Ask The Experts on Braces, Pop Culture and Shy Children

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Cases for Braces

Q (Elementary Age): My son is 9 years old and I've noticed that some of his front teeth are protruding out farther than the rest. He may have an overbite. Is he too young to see an orthodontist?

A: Many parents are surprised to hear that the American Association of Orthodontists recommends that children see an orthodontist for an orthodontic check up by age 7. "Why so young?" they ask. "When I was a kid, I didn't see an orthodontist until I was 13!" Orthodontic treatment of the past most often included the removal of several teeth, the use of a headgear, and much longer treatment times. Newer technology now allows us to use patients' early growth to help correct and more importantly, prevent orthodontic problems as the child's permanent teeth begin to come in. 

At age 7, most children have the perfect combination of permanent and primary teeth, and are in the middle of their jaw growth curve. This is the ideal time for the orthodontist to take measurements of the child's face, jawbones and teeth in order to determine their facial growth patterns. The orthodontist can then determine whether the child will have room for their permanent teeth, and if the child has a harmful bite or harmful habits. If the orthodontist notices narrow growing jaws, impacted teeth, or an overbite that will necessitate extractions of headgear in the future, for example, he or she can now utilize orthopedic techniques to train the bones to grow correctly. Re-establishing the proper jaw size in this way makes extractions (teeth removal) and headgear virtually unnecessary. With this earlier intervention, treatment time in braces is now usually much shorter and more comfortable.

An orthodontist is a dentist who has completed an additional two to three years of specialized, accredited training in orthodontics. This training includes the study of facial growth and development, as well as the proper and safe way to move teeth and bones.  Many dentists do offer their patients timely referrals to qualified orthodontists, but parents need not wait for that referral, as not all dentists are aware of this critical window of growth. Parents can quickly and easily assess their child's need for an orthodontic checkup by simply looking for the following common signs:

• Lack of spacing between baby teeth
• Difficulty in chewing or biting
• Mouth breathing/snoring
• Finger or thumb sucking habits beyond age 5
• Speech difficulty
• Biting the cheek or roof of the mouth
• Protruding teeth or overbite
• Underbite
• Crossbite (when the top teeth fit inside the bottom teeth on either or both sides)
• Teeth that don't meet in a normal matter, or don't meet at all.

The need for an orthodontic checkup sometimes goes beyond the physical problems. Children who are teased as a result of their dental appearance often suffer from low self-esteem. Early intervention and treatment in these children often increases their self-confidence.

When a child comes to see me for their first orthodontic checkup, I always take time to talk to both the child and the parents, in order to address any questions and concerns they may have. I take measurements of the teeth and face, and then discuss my findings. If treatment is recommended, clear goals are presented. Many times, treatment is not warranted, and the child is scheduled for a growth recheck every six to 12 months. 

With this earlier intervention, many cases that used to involve complicated orthodontic treatment, can now be treated in less time without teeth removal, surgery or headgear‚ now that is something to smile about! Dr. Christopher Zachary

Pop Star Impersonator

Q (Children): My 8-year-old daughter is showing an interest in young pop stars, but I am concerned that she is starting to mimic their style, which can be inappropriate. How do I explain to my daughter that I'm looking out for her when I censor her clothing?

A: This is such a good question, as most parents struggle with the same concerns. A major part of our job as parents is balancing how we set limits for our children according to our personal values, while still enabling our kids to fit in with their peers. Where do we draw the line? How do we respond when our children look up at us with those big puppy dog eyes and say, "But everybody else is wearing (doing, watching, etc.) it!"

The answer to these questions will vary from family to family. A good place to start might be to sit down as a family and identify your family's personal values—values that will lead to raising the type of adults you want your children to become. Try to take into consideration that times have changed and some of the things that were not acceptable when you were young may be generally accepted now. Check with other parents to be sure your expectations are not too far off base. Out of these values come family rules. I find that when children have played a part in identifying values and deciding on the rules that support these values, they are more likely to comply with them.

Once you have decided your personal values and rules, discuss particular situations, such as how your children are expected to dress, at what age you will allow your child to have his or her own cell phone, when you will allow texting or participating on social networking sites, etc. It's important to remember that our expectations as parents should be as reasonable as possible. Remember, we want input from our children, but parents are the leaders and ultimately make the final decision. Don't be afraid to take a stand—our children depend on us to lead them.

It's a natural process for children to want to be like their peers, and it is possible to allow them to fit in, while still maintaining the family's personal values. If you and your partner decide that the pop star clothing your daughter is attracted to does not fit into your personal values, explain to her that clothes tell others a lot about you, and that wearing clothes that are too mature for your age can send the wrong message. Let her know it is not acceptable in your family for a child her age. You might be able to compromise by shopping for a similar look that is more age appropriate.

You will be able to navigate many situations in your children's lives if you keep your personal values in mind. Hopefully, with a model of strong values, your children can take these important lessons with them and mature into adults you are proud of. Susan Kelsey

From Shy to Social

Q (Toddler): My 5-year-old daughter is graduating preschool and heading on to elementary school, but I worry that she isn't as social as other children her age. What is the best way to encourage her to interact with her classmates?

