Ask the Pediatrician

Q1: My four-year-old is stuttering a lot, and I am worried that he will have problems a year from now when he starts kindergarten. What can I do? 

Stuttering is a very common in preschoolers and is seen in many three- to five-year-olds. Speech and language development is rapidly progressing at this time. The child’s ability to keep up with producing the words that he or she wants to say does not always happen smoothly. This frequently shows itself as stuttering, when a child searches for the right “next word” to use or is trying to say a more complex word than what they have used in the past. It may be helpful to look at stuttering as a kind of brain “software upgrade” as the neural connection continues to evolve and expand.

There are a few things that parents can do while a child is going through a phase of stuttering. Read to your child a lot during this time. This is good for many reasons beyond just stuttering. Try not to correct your child while they are stuttering; it is likely to not help the underlying condition and may actually increase anxiety around speech development. Finally, some parents benefit their child if they start talking a little slower, which will help model that a slower pace of speech is very acceptable.

A small number of children will have speech and language issues at this age that may require intervention by speech therapy. This includes children who have additional “dysfluency” problems such as consistently unclear speech or difficulty forming most words. Hearing problems can show themselves as speech issues at this age. Finally, significant stuttering that persists beyond six years of age will likely benefit from intervention help. 


Q2: My fourth grader seemed to be sick a lot last year, especially during the winter months. What can I do to help her be healthier this year?

Children and teens in school—especially in the first few years—are susceptible to catching many of the illnesses that are present in their classrooms. Unfortunately, there is little that parents can do to prevent most of this from happening. Good hand washing and not sharing utensils or drink cans will help a little, but most viruses and bacteria can live on tables, doors, desks, counters, and other surfaces for several hours. All it takes is your child touching that surface and then rubbing her eye or eating something by hand.

One recommendation that will help prevent one of the more serious viral infections is for your kids to receive the flu vaccine each fall. There is both an injectable form of the vaccine and a nasal spray. People with certain conditions—asthma or suppressed immune systems, for example—cannot get the nasal spray and should definitely get the injectable form of the vaccine. However, the nasal spray tends to be a little more effective, especially when there is not an exact match between the viral strains that are in the vaccine and the flu strain that actually affects the community. This year is the first year there are will be four strains of influenza included instead of three.

For kids and adults that show signs of actually developing the influenza infection, there are a handful of oral medications that can help to reduce the severity of the disease. These generally have to be started within the first 48 hours, so contact your doctor if you or your child starts to develop symptoms of the flu.


Q3: My child just started second grade and is worried about going to school every morning. What can I do to help him have a better attitude?

Worries about going to school—also called school phobia—can happen for three main reasons: 1) what is happening at home; 2) what they think will happen at school; and 3) after a prolonged or serious illness. If there major life events happening at home, younger children will likely be afraid of leaving home because of the uncertainty they feel. Having a talk with them with a heavy dose of reassurance added in will help to ease their fears of leaving for the day.

Fear about what may happen to them at school needs to be addressed with the school. Fear of the consequences of bad behaviors in the classroom and what the teacher is likely to do about it needs to be resolved quickly. Fear of a bully situation at school—or any place between school and home—also needs to addressed as quickly as possible, but will likely be a more complicated situation. 

Finally, if your child has a significant health issue or had a prolonged absence, he may be afraid of what might happen to them outside of their more medically protective home environment. Talking through a plan with your child about his or her health worries is a good start. Reassurance ahead of time that knowledgeable people are close at hand is also part of a good strategy for most children as they transition back to school.


This column is intended to provide general information only and not medical advice. Contact your health care provider with questions about your child. Dr. Peter Dehnel is a board-certified pediatrician and medical director with Blue Cross Blue Shield of Minnesota. Send questions to drdehnel@mnparent.com.