Twins with Autism Benefit from Therapy and Mom’s Boundless Love

Receiving a diagnosis of autism for her twins was not the end of the world for Alisha. Through the Comprehensive Autism Program at The Children’s Hospital, she was able to find the help she needed so her boys could thrive and develop.

Alisha’s twin sons Xander and Royal were diagnosed with autism when they were 4 years old. Today, they are 11 and thriving with the help of their devoted mom, behavioral therapists, and Dr. Andrew Martinez, a psychologist and program director at the Comprehensive Autism Program at The Children’s Hospital of San Antonio. We asked Alisha to share her experience through the following Q&A.  

When and how did you first find out about your children’s diagnosis?  I noticed significant delays in developmental milestones and behaviors with my twins at a very young age. Speech, smiling, eating, and drinking were minimal to nonexistent. They also displayed daily, repetitive unique, rhythmic mannerisms, motions, and patterns. Those were some of the cues that gave me enough concern to suspect the twins may have autism.

The love I had for my boys outweighed any fear I had of a diagnosis. Whatever it might be, I needed help and information. So I took the initiative to ask their primary care provider for an evaluation for autism spectrum disorder. Without pause, I received the referral for both boys to be seen and evaluated by Dr. Martinez. After testing, he confirmed the diagnosis. Both twins had autism. Each child was sitting at their own spot on the spectrum. They each had their own set of strengths, gifts, and challenges. That is where our journey began. 

As twins, Royal and Xander share everything including a diagnosis of autism. Both boys now thrive with the help of Applied Behavioral Analysis therapy.

Describe your treatment plan. Why did you choose this treatment plan?    Royal and Xander both receive one-on-one Applied Behavioral Analysis (ABA) therapy. I chose this specialized therapy because they each have a personalized treatment plan specifically outlined for them. The goals for my children are carefully planned and written out by a program manager, then reviewed and approved by their doctor. My input as an involved parent is always incorporated into their treatment. ABA therapy can be hard, it is work, but that is precisely why I wanted my boys to have it. ABA therapy is the gold standard of care for any child on the autism spectrum. The payoff has been incredible for our family. 

Dr. Andrew Martinez is the Autism Program Director at The Children’s Hospital of San Antonio. He provided the evaluation and diagnosis of autism for Xander and Royal when they were 4 years old.

What has your experience been like with The Children’s Hospital of San Antonio Autism Program? My experience at the CHofSA Autism Clinic has been nothing but positive, informative, and helpful.  Royal and Xander are almost 11 years old now. It is hard to put into words the change in my boys since they have been in care. There have been remarkable improvements all the way around. Speech. Behavior. Demeanor. Understanding. Social interaction. Everything. Had I not reached out to the clinic for help, none of this would have been possible. 

What would you tell other families who have just received a diagnosis?   When my little twins were officially diagnosed, I was confused, frustrated, and scared. You may be feeling all of this and much more. Try to take comfort in knowing this. Now that you know, you can do something about it. There is so much power in information! The help, peace, and clarity you are seeking for yourself all come with this diagnosis. The number of helpful resources available to you and your family is endless. The heights your child can reach are limitless. The love and support your child receives at home counts more than anything else.  

Alisha was overwhelmed with fear when she first received a diagnosis that her twin sons were autistic. But along with the diagnosis she received information and resources that put the boys on track to learn and develop.

 Anything else you would like to add?   The love I have for Royal and Xander is boundless. That is why I will always be their voice and their most fierce advocate. In all things, I have been and will continue to be the voice for other children and families in need of a helping hand as well. Royal and Xander are not only twin brothers. They are best friends. Where one is weak, the other is strong. Most importantly, they both know Mama is right there to pick up any slack when necessary. 

If you need more information about autism, talk to your child’s pediatrician and request a referral for an autism evaluation.

A Parent’s Guide to Understanding Autism: April is Autism Acceptance Month

April is austism awareness month. At The Children’s Hospital of San Antonio we have a multidisciplinary team devoted to the the evaluation and diagnosis of autism in children. Read our blog to learn what every parent should know about autism.

