Brain Health and Understanding Your Child's Neurologic Development

When health headlines leave you confused, when medical myths need busting, when you need straight talk from someone who's seen it all, it is time for What the Health Is Happening, your weekly dose of medical reality from the front lines of healthcare. Hi, I'm your host, Dr. Valda Crowder, but you can call me Dr. V, and this is What the Health Is Happening. And I'm a board-certified emergency physician who has spent decades on the front lines of health care in hospitals across America. With experience treating everything from common colds to major traumas, I bring you the insight scoop on what is really happening in medicine today and what you need to know to improve your health and the health of your family. Get ready for straight talk, real stories, and medical insights that you need to take control of your health and wellness. There won't be any jargon, no sugar coating, just clear answers from a doctor who's seen it all. We give you the inside scoop on health matters and empower you with information on everything from breaking news to cancer updates to medical research. Each week I'll be answering real medical questions from listeners like you and providing evidence-based research and science you can trust. Have a pressing medical question? I want to hear from you. Send your questions to info at asdrv.us. That's info ataskdrv.us. And you might just hear your question being answered on our next episode. This is What the Health Is Happening, your weekly dose of medical reality from the front lines of healthcare. Welcome. I'm your host, Dr. Valda Crowder, but you can just call me Dr. V. I have over 30 years of award-winning experience as an emergency medicine physician, and I have witnessed all types of countless health crises that change people's lives in a nanosecond. But one thing I've noticed time and time again is how many families really struggle to sort of navigate the whole healthcare system. And so this show is really dedicated to giving you the tools that you need to actually navigate the healthcare system, whether or not it's with your physician or with your with a with a hospital system, so that you can actually get the information that you need to actually begin to heal. So that's where this show comes in. This is about empowering you with the knowledge and tools to control your health. Today we're gonna actually talk about a really interesting topic. And basically, it's part of our brain health series, and we're going over neurologic development and how does your brain and the nervous system develop. And specifically, we're gonna focus a lot on the neurologic development of children. So stay tuned as we break down this issue and we offer insights that will actually really make a difference. The neurologic development that actually occurs is really dynamic and really complex, and it occurs much earlier and lasts much longer than a lot of people believe. So your brain begins to first form at three to four weeks of pregnancy, and this is often before people even realize that they're even pregnant. And it continues until you're 26 years old. So a lot of people feel like their brain is fully developed at 15, 16, 17. No, it is not. Your brain is fully developed right around the age of 26. For some people, it may be 25 a little earlier, for other people, it may be 27. So let's kind of break it down and let's go through what this really looks like. So when a woman is three to four weeks pregnant, you begin to get the four the formation of a neural tube. And this neural tube is eventually going to develop and it's going to become the brain on one end and then the spinal cord. So what happens at three to four weeks is the neural tube actually forms into a layer of cells called the neural plate. And it kind of folds and forms and becomes an actual tube. So, or if it doesn't actually close properly, then it results in neural tube defects. And those are things like spina bifida or anasehaly, which is where there's parts of the brain that's actually missing. Around five to six weeks of pregnancy, that is when you actually begin to get distinct parts of the brain. So you start to get a forebrain, a midbrain, a high brain, hindbrain, and you actually begin to get the development of the cerebral cortex, which is responsible for all of your higher level thinking. Then around seven to ten weeks, the brain begins to grow very, very fast. And at this stage, what happens is you start seeing the beginnings of neural activity where you actually see the nerve synapsing and certain neural activity actually occurring. Right around mid to late pregnancy, right around 16 to 24 weeks, the brain begins to grow in size, and the structure itself becomes much, much more defined. And so it starts looking like the typical groove and folds that you see in a normal brain, which you would think of when you actually see a photo of a neural brain. 25 to 40 weeks, the brain continues to mature, and you start to get myelination. And this is a process where the nerve cells become insulated, so it actually improves signal transmission. So myelination allows the signal to jump from place to place to place and move down a particular nerve faster than if it had to be conducted all the way through the nerve. So then at 40 weeks, the child is born. So in the first few years of life, and we'd say like maybe zero to five years, this is sort of a period where the brain is really blooming, right? You begin to see if you're looking at the brain from the from the perspective of the cells, you see all of these synapses and connections occurring at a really, really fast pace. And that's why you see with younger kids, they learn very, very quickly. They develop their cognitive skills, their language, their social development. They