Is your child already struggling to pay attention in school? Don't jump to Ritalin for the answer. Check out his eyes, ears and teeth for possible trouble spots.

One Davidson, N.C., mother of a first-grader says she has been pleased that several months of eye exercises with a vision therapist have helped her son focus better in school this year.

"Parenting is very educational," the mother said, as there's always something new to learn to care for your child. "Who even knew there was such a thing as vision therapy?"

Young kids generally don't complain about their eyes, but parents need to be aware of symptoms that may indicate a vision problem. The American Optometric Association says that even though a child may have 20/20 vision, these habits can signal less obvious vision problems:

Loses his or her place while reading.

Avoids close work.

Holds reading material closer than normal.

Tends to rub his eyes.

Has headaches.

Turns or tilts head to use one eye only.

Makes frequent reversals when reading or writing.

Uses his finger to maintain place when reading.

Omits or confuses small words when reading.

Consistently performs below potential.

Has difficulty with hand-eye-body coordination when throwing a ball or riding a bike.

Avoids detailed work such as coloring or puzzles.

The eye association recommends that children receive comprehensive eye exams -- beyond a brief screening -- beginning at 6 months, 3 years and again when a child enters school.

A simple vision screening in school could miss what some parents have realized: Their underachieving children cannot keep written text in focus. Their eyes tire easily, so they look up often from what they're reading. They appear bored and distracted, when actually their eyes are not working together.

Similarly, some kids may pass an initial hearing screening but still be at risk for hearing loss that fluctuates, gets worse or is acquired later in development, according to the American Speech-Language-Hearing Association.

The goal of screening for hearing loss in preschoolers age 3 to 5 is to identify children most likely to have hearing loss that may interfere with how they speak, understand language and perform later in school.

Attentive preschool teachers have a special vantage point: To flag vision and speech difficulties if a child is behind his peers in development.

Prevent dental problems

Toothaches also can also keep kids from paying attention in school or have difficulty learning.

Progressive dental decay is one of the most common childhood diseases, and mouth pain and tooth complaints are a common reason kids miss school, according to the University of Southern California School of Dentistry Pediatric Dental Clinic.

"When you're in pain, you can't concentrate and you can't learn," said Gardner Beale of USC.

Keeping an eye on your child's oral health and instilling good habits is one more important job on a long list for parents. A new toothbrush and dental floss belong on the back-to-school shopping list, but what your child eats is just as important in preventing cavities as oral hygiene.

Snacks such as chips, cookies and dried fruit have cavity-inducing sugars that can stick on teeth for long periods, Beale warns. Fresh fruits, veggies and string cheese make the healthiest snacks, she says.

Beale reminds parents that sodas, with both their sugar and acid content harmful to teeth, should be consumed sparingly.

If you have tips or a question, please e-mail us at p2ptips@att.net. Betsy Flagler, a journalist based in Davidson, N.C., teaches preschool and is the mother of a teenage son. If you have tips or questions, please e-mail us at p2ptips@att.net or call Parent to Parent at (704) 236-9510.