fall asleep and have your child wiggle free. Rock wall climbing is also a fun activity that strengthens proprioception, in addition to horseback riding and Therapeutic Eurythmy. Most of these proprioceptive strengthening activities strengthen the balance pathways as well. As children's proprioceptive pathways develop normally or as proprioceptive pathways are opened by biodynamic cranial therapy followed by movement therapy, you will see a change in their drawings. Children draw for us the proprioceptive connections that their mind has made to the trunk and extremities of their body when they draw for us a picture of a person. Children less than age 2 years usually only scribble when asked to draw a person. Their mind has not yet connected proprioceptively with their body. Girl age 2 years and Boys age 3 years usually draw a circle with dangling sticks for legs and/or sticks for arms coming out of the circle. This means that they are starting to make proprioceptive connections to their arms and legs but not yet their trunk, hands, fingers, or feet. Usually by age 3 years for girls and 4 for boys, children draw a full stick figure often with 3 to 5 stick fingers on each hand. Starting around age 5 years of age, children start to experience their body in 3 dimensional space (ie forward/backward, left/right, and up/down) so their drawing of a person now shows dimension. Now the drawing consists of clothes on the trunk (e.g. shirt, pants, or a dress) with tubular (rather than stick-like) arms, hands, fingers, legs and feet. The drawing becomes more detailed along with the appearance of a neck around age 7 years. When children draw this detailed and 3-dimenisional drawing of a person, their proprioceptive pathways are formed and they will have an accurate visual memory for numbers and letters.

Once children can fully perceive their body in 3 dimensional space, they will be able to stand on each foot, in stillness, for 8 to 10 seconds with their eyes closed. They will also be able to accurately draw on paper all the numbers and letters that are firmly drawn on their back, with your finger. Remember that children will still perceive the diagonal lines in the letters, M, W, or V, as straight lines until they fully feel their body in 3-dimensional space. When their proprioceptive pathways have fully developed, children will be able to recall and write down a series of 6 numbers, letters, and/or shapes that they are shown visually for 10 seconds, without reversals. This is why we do not want to push children to read or write until their proprioceptive and bilateral integration pathways are fully developed, or we will cause children to develop visual processing, nonverbal learning disabilities.

When children can draw a dimensional drawing of a person without being coached by a teacher or a parent, then their minds have fully imprinted the location of proprioceptive receptor sites in the muscles, joints, tendons, and ligaments within their trunk and extremities and they will have an awareness of their body in space. Now they will be able to sit still in a chair without wiggling, sitting on their legs and feet, and/or lying on their desk top. They will have an accurate visual memory for letters and numbers when writing or doing mathematics and be able to easily fall asleep and stay asleep, since their mind can now perceive their body even when their eyes are closed.

In parenting and disciplining our children, always remember that the age of children proprioceptively, based on their drawing of a person, usually corresponds to their social/emotional age. For example a 5 year old child who is still scribbling because of cranial compressions (usually over the cerebellum brain tissue at the base of their skull) that block the higher parts of the brain (in the parietal area of the brain at the top of the head) from receiving proprioceptive feedback will have an emotional/social age around 1 1/2 to 2 years of age. Their intelligence may be completely normal and even gifted, but their mind is overwhelmed with keeping their body upright and not available for noting the nonverbal, social cues of other children. These children, that are either still scribbling at 5 years of age or barely able to draw a stick-figure often lacking fingers, will also have challenges with fine motor finger movements and show a fist-like pencil grip when using a crayon or colored pencil.

When a 7-year-old child is still drawing only a stick-like person, then he or she will have not yet developed spatial awareness and therefore may inappropriately hug other children, get into other children's body space, bump into furniture, and/or withdraw to the periphery of a room when there are lots of children running around the room (because they feel overwhelmed and unable to navigate around the other children). These 7-year-old children, who are drawing stick figures, have a proprioceptive age of 4 to 4 1/2 years. This often means that they have an emotional/social age of 4 to 4 1/2 years as well. Their social skills will continue to seem young until their proprioceptive system more fully develops. Knowing this helps us as parents and teachers to adjust our expectations for the child's behavior and social skills as well as our methods for disciplining and ways of communicating with our children.

Once again, when proprioceptive pathways are still developing, children need their minds to judge spatial distances and keep their body upright especially when their feet are off the ground. Therefore, their minds are not yet free to focus on the nonverbal social cues given by other children or adults. In addition, their autonomic nervous system is often in fight/flight or stressed so they can be very physically and emotionally reactive and show overly large (dilated) pupils while in indoor, moderate light.