begin interacting with caregivers and friends, and they get various social cues, and the brain begins the brain and the neural system begin learning very, very fast during the zero to five year period of time. Then as a child begins to actually enter into adolescence, this is where the brain goes through sort of like a reorganization and sort of an efficiency. And so what happens is there's part of the brain where it actually starts doing what we call synaptic pruning. And basically what it does is there's certain connections or processes that are not used very frequently, and those are sort of eliminated. And then the processes and frequencies that you are using a lot actually get used over and over again and become more efficient. The other thing that happens during the sort of adolescent period is you get a full maturation of the myelination, which is the coating of the nerve fibers, that little fatty sheath that allows for improved speed, improved efficiency of all sorts of neural transmissions. Then from the age 20 to 26 is actually when you get the final development and maturation of the brain. And that's where you begin to get impulse control, judgment, a refining of social behaviors. And this is the when, you know, as a young adult, you become better at managing your emotions, you become better at making reasonable decisions, and also controlling your impulses. So this is sort of the total maturation of the brain from in utero all the way up to the brain's spinal maturation and development right around the mid-20s, 26 or so years old. Okay, so what sort of problems do we actually see with the brain and the development of the nervous system along this in utero process all the way up to 26 years old? As I talked about earlier, um, one of the first problems that you can see is when the neural tube does not close properly and does not actually form a tube. Um, and this usually occurs during the first month of pregnancy. Um, and this is when you can get a spina bifida, uh, which is where either the neural tube or the vertebrae are not completely formed into a ring. Um, sometimes the spinal cord can actually be exposed, which is very dangerous. The other thing you can see is what we call a meningoseal, which is a protective covering of the spinal cord, and it can sometimes protrude through the bone. And then lastly, you can see a myelomingo seal, which is a very, very severe form where both the meninges that cover the spinal cord and the spinal cord itself protrude through the opening. How do you prevent this from happening? This is really, really important, and this is why it is so, so important that if you miss your period, you check a pregnancy test as quickly as possible. Because you are if you are pregnant and you plan on carrying the child all the way to term, it is really important that you actually start your prenatal vitamins very, very early. So, one of the things that actually leads to these types of spina bifida and neural tube defects is a folic acid deficiency, and folic acid is benign. And so one of the things that's in the prenatal vitamins is folic acid. And the use of folic acid supplements are really, really important during the pregnancy to actually help prevent neural tube defects. The other thing that's important is that you actually look at sort of environmental factors and genetic factors. So some people have neural tube defects that run in their families. Other things that you'll see, you'll see that there are certain environmental factors like smoke and carbon monoxide, high levels of heat during pregnancy that may also contribute to neural tube defects. Lastly, obesity and poorly controlled uh diabetes are also associated with neural tube defects. So the way to really prevent this is one, find out that you're pregnant as quickly as possible. And if you're trying to get pregnant, you may just want to actually start taking prenatal vitamins so that you get the folic acid supplementation. Then the other thing that's important is really maintaining a healthy weight and controlling diabetes and staying away from any sort of harmful or toxic substances during your pregnancy. All right, the other thing that really impacts brain development, and I have a lot of conversations with this with parents when they're in the emergency department, is small children on screens. And it doesn't really matter what sort of screens, it doesn't matter if it's the iPad or if it's a laptop or if it's a phone or if it's TV. Um, but we have found that screen time, or specifically excessive screen time, um, can really have uh negative effects for children. I know a lot of uh parents love to use these apps and things where they can teach the kid to read and colors and things like that. And these things are very, very good for cognitive development, right? But the I think what's really important is that we actually really make sure that they're not overused. So I want to talk a little bit about what is overuse and also a little bit about what happens when screen times are overused. So the American Academy of Pediatrics has recommendations for screen times for children. And they have these recommendations because we found that too much screen time can be detrimental to brain development in children. So this is really important. Any child less than 18 months old, which is basically a year and a half, should have no screen time except for video chatting maybe with family or friends. So no screen time, that means no phone, no uh no iPad, no laptop, less than 18 months. So around 18 to 24 months, um the uh the American Academy of Pediatrics is okay with some screen time along as as long as it is with a parent or a caregiver and it is strictly for educational purposes. Once you get to two to five years old, American Academy of Pediatrics says up to one hour of screen