Undiagnosed hearing loss (conductive or nerve hearing loss)
Conductive: children who have developed "fluid" or "mucus" chronically trapped behind the eardrum causing a decrease in hearing. Unless a primary care doctor is astute and has great diagnostics skills, I often meet children whose pediatricians told the family their child is fine. With a delayed diagnosis of mild to moderate hearing loss it can be completely reversed with a 5-10 minute ear tube placement and removal of the fluid.
Sensorineural: hearing nerve and hearing can be affected to a varying degree. Most children who are not deaf may compensate to a certain degree but the more severe the hearing loss, the less they learn nor can respond/perform.
MUST get a hearing test by an audiologist professional and see an ENT as well. These children need hearing aids, and unfortunately commercial insurance does not cover them and many public health issues impacting children result in lack of support for better development and school performance.
Rare condition called Central Auditory Processing Disorder (ages 7+)
These children pass their hearing test, (NOT A SCREENING test which is done at the pediatrician’s office, rather a hearing test is done in a sound booth by a professional called an audiologist), yet there are processing issues such that they struggle with instructions and learning despite having medically normal hearing.
Undiagnosed obstructive sleep apnea (OSA)
Long history of snoring, poor sleep, gasping and frequent awakening.
Often OSA is not diagnosed and instead ADHD is the diagnosis. One in four children are misdiagnosed as having ADHD when in fact they have underlying OSA. If OSA is due to enlarged tonsils and adenoid, surgery is the best option and can resolve the OSA, improve sleep, and improve school performance.
Normal hearing, normal vision, but difficulty with learning.
This is complicated. I personally ask families about early childhood: drug exposure during pregnancy, early childhood social situations, history of challenges such as neglect or abuse, etc. I humbly observe based on the population my team and I serve, that so many children live with adults who are struggling themselves. Children who were not raised with adults who read to them, or could afford to spend time with them, stimulate their learning, who themselves do not have the level of vocabulary, the children will likely face academic challenges. Currently millions of children are being raised by grandparents or others due to our narcotic epidemic, and so many parents incarcerated or tragically lost their lives to addiction—how will these children survive and thrive?
Undiagnosed vision issues
Even if diagnosed, are they adequately fitted with corrective lenses?
So many children do not have routine bedtimes, or social situations are such that they share rooms with adults and/or siblings, there may be too much noise and a lack of adequate and consistent sleep. This alone contributes to “behavioral” problems and possible learning difficulties.
Food security and quality.
Many children, who may be hungry, can’t possibly focus on school or perform. Thankfully most public schools have meal support programs, but often children may be consuming excessive sugar and processed foods, lack proper nutrition, and have poor eating habits. This can contribute to poor sleep and overall development, with or without health issues.
To learn more about nutrition, acid reflux and the "Milk and Cookie Disease" (MCD), take an online course.
Are children being adequately stimulated and challenged?
My personal bias certainly is based on being born and raised in Taiwan for the first 10 years of my life, where expectations are set perhaps too high but one could never say we didn’t have them. When children are NOT expected to achieve, or encouraged to believe they can, or given support in the form of a safe environment, great teachers, adequate supplies and materials, free resources to parents for reading at home, and public awareness about what is required to help a child learn, then we will continue to read about the staggering statistics of 1 in 6 American children “failing” in school.
Commentary on the New York Times article, Is Your Child Struggling in School? Talk to Your Pediatrician.
While I am not a pediatrician, a teacher, nor a developmental specialist, as an ENT surgeon who only cares for children and particularly focuses on hearing, speech, and overall development, this article is highly relevant. Here are the top 8 frequently "missed" diagnoses that contribute to a child who may be "failing" in school, even when missed by pediatricians:
Being able to swipe using a thumb or finger will not translate to lifelong effective learning. This will require public policy change, funding, federal and state level support, insurance and health care system reform for adequate access for those who are particularly at risk, minorities, immigrants, and anyone in our own back yard who may be struggling socioeconomically. Struggling early in life undoubtedly paves the way for struggles later on as adults if we don’t provide positive interventions now.
May we all contribute in our own way and help as many children as possible learn and stop struggling.