7) Give your child a pressure squeeze massage at bedtime to strengthen his or her proprioceptive pathways. Start by squeezing the thumb and each finger of one hand with your whole hand and then sequentially squeeze their hand, wrist, and up their arm until you reach the shoulder. Now squeeze the thumb and fingers of the other hand up to the shoulder (making sure to squeeze all the joints-fingers, hands, wrist, and elbow along the way). Next firmly squeeze all the toes and the entire foot with your hands (you do not need to squeeze each toe individually) and then continue squeezing from the ankle up to the thigh (squeeze the knee on the sides). Now do the other leg from toe to thigh. End by squeezing the child's shoulders and squeezing along the sides of the rib cage down to the hip bones. If children are too ticklish when you squeeze their rib cage on either side, you can have them extend their arms along their sides and squeeze down their arms to squeeze their ribcage. Always adjust your squeezing to your child's comfort. If the child is ticklish then you may be squeezing too lightly. If the child says it hurts then you are squeezing too firmly.

8) Play catch with your child, 5 to 10 min./day, with progressively smaller and smaller bean bags, rice-filled balls, ping-pong balls, or tiny soft balls to strengthen his or her eye tracking and convergence. For fun if your child is younger and struggles catching a ball, you can start by tossing a balloon in the air and taking turns hitting it up in the air and seeing how many times you can tap it sequentially (so it is not a competitive game that stresses the nervous system) before the balloon falls to the ground. You can also have your child practice throwing a bean bag, ping pong ball, or small rice ball in the air and catching it by herself or himself (#times equals your child's age in years) first with both hands and then each hand separately, using an underhand catch so the eyes track more up and down. Later your child can practice tossing the ball or bean bag back and forth between the hands. If your child is older (1st and 2nd grade or older) he or she can do this catching activity while on a balance board, then the movement becomes cross-lateral and will strengthen bilateral integration pathways. Ping pong, jacks, tennis (noncompetitive), and badminton are also great games for strengthening eye tracking, eye convergence, and hand-eye coordination. Even solving mazes on paper and playing board and card games (though not on a computer screen!) will strengthen eye tracking. Eye strengthening activities need to occur in 3-dimensional space and not by looking at a flat, 2-dimensional screen, which will only strain the eyes.

Playing catch is so important because it strengthens visual tracking, eye convergence, balance, proprioception (especially in the fingers), eye-hand coordination, and fine motor finger movements. It is the best thing to do to prepare and/or strengthen your child's abilities to read and write.

9) Do lots of cross-lateral movement activities to strengthen your child's bilateral integration pathways. Movements like noncompetitive swimming, climbing rock walls, hiking with poles, snow shoeing with poles, cross country skiing with poles, jumping rope by self (especially in a double jump to single arm swing pattern), Bal-a-vis-x.com (bouncing a ball from one hand to the other while on a balance board), contra or square dancing, ballroom dancing (in middle school or high school), certain extra lesson movements, and of course Eurythmy (which is one of the most powerful movement therapies for bilateral integration) are all great. Circle time in k through 4 grade at your school often includes cross-lateral movements, as does doing Spatial Dynamics in the older grades. Doing a circus skills camp some summer (e.g. learning how to ride a unicycle while juggling) would also be great, as well as learning how to paddle upright on a flat board in still water (a popular sport in Hawaii right now). Even kayaking, canoeing, and rowing are cross-lateral activities (because the trunk and lower extremities hold tension while the arms are paddling) and will strengthen bilateral integration and proprioceptive pathways.

Starting in the first grade at Waldorf and Waldorf-method schools, all the form drawing and practicing of cursive writing (in a flowing manner without pausing between each letter), will also strengthen bilateral integration pathways. Printing just requires the left hemisphere of the brain while cursive writing requires the right and left sides of the brain working together. Older children who have not yet fully developed their bilateral integration pathways will find cursive writing very challenging and will prefer to print.

10) Read the Articles, Healing our Children with Attention, Emotional, and Learning Challenges, Teaching our Children to Write, Read and Spell-Part I (The Feb. 3, 2014 version) and Part II, and Visual Tracking, Eye Convergence, Reading and Writing, on my web site or in my book, Healing Our Children.

11) If your child is in 4th grade or above, he or she may need an individualized, phonetic-based reading program like Susan Barton or Linda-Mood-Bell to switch the reading pathways from the right brain (sight memory) to the left brain (phonetic-based meaning sounding out the words). These programs first work on phonemic awareness, having children practice hearing the separate sounds in a given word. Next, children learn the different sounds that each vowel can make and the spelling rules that determine what particular sound a vowel uses within a given word. For example, the vowel A says its name, A, in the word MAY and also gives this sound in the words BAY, RAY, SAY, and DAY. The vowel A uses a different sound in the words, SAT, MAT, BAT, RAT and yet another sound, the AH sound, in the words, SAW, RAW, LAW, BALL, TALL, and CALL.

Susan Barton's phonetic program describes children as being dyslexic, assuming the reading challenges are all genetic. Just realize that sight reading results when children are taught to read before the left side of their brain has developed for phonetic based reading. There may be a genetic reason why the left brain develops later for phonetic based reading, but it could also be due to an unresolved cranial compression that is blocking the development of these pathways.

