Friday, September 25, 2015

When should your child start to see the dentist/ good practices


 Please see updated post January 2017


When should your child start seeing a dentist?

Parents often ask us when they should start taking their kids to the dentist. Believe it or not, the current official recommendation now is that your child should have his or her first dental visit by age one.

In California, about one third of preschoolers have dental decay.  It is much easier to prevent decay in toddlers' teeth than to fill a cavity in a young child. Although tooth decay is the most common chronic childhood disease, it can be prevented.

As parents, we may think, "baby teeth fall out, so we don't need to worry about them." This sounds logical, but unfortunately is not true. Luckily, dental science has found out many new facts about how to prevent dental decay. We now know that bacteria causes tooth decay. This "bad" bacteria can find its way into your babies mouths in many ways. Eating foods high in sugar is one of the most obvious offenders. In order to prevent decay in our adult teeth, baby teeth have to be kept healthy as well.

What can you do to keep your child's teeth healthy right from the start? For the youngest babies with brand new teeth you can wipe them off with a soft piece of gauze or a wet wash cloth. Not only are you cleaning off the teeth, (breast milk does have sugar) but you are getting the baby used to a routine. Training your child from the start that teeth get brushed is a good way to create good dental habits that will last a lifetime.
There are other options besides the standard hand held toothbrush. For very young babies there are little flavored towelettes specially formulated for wiping baby teeth. Spiffies was the first of these that I was familiar with. Now there are several brands available.

You could also consider using a soft finger brush. These fit over your finger and if your baby will let you, they allow you to get in there and do a nice thorough job.

If you use a regular toothbrush, make sure it has soft bristles. Replace the brush when it looks like the bristles are getting worn. It is also a good idea to run all the family toothbrushes through the dishwasher every once in awhile. One extra perk about routine dental care is that you might walk out of the dentist's office with a new toothbrush! Younger children will have an easier time handling a toothbrush with a thicker handle.

Perhaps you can let your child be in charge for one brushing a day and the parent be in charge of the other; that way you know you are doing a more thorough job at least once a day. Some people use a two toothbrush approach. Toddler gets to hold one, but so do you. Both of you can be in there at the same time.

Consider putting a little tune on while you brush. This can act as a timer. Brushing is ideally supposed to last 2 minutes. Do the best you can. A full two minutes might be a goal that is a little unrealistic for many of my patients.

The old recommendation was to use non fluoride toothpaste for kids younger than two years. The new suggestion is to actually use a tiny amount (just a little dab) of fluoride toothpaste. It is important to note that too much can be harmful so keep the amount tiny. Once kids get to be over two and can spit it out after brushing, you can use a pea sized amount. Xylitol is another recommended ingredient for dental health. It is found in some toothpastes. This natural sweetener is found to help reduce bacteria and strengthen tooth enamel.

It is important to use a toothpaste that is non abrasive. Most kids brands are specially formulated to be gentle. Some adult ones are fine. Most toothpastes will have the abrasive rating noted on the package.

Ideally try to  brush twice a day and floss once a day (for teeth that are touching).

Pay attention to habits that may or may not be good for your teeth. Children who are “grazers” tend to have more cavities than the those who eat less frequently. Saliva neutralizes the acids in the mouth and actually ‘washes’ the teeth, but it needs about 2 hours in between meals to work. If someone is constantly eating, the saliva isn’t getting a chance to do its job.

Foods that are high in carbohydrates and sugar are not healthy for our teeth or general health. A daily intake of 60 grams of carbs or higher more than doubles your chance of getting caries (and all that sugar can lead to type II diabetes in kids!)

FINDING A DENTIST

Find a dentist that treats very young children and bring your child to his or her first appointment when the first teeth erupt - no later than by age one. During the visit, the dentist will check your child for dental decay and talk to you about cleaning your baby's teeth. They might also talk to you about proper nutrition for keeping baby teeth healthy. 
If you have any concerns about the manner in which the teeth are erupting, having a dentist who is familiar with your child will be very useful.

Another important thing to think about is that having a dentist can come in very handy if you happen to have any dental emergencies. Kids have accidents! It is not unusual for me to get calls about chipped or loose teeth after a fall. I usually suggest that they contact their dentist on those occasions, and the folks that already have one are way ahead of the game.  If there is a dental emergency, early intervention can be the difference between saving the tooth or losing it.