Andrew Martinez, PhD, Clinical Director, Autism Program, Psychology Department

What is Autism Spectrum Disorder (ASD)? ASD is a lifelong neurodevelopmental disorder where individuals have social and behavior difficulties. The first (and main) symptom is trouble with social skills. Social skills do not come as natural to individuals with ASD as they do for those without ASD. Social difficulties are different in everyone, but these are some common symptoms:

  • Poor/avoidant eye contact
  • Limited or unusual gestures
  • Trouble using nonverbal language (e.g., eye contact, gestures) to communicate
  • Trouble reading emotions, feelings, and/or facial expressions
  • Trouble making and keeping friends
  • Not understanding social relationships (e.g., marriage, friendships, etc.)
  • Not interested in socializing with others
  • Trouble having a shared conversation

Also, individuals with ASD frequently have restricted and repetitive behaviors. These behaviors are different for everyone, but these are some common symptoms:

  • Hand flapping
  • Full body rocking
  • Other unusual repetitive motor movements
  • Repeating someone else’s speech (called echolalia)
  • Repeating scripts or specific statements they have heard (called delayed echolalia)
  • Trouble adjusting to changes with routine
  • Having specific routines or habits that must always be done a certain way
  • Lining up or organizing things
  • Obsessed with specific topics or interests where they know “everything” about it
  • Interested in unusual topics or interests compared to others their age
  • Sensory sensitivities – loud noises, clothing, food textures, specific textures, grooming, etc.

It is important to note that just because someone has social problems and repetitive behavior, they do not necessarily have an ASD. Many other disorders have similar or overlapping behaviors (e.g., ADHD, intellectual disability, anxiety, mood disorder, schizophrenia spectrum disorders, etc.).

What are some early behaviors/risk factors I should look out for? Risk factors vary depending on age, but here are some risk factors for infants and toddlers:

  • Does not smile back at you when you smile at them (called social smiling)
  • Does not respond to their name
  • Has trouble making requests
  • Avoidant or poor eye contact
  • Seems to be “in their own world” most of the time
  • Is not interested in interacting with you or in social games (e.g., peek a boo)
  • Does not share their interests with you
  • Unusual motor, verbal, or sensory behavior
  • Unusual or repetitive play

In addition, two other risk factors are having a sibling or another immediate family member with ASD and having a specific medical condition associated with ASD.

Dr. Andrew Martinez, the author of this blog, evaluates a child for autism. Dr. Martinez recommends parents first check with their child’s pediatrician before considering a visit to the Autism Clinic.

If my child is showing symptoms of ASD, what should I do? The first thing you should do is talk to your pediatrician. It is very important to be open with them and share your concerns. They are very good at knowing what is typical development versus delays or concerns. They may have you fill out some questionnaires to help them see if there are enough symptoms to warrant further workup. If they notice concerns or are unsure, they will refer you to a specialist. Referrals will more than likely be sent to one of the following specialists: psychologist, neuropsychologist, developmental pediatrician, neurologist, or neurodevelopmental pediatrician. At The Children’s Hospital of San Antonio (CHofSA), these referrals will be sent to either Dr. Andrew Martinez, Dr. Melissa Svoboda, or Dr. Veronica Villarreal.

Dr. Melissa Svoboda is the section chief of neurology at The Children’s Hospital of San Antonio. Dr. Svoboda has extensive experience and knowledge in the evaluation and diagnosis of autism in children.

In addition, your pediatrician might also refer for therapies while you wait for a specialists’ appointment (if it is needed). These therapies often include speech therapy (ST), occupational therapy (OT), or physical therapy (PT). They may also refer to Early Childhood Intervention (ECI) if they are under 3 years old. If your child is older than 3 years old, they may encourage you to request an evaluation through your local school district.

What does an ASD evaluation look like? Evaluations vary depending on who is completing it, but most ASD evaluations include a detailed parent interview and standardized testing. Interviews are used to gather details about the current ASD-like symptoms, when they started, and how frequent or severe they are. The interview is also used to gather information about the family, the gestational history, the child’s development, any other medical or psychiatric problems, and what services or therapies they have received. Standardized testing is used to see how well a child functions compared to other children their age. Testing often includes intelligence (i.e., IQ), language, motor, sensory, and autism specific tests. It is very important to note that tests are used to gather data. There is not one specific test used or that can diagnose ASD alone.