A: Congratulations on your child entering an exciting new chapter of her life. Transitioning from preschool to elementary school is a big step and can be both exciting and scary. Your daughter's emotional and social development are key skills to master at this stage in her life. For some kids, developing these skills can be a challenge.

A good starting point would be to speak to your daughter's preschool teacher to see if there are areas that your daughter may need to work on. For instance, does she play alone? Is she shy, unfriendly or does she take a while to warm up to new people? Find out if she is aggressive toward other children or if she has difficulty managing when another child oversteps his or her boundaries with your daughter. Feedback from her teacher will help you guide your daughter's social skill building. Also, if you are able to, speak with your daughter's future kindergarten teacher and find out what is expected of her during this next year. Being aware of expectations is key to understanding the areas your daughter will need to work on.

You can further encourage social behavior by giving your daughter the opportunity to practice making friends. Have your child socialize outside of her normal circle of friends, so that she sees she is capable of making new friends and becomes more comfortable with the process of developing relationships. She can practice talking about her favorite toy, movie or family member with her new friends, and asking them the same questions. If she is shy around other children, you can teach her some phrases to use to start a conversation with her peers.

Being able to separate from parents is a big part of being able to socialize. Even if children don't have the language to say so, they are able to read our emotions. They need to see that you truly feel that kindergarten is a good idea for them. Make sure you are positive and upbeat about the change, even if you are feeling some apprehension. By reinforcing the positive aspects of social interaction, such as learning new things and making new friends, your daughter will be more willing to interact with her new peers. Also, learning how other kids have the same worries or fears about going to kindergarten may lower her anxiety.

You can also be reassured that your daughter has already succeeded in a transition by going to preschool. She was able to separate for a period of time, develop trust with the preschool teacher and follow the rules of the classroom, even if she may not have shown the same level of socialization as her peers.

If you are still concerned about your child's behaviors, it may be beneficial to talk with other parents. You likely will find that many parents are experiencing similar feelings. If you feel that you may need additional help, consulting with a counselor or play therapist who specializes in children is the next step. They may offer therapy sessions or refer you to a social skills group.—Michael Uram


Health and Wellness Resources
Survivor: A Parent's Back-to-School Guide

For many families, sending children back to school in the fall can be a challenging transition.

"As the mother of three kids, I can tell you that the pace and schedule of the summer is hard to leave behind," says Susan Fletcher, an author and psychologist. "Going back to school means you have to be on a schedule, and most of the time there is little flexibility to fit it all in."

Fletcher, author of "Parenting in the Smart Zone," (2005, Greenleaf Book Group) believes the cornerstone to being a successful parent is knowing what you expect from yourself, your own philosophies and goals. Beyond that, if you want to stay in the "Smart Zone," you have to be able to adjust with whatever life might toss your way, she says.
Fletcher describes the beginning of school as a "honeymoon period."

"For most children, there is some excitement going back to school, seeing their friends and having something to do," Fletcher says. "Believe it or not, some children report being bored at the end of the summer."

It's important for parents to anticipate the honeymoon period wearing off about two to three weeks after school starts. Be prepared for the challenge when you least expect it.
Fletcher offers some excellent ideas for all families to consider for the beginning of the school year.

Establish routines. Beginning with the first day of school give children age-appropriate responsibilities for the morning routine and the responsibilities associated with school commitments. Have them write schedules on the calendar, get their backpack ready the night before and designate a spot to put their stuff parents need to review.

Plan a get-together. Schedule in advance to have a friend over to play, spend the night or watch a movie about the third or fourth week of school.

"This gives your child something to look forward to and positive anticipation about spending time with a friend they haven't seen all summer, especially if they had some disappointment about not being in the same class this year," Fletcher says.

Set clear expectations. Be clear about your expectations about homework time. Develop a routine and stick to it.

"Children, at any age, benefit from predictability," Fletcher says. "We train people how to treat us. If you are relaxed about routine at the beginning of the school year, and then begin to tighten up when assignments are due, it could be a mixed message."

Even if your child doesn't have a lot of homework, encourage him or her to read, or work in work books during the time designated for homework, even it is only for a half an hour.
Use smart discipline. It's also part of what she calls a SMART Discipline model, which she expands on in her book.

Fletcher suggests to parents to focus more often on "low value" items‚ having children carry their own backpack into school and bringing their dishes over to the sink after dinner. With this consistent focus, parents are prepared to better manage the "high value" items‚Äîhitting a sibling and doing poorly on a test‚Äîwhen they occur.

"Developing the discipline for 'low value' items helps a child experience success, promoting more success for later."

Plan to relax, celebrate. Parents need to take care of themselves too during this time of family transition. Plan activities that are stress relievers during the honeymoon period and use them when the challenges are about to begin.

"I've seen parents have a party the first month of school where everyone brings something to share for dinner, and you celebrate the beginning of school," Fletcher says. "This will help you reconnect with your friends too. We celebrate the end of school and the end of summer more often. Why not initiate the beginning of school as a time to celebrate?"

Kim Seidel is an award-winning writer and editor, specializing in parenting, health and wellness, and family topics. She and her husband have been married for 17 years, and they have two daughters, ages 12 and 8.