Some parents avoid taking children to the dentist to save money, yet studies show that the dental costs for children who have their first dental visit before the age of one are 40 percent lower in the first five years of life than for those who do not see a dentist before their first birthday. Consider this when deciding whether or not to add your child to your dental plan (if you are lucky enough to have one.)

We are fortunate to have lots of excellent choices in our city. Below is a partial list of dentists who we send patients to. If someone is conveniently located or is on your insurance plan that is certainly worth consideration.

David Rothman 415-333-6811
Dr. Rothman is over on Ocean avenue near Stonestown. He was my kids' dentist and they loved him. He is an excellent dentist with a wonderful sense of humor. His office is able to do procedures under general anesthesiology, in the office, if needed. Bonus points for Dr. David just this month for stepping up to help one of our kids with a dental emergency who wasn’t even his patient. He is also my "go to" guy if I have any tooth related questions.

Bergen James, Doris Lin-Song and Jennifer Yu 415-668-3500
They are located on Parker Street near Laurel Village. Love dogs? They have one in the office! Dr. Kaplan uses this office for her son and gives them two thumbs way up.

Claudia Masouredis 415-753-2777
Dr. Masouredis is fairly close to our office, just up the hill on Portola.
Nurse Jen brings her kids here and they adore her.
Dr Masouredis can also do procedures in her office that require sedation.

Dorothy Pang 415-681-8500
Dr. Pang is on Taraval and 18th in the Sunset.
Dr. Pang  is affiliated with the UCSF dental school. If someone needs a dental procedure under anesthesiology she can do this at UCSF rather than in the office.

Raymond Katz 415-751-7900
This practice is at 5233 Geary. We have plenty of patients who have been using these folks and only have nice things to say about them. Dr Schwanke used to take his girls over there when they were young.


Dr. Charles Spitz and Dr. Tyler Davis  650-375-8300
Peninsula Pediatric Dentistry and Orthodontics 

If you are looking for a practice down on the peninsula, this great practice is located in San Mateo. Dr. Davis works with Dr. Spitz, who used to have a practice in the Mission.
They are located in the Mills Medical Arts building on the corner of South San Mateo Drive and 2nd Avenue in downtown San Mateo.
"We are a preventative practice first and foremost. We believe the best dental care is personalized to meet the individual needs and preferences of each child we see. We work hard to get to know our patients and their families. We're always willing to listen, to discuss options and to answer your questions."



Help your child keep their shining healthy smile! If you need assistance in finding a dentist, or low-cost children's health insurance in San Francisco, please call the Women and Children's Health Referral Line @ 1-800-300-9950.

RECAP   Tips for Healthy Teeth
  • Take your child to a dentist twice a year; starting by age one
  • Brush your child's teeth everyday; as soon as they come in
  • Make those snacks healthy ones
  • Take care of your own teeth; adults can spread cavity-causing bacteria to children
  • Never let your baby have a bottle or cup in bed that has anything other than water

Friday, September 18, 2015

Vitamin D/ Is your baby getting enough. Are you???



This Post was updated March 2017


Vitamin D - Is your child getting enough?

Food superstars come and go. One minute something is going to cure all of your ills and the next minute it might be considered poison. (Who agrees with me that as long as chocolate and wine are considered to have some health benefits, they should stop doing further studies?)

One of the current favorite good guys is vitamin D. At the same time that scientists were stressing the importance of this vitamin, they were also discovering that many folks are surprisingly quite vitamin D deficient without being aware of it. There are 2 forms of vitamin D: D2 and D3. Most experts are in favor of focusing on D3, which is the more natural form.

Years ago, vitamin D deficiency was most associated with Rickets (a disease that causes very soft bones.) More and more recent studies are finding that Vitamin D levels are also very important well beyond good bone health. Deficiencies are linked to multiple illnesses including diabetes, cancer, heart disease and even mood disorders. There are also current studies underway to see if there is a link between low Vitamin D levels and increased allergies. Other studies are linking D deficiency to insomnia and ADHD. The sunshine vitamin made the news again just this month (September 2015) in the JAMA
(Journal of American Medical Association) where there was a study linking vitamin D and cognitive health in older folks.

For several years now, the American Academy of Pediatrics has recommended that all breastfed babies start getting 400 IU of a vitamin D supplement within the first few days of life. (IU stands for international units, which is a common way that vitamin D is measured.) Quality infant formulas have vitamin D in them. Babies who get 32 ounces of formula per day have their needs covered.