The problem with the more formalized Linda Mood Bell training centers is that they are very expensive and their instructors teach phonetic reading without realizing that it is a developmental task. In my opinion, they often push phonetic reading in very young children who have not yet fully developed their proprioceptive and bilateral integration pathways and/or still have unresolved cranial compressions that are blocking these sensory processing pathways. These Linda-Mood-Bell instructors will have children do tutoring 3 to 4 hours a day, 5 days a week to attempt to teach phonetic reading in a child whose pathways are not yet ready to learn it. I have children receive tutoring from Linda-Mood-Bell instructors but only after I am sure that their sensory integration pathways, especially proprioception and bilateral integration, are fully developed.

I recommend that phonetic-based tutoring be for only 1 hour, once or twice a week. If the tutoring does not imprint easily for your child, the proprioceptive and bilateral integration pathways have not yet fully developed, and I would stop the tutoring and focus on cranial work in conjunction with movement therapy. I also recommend a physician who specializes in Functional Neurology and teaches whole body and eye movement exercises to parents that they can do at home to further open and develop the cerebellum, parietal, temporal, and frontal areas of their child's brain needed for phonetic-based reading and to develop more flowing fine- and large-body movements. If eye tracking and eye converging pathways are not fully functioning after cranial and movement therapies, then I sometimes will recommend Vision Therapy if the vision therapist works with an occupational therapist who specializes in whole body movements and does not use a computer program with children, which I feels strains the eyes. In my opinion, eye tracking and eye converging movements need to be done in 3 dimensional space and not by looking at a flat, 2-dimensional computer screen.

Once children can easily hear the separate sounds within each word (ie. phonemic awareness) and can quickly sound-out words backwards as well as forwards (such as TRAMS=SMART, WARTS=STRAW, POTS=SPOT etc.), their left brain has usually developed enough to learn phonetic-based reading. I also want to make sure that bilateral integration pathways are fully developed so that children are forming mental pictures in their mind while simultaneously reading phonetically.

12) if your child has sensory integration dysfunction or was pushed to read words using right brain sight memory and now needs to switch reading pathways to the left side of the brain (so the child reads phonetically, by sounding-out words, rather than guessing at the words by their shape), then the tuition at a private Waldorf School may be tax deductible as a medical expense each year. I often recommend and prescribe Waldorf-based teaching methods to meet children's learning needs through the 8th grade and even through high school. This is because Waldorf and Waldorf-method schools teach children using visual, auditory, and hands-on, kinesthetic teaching methods. Waldorf schools also provide lots of handwork, painting, drawing, singing, playing of musical instruments, circle movement activities, classroom eurythmy, and outdoor movement games and activities such as spatial dynamics and circus skills training (ie juggling while on a unicycle, walking a tight rope etc.) activities. In addition all movement therapies, cranial work, supplements, dietary restrictions (e.g. gluten free foods) and remedies that I recommend during assessment and follow-up visits are tax deductible as medical expenses each year. Let me know if you need a letter stating this for your taxes.

13) Continue reading lots of books and lots of stories to your child to strengthen the right brain's (mind's) capacity to create imaginative scenes and pictures. Eventually as the left side of the brain strengthens for phonetic-based reading along with the strengthening of bilateral integration pathways (ie the connections between the right and left sides of the brain), your child will be able to simultaneously create scenes/pictures in his or her mind while reading. In my experience of 30 years of pediatric practice, these pathways for phonetic based reading and mental picturing do not start developing in girls until around ages 6 1/2 to 7 1/2 years of age (the earliest age I have seen phonetic based reading with simultaneous mental picturing is age 6 years and 2 months). Boys' sensory integration pathways of proprioception and especially bilateral integration need at least an additional 1 to 2 years to develop. Therefore, their ability to read phonetically while simultaneously forming mental pictures may not develop until they are 7 1/2 to 9 years of age. These pathways are easily blocked from developing in both girls and boys by unresolved cranial compressions, brain malnutrition and/or inflammation in the brain due to the Leaky Gut Syndrome.

In addition, if children come from more artistic, intuitively gifted, right brain dominant parents, then they will need additional time before the their left brain myelinates fully for phonetic-based reading. Some of our most gifted children may not read until age 12 years because they are myelinating so many connections first in the right hemisphere of the brain and are not yet ready to myelinate the left side of the brain and the connections between the right and left sides of the brain, which are required for true reading that is phonetically-based (left brain activity) with simultaneous, mental picture imaging (frontal area of the right brain).


II. Recommendations for healing the Leaky Gut (ie. inflamed intestinal lining) Syndrome which often causes allergies, chronic sinusitis, serous otitis, expressive and receptive language delays, behavioral and emotional outbursts, autoimmune conditions (including Crohn's disease, Ulcerative Colitis, Autoimmune thyroiditis, Multiple Sclerosis etc.), asthma, brain inflammation (ie. Autism), and/or sensory integration dysfunction.