Nurse Practitioner Katherine Holt conducts an interview with a parent whose child is undergoing an autism evaluation.

At CHofSA, an autism evaluation begins with a clinician interviewing a caregiver and then observing and interacting with the child. The next steps will be determined by results from the initial appointment. For some children where the doctor can tell during that appointment they have an ASD, they will be diagnosed with ASD and referred for treatment. If the doctor is not sure, they will be recommended for further testing. Testing might be with only the same doctor or might be with our multidisciplinary autism team. If the doctor is sure the child does not have an ASD, they will speak with you about treatment (if it is warranted). Regardless of the diagnosis, we will make sure to discuss your child’s strengths and weaknesses and come up with a plan to help them.

What happens after an ASD diagnosis is made? This varies depending on where and who is evaluating your child. At CHofSA, we will discuss the results and treatment plan with you. Treatment options will depend on the child’s specific difficulties, but Applied Behavior Analysis (ABA) therapy is often recommended. ABA is a therapy that focuses on increasing positive or helpful behaviors and decreasing negative or unhelpful behaviors. ABA therapy can be used to work on social skills, language, inappropriate and harmful behaviors, and many other skills. In addition, ST and OT are often recommended, as many children with ASD have trouble with speech, language, motor, sensory, and adaptive skills.

In addition, we will also discuss what medical work up is needed to find the cause of ASD (also called etiology). This often includes a genetic evaluation and possibly a neurological work up. Also, there are currently no medications or other medical treatments approved for ASD. There is no cure for ASD. Some children with ASD take medication or have other medical treatments, but these are due to other factors and NOT ASD alone. There are several alternative therapies that are available; however, there is very little or no data to prove these work or help. Most of these therapies are expensive (cash pay only as insurance will not cover them) or can be dangerous for children. For this reason, we strongly recommend you speak with your pediatrician or autism specialist about any alternative treatments you are considering. Just like you, we want to keep your child safe.

Lastly, ASD is a lifelong disorder. Individuals with ASD symptoms will fluctuate over the years. Thus, it is important to connect you with community resources and develop a strong support system. At The Children’s Hospital of San Antonio, we will connect you with local and statewide resources. We will follow up with you as needed, and we will always be here to answer any questions or concerns that may come up.

If you are concerned about your child’s development, talk to your pediatrician first. If you need a primary care physician for your child, visit our website to find a pediatrician near you.

Consider these 5 questions before getting a puppy for Christmas

Kristina Michaud, DO, Baylor College of Medicine, PGY-2 Resident, The Children’s Hospital of San Antonio

The bond between children and their dog is magical. Dogs teach children how to love and care for someone, how to put others’ needs above their own, and how to be responsible. Dogs can also be extremely therapeutic for children, acting as a friend and adventure buddy, which is especially important during these current times when children may feel isolated.

The COVID-19 pandemic has caused people to stay home, which may prompt parents to finally add a furry friend to their family. After all, what better way to train a new puppy than when you’re already doing school and work from home, and don’t plan on traveling for the holidays! Except it’s not quite that simple!

Just like having a child changes your life, getting a puppy (and caring for it properly) will also change your life. Dogs are intelligent, active, social beings who require time, love, and attention in many of the same ways children do. Likewise, when they are not given adequate attention and exercise, they can become lonely and depressed. So, before you bring home a cute puppy for your child who has been so kindly asking for one, be sure you can answer “yes” to these 5 questions!