But what about the majority of our babies who are partially or completely breast fed? I instinctively like to believe that breast milk is  a "complete source" for all of your baby's needs. In the case of vitamin D this is not necessarily the case. It comes down to the mom.

The only way a baby is getting enough D through the breast milk is if mom has a good level. Unfortunately, the segment of the population who test the lowest for vitamin D are pregnant and breastfeeding women.  If you are a nursing mom and you are deficient, your baby is simply not getting the amount that they need. There are some studies that claim that a nursing mom might need to take 4,000 IU/daily to be sure the baby is getting the suggested amount of 400 IU through her milk. Giving vitamin D drops directly to the baby can take the guesswork out of this. If you do end up giving your baby vitamin D supplements, one of the most common brands is the Enfamil D-Vi-SOL. One  dropperful is 1 ml. This gives the daily dose of 400 IU.

Babies seem to tolerate this well. There are some other forms out there that give 400 IU in each drop. That is quite a difference. It is very important that you pay attention to the form that you are giving.

If you are giving your baby a multi vitamin supplement like Poly-Vi-Sol, that already has the D in it. Be a label reader! While vitamin D is one of the fat soluble vitamins, you cannot get "too much" from sun or diet. But, as with any supplement, you don’t want to overdo it. Most studies suggest that the upper limit for safe supplementation is 1,000 IU/day for babies or 4,000 IU for adults. There are some current studies taking place that may in fact raise that level, but as of now I wouldn’t recommend going beyond that upper limit unless you are working closely your personal physician.

Children over the age of one and all adults, should make sure they are at the very least getting 600 IU daily.  Milk and orange juice that have D added, some fatty fish, and cod liver oil are on the short list of good dietary sources for vitamin D, but a person would have to drink ten tall glasses of vitamin D fortified milk each day just to get minimum levels of vitamin D into their diet.
Other foods like some mushrooms and eggs will get you a bit, but not enough to begin to make a dent in the daily requirement.

Historically much of our vitamin D is/ was from sun exposure. Folks who live in sunny climates generally have higher levels. Darker pigmented skin has a harder time absorbing it. Being out in the sun, unprotected for 30 minutes 2 or 3 times a week would probably give most people the amount they need. But wait!! Do we really want to expose ourselves and our children to the risks associated with sunburn? To compound things, the rays of natural sunlight that produce vitamin D in your skin cannot penetrate glass. This means you can’t get vitamin D from indirect sunlight in your car or at home,

In fact, our recent healthier sunscreen practices are quite possibly the cause of our lower vitamin D levels. Weak sunscreens (such as SPF 8) can block Vitamin D by up to 95%. It is hard to find a balance. Some exposure is healthy, but overdoing it is problematic, Sunburn and an elevated risk of skin cancer don’t seem like a sensible answer.

If you are a nursing mom and are one of the many folks out there who has a low level, it is very important that your baby get the vitamin D that they need (and yourself as well !!) In our office we are not wedded to babies receiving a daily supplement as long as you are sure that they are getting enough through their milk intake. In any case, giving your baby a daily vitamin D supplement is certainly harmless if giving the proper dose. If you choose to skip the vitamin D recommendation, please consider getting a blood test to see what your level is. The recommended test usually ordered is a 25-hydroxy vitamin D level. There is some debate about what the proper level should actually be, but everyone seems to agree that:

< 12ng/ml is severely deficient.
12-20 ng/ml still not adequate
20-50ng/ml  reasonable range of normal

40% of folks tested in this country are low!! Please make sure that you and your baby are not one of those.

Friday, September 11, 2015

Tummy bugs 101/dealing with diarrhea and Vomiting

This is an update of the post from 3/13
By far most of the tummy bugs that we see are caused by a virus. Time will generally take care of these. The typical symptoms are vomiting, loose stools and sometimes fever. Not everyone has every symptom. Vomiting without the loose stools could also indicate something else going on, like strep throat, a urinary tract infection or an ear infection. When the diarrhea comes along, it usually signals that we can narrow our attention to  some type of tummy issue. The problem with the patient losing fluids from both ends, besides being miserable, is that dehydration now becomes more of a concern.

Your main focus is to keep the patient hydrated. It is okay and even expected for them to have less of an appetite for a few days. Unless they are extremely slender,  we are not too worried if they lose a bit of weight. They will fatten right back up when this passes. Don’t stress about the food intake. Pushing food will likely just prolong things. We just need to make sure that they are getting adequate fluids.

