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Health problems delaying progress

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Question: Our daughter Sarah, who is in kindergarten, is shy and has anxieties about school. (She's afraid to go through the lunch line; she frequently asks if I will be there to pick her up, though I'm always there.) We are in angst about whether to keep her back in kindergarten next year.

She has had several physical/medical problems since birth: reflux, eczema, chronic constipation, sleep problems. Though these have improved, she was a miserable baby/toddler and is just now sleeping on her own without waking up and crying.

In school, the teacher says that she has difficulty finishing her work. She seems to have problems with new concepts and following directions. Since Sarah is too shy to raise her hand if she needs help, the teacher often has to check on her. Often, she needs help getting the instructions down. She also wants to change activities if the task seems too difficult.

Could this just be developmental, meaning she needs more time, or could this be the beginning of a learning difference or disability? We want her to feel successful and have more confidence in herself. Should we have her tested to see if we should hold her back?

—A.D.R., via e-mail

Answer: Any parent who is as concerned as you sound, and who is asking such searching questions, deserves a chance to look for answers — even though they may not be found. Neuropsychological testing to assess for strengths as well as weaknesses, learning style as well as disabilities, and possible attention issues does make sense when a child appears to have trouble understanding directions and seems to change tasks to avoid one that she is unable to manage.

Sometimes developmental learning delays occur along with fine motor or motor coordination delays, and sometimes with sensory integration difficulties. An experienced occupational therapist can usually make such an assessment.

Armed with this information, you should feel better about making a decision on an additional year of kindergarten. Even if "more time" is important, why not find out how you, your child and her teachers can most effectively use this time to help her overcome the difficulties you describe?

One of the biggest casualties of an undiagnosed learning disability is a child's self-esteem. Your daughter is lucky that you've been so involved and are ready to help so early. With early intervention, many children become highly successful at mastering or learning to compensate for their learning disabilities.

Question: My son just turned 3, and I'm wondering: What should I expect of his social skills? He will play with other children, but only for short periods. Then, he'll usually return to my husband and me, asking us to play.

Should he be regularly playing with other children? We live in an area with few children, and we're considering a play group or early enrollment in preschool to develop his social skills.

—S.H., via e-mail

Answer: This is a good time for your son to learn about socializing with peers. Watch two 3-year-olds together: They almost match each other's rhythms, speech and play. It is wonderful to see and to realize how much learning goes on by modeling on each other.

Since your son is naturally clinging to you in strange situations, try to make it easier for him. If you can, collect one or two friends for a play group on a regular basis — and talk to him about it before you go.

Try to find a playmate who is like him in temperament. Help them to become close before he enters a group situation, especially preschool.

At school, give him a "lovey" or substitute for you that he can cling to when you have to leave him. Plan to stay with him until he gets used to the new group or school. But when he turns back to you after playing briefly with other children, try to keep your responses minimal and not too exciting so that he'll be motivated to go back to play with his new friends.

You should also become friendly with the teacher so he can more easily transfer his trust to her.

Just be sure to let him take it at his own speed. It's too early to expect much in the way of social skills.

Your question is a good one for children in areas like yours, where there are few other children.

Questions or comments should be addressed to Dr. T. Berry Brazelton and Dr. Joshua Sparrow, care of The New York Times Syndication Sales Corp., 122 E. 42nd St., New York, N.Y. 10168. Questions may also be sent by e-mail to: nytsyn-families@nytimes.com Questions of general interest will be answered in this column. Drs. Brazelton and Sparrow regret that unpublished letters cannot be answered individually.

Responses to questions are not intended to constitute or to take the place of medical or psychiatric evaluation, diagnosis or treatment. If you have a question about your child's health or well-being, consult your child's health-care provider.