  1. Do you have the financial means? Not including the adoption fee itself, puppies are very expensive to care for. They require frequent visits to the veterinarian when they’re young to receive their vaccines, and the cost of spaying/neutering them can be upwards of $200. You must also account for the cost of their monthly food, flea and tick prevention, heart worm prevention, toys, and crate. One of my dogs developed seizures after her first year of life and now requires an expensive daily medication—just like in humans, medical needs come up and lead to additional costs. Over the course of the dog’s lifespan (10-15 years), the expenses add up. And this doesn’t account for things like safely boarding the dog if/when your family goes out of town, unexpected veterinary visits, replacing the shoes or the sofa that the puppy chewed (oops!), etc.
  2. Are you and your family physically ready? Dogs require a lot of exercise. Unless you have a large yard where the dog can run around, the dog’s exercise will likely come in the form of you walking or running with him/her every day. This is great exercise for humans too!
  3. Do you have the space? Depending on the size of the dog, he/she may take up a lot of space in your home. Dogs also need plenty of room to run, play, eat, go potty, and have moments of privacy away from young children to rest.
  4. Is your child old enough to help care for the puppy? Children don’t usually develop abstract thinking until after the age that they’ve started school — some experts say they maintain concrete thinking until age 12 years.  This means it is difficult for them to anticipate others’ needs before this age. Many young children will ask their parents for a puppy, but remember that they probably won’t be able to fully help care for the dog until they are older. It may also be smart to wait until your child is older and does not have as many toys around, as these can be choking hazards for the puppy!
  5. What will your life look like 5, 10, or 15 years from now? When thinking about getting a puppy (or any pet) now, it’s important to think about how your life may change in the years to come. Will you be in the same home with the same yard? Will you want to travel? Will you want to care for the dog when your children are grown up and no longer living with you? Who will care for the dog if something unfortunate happens to you?

While these questions can be difficult to imagine, it’s best to be prepared when adding this new member to your family.

If you have considered these questions and feel that now is the right time for you to get a puppy, how exciting! You will have lots of love, puppy snuggles and great memories ahead of you.

On behalf of The Children’s Hospital of San Antonio, we wish you and your family a merry Christmas and blessed New Year!

5 Ways to Prep for School During a Pandemic

Mahwish Khan, DO, PGY2, Resident, Baylor College of Medicine at The Children’s Hospital of San Antonio

It’s that time of the year again, the time when stores’ aisles are filled with back-to-school supplies and composition books are 50 cents apiece. Back-to-school time used to be one of my favorite times of the year, and I really looked forward to getting to pick out all of my things for the new school year. But this year will be a little different with COVID in play. Whether your child will be in school in-person or partaking in distance learning, parents need to prepare children for a very different school year. Here are some tips to prepare you and your child for back to school:

1. Buy your school supplies online

While it may be tempting to go to your local department store for that specific blue three-pronged folder your child has on their school supply list, try and see if you can order school supplies online. Most department stores right now have options to order online and either deliver or pick up items curbside. We want to limit our exposure to others as much as possible, and back to school aisles can be some of the busiest aisles this time of the year.

2. Have your child practice wearing a mask at home

When schools open up for in-person learning, many schools will require their students in 1st grade onward to wear face masks all day. It’s hard for most adults to wear a mask all day, and this is going to be a big change for our kids. You can try to ease into this by having your child and family members wear their masks at home for extended periods of time. Start with just 30 minutes at a time and gradually work your way up to a full day. Make sure to demonstrate the proper way to wear a mask (covering both the mouth and nose).

3. Have your child practice proper hand hygiene

Make sure you go over proper hand washing techniques and have your child practice it at home. Remember, your child should wash their hands anytime they touch their face or mask, eat or drink, touch any contaminated surface or object, blow their nose, cough, or sneeze. Your child should follow the following five steps in hand washing. (These steps are from

  • Wet your hands with clean running water, turn off tap, and apply soap.
  • Lather your hands together by rubbing them together with soap. Lather the backs of your hands, between your fingers, and under your nails.
  • Scrub your hands for at least 20 second. Need a timer? Hum the “Happy Birthday” song from beginning to end twice.
  • Rinse your hands well under clean running water.
  • Dry your hands using a clean towel or air dry them.

4. Demonstrate social distancing to your child

We should be staying at least six feet apart from each other when possible, but do you really know how far six feet is? Take out a tape measure at home and show your child just how much distance they should keep between themselves and others. You can also practice this among family members at home and try to maintain at least a six-foot distance for a whole day. If you are at the grocery store or any other public place with your child, make sure to put this into practice, by standing at least six feet apart from others and keeping your mask on at all times.

5. Be flexible with your children and yourself

This school year is going to be very different from other years. With many of our children in distance learning classrooms and having to learn outside of the traditional education model, we may need to adjust our expectations for our students and for ourselves. Many of our kids may need extra help getting their assignments done on time and communicating with their teachers. And with parents having to both work and help their children with schoolwork at home, it can be easy to get overwhelmed. Don’t be afraid to ask for extra help, be it from teachers, other parents, counselors, or anyone else.