time per day. Now, I want to remind people this screen time includes TV, right? So it's not just laptop or phone, it's laptop plus phone plus TV. So five years or less, American Academy of Pediatrics recommends one hour or less a day. Um as you get older, six years and older, they they recommend limiting uh screen time and just encouraging healthy habits. You'll know if your child is getting too much screen time because when you attempt to take away the phone or turn off the TV, they'll have an absolute tantrum. And that means you actually have they have been being exposed to too much screen time because it does lead to a very addictive-like behavior and then an out-of-proportion tantrum when uh the device or TV is actually uh taken away. Teens and up to uh adults, uh they say two hours a day. So that's kind of an idea of what uh American Academy of Pediatrics actually recommends. Now let's talk a little bit about what happens when a child gets too much screen time and what do we actually need to do about it. Alright, so so the first type of screen time that is really kind of like the most dangerous is the screen time that's before bedtime. So you want to make sure that if your child is going to bed, you actually use a regular old paper book, not a laptop, not your phone, and not anything that is a particular device. Specifically, um, screens can interfere with your sleep by suppressing melatonin production, and it really leads to a lot of downstream uh negative effects. So people have problems with mood regulation, they have problems with memory, uh, they have problems with uh keeping their attention. Um, and then what happens is then the sleep deprivation itself then leads to cognitive impairment. Um, the child may become more impulsive, um, or you may have more behavioral issues. So before bedtime, you really want to eliminate all screen time. And if you want to go over a book or something or read something to the child, I would do that from an actual physical paperbook. The other thing that we find that happens with screen time, and it doesn't really matter whether or not it's a again, a TV or social media or something, an educational product, is that what we have found is that it actually begins to limit the child's ability to communicate and express. And what happens is we see a lot of kids that become socially isolated. Uh they have uh problems with anxiety and or depression. Um, when it comes to adolescence and social media, uh, they can have a lot of vulnerability related to peer pressures, which can lead to issues related to body image, self-esteem, and having uh poor relationships. So I remind parents all the time, really sort of pay attention when you see these things occurring, because this is really, really uh an important area. And it's some it's an area where if we as parents uh take a little bit more uh responsibility and control the situation, we can really help our children develop into adults with a higher sense of well-being and confidence. All right, so then there's also a lot of social and environmental influences that actually can positively or negatively impact uh brain and brain development. So one of the one of the most important things is early attachment. So early attachment between the child and their caregiver, whether or not it's a a parent or a grandparent, those sort of secure attachments and loving attachments really result in positive outcomes. They help the child emotionally regulate, um, they help them develop very good social relationships and also confidence. And in the converse, when those social interactions between the child and the parent or the child and the grandparent or whoever is the caregiver giver, when those do not occur, when there is actually insecure attachments or there are there is abandonment or there is neglect, it can actually lead to a lot of difficulties for children in actually how to process their emotions and also how to function later in life. So if you have a situation where there are some negative uh interactions between a parent and a child, you want to just make sure this can be supplemented by aunts, uncles, grandparents. You know, you want to create a loving community for that child, no matter who it is, so they're able to actually develop those skill sets. The other thing that's important is that chronic stress really does make a difference in the long-term changes to the brain, particularly in areas related to emotional regulation and stress responses. Kids who actually experience prolonged stress sometimes wind up being developmentally delayed and again can have cognitive and emotional difficulties. All right, the next area that is really, really important is concussions and head trauma. And I get I see a lot of this in the emergency department with kids playing, whether or not it's soccer or volleyball or football. And it's really, really important that young children avoid concussions or head trauma. Again, the brain is not fully developed until you're 26 years old. The other thing that's important is that when you're younger, the brain is mushier, right? So, and it firm up over time. So uh head trauma in a child that's very young is actually more significant and can do more damage than that same amount of force to maybe somebody that's 20 years old. So this is really, really an important area as parents to watch out for. Now, obviously, there's always things that occur, kids fall, kids do things that you can't really control. But there are some areas that you can control. So, a couple of recommendations is that, you know, when you're looking at contact sports like football, I recommend football is a great sport, but I really recommend that kids play flag football, right? So that there is less uh contact and head-to-head contact. There really is no need for tackle football at a