Start by  giving  clear fluids (breast milk is also perfect if you have it.) Because we lose lots of electrolytes when we vomit or have diarrhea, it is best to replace the fluids with something that replaces the electrolytes as well. Water is not your best choice.
There are products on the market that are specially formulated for this purpose.
Pedialyte has been around for quite a while. There are pedialyte popsicles that are terrific for older kids. Regular pedialyte has always tasted a bit like soap, but they are trying to remedy that. If you can get your child to take it, consider yourself lucky. There is also  product out there called Drip Drop that tastes a little better. Coconut water is another fine choice. Consider keeping some of these products on hand so that you are prepared if a tummy bug strikes.

I don’t have any hard and fast rules. Do the best you can to get some type of fluids in them. Electrolytes are nice, but you have to do the best you can if they refuse those. See  if diluted juice, ginger ale, or colas that have lost some of the fizz are better accepted.
Whatever they are agreeing to drink, I typically wait at least  ten minutes after they have thrown up before I offer anything to eat or drink. Think of a drip irrigation system. Sometimes all you can get in there is a dropper full. That’s okay, get that fluid in, drop by drop, ice chip by ice chip. Do the best you can.

If you are breast feeding, don’t let them have too much at a time. If they overdo it they will likely keep barfing (like my medical lingo?) Please note, so that you don’t freak out, right before someone is going to vomit, it is normal for them to look quite miserable. Some kids get very pale and shaky. Some folks actually look greenish. Once they throw up, most of the time they feel a bit better and the color normalizes.

If your child has an elevated temperature as part of this illness, a tepid bath can help get the fever down. If the bath hasn’t done the trick, the fever is over 101, and your child is miserable it is worth giving some fever reducing medicine. Ibuprofen tends to be a bit harder on the stomach so I would choose acetaminophen (Tylenol) when I have an illness that includes tummy symptoms. Another advantage to the Tylenol is that it comes in suppository form, so it is more easily tolerated by a vomiting kid.  Dosage chart

If your child is running around and has good energy  I am usually  not too concerned. There is a big difference between subdued and lethargic. Some kids are well hydrated  but still feel lousy and are quieter than usual. We can call them subdued. If you have a kid with big juicy tears and lots of drool, they are probably not terribly dehydrated. The body doesn’t waste the fluid.

On the other hand, a dehydrated child is lethargic. They do not want to play. The urine is more concentrated (darker and smellier) and way less frequent. Their mouth feels dry. Their breath might be stinky (of course if they have been vomiting that is probably a given.) Their skin may be dry. Normally if you pinch up a bit of skin on the wrist, it will immediately correct itself. If someone is dry, it may remain up in the pinch for a moment.
If they are refusing fluids or can't keep down anything, you need to check in with your doctor’s office. If they are vomiting up bile ( bright green) that is another signal that their tank is really on empty and they need a little help turning things around. These are the kids that sometimes get carried into our office draped over their parent’s shoulder.

If I am giving phone advice, I am usually going to skip the office visit.  If we are concerned that you are not able to win the hydration battle then a trip to the emergency room is appropriate. Once there your child may get some IV fluids which often perk them right up.

Most of the time the ER is not necessary. Frequent but tiny amounts of fluids is a remarkably effective approach. Generally the vomiting is the first thing to ease. Once your child has started keeping down fluids, it is okay to advance the diet if they are interested in food. More often than not, we expect the stools to continue to be looser than normal for a bit longer. Trust your kids to some extent. I find that most of the time they accept foods that their bodies can handle. (Just in case, ignore the request for pepperoni pizza for a few days.)

Bland starchy foods are your best bet. I suggest a modified BRAT diet. Bananas, rice, applesauce, crackers, toast, potato, pasta, boiled chicken and watermelon are all okay.
I find that folks have a quicker time getting over this if they avoid dairy (some folks can stay on yogurt and tolerate that fine.)

In my experience, getting started with probiotics right away is the key to getting over this quickly. We need to get the gut healthy again so that it can tolerate a normal diet and the good bacteria in the probiotics is critical to this.

There are plenty of good brands out there. One of my favorites is Florajen for kids which you can get from the Noe Valley or Diamond Heights Walgreen’s.  It is kept in the back in the refrigerator, but there is no prescription needed. Baby Jarro Dophilus  (Whole Foods or health food stores) is another brand that we have had success with. If you have a trusted brand on hand, it is fine to stick with that.