We hope this list has given you some ideas on ways to prepare for back to school. If you or your child are having a difficult time coping with the pandemic or any of the changes that it has brought to our everyday lives, please talk to your pediatrician. If you need help finding a pediatrician, check out The Children’s Hospital of San Antonio Primary Care Clinics for a location near you.

Fresh Ideas for Summertime Fun

Likhitha Reddy, MD, PGY2, Resident, Baylor College of Medicine – The Children’s Hospital of San Antonio

How many times have your school-age children told you they are bored today and that there was nothing to do? Have they given up asking, “What are we doing today?” because they know the answer? It’s tough being a kid – even tougher being a parent the past few months.  

We’ve compiled a list of things parents and caregivers can do to keep kids of all ages occupied and maybe even stimulate their curiosity and knowledge – helping you all get through the crazy summer of 2020.  

1. Schedule activities ahead of time While it may not be possible for children to physically attend camps, extracurricular activities or play dates in person, there are an abundance of activities available for your children to enjoy. Scheduling activities beforehand will help children maintain a routine and have something to look forward to every day.

2. Active play is a child’s best friend It is important to incorporate as much active play into children’s schedules as possible. Playing outside, riding bikes in the park, hiking, playing soccer, basketball, volleyball, or just going for a walk around the neighborhood are great ways to get exercise while also spending valuable time with your children.

3. Read, read, read As much as exercise and active play are necessary, it is just as important to make sure kids have time to keep their brains engaged and continue to learn through the summer. Schedule time for reading or listening to audio books or podcasts this summer. The San Antonio Public Library is a wonderful resource to achieve this goal.

4. Limit screen time as much as possible Electronic devices may seem like the easiest option to keep kids busy for most of the day. You can still find ways to make sure screen time includes interactive and educational components. As a parent, it’s important to make sure screen time doesn’t interfere with activities that engage the brain and keep children physically active. Also, make sure devices do not interfere with sleep and family relationships.

Let’s keep our brains active!

Google Arts & Culture has partnered with thousands of museums around the world to offer virtual tours from the comfort of your home. Click here for the complete list.

If you prefer a virtual zoo experience, the San Diego Zoo has set up virtual cams for children to watch the animals. San Diego Virtual Zoo

The San Diego Zoo offers a virtual experience. What are the elephants up to today?

From drawings to science experiments, NASA is providing lists of activities for kids to enjoy with their parents at home! Check out Outta This World!

For a low price of $5, Scholastic provides educational activities for children all summer long. Learn at Home

Chrome Music Lab is a hands on website that helps kids tap into their musical side

Texas Home Learning provides at-home resources for parents to help access educational activities for children. Let’s Learn!

Summer camp…Virtually!? Use Varsity Tutors to help kids (K-12) make the most of their break with interactive camps taught by expert instructors online.

Get your art on with Ms. Sue! Let you and your kids’ creative side flow with free online art classes on Youtube! Ms. Sue’s Art Studio is always open!

Story time is fun time!

Audible is one of the world’s largest collections of audio books and they are currently offering free stories in all different languages for kids! Start Listening Here!  

Podcasts especially for younger children between 2  and 6 years old! List of Podcasts

Storyline Online is a children’s literacy website that streams videos of celebrities reading children’s books along with illustrations.

Imagine a world of possibilities thru the San Antonio Public Library! Subscribe to the Youtube Channel to get more information. IMAGINE!  

Summer sunshine

  • Go on family bike rides or hikes, try to see how many different animals they can identify.
  • Go to the San Antonio Zoo.
  • There are a number of parks still open in San Antonio and families can spend time there while safely social distancing:
    • Friedrich Wilderness Park – By far the most popular park in San Antonio!
    • Brackenridge Park – Great place for biking!
    • Government Canyon park
    • Woodlawn Lake Park – Great place for hikes and fishing!
    • Japanese tea garden
    • Botanical Gardens
    • Jenschke Orchards in Fredericksburg has peach picking tours available for the family. Pick Peaches here!
  • Plan a picnic in the park on a nice sunny day.

Stay in and bond!