very, very young age. Um so I think it's really, really important. Um, the other thing that I also talk about is that if a child does have head trauma, it's very important that that head trauma heals completely before the child is actually put in an environment where they may have another head trauma. So back-to-back head trauma or concussions are particularly dangerous. So, you know, if there is a situation where your child does experience some head trauma or maybe has a concussion, then you want to make sure that they actually avoid any contact sports until that has healed completely. We now are able to do neuropsych testing and linguistic testing to actually make sure that a patient has complete healing from a head trauma. Another thing that's important is if the child has a particularly serious head injury or they blackout or they fall from a significant height, or they have vomiting, or they have problems walking, or they seem dazed or confused, it's really, really important to take your child to the emergency department and actually get checked out for that. Because you do not know the difference between a concussion or an intracranial bleed. And so it's really, really important to get checked out in an emergency department if your child has a significant head injury. All right, so there's things that also occur during pregnancy that actually impacts a child's brain development. And so, you know, when a child is born premature, and we consider uh premature to be any child that is born 37 weeks or earlier, there's an increased risk for developmental delays, cognitive impairments, and also motor, particularly fine motor skills, right? And premature births really kind of disrupt or interrupt the normal brain development that occurs in the last trimester of pregnancy. So then what can happen is later on you may find that the child may have problems with memory or uh attention and focus, or may have difficulty actually solving problems. There are also maternal infections that actually make a difference in the development of the brain and spinal cord. Specifically things like rubella and Zika virus, which is often in warmer climates, these things can cause all sorts of brain malformations and really alter the development of very key neural pathways. Lastly, I think it's really important, and we talk about this often, that smoking, alcohol, drugs, environmental chemicals, you really want to stay away from all these things when you are pregnant because the brain and the heart and the liver and the kidneys are all developing in the small child. What we most commonly see is uh problems related to maternal. Smoking or maternal alcohol use. The other area where we see impacts on uh brain and brain development is when we have adolescents that are experimenting with either drugs or alcohol. We're seeing this a lot more, particularly with the legalization of marijuana. And a lot of times uh young people don't really understand the impact that marijuana has on their actual cognitive functions and specifically memory and attention. We are now seeing chronic marijuana use in young adolescents, and some of them are presenting with memory deficits that are almost like a dementia that we would see in someone that was 70 or 80 years old. So it is really, really important with adolescents that are experimenting with alcohol and various drugs that they understand the impact of this risk-taking behavior on their future brain development and the impact on their impulsivity and judgment and memory and cognitive skills moving forward. Now it's time to answer your questions. So you can email me at info at asdrv.us. That's info at askdrv.us with your name, location, and question. You never know. You might hear your question on the show. All right, my first question. Hey Dr. V, I work in the juvenile justice uh field, and I see a lot of young kids, particularly brown and black boys, being locked up for stupid decisions. Lawmakers seem to forget that their brains are not grown, uh, or even if they seem to be acting grown, they're not fully grown. How long does it take for your actual brain to mature? So, great question. Yes, this happens a lot, and you would see it in the juvenile justice system. So often um uh kids that are arrested in the juvenile justice system are less than 17 or less than 18, and their brains are not fully developed. So their brain fully develops at 25 years old, 25 to 26 years old. But here's what's really important one of the last areas to develop is your prefrontal cortex. And this is really the area of your brain that helps with judgment, it also helps with uh self-regulation, and it's it it leads to you not doing all the stupid things that you see kids do when they're younger. And it's really, really important that that brain development and/or the or the lack thereof of that prefrontal cortex, it really does make a difference in decision making and impulsivity. And um I I really do believe that that should really be factored into what happens with adolescents and and young kids that actually get in trouble. I do believe in the future we are going to be able to actually measure prefrontal cortex activity and actually understand in real numeric values how developed someone is or is not. Because some people are more developed than others, and everyone is sort of on their different maturation pathway. So thanks for that question. All right, so Keisha from Northeast, I'm a young mom, and my kids and all my kids' friends start these games and educational apps at one year or younger. Is this bad? What are the pros and cons? So, yeah, this is bad. So it is really, really important that no screen time is recommended 18 months or younger. And I see a lot of kids in the emergency department that are six, seven, eight months old holding a cell phone. It is not cute. And