One of the most common calls to our advice nurse team is when a patient seemed like they were improving and have had a bit of a relapse. This is usually caused by advancing the diet a little too quickly (especially dairy.) You may need them dairy free for a week before things return to normal. Yes, this includes cheese....

If your child is keeping food down but has loose stools, I have had great success using  the Similac expert care for Diarrhea (it used to be called Isomil DF) The Walgreen’s in Noe Valley and Diamond Heights try to keep this in stock for me. You may need to ask the pharmacist if you don’t see it on the shelves. It is ready to feed and doesn't not need to be mixed or diluted. Google shop has been another source when it is hard to find. For older kids,  I still  use this soy based formula as the base for a smoothie:
    -    Similac DF
    -    Banana
    -    Frozen yogurt (if not tolerating dairy, find a non dairy alternative)
Mix the ingredients in a blender. This smoothie is usually easily accepted, well tolerated and helps form up the stool. Watch out that it doesn’t do too good of a job and you are all stopped up.

If your baby is under 2 months old and you suspect that they have a tummy bug, we will want to monitor them closely. Young babies can get dehydrated much more easily than a larger child.

Of course it is not always easy to know what's up. Many babies spit up on a regular basis daily and normal baby poop is very liquidy. But, if you are worried, they are spitting up more than normal and have increased fussiness I will likely get them in to be seen. For a young infant,  watery/clear stool would also get my antenna up. With a dehydrated infant, the fontanel (soft spot) may appear more sunken, and they will be way sleepier or fussier than usual.  If they are nursing well, and peeing fine that is very reassuring.

If you or your child has fever, chills, bloody diarrhea and vomiting,  that could be food poisoning. The most common culprits are Salmonella, Shigella and Campylobacter.

Even though many of those illnesses are self limiting, getting seen is a good idea. We may send a stool sample to the lab to check for a bacterial stool culture. There are special containers required for this. You can get those from the office or the lab. Mom or dad, it is your job to get the poop into the specimen container (thank you for your understanding.)

If you or your child are just back from travel or camping and have awful gassy, incredibly stinky stools, we should make sure that you don’t have giardia or some other parasite.
If that is a possibility, we would send another type of stool sample to the lab that requires a different set of specialized containers. This is called an O&P (ova and parasites.) As opposed to many of the other tummy issues, these do not usually resolve without help of some medication.

Many times tummy pain is from constipation (http://nursejudynvp.blogspot.constipation)
Gas pains tend to be sharp and intermittent. Any steady abdominal pain that is lasting more than several hours should be evaluated.

With anything poop related, often defense is your best offense. Wash your hands!!!

Friday, September 4, 2015

Speech Milestones

Speech Therapy

My older daughter Lauren reached her verbal milestones at  a young age. It turned out that she was stringing together sentences quite a while before we could actually understand what she was saying. The fact that she was actually using real words to communicate became apparent to me one day when she and I were wandering around the zoo. She may have been as young as 15 months at the time. Lauren started to tug on my arm saying “shoofaloff”

It sounded like typical babble; I tried to figure out what she was trying to say as we walked. Was it an animal perhaps? Did she want a snack?

“SHOOFALOFF” She kept repeating. She was getting upset that I clearly wasn’t understanding what she was insisting on telling me. “SHOOFALOFF”

I paused for a moment, happened to look behind us and saw that her shoe had fallen off and was about 10 feet behind us. Shoofaloff was “shoe fell off!” Duh! At that moment I realized that her fairly incessant cute little gibberish was actually speaking. As the weeks passed, Lauren became more and more articulate and I completely took it for granted that we lived with a little talking wonder.

When Alana came along, I expected nothing less. Alana (no need to fret about her, she is a superstar working on her Master's degree in Social Work at the University of Michigan) didn’t care about reaching milestones (any of them!) She had no trouble at all with comprehension, but her speech was incredibly garbled. By the time she was two, we could still barely make out a dozen words.  Fortunately we had Lauren, who translated for her without any problem.

GUGUGUGGODH  might mean “I would like more popcorn please”. Lauren was puzzled as to why we couldn’t understand her sister. This just goes to show that often siblings have magic communication skills with each other at a very young age.

Eventually Alana had plenty of words, but there were still a few letters that were hard for her to pronounce until she was quite a bit older.

There is a huge range of normal, so when do we need to have our antenna up? There are a few basics to keep an eye on.