Garden in your own backyard.

Cook with your brand new planted garden crop! Explore new recipes with the help of local San Antonio CHEF program. Children as young as 3 can help you cook in the kitchen and it can be a fun adventure to get them to try new cuisines as well!

Camp out in your backyard and cook up some s’mores.

Shoot for the stars! Go stargazing outside on a nice clear night. How many different constellations can you identify?

Pick up some chalk at any local store and decorate the sidewalks. Maybe even play a game of hopscotch!

How about a good old fashioned game of hopscotch on the sidewalk? Hopping can be great exercise. Use sunscreen and stay hydrated when playing outside.

It may have been a while since the kids saw their elderly loved ones. Have them write and decorate homemade letters to the grandparents! Plan time to visit with them through windows or glass doors. If it’s hard to hear each other, use your mobile phone to chat at the same time. They will love seeing how big you’ve grown … and they miss you more than you know!

We hope this list has given you some new ideas and resources to make it through the summer, get some exercise, and keep the boredom blues away!

If your child is having a tough time coping during the pandemic, talk to your pediatrician. If you need a pediatrician, check out The Children’s Hospital of San Antonio Primary Care Pediatricians

E-cigarettes Harmful to Teens and Young Adults

By Dr. Liz Donner, Pediatric Hospital Medicine Fellow, Baylor College of Medicine at The Children’s Hospital of San Antonio

Serious lung disease associated with e-cigarette use is on the rise. The CDC released a health advisory on August 30 reporting 215 cases of lung disease associated with e-cigarette use. Users have experienced cough, shortness of breath, chest pain, nausea, vomiting, diarrhea, fatigue, fever, and/or weight loss. Symptoms typically develop over days to weeks. Outcomes include the need for oxygen supplementation, intubation, and even death.

E-cigarettes are commonly called “e-cigs,” “vapes,” “e-hookahs,” “vape pens,” and “electronic nicotine delivery systems (ENDS).” E-cigarettes can look like regular cigarettes, cigars, pipes, USB flash drives, pens, or other everyday items. They are battery-powered devices that can deliver flavorful nicotine, marijuana, THC, synthetic cannabinoids, or other illicit drugs to the lungs in the form of an aerosol.

An increasingly popular device called JUUL looks just like a USB flash drive, making it easy for children and teens to conceal it. It comes in enticing flavors such as cool cucumber, mango, and mint. According to the manufacturer, a single JUUL pod contains as much nicotine as 20 cigarettes. Several news outlets report widespread use of JUUL by students, even within the classrooms and restrooms at school.

Nicotine is an addictive substance that can harm brain development until age 25 years. Therefore, the use of any tobacco product – including e-cigarettes – is especially unsafe for children, teens, and college students.

Parents are urged to learn about the different styles of e-cigarettes and the risks of use among children and teens. Talk to your kids about the risks of e-cigarettes and express firm expectations that they remain tobacco-free. Remind them that healthy lungs are required to play sports, sing, play wind instruments, etc. Lastly, set a positive example by remaining tobacco-free yourself.

Scientists have not been able to prove that e-cigarettes are a safe and effective way to quit smoking. They contain potentially harmful substances including nicotine, heavy metals (lead), volatile compounds, and cancer-causing chemicals.

The CDC recommends that everyone refrain from using e-cigarettes while the risk of serious lung disease is under further investigation. Use is especially discouraged among children, teens, young adults, pregnant women, and adults who do not currently use tobacco products. Never buy products off the street or attempt to modify them at home. Users should monitor themselves for cough, shortness of breath, and chest pain. Seek medical attention right away should any health concerns arise.

Those attempting to quit e-cigarettes should seek out evidence-based treatments such as nicotine replacement, counseling, and other FDA-approved medications provided by their physician. You can report any e-cigarette-related health issues to the FDA using the online Safety Reporting Portal at

August is Children’s Eye Health and Safety Month

Matthew Sattler, M.D., PGY-2 Resident, Baylor College of Medicine at The Children’s Hospital of San Antonio

Vision assessment is an important component of the routine care of all children. Most children are able to participate in a formal vision screen at their well-child visit when they are 4 years old. Between five and ten percent of preschool children have an undetected problem with their vision. Here are some warning signs that your child may have difficulty seeing:

  • Wandering or crossed eyes
  • A family history of childhood vision problems
  • Disinterest in reading or viewing distant objects
  • Squinting or turning the head in an unusual manner
  • Eyes that flutter quickly from side to side or up and down
  • White or grayish-white color in the pupil

Discuss any concerns about your child’s vision with his or her pediatrician as your child may need to be referred to an eye doctor (ophthalmologist) for treatment. You can read more about common eye problems at, a website approved by the American Academy of Pediatrics.

