Questions and answers about raising children

Question from Dr. Sarah Maguire, Teaching and Learning Development Unit School of Environmental Studies, University of Ulster, Northern Ireland: Myself and my two older children have CMT 1A. We have just been told that my youngest child (19 months) has low muscle tone (all over, not just peripheral muscles). Do you know whether this could be a symptom of CMT (he is currently being tested) and if so whether you would see it in a child so young?

Dr. Charlotte Thompson, assistant Clinical Professor at the University of California at San Diego School of Medicine, and Director of the Center for Handicapped Children and Teenagers in San Francisco, California, answers:
My reply would first be that 19 months is not too soon to diagnose CMT. With the strong history I would certainly be concerned, but would need more information. Does the child have any developmental delay, what is the CPK or CK, do the feet show high arches and is the neurological exam within normal limits? There are many reasons for low muscle tone and of course, you can have two associated conditions. I would refer her to London to Hammersmith Hospital to the neuromuscular unit, if she can't get any real answers.

Linda asks: Just an observation, when I was about that age, my very high arched toddler feet went totally flat as I began to bear weight more in walking.
That's what alerted my mother that there was something wrong. Could not flat feet be part of the diagnosis for children as well? I realize that most children's fat little feet look flat but really flat is over on the ankle bones. What do you think?
Dr. Thompson answers: You are certainly right that flat feet can be part of CMT. However, in little children it may be difficult for a parent or doctor to determine this, since kids often have pudgy little feet. The high arches are much easier to see.

Question: My young children are having trouble staying awake in class in school. They have a long way to walk to school and when they get there they’re tired. I’ve found that supplying the teacher with small packets of dried fruit to give the kids when they start to doze off helps, but I’m wondering if there isn’t a better way. Is there something they should be eating for breakfast that will keep their energy level going all morning? What do you suggest?
Dr. Charlotte Thompson answers: I would want to ask several questions: What time do the children go to bed at night and how many hours of sleep do they get? Also, when did they have their last physical examination and blood count and urinalysis? Anemia can cause tiredness. Also what do they eat for breakfast? Do they have some protein, such as oatmeal, eggs, sausage or just orange juice and cold cereal? Both orange juice and cold cereal have lots of sugar which can cause problems. Also have they had tests for thyroid function? Has their hearing been checked? Some kids who can’t hear well fall asleep because they can’t understand what is going on. Are the children wearing braces, if so plastic or metal and what kind of shoes do they wear? Do they have considerable muscle weakness and walk with drop foot? This can be exhausting for long distances. Are you having a hard time getting shoes that are comfortable? All could contribute to tiredness. These are all reasons why children would get sleepy in class. Also, they could be just bored. Are there any learning disabilities and what kind of students are they?