By 4 months your baby should be cooing and making sounds. If they are not, one of the first things we would want to make sure is that your child doesn’t have an issue with their hearing. Babies born in California are given a hearing screen at birth, but it is still something to check out if you have concerns. Does your baby react to  your voice? Do they look in the direction of a loud noise? As they get older, can they follow simple commands? If you are looking at a picture book, can they point to the appropriate picture with your prompt?

By 15 months they should be able to speak at least a few recognizable words.These don’t even need to be valid words. Alana couldn’t pronounce Lauren, but she could say Yaya and it was clear that Yaya meant Lauren.

Perhaps da means dog. As long as they are consistent and communicating, those sounds count as a word. If your child knows some signs, those are counted among their words. If you know for sure what they are saying, repeat after them. When they see the dog and say “da!” you should say “Yes..DOG!”  If they are using a sign, say the word. For instance if they are signing “more” during a meal, say “more.”

Michelle Geffen, a speech therapist at Jennifer Katz, Inc., advises not to pressure your kids by always asking them to say the specific word, instead, let them hear you use the word and wait for a response. Waiting can do wonders!

If your child reaches 18 months and there isn’t  any understandable language, this is an appropriate time to get a baseline evaluation from a speech and language therapist. Sure, it is okay to wait a bit longer if you like, but early intervention is always a good thing. I like to be proactive. Often the evaluation is covered by insurance.

By the end of the 2nd year, children should be able to speak roughly 100 words, understand 300, and have some word combos.

The earliest sounds for kids are usually  Pa Ba Ma Na Wa Ka Ga. By the age of 3 kids should have most speech sounds. Ruth White, a local speech therapist, councils that if the majority of folks can’t understand most of what your three year old is saying, an evaluation is advised. On the other hand, it is not uncommon for many otherwise articulate kids to  distort some of the more difficult sounds such as l, r, s, sh,ch, y, v, z, th. These sounds may actually not be fully mastered until age 7 or 8.

Even though  we know that some sounds aren’t perfected until later, 4 or 5 is a reasonable age to check in about articulation issues.

Frequent ear infections or fluid in the ear can impact your child’s early language skills so it is important to work closely with the doctor if this is an issue. We may send you along to an audiologist or ENT to be part of the team.

Of course, keep in mind that there is a huge difference between hearing and listening.
I can’t tell you how many young child failed to follow the directions with our in-office hearing test, but when I quietly whispered “ would you like a sticker?” they heard me just fine.

One of my favorite in-home hearing tests is an active listening game. Tell your child to whisper a word to you (perhaps the name of an animal.) Then you quietly whisper a word back to them. Make sure they can’t see your face so that there is no lip reading. If you have any concerns that the hearing isn’t as sharp as you think it should be, get them checked.

I am grateful to Jodi Vaynshtok from  Sound Speech and Hearing Clinic for taking the time to chat with me about this post. http://www.soundshc.com/ I am sharing her explanation of the different aspects of communication skills that a speech language pathologist addresses.

Listening: In order to use the correct speech sounds, and understand/use language, a child must build upon their listening skills. This includes detection, identification and comprehension of spoken words. Listening therapy helps children learn to detect and interpret sounds, allowing their learning system to develop speech and language skills appropriately.  

Speech: This is often what people think all speech therapy sessions consist of – the production of sounds that make up our words and sentences. Speech involves the coordination of articulators (i.e. jaw, lips, tongue, vocal folds, vocal tract and respiration), divided into three areas: articulation, voice and fluency.

Language: A child’s language can be split into two domains. The information they understand (receptive language) and the language they use (expressive). Language therapy can concentrate on spoken, written or non-verbal communication. Goals can target vocabulary, grammar, formulation of sentences, following directions, and reading comprehension, just to name a few! A child’s ability to correctly understand and use language can affect their behavior, academic and social success.

Sound Speech & Hearing is one of the wonderful resources here in SF. They are the one stop shop that can combine the hearing and speech assessment in one visit. They also have the option of having  Mavis, the animal therapy pup at the visits ( it doesn’t get better than that.)
 
Here is a partial list of some excellent resources that we have in the SF area

Northern California Speech and Hearing 415 -921-7658

Sound Speech and Hearing 415-364-8774

Jennifer Katz Inc. 415-550-8255

Ruth White 415-225-6152

Bailey Levis 415-496-6757

Shannon Kong and Sara Spencer 415-469-4988

Tulips Speech  415-567-8133

SF Speech and Hearing 415-921-7658

UCSF Audiology 415-353-2101