Taking care of your child’s eyes also means keeping them safe from injury. Did you know there are more than 19,000 children treated in emergency rooms for eye injuries every year? Most eye injuries in children are the result of sports injury, especially basketball, baseball or softball, and non-powder guns (e.g. paintball, BB guns). The American Academy of Pediatrics and the American Academy of Ophthalmology recommend the following for each sport:

  • Basketball: protective eyewear with polycarbonate lenses
  • Baseball or softball: facemask attached to batting helmet when batting, polycarbonate faceguard for fielders
  • Non-powder gun: Eye protection meeting ASTM standard F1766

Another way to prevent eye injuries in children who are too young to play sports is to ensure that all toys are age-appropriate and do not contain sharp edges that could damage the eye.

As always, if you have any questions or concerns about the health of your child’s eyes, please schedule an appointment to talk with your child’s pediatrician. If your child experiences a serious eye injury or eye infection, visit one of our 24/7 emergency centers in San Antonio:

  • The Children’s Hospital of San Antonio, 333 N. Santa Rosa Street
  • The Children’s Hospital of San Antonio Emergency Center – Stone Oak, 1434 E. Sonterra Blvd.
  • The Children’s Hospital of San Antonio Emergency Center – Westover Hills, 11130 CHRISTUS Hills, Medical Plaza 3, First Floor

Beating the Summer Slide

By Tiffany Ponzio, M.D., Resident, Baylor College of Medicine, PGY3

When you hear “summer slide” you may think of water slides, slip ‘n slides, or slides into second base, but there’s a far more dangerous slide you should know about. “The summer slide,” otherwise known as summer learning loss, can happen to children while they are off during the summer months.

Some facts about the summer slide:

  • Children lose two to three months of reading development over the summer if they do not read.
  • Most students lose two months of math skills every summer.
  • Students from low-income households, who often have less access to books, are most likely to fall behind their peers.
  • A three-month gap in reading achievement exists between low-income and middle-income children following the summer break.
  • Over time, these months turn to years. By the time children enter middle school, a two-year gap in reading skills develops between kids who read during the summer and those who do not.
  • On average, teachers will spend the first four to six weeks of a new school year re-teaching lessons in an attempt to get children caught up.

How to beat the summer slide:

  • Visit your local library. Many local libraries offer free summer reading programs for kids that include not only access to lots of books but arts and crafts and other fun activities to encourage reading.
  • Make learning fun. Find books that your kids really love (topics that interest them such as comic books, dinosaurs, fantasy, etc.), or offer rewards when they complete at least 20-30 minutes of reading each day.
  • Look for math opportunities. Math is all around us. At the grocery store, children can count items in the shopping cart and add up the prices.
  • Cook together. Spending time in the kitchen involves both reading and math skills. Children can help out by reading recipes and measuring ingredients. Find healthy delicious recipes on The Children’s Hospital of San Antonio CHEF website.
  • Lead by example! If a child sees you reading for fun, they will likely want to do the same.

If you are concerned about your child’s summer slide, talk to your pediatrician for more tips. If you need a pediatrician, check out our online referral:

Occupational Therapy Develops Skills for Daily Life

By Sandra Ramirez, OTR, The Children’s Hospital of San Antonio

April is Occupational Therapy Month! And though the term “occupational” may throw you a bit in regards to children, occupational therapy is a vital part of many children’s therapy regimens.  A pediatric occupational therapist focuses on helping children develop the skills they need to grow into functional and independent adults. There are many different areas that occupational therapy focuses on such as:

  • cognitive skills (problem solving, using judgment, completing higher level tasks)
  • fine motor skills (using smaller muscle groups such as hands and fingers)
  • gross motor skills (using larger muscle groups such as those necessary for sitting up, crawling, walking)
  • sensory integration (exposing stimulation in a structured repetitive way so the brain will adapt and allow kids to process and react to sensations more efficiently whether that be noise, tactile, taste, or visual sensations)
  • self-care tasks (dressing oneself, buttoning shirts, brushing teeth, self-feeding)
  • social skills

When working with children, pediatric occupational therapists often incorporate play as a way to motivate and reduce anxiety and fears children may have. Each session is made to target a new goal, build self-esteem, and build confidence when it comes to their capabilities.