14) Read my articles, Leaky Gut Syndrome and the Allergy Treatment Sheet, as well as the excellent book, Gut and Psychology Syndrome, by Dr. Natasha Campbell-McBride from Cambridge, England. In my articles and her book we discuss how our diets high in processed sugars, frequent antibiotics and chronic stress all destroy our healthy intestinal bacteria and allow yeast to overgrow. The yeast steals and absorbs valuable minerals and vitamins from our food so we crave salt and it also absorbs simple carbohydrates (ie glucose) from our diet so our brain does not get enough sugar for energy, and causes us to crave sugar. In addition, the yeast can burrow into our intestinal lining causing inflammation (ie stomachaches after eating or before having a bowel moment). Certain unhealthy bacteria can also produce an endotoxin that hurts our intestinal lining and/or the gluten protein itself can trigger inflammation of the intestine directly in some people. Whatever is the cause of the inflammation, this inflammation of the intestinal lining allows undigested food products to gain direct access to our bloodstream, triggering an immune response, allergy symptoms, and when severe, brain inflammation. Both receptive and expressive language as well as other sensory processing and learning pathways can be disrupted from this inflammation in the brain.

Dr. Campbell-McBride recommends taking probiotics (containing beneficial intestinal bacteria) and going on a gluten-free (wheat, rye, corn, barley) and mostly casein-free (milk products) diet called the GAPS diet for at least 6 months to heal the intestinal lining (some children need this diet for 1 to 2 years). I recommend her maintenance diet, but be careful with the intro diet which can cause children to go into ketosis and lose muscle if they are not getting enough sugar from vegetables before fruits are added. This diet, along with going on probiotics, juicing vegetables, and eating lots of chicken mineral bone broth, will usually stop all stomachaches in 1 month and decrease any congestion. Expressive and receptive language should also start to improve. It usually takes a little longer for eczema skin rashes to go away, tonsils to shrink, and/or serous fluid behind the ear drums to resolve. There are several web sites with great gluten free recipes (See page 4 of my referral sheet under additional resources).

There is an at home, finger prick test by Bio-tek laboratories that can assess the presence of IGG antibodies in the blood to 96 different types of food proteins. The test is $139. This test helps to sort out whether a child or an adult needs to be only gluten-free, only casein-free, or both gluten and casein-free. Normally there should be very low levels of detectable IGG antibodies in the blood to food products, since the intestinal lining does not allow whole food proteins to get into the blood. With proteins, only the amino acids should pass through the intestinal lining and get into our blood. Our liver then makes human proteins from these building-block amino acids. IGG antibodies are only produced by our immune cells if they detect foreign (ie non-human) proteins, like gluten or casein, in our bloodstream. This would only happen if there was yeast overgrowth or a bacterial endotoxin in our intestine causing inflammation and compromising the integrity of the intestinal lining.

15) Take Bio-kult capsules (2 to 3 billion organisms/capsule) at bedtime for 6 months to restore beneficial intestinal bacteria. The treatment dose is 2 to 4 capsules/day for children 2 to 4 years of age and 4 to 6 capsules/day for children 5 to 10 years of age. Older children and teenagers can take 6 to 8 capsules/day. This is an excellent probiotic formulated by Dr. Natasha Campbell-McBride and can be ordered on-line by calling 800-899-3413 or going to the web site www.GAPSdiet.com. For adults I recommend taking 8 to 10 capsules of Bio-kult at bedtime, 1 capsule (30 to 50 billion organisms) of Trinity probiotics by Natrens, or 1 capsule (80 billion organisms) of Critical Colon probiotics by Renew Life. With Bio-Kult, start with just 1/4 to 1/2 of capsule for the first week and then increase to 1 capsule at bedtime for the next week, followed by 2 capsules at bedtime for the subsequent week. Continue increasing the number of capsules each week until your child is taking the appropriate treatment dose at bedtime. It is best if your child can swallow the whole capsule with water or buried in applesauce since the stomach acid often destroys most of the bacteria if the probiotic is in powder or liquid form. If your child can't swallow the capsule, you will just have to open it.