let me tell you, it causes a lot of problems with their social skills and with their uh communication skills and with their ability to actually uh modulate and their emotions and regulate their emotions. There is a recommendation that any child 18 months or younger has no screen time other than video chatting with family members. And after that, two to five years old is no more than one hour a day, and that includes the TV. So, really, really important. Thanks for the question. I've heard that the use of screens, particularly before bedtime, have a negative impact on sleep. But if I'm being honest, I let my kids bring it into their bed because he literally has a tantrum if I take it away from him. I'm scared he's addicted, but I'm not sure what to do. How bad is it? So let me tell you, this is really bad. So if he's having a tantrum and really acting out when you take it away, you really, really want to get on top of this because it is only going to get worse later. So a couple of things. So screens really emit blue light, which can interfere with the production of melatonin, and that hormone is necessary to regulate sleep. So it can make it harder and harder for your kid to fall asleep, and also harder and harder for them to actually feel rested. Then what happens in the morning is they're moody, they're irritable, they have difficulty managing themselves and managing their emotions. So the first thing you want to do is really develop a bedtime routine. Whether or not that bedtime routine is reading a book, whether or not it's having some hot cocoa or some warm milk, and really kind of have a calm, screen-free bedtime routine. Now, at first your child is going to be very, very resistant to this, right? But you've got to just keep with it. And if you have to, you may actually need to take the phone earlier in the day, maybe after dinner. You know, you can say everybody turns in their phone at dinner time, and then everything from dinner time on is no phone and no screens. And gradually you want to really reduce the screen time and you really want to set limits. You want to look at other activities that may soothe or calm a child before going to bed. So, for instance, reading or drawing or listening to calm music. I've even seen programs where they've taught young children how to meditate. And usually young kids really love it. So anything that kind of actually provides some calming other than the screen before bedtime. This is really, really important. We've got another question here. My nine-year-old son is obsessed with football and he has dreams of playing in the NFL. I'm a protective mama bear and I'm concerned about concussions and head trauma. What should I know? What should I do? I don't want to actually keep him from the sport that he loves. So this is really, really important. So I'm going to tell you what a lot of the colleges, particularly the Ivy League colleges, are doing now, is they have no contact practices. And I believe if you have a child that's nine years old, he can still enjoy the sport of football. He can just play flag football. And it you still get all of the fundamentals. And as he gets older and his brain is more developed, um, then you can decide and you can consult with your pediatrician and decide when is the best time to go back into contact football. But again, the brain is not fully developed until about 25 years old. If you do get the okay from your pediatrician to go back into contact football, what you want to do is you want to make sure he's being taught the proper tackling techniques so he's not going head first and you're decreasing the likelihood of head injuries. Again, as I said, with any contact sport, and football is not the only contact sport. Soccer, people headbutt the ball in soccer, um, you have all sorts of contact sports. You really want to make sure that if your child does actually experience a concussion or experience some sort of head trauma, that if it's serious, you actually go to the emergency department and you get checked out, and that you really protect the child afterwards because repetitive back-to-back head traumas really cause the most damage. So this is an area where you really should be a protective mama bear because this is their brain that they're going to use later for most of their life. Thanks for the question. Okay. All right, next question. All right, Dr. V, I find myself getting sad and irritable around this time of the year every single year. I used to think it was because I was lonely. However, I finally am in a loving and healthy relationship. But guess what? I'm starting to feel lonely and heavy again. My girlfriend said that I might need vitamin D. What does vitamin D do? And is it really a thing? Is it really helpful? So, very interesting question. So I'm going to do another show that includes a seasonal affective disorder. Um, and seasonal dis seasonal affective disorder is also called SAD, SAD. And basically, what it what it happens is it's a it's a type of depression or mild depression or can be severe or mood alteration that occurs in the fall and winter, and it's usually associated with decreased sunlight. So, what happens is people that have a deficiency of vitamin D are actually more likely to actually develop seasonal affective disorder. So you can take vitamin D supplements. Some people also actually get lights in their house that actually replicate the sun. And then also you can get outside if you're in an area where even though it's fall and winter, it does get sunny. You can get outside in the sun. If you if you connect with the sun at least 30 minutes, three or four times a week, you will usually then get the amount of vitamin D that your body needs. But sunlight and vitamin D are absolutely important in mood regulation. So your girlfriend is right about that. All