Being a part of the occupational therapy profession has been so rewarding and has brought such joy to my life. I knew that being an occupational therapist would be rewarding when I first came into this field.  Helping medically fragile children become strong, independent people during their stay and be discharged from the hospital knowing they can do anything they put their mind to is the greatest gift. Being a part of this field has allowed me the opportunity to be a part of these kids and their families’ stories and it has helped me grow as a clinician and as a person. My greatest joy is when children and their families return to the hospital and they want to find me to show me how well they are doing! What can be better than that?

Being an occupational therapist is not just a job; it is a lifestyle and who we are. People who want to help, people who want to advocate, and people who want to do whatever is best for their patients and families. Growing into a self-sufficient adult may be easy for some. Others, though, need a hand. Whether that hand teaches them to write better, to gain specific motor control, to perform their self-care with increased independence, it helps them reach maturity with strength and confidence. These qualities are vital to making it on their own.

For more information about occupational therapy, visit

Is your child getting enough sleep?

Samiya Ahmad, MD
Pediatric Neurologist and Sleep Medicine Physician
The Children’s Hospital of San Antonio
Diplomate of the American Boards of Sleep Medicine, Neurology and Psychiatry with Special Qualification in Child Neurology

March 15 is World Sleep Day 

Spring is upon us and so is World Sleep Day on March 15 this year. World Sleep Day was established to promote the understanding that sleep is a privilege that is compromised all too often by the rigors of modern life demands.

Profound, huh? Not so mind boggling if you know exactly why sleep is so important for you and your family.

Why is sleep important?
We spend a third of our lives sleeping. Children under 2 years spend over half of their lives sleeping. It is the principle activity of the developing brain. Sleep is a basic human need, like eating and drinking.

Insufficient or inadequate sleep can negatively affect well-being by impairing memory, attention span, and learning capabilities. Chronic sleep deficits can lead to obesity, weakened immune system, high blood pressure, heart disease, and diabetes.

Do you know these sleep facts?

  • Sleep-related accidents account for 71,000 injuries each year in the U.S.
  • 1,550 people die of sleep-related accidents
  • Sleep problems are reaching epidemic proportions and affect the quality of life for up to 45 percent of the world population
  • Sleep disorders are almost always preventable and treatable, however only one-third of affected people seek medical help

How can I ensure good sleep?

  • Maintain a consistent, age appropriate bedtime and wake-up time
  • Bedtimes before 9 p.m. for children are associated with better quality sleep
  • Establish dim light conditions one hour prior to bedtime; this is the most potent stimulant for the natural secretion of melatonin
  • Avoid use of electronic entertainment 30 minutes prior to bedtime
  • Establish and nurture a relaxing bedtime routine
  • Schedule age appropriate naps (naps phase out after age 5)
  • Exercise regularly, but not too close to bedtime
  • Enjoy sunshine during the day
  • Avoid caffeine after 4 p.m. and 6 hours prior to bedtime
  • Create a comfortable sleep environment with appropriate bedding and ambient temperature, in a quiet, dark, and well-ventilated room
  • Use bed only for sleeping and avoid eating, reading, and doing homework in it

 How much sleep does my child need?

  • 0-2 month: 12-18 hours
  • 3-11 months: 14-15 hours
  • 1-3 years: 12-14 hours
  • 3-5 years: 11-13 hours
  • 5-10 years: 10-11 hours
  • 10-17 years: 8.5-9.25 hours
  • Adults: 7-9 hours

If you child is experiencing sleep problems, talk to your pediatrician and ask for a referral to a pediatric sleep doctor at The Children’s Hospital of San Antonio.

If you need help finding a pediatrician, visit