16) Juice 12 large organic carrots, 1 organic green cucumber, 1 organic red beet with beet greens (leaves), 6 organic stalks of dino Kale (if available), 1 to 2 organic apples, 1 peeled lemon and sometimes 1 peeled orange if your child wants a sweeter drink. Sometimes I add 2 to 3 large stalks of organic celery but make sure the celery is not bitter, because if it is, it will really ruin the flavor of the drink so children won't drink it. Have children drink 8 to 12 ounces of this juice at least 3 to 5 times a week or even daily (I recommend that adults drink 16 to 32 ounces). This juice will provide lots of vitamins, mineral, antioxidants, and raw plant enzymes to better digest your food and even help to get rid of excess intestinal yeast. Drinking this juice will provide so many minerals for the body that the saliva pH will stay alkaline (7.0 to 7.4) the entire day, so energy level will be high and the immune system as well as the brain will function more effectively. Taking in lots of vitamins and minerals usually will stop the craving for sugar. We often crave sugar when we are B vitamin deficient, yet most of our breads and sugary foods are depleted in vitamins by over-processing and cooking (cooking inactivates most vitamins). Whole Foods store has a juice bar where you can order a 16 oz drink containing beets, carrots, cucumber, parsley, spinach, apple and lemon (they sometimes have kale). On days that you juice your child does not need to take the Oxylent supplement containing extra vitamins and minerals (See #21a).

17) Make organic, free-range, chicken bone broth soup (see the recipes in my book) to provide your child with lots of mineral especially calcium and magnesium. The bone broth also helps to heal any inflammation in the intestinal lining. Usually if adults or children have stomachaches it is recommended that they drink about 1/4 cup before meals, or mix the broth into the food you are cooking. The chicken bone broth can be frozen in ice cube trays and then be easily used when cooking. If you make the chicken-vegetable soup with the bone broth it has lots of garlic and onions that also help to discourage yeast growth in the intestine.

18) Increase magnesium containing foods in your diet such as dark leafy greens like kale, green colored pumpkin seeds, chia seeds, presoaked/slow roasted almonds, seaweed, and of course bone broth soup. Magnesium also makes up Epsom Salts, and can be absorbed through the skin if either Magnesium sulfate crystals or Magnesium chloride salts are added to the bath. Children and adults can also take 1 tsp (for children) and 2 heaping teaspoons (for adults) of cherry flavored or raspberry-lemon flavored adult Calm by Natural Vitality. Make sure to buy the Calm that only contains magnesium. The Calm is added to 8 to 12 ounces of either cold or warm water and usually taken orally in the late afternoon (raspberry-lemon flavored Calm can be combined with Oxylent vitamin and mineral powder and mixed with cold water). Calm relaxes skeletal muscles and so relieves growing pains, muscle cramps and restless legs. It stimulates smooth muscle contraction in the small and large intestines and therefore increases the frequency of stools. It is great for constipation and does calm the nervous system. Usually I have children take 1 to 2 tsps of Calm in water every day for 2 weeks and see if they note any calming effects during the day and better sleep at night. If they do, I have them continue taking Calm and increase magnesium-containing foods in the diet.

Magnesium is a mineral and a cofactor for sugar metabolism and neurohormone/neurotransmitter production (e.g. melatonin to promote sleep and serotonin to calm the nervous system). According to the Weston Price Journal magnesium is required for the production of all proteins, including those that interact with vitamins A and D. Read the article on Magnesium that I gave you from the Weston Price Journal for much more information. Magnesium deficiency causes among other things, cold hands and feet, tooth decay (poor enamel), asthma, seizures, chronic fatigue, hyperactivity, temper tantrums, hypertension, migraine headaches, insomnia, calcium kidney stones, muscle cramps, osteoporosis, menstrual pain, restless leg syndrome, decreased learning, poor memory, numbness and tingling in the extremities and angina from coronary artery spasm. We tend to crave salt when our body is magnesium deficient.

19) Remember that eating lots of presoaked, slow roasted almonds (recipe in my book or on the web site) and turkey will increase serotonin levels, the good mood neurotransmitter. I would also give your child a hearty protein/fat-containing snack, like almonds or turkey every 2 to 3 hours between meals to stabilize his or her blood sugar levels. Eating healthy fats will slow the emptying time of the stomach and therefore slow the rate and the amount of sugar that is absorbed into the blood stream via the small intestine. This lowers the amount of insulin secretion by the pancreas and lessens the chance of low blood sugar and cortisol secretion. Having yeast in the intestine and being in the fight/flight portion of the autonomic nervous system also causes the brain to rapidly use up the sugar in the bloodstream. Low blood sugar (ie low sugar to the brain) makes adults and children more irritable and tired and therefore less able to focus. It also increases the likelihood of having meltdowns since it stimulates cortisol and other stress producing neurohormones (like epinephrine and norepinephrine) from the adrenal gland.

20) Read the articles on my web site or in my book on nutrition, especially the article More About Nutrition that talks about cooking with healthy fats like coconut oil and ghee while avoiding partially hydrogenated (trans) fats, like corn oil and cooking with canola oil. Even olive oil should be used cold and not for high temp cooking. The cookbook, Nourishing Traditions, is also a great book to read. Just reading the first 75 or so pages of this book in addition to the pages about wheat give an excellent review of nutrition. My entire 6 week course in Switzerland is covered in this book. This book also discusses how to soak and prepare grains so they are more easily digested, how to ferment vegetables like cabbage and beets to provide beneficial intestinal bacteria, and provides homemade yoghurt and kefir recipes.