right, thanks for the question. Hey Dr. V, I'm asking this question for a friend. Um, I've heard that it's okay to have a little wine when you're pregnant. Is that true? Also, how can you tell if alcohol messed messed up with your baby? So, great question. Um, so it is you it is really, really important to avoid all alcohol consumption during pregnancy. There is no safe amount of alcohol consumption when you are pregnant. Um, and it doesn't matter whether or not you're in your first trimester, second trimester, or third trimester. Um, drinking alcohol during pregnancy can lead to fetal alcohol spectrum disorders. And this kind of causes uh developmental delays, learning dis learning difficulties, and physical abnormalities in the baby. Um it's not always immediately clear that someone has phys uh fetal alcohol syndrome. I'm sorry, it is not always clear, it is not always immediately clear if alcohol has had an effect on the baby. So what happens with fetal alcohol spectrum disorders is that sometimes the child is born and seems to be normal, and that you may see the developmental delays later on. There can be delay in growth and development, problems with learning and attention and memory. There can also be facial abnormalities, so there's sort of a look of fetal alcohol spectrum uh babies, and usually it's sort of like a thin upper lip and a kind of narrow face. And so there really is no amount of alcohol that is safe during any trimester of pregnancy. Great question. All right, give me just a second here. All right, I got a question here from a girl dad, and he says his ex was a little reckless when she was pregnant, and he believes that that led to his daughter being delivered prematurely. So here's his question. My daughter is now eight years old, and she's a little slow, if you know what I mean. How does premature birth disrupt normal brain development and can a child grow out of it? So, great question. Um, premature birth is anything below 37 weeks. Um, and the earlier the baby is born, the higher the risk for cognitive and motor delays, right? And so what happens is um a premature child can actually have difficulty early on with cognitive and motor skills, but they are able to catch up a lot. Now the question is, do they catch up to where they're actually supposed to be? It depends. Um and what really is needed is um a lot of different support. So there's a couple of things that make a difference. Early intervention of speech therapy, physical therapy, occupational therapy that's really uh geared towards fine motor skills. Sometimes uh children will need extra educational support or tutoring. Um, sometimes they need extra emotional or behavioral health support. And so it's really important to get these services around the child as quickly as possible. So, what is important? Your child, you said, is eight years old. Whatever school they go to, you want to actually see do they need a an independent educational plan, an IEP, and and do they need extra services. Um all of the schools are required to really provide the services, and the child can be assessed to sort of see what services they need. Some children need more more help with memory or cognition, and other kids need more help with fine motor skills. But when you wrap the services around that child, um they really do develop faster and they do begin to catch up, and some of them can catch up to normal. It's really, really important to get those services around them as quickly as possible. Great question. All right, I got a question from Khalil. Uh Dr. V, I've always heard that girls develop faster than boys. Is this always the case? And if so, in what ways? So interesting. Um, it's not always the case. Um I think that, you know, again, you know, we're looking often when we have these discussions about the average boy or the average girl, but in general, in general, girls do tend to develop faster than boys in a particular in in several particular areas. So one is that girls will often reach uh puberty earlier, typically between eight and thirteen years old. We have noticed that, you know, if you go back 50 years or 60 years, girls uh reach puberty later in life. And we don't know why menarch or puberty is actually occurring increasingly earlier in age for US American girls. The other thing you will find that girls develop is they develop faster in language skills. They will have larger vocabularies at younger ages than the boys, and this is something that, again, on average, we see young girls develop uh language skills faster than boys. Lastly, is fine motor skills. So very, very fine motor skills. Anything that involves handwriting or utensils, you'll find that the girls will develop that often faster than boys. In general, boys will experience like a growth spurt later in life, and they often catch up in both physical strength and size uh during adolescence. Most of these differences are related to uh hormonal variations. And while girls seem to meet mature faster, both genders really sort of reach full adulthood at the same time, right around the mid-20s. So great question. Thanks for asking, Khalil. All right, got another question here. Dr. V, can you discuss the trauma that happens to a child's head at birth? When I saw them pull the baby out during a delivery, I seriously thought they were going to break my baby's neck. And if that wasn't enough, he came out with like this cone head from the suction or forceps or something. It's all better now, but um is this all really necessary? I mean, is there a is there a way to to deliver a child with less trauma to the head? So great question. I I've I've seen these deliveries as well. And uh, you know, so so what you're talking about is what we refer to in medicine as birth trauma. And what happens is there's a molding of the child's head as a