21a) I usually recommend that children and/or adults who are vegetarians take a sublingual (dissolved under the tongue) vit B12 (methyl and not the cyano form), Vitamin B6 and folic acid combined pill, 2 times a week if a child and daily if an adult. Wellgenix makes the best tasting combined, dissolvable Vitamin B12, B6, and folic acid pill. If children drink juiced vegetables at least 5 times a week, then I just have them take this Vitamin B12, B6, and folic acid supplement under their tongue (Juiced vegetables/fruits usually do not contain vitamin B 12). If children do not drink the veggie juice then I have them take Oxylent instead, which also has Vitamin B12.

While children are gluten-free or if children are in their stressed nervous system or have clinical symptoms for having lots of yeast in their intestines (which act like parasites and steal all their vitamins along with the minerals from their food) and/or have expressive and receptive language delays, I recommend that they take the powdered vitamin and mineral supplement called Oxylent for a few months. I usually recommend that children drink 1/2 of the adult packet/day mixed in 8 to 12 ounces of water while adults take 1 packet/day mixed in 16 ounces of water. A full packet of Oxylent (by Vitalah 877-699-5368) contains 1000 IU of Vitamin D3. It also contains the methyl form of Vitamins B12, Vit B6, Folic acid and several other B vitamins. I would not exceed 1500 IU of Vit D3/day in children (remember taking 1 tsp of Arctic D cod oil will provide 1000 IU and 1/2 of a packet of Oxylent provides 500 IU which is fine). Oxylent is sweetened with Stevia rather than sugar or corn syrup. It also contains methyl B12 (cobalamin) rather than the cheaper and less effective cyano-B12 found in other less expensive brands.

You can see why I recommend taking Oxylent for a few months when you read the article, Violence and Nutrient Deficiencies in the journal, Wise Traditions, Spring edition, 2013 (published by The Weston A. Price Foundation),

Vitamin B12 (which is made by our intestinal bacteria if our intestine is healthy) when deficient causes irrational anger, fatigue, weakness, amenorrhea, soreness in arms and legs, diminished reflexes, mood changes, mental slowness (Alzheimer's), a red sensitive tongue, tingling and shooting pains in extremities, numbness, sensory hallucinations, paranoid symptoms, ringing in the ears, headaches, irritability, memory loss, nervousness, and palpitations. Vitamin B12 is in grass fed meats (assuming animal has healthy intestinal bacteria to produce it), brewers yeast, egg yolks (lightly cooked since heat denatures the vitamin), alfalfa, raw organic milk, and miso. Deficiencies occur in vegetarians and vegans with low animal protein intake and individuals with the Leaky Gut Syndrome.

Vitamin B6 is involved in the metabolism of amino acids and for maintenance of the immune system. It is also necessary for the process of methylation, which is critical for mental health. A deficiency of Vitamin B6 causes acne, allergies, anxiety, asthma, carpel tunnel syndrome, depression, seizures (epilepsy in children), crohns disease, cracked sores on mouth, dandruff, headache, irritability, violence, fatigue, hyperactivity, calcium kidney stones, learning disabilities, muscle fatigue and pain, nausea with pregnancy, neuritis, PMS, schizophrenia. stress ulcers, toxemia during pregnancy, joint pain, water retention, and infertility, to name a few. Vitamin B6 is needed to make serotonin, the good mood transmitter, along with the mineral magnesium. Avoid any deficiency by eating lots of fresh fruits and vegetables.

Folic acid deficiency causes acne, anemia, canker sores, depression, diarrhea, fatigue, sore red tongue, irritability, hostility, headaches, immune weakness, neuropathy, periodontal disease, poor appetite, restless leg syndrome along with magnesium deficiency, seborrheic dermatitis (cradle cap) along with Biotin deficiency, poor memory, growth impairment, insomnia, weakness, and digestive disturbances. Microwave cooking destroys this vitamin along with many others. Avoid any deficiency by also eating lots of fresh fruits and vegetables.

Thiamin (Vitamin B1) deficiency impacts the hypothalamus and impulse control. Symptoms of deficiency include depression, irritability, confusion and loss of memory. Chronic deficiency results in paralysis and insanity. Marginal deficiencies cause impulsiveness, high irritability, aggressiveness and sensitivity to criticism. People who eat foods with mostly empty calories such as sodas, fast foods, snack foods and alcohol are at risk for B1 deficiency. Thiamin is found in animal foods and selected seeds.

Niacin (Vitamin B3) deficiency, also known as pellagra causes diarrhea, dermatitis and dementia-The three D's. The psychotic (schizophrenic like) symptoms are variable and sometimes can precede the diarrhea and dermatitis. Subclinical (mild) symptoms include anxiety, hyperactivity, depression, fatigue, headaches, insomnia and hallucinations. Niacin is found in fish, liver, meats and bacon. It is also now added to processed grain products. Our bodies can synthesize niacin from the amino acid, tryptophan, which we need from our diet. Good sources of tryptophan include cheese, chicken, turkey, beef, fish, shellfish, peanuts and eggs. The whey component of raw milk is an excellent source of tryptophan because the protein has not been denatured (ie destroyed) by heat (ie pasteurization).

21b) Zinc mineral deficiency (or copper excess) will cause white spots in the nails, frequent colds, sore throats, hypertension, fatigue, memory impairment, infertility, environmental sensitivity, impaired night vision (along with vit A deficiency), slow growth by interfering with growth hormone production, weakened muscles, slow wound healing, and impair the senses of taste and smell among many other symptoms. We need about 15 mg/day and 50 mg/day to make a sore throat go away if we catch it early enough. I don't recommend more than 50 mg/day and usually recommend 25 mg day if a child or adult is deficient. Zinc occurs in grass fed beef, organ meat and the dark meat of chicken or turkey. It also occurs in egg yolks, salmon, sardines, oysters, crab, unsweetened cocoa powder, raw wheat germ, dried yeast, cashews, pecans and dates. During the winter or at the first sign of a cold, I recommend sucking on Elderberry/Zinc herbal lozenges by Zand with 5 mg of zinc gluconate/lozenge. Oxylent also contains 15 mg of zinc. Zinc can upset an empty stomach so have after food and don't take it the same time as an iron supplement (which is why Oxylent does not contain iron). According to Weston Price Journal, Vitamins A and D support the absorption of zinc and zinc supports the absorption of all the fat-soluble vitamins. Many of the proteins involved in Vitamin A metabolism and the receptors for both vitamins A and D only function correctly in the presence of zinc. Zinc is also rapidly depleted if we are consuming lots of breads, pasta, sugar or other simple carbohydrates since it is a cofactor in sugar metabolism pathways along with the mineral magnesium and several B vitamins.

21c) Vitamin C deficiency causes nose bleeds, sore gums, slow wound healing, weakness, mouth ulcers, loose teeth and decrease bone growth. Orange juice that is pasteurized will deactivate the vitamin C so unpasteurized orange juice from Trader Joes or freshly squeezed orange juice is the best.

21d) According to the Weston Price article, Vitamin A deficiency results in problems with spatial learning and memory and may lead to dopamine receptor hypo-activity and typical symptoms of schizophrenia, such as flat affect, apathy and lack of insight, as well as hallucinations and delusions. Low levels of Vitamin D are associated with increased risk of depression and panic...vitamin affects portions of the brain involved in learning and memory as well as motor control (since there are many Vitamin D receptors in the brain). Vitamin D is very much involved in production of serotonin, the molecule of will power and delayed gratification. Decreased serotonin activity can lead to an inability to create and act on well-formed plans. Bright light going through the eyes increases serotonin production-sunglasses block this effect- and sunscreen blocks the Vitamin D formation in the skin. This is why I recommend Nordic Naturals Arctic D cod liver oil that contains both Vitamin A and Vitamin D3 (avoid D2) in addition to omega 3 fatty acids for brain myelination.

21e) Vitamin K2, which is produced by the beneficial intestinal bacteria along with Vitamin B12, is involved in the formation of myelin in the brain and cell growth. It can affect psychomotor behavior and cognition.


III. OTHER RECOMMENDATIONS FOR STRENGTHENING YOUR PRESENCE WITH YOUR CHILD AND BRINGING CALMNESS AND MORE JOY TO YOUR FAMILY LIFE:

22) Read my new articles, Unconditional Love-Parts I and II, that talk about living in the present moment and how our upbringing and just being depressed can often make it challenging to parent our children effectively and remain present when our children do things that displease us. Often we can withdraw our loving energy if we feel tired, overwhelmed, disrespected or our feelings get hurt. We also withdraw our energy from our children if we our experiencing stress in our other relationships. For children this feels like we just disappeared energetically from the room, and they will unconsciously do things to get us angry. For when we become angry with our child we often become fully present. If children can't feel our presence, as parents or teachers, when they are with us, then they will become clingy and/or act out in such a way to get our full presence. It is our present-moment energy that helps children feel grounded when they do not yet feel grounded in their own body because they are still neurologically connecting their mind to their body.

Giving our children unconditional love (staying present with them even when we are tired or frustrated) is what builds children's self-esteem and protects them from always looking outside of themselves for love. Find lots of activities that you and your child both enjoy doing together and do them so there is more joy and laughter when you are with each other. Watch your child's pupils when your child is in indoor light for signs of being too stressed. When predominately in the relaxed portion of our autonomic nervous system, our pupils are not larger than 30 percent of the colored portion of our eyes. The autonomic nervous system needs to be predominately in its relaxed state (ie parasympathetic tone) in order for learning or movement to imprint in the brain or mind.