mother goes through labor. And labor sometimes can at last for several hours. And during that time period, the the head molds to really fit through the birth canal. And that's what actually, that molding actually is what leads to what we call a cone head, basically. Um and it is a temporary condition, it usually resolves in a few days to a couple weeks. You can get significant birth injuries related to birth trauma. And usually it kind of occurs when the child is very big and maybe the birth canal on the mother is very small. We this is more likely to happen if the mother is diabetic. But you can get things like brachial plexus injury, which is damage to the nerves of the neck and shoulder, um, when they're actually uh pulling the baby out for delivery. You can also get intracranial hemorrhage, which is bleeding inside the brain. This particularly occurs in premature infants. It can occur related to the actual trauma of coming through the birth canal, but you can also see intracranial hemorrhages with premature uh children that have to be put on a ventilator. So having to be a ventilator being put on a ventilator and being oxygenated through a ventilator also increases the risk for intranial hemorrhages. So it is it is it is very traumatic. Uh, I think that one thing to know is that most of the time the the head reshapes itself over time. Usually the children are healthy and okay, but there are times when you can get a significant injury as a relate as it relates to uh the whole birthing process. Um, and that does happen sometimes. Great question. All right, we have a question from a retired educator, Melissa. She says, I'm a retired teacher, and with everything that's going on and the threat to eliminate the Department of Education, I'm concerned about free lunches taken away from our from our children, particularly our children that come from poor or vulnerable households. How exactly does nutrition impact the developing brain? Oh my gosh, this is such a great question. So, nutrition is critical to the developing brain. So the brain is one of the areas of the body that can least withstand the withholding of nutrition or oxygen or blood supply, particularly in uh the early years. So a well-balanced diet is really, really important to get those neural connections that you need, the learning, the memory, the cognitive functions. Um, also, it's really, really important that uh children get key nutrients like iron, zinc, omega-3 fatty acids that really help with uh developmental maturation. So, inadequate nutrition can lead to a lot of problems later on with cognition, behavioral issues. So, access to free meals is really, really important for low-income families that may not be able to actually afford lunches for their children, or in some situations, children get a free lunch and they actually don't get dinner at home because of the family may be dealing with financial issues. So these programs are really, really important. Next question. Uh, Dr. V, I have a two-part question. What are the most important influences on brain development before birth? And what are the most important the most important influences to brain development after birth? So, you know, before a child is born, you know, really the most important thing are uh genetics, nutrition, I would say the mother's nutrition, and also the maternal health and her exposure to either alcohol or drugs or environmental toxins. And I would say the last thing that would be really important is um how stressed the mother is. Emotional stress can also impact significantly brain development in a child. You know, after a child is born, um, it's really things like the bond between the child and the parent or the parental community, also any sort of ACEs, adverse stressful events that occur in the child's life. Um, also it's sort of exposure or exp, you know, we saw a lot during COVID where kids maybe didn't at interact with other kids um as frequently because they weren't going to school. So those sort of social interactions make a very big difference in the development of a child's language skills and also in their um in their social abilities. So these are kind of the things that I think are sort of most important after birth. Thank you. Dr. V, I suffer from chronic depression. And is there a way I can tell if my child is going to develop mental health issues? Or is there a way that I can prevent my child from developing mental health issues? This is a complicated answer, but I'm gonna give it the best I can. So there is a familial or genetic predisposition to some mental illnesses if you have mental illness in your family. But that is not all the time, and it is not a direct correlation. So because you maybe have somebody in your family that is depressed or has bipolar disorder, it doesn't mean automatically that you will have depression or bipolar disorder or schizophrenia. It does mean that you are at an increased risk. So if you are at an increased risk, how would you know? So usually mental disorders and behavioral disorders do not actually uh show themselves until right around 15 to 25 years old. So there are some situations where we see mental disorders before the age of 15, but in general, the most likely time period that you're gonna see it and notice it is between the ages of about 15 to 25, 26 years old. So here's what's important if you have an elevated risk of mental health disorders in your family. Say it is really, really, really important to follow what I said about screen time in a young child. It's important anyhow, but it would be even more important risk if you have an increased risk of mental health disorders in your family. So all of those recommendations from the American Academy of Pediatrics around screen time. No screen time if you're less than 18 months old, other than video chatting