23) Some of my favorite parenting books include (see my Resource List):
You are your Child's First Teacher by Rahima Baldwin Dancy
*Unconditional Parenting and Punished by Rewards, both books by Alfie Kohn
Simplicity Parenting by Kim John Payne
Stress-Free Parenting in 12 Steps by Christiane Kutik
Hold on to your kids: why parents need to matter more than peers by Gordon Neufeld and Gabor Mate.

Also read my articles on Win/Win - The Cello, and my summary of Dr. Marshall Rosenberg's 9 day retreat on nonviolent or what is now termed compassionate communication.
HandinHandparenting.org is also a good resource for on-line classes about how to parent with unconditional rather than conditional love.

24) Some of my favorite relationship books include (see my Resource List);
How to be an Adult by Dave Richo (a buddhist psychologist)
How to be an Adult in Relationship also by Dave Richo (davericho.com)
Nonviolent communication-a Language of Life by Marshall Rosenberg
Hold Me Tight and Love Sense-The Revolutionary New Science of Romantic Relationships both by Sue Johnson (a psychologist in Canada)
(I also recommend the Hold Me Tight Couple's Workshop by Dr. Paul Aikin and his Wife, Nancy, at their home in Davis, CA. Their phone number is 530-758-1960).
The Seven Principles for Making Marriage Work by John Gottman
Boundaries: Where You End and I Begin by Anne Katherine

25) Some of my favorite personal growth books include (see my Resource List):
Buddha's Brain: The Practical Neuroscience of Happiness, Love, and Wisdom by Rick Hanson et al.
Mindsight by Dr. Daniel Siegel
A New Earth and The Power of Now by Eckhart Tolle
Biology of Transcendence by Joseph Chilton Pearce
Biology of Belief by Bruce H. Lipton
A Parenthesis in Eternity by Joel Goldsmith
In Tune with the Infinite by Ralph Waldo Trine (written 113 years ago)
First Steps in Inner Development by Rudolf Steiner The Way of Mastery by Jon Marc Hammer, www.shantichristo.com
A Search for God-Books 1 and 2 by Edgar Cayce

26) Remember to have your children (when they are toddlers or in preschool or kindergarten) lead you in their play themes. You are mostly there as a present moment observer for them while they do all the imaginative work, showing you different things, sharing their ideas with you, and/or directing you in how to play with them. If you orchestrate and direct your children's play too much, they will always rely on your play themes and will need you constantly there talking and guiding them. If children tend to always be in their own world with their play and not able to play with other children or seem disconnected from other human beings, it is important to do play activities, like playing catch together, or doing parallel play right next to them, so children start to learn how to play and interact with other human beings and not just toy objects. Also when we keep asking questions of our children while they are playing, we actually disrupt their play themes and cause them to stop and think about a response rather than remain in their imaginative, creative world. Play is crucial for children. We want children to have a calm space to develop their own imagination. This will help them play more independently, have confidence in their playing, and give them an opportunity to be in the more relaxed portion of their autonomic nervous system.

27) We were not meant to parent children with only 1 or 2 adults. I was taught that we need 4 adults around for every child just to provide each adult with resting time so he or she can be more present in parenting. I did not have extended family around, so I built a network of 2 adult baby sitters and 12 children in grades 4th through high school. The young children I had as parent helpers just to give me a break for 2 hours in the afternoon. They played with my son while I stayed at home. This was how I was able to stop screen time at our home. Prior to having parent helpers, my son's watching of Barney was often the only break I had as a parent. This gives truth to the statement, It takes a village to raise a child! Also as adults we need to make sure that we do things in our daily life that keep us energized, grounded, and living in the present moment. Find the things you love to do and continue to do them. We sometimes sacrifice our own physical, emotional, and mental health just doing for others (ie. our children and significant others) while we ignore our needs. If we do not nourish ourselves on a daily basis, we will have nothing to offer others and what we do give them will have resentment attached and will not come from a place of unconditional love.

28) I usually recommend that all children born after April 30th do another year of kindergarten so they are 7 years old when they enter 1st grade. All children that turn 6 years of age before March 1st can go onto first grade even if they need a lot of support. Children that turn 6 in the months of March and April

29) Apply a pea-size amount of Aurum/Lavender/Rose cream containing St. John's Wort around your child's heart at bedtime for calming. A tube of this cream can be purchased from Uriel Pharmacy in Wisconsin (866-642-2858) or by calling the Rudolf Steiner College Bookstore in Fair Oaks, CA (916-961-8729).

30) Please call my office voice mail at 916-638-8758 to schedule a phone time anytime you have questions or want to set up an assessment or a follow-up visit.

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© Susan R. Johnson, M.D., F.A.A.P.
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