with family, and limiting the screen time. And again, that's TV, iPad, laptop, and limiting it for the particular age group is really important. The other thing that's really important in preventing mental mental health disorders is actually making sure that your child really gets good sleep. So I would almost eliminate any type of screen time before going to bed. This is really, really important. Sleep is very, very important for the maturation and the development of the brain. So these are the sorts of things you can do to actually make a difference. I would also say if you are all if you do also have a risk of mental health disorders in your family, talk to your pediatrician so that they can actually screen for that in your child and see whether or not there are any early signs. It's really important that in the case of mental health or behavior disorders, that these things are caught early and actually the support services and treatment is brought into the child's life as quickly as possible. Thanks for the question. Alright, we've got a question from Bridget. My son is 25 years old and he still acts very immature. He's playing video games all the time, smoking weed all night after work. My daughter, who is 18, swears that she's as grown as me. Is smoking weed hurting my son's brain health? He's too old for me to control him. I love my son, but I need him to grow up and get out of my house. So there's a couple things going on here. So one is that the video games specifically can really slow down maturation. And I know your son right now is at an age where you have less control over him because he's 25 years old. But this is why I say to parents, this is really, really important to nip in the bud very, very early when the child is four, five, six years old. If you see them having uh a predilection or an addiction to screen time or demanding or having a tantrum when they want to actually be on the screen. The smoking weed piece of it, so chronic use of weed can actually make a difference in your uh cognitive and memory abilities, but it can also make a difference in a child's ambition or motivation. So when you say, you know, he comes home and he sleeps in my basement and he won't get out of the house. So so a couple of things are important, particularly since you're dealing with an older child. So you're dealing with a child now that's 25 years old. He's very close to his brain being fully developed, um, if it is not already fully developed. So you really want to actually, you need to actually begin to set some boundaries because sometimes children have to learn by experience, right? And so one way of actually doing it is actually saying, set a deadline. You can live in the house for another six months, and after that, you have to get your own apartment. And this is the this is your move out date, right? And you can you now have to do the things that you need to do because you're an adult, whether or not you have to work overtime, whether or not you have to get a better job, and allow him, he has to make these decisions on his own. But I think it's really important that we don't enable uh our young people and that we actually uh encourage them to actually get out on their own, get their own apartment, get their own car, etc. Um, and I know it's not easy, and it is and it is it is not easy for for a lot of families. And you want to provide your child with some foundation. But if you've allowed them to live in your home for one year or two years, that certainly is enough time for them to actually save money so they can get out on their own and possibly have have a roommate to make it more affordable and make some of these decisions in life. It's really, really important. So I would say, you know, if you have a son that's 25 years old living in a basement, you know, really set some really clear boundaries so that that way there is a plan for him to move out and get on his own and become independent. Dr. V, what vitamins are good for brain development? Great question. All right. So uh one of the main things that's really good for brain development is omega-3 fatty acids. Um, and you find omega-3 fatty acids in fish, flaxseed, walnuts. These are very, very good for cognitive function. The other thing is vitamin D. Vitamin D is, as I said, important for mood regulation. Um, and you can also get vitamin D by being outside in the sun for at least 30 minutes, three or four times a week. Vitamin B12 is also important for nerve health and brain function, and folic acid, as we talked about earlier, uh, in the prenatal setting, in a pregnancy setting. Um the other thing that's important is iron. A lot of people have iron deficiency anemia. And what's important, I actually have iron deficiency anemia, and I have to take iron supplements all the time. And what happens is your brain is really, really uh sensitive to decreased uh concentrations of oxygen or decreased concentrations of nutrients. It needs to be fed constantly. So if you have iron deficiency anemia, you want to make sure to take those iron supplements and get your hemoglobin levels up so that that way you get good, good oxygen transportation to your brain and your brain gets all the nutrients it needs. All right, guys, that's a wrap for today. I've had a great time chatting with you about neurologic development of children. Thank you for tuning in. If you've got a question or a topic that you would like for us to cover, please don't hesitate to reach out. You can email me or send me an audio message at infoaskdrv.us. That's info atask drv.us. You can also catch me on social media. You can follow me on Twitter or Instagram at askdr underscore v. That's askdr underscore v. We will be back next week with more insights and information. Until then, stay informed, stay empowered, and remember your health matters.