Baby 411 Blog

New Autism Screening recommendations

The American Academy of Pediatrics now recommends that ALL children be specifically and systematically screened for autism at their 18 month and 2 year old well checks. A questionnaire should be given to parents at both visits and reviewed by the doctor. While there is no one perfect screening test, the one being recommended by the AAP is called the "M CHAT". It is available in the public domain and we will post it on our website for you to download shortly.

The goal is to identify children at risk at an earlier age so that therapy can begin as soon as possible. Kids who have early intensive therapy clearly do better.

The New McCarthyism: Vaccines & Autism

Here is a reprint of guest opinion authored by Dr. Ari Brown in this weekend's Wall Street Journal:

October 27, 2007
   
Vaccines and Autism
By ARI BROWN
October 27, 2007; Page A8

Dangerous vaccines that harm kids. An epidemic of disabled children, hurt by an uncaring medical establishment.

Sounds like a B-grade Hollywood thriller. But this is supposedly a true story as told by actress Jenny McCarthy, author of the best seller, "Louder Than Words: A Mother's Journey in Healing Autism."

When I heard Ms. McCarthy tell Oprah and Larry King that vaccines caused her son's autism, I had a flashback to a cold winter's night, 13 years ago. I was the senior pediatric resident on call in the Intensive Care Unit. Cradled in the arms of her parents, a seven-year-old girl was brought to the emergency room at Children's Hospital Boston. The girl had come down with chickenpox a few days earlier -- she had a fever and hundreds of itchy skin lesions. That night, she had taken a turn for the worse. Her fever shot up to 106 and she became confused and lethargic. She was unresponsive and limp in her mother's arms.

The ER doctors suspected that her open sores allowed Strep bacteria to get under her skin and rage through her bloodstream. Now she was in "multiple system organ failure" -- every square inch of her body was shutting down all at once. IVs were placed into her veins to start fluids, antibiotics and medications to stabilize her heart and blood pressure. She was placed on a ventilator machine to breathe. Then she was brought to the Intensive Care Unit.

By the time I met my patient, she had tubes coming out of every opening and weeping skin lesions all over her body. I was used to blood and gore, but it was hard to look at her and not cry. Imagine how her parents felt when they saw their once-beautiful little girl in this grotesque state, struggling to survive.

My attending physician told me to grab dinner. This child would need me for the rest of the night. I returned to the ICU to find that my patient had gone into cardiac arrest and died. I watched, helplessly, as the nurses placed the little girl into a body bag.

Fast forward five months: The first chickenpox vaccine was approved. That day, I vowed never to let a child on my watch suffer from a disease that was preventable by vaccination.

That's a story that doesn't grab headlines or guest shots on Larry King. Vaccines are one of mankind's greatest scientific achievements. This year alone, they prevented 14 million infections, $40 billion in medical costs, and most important, 33,000 deaths. Yet vaccines are victims of their own success. Today's parents are unfamiliar with the diseases they prevent, but these diseases are alive and well in the U.S. -- I have personally seen children suffer from them.

Call it the New McCarthyism: Who cares about 100 years of scientific research? Vaccines are evil, because the Internet says they are. When a well-meaning parent like Ms. McCarthy blames vaccines for her child's autism, it's dangerous. Celebrity books come and go, but the anxiety they create lives on in pediatricians' offices across the country. A small but growing number of parents are even lying about their religious beliefs to avoid having their children vaccinated, thanks in part to the media hysteria created by this book.

Parents go through stages of grief when their child is diagnosed with a disorder like autism. We all want to blame someone for our suffering. That's understandable. Was there something we could have done as parents to prevent this? But why hasn't the media called out Ms. McCarthy on all the medical inaccuracies in her book? Has anyone actually read it? I have -- cover to cover. Here are two revealing points:

Ms. McCarthy told Oprah that her son was a normal toddler until he received his Measles, Mumps and Rubella vaccine (at 15 months of age). Soon after -- boom -- the soul is gone from his eyes. Yet she contradicts herself in her book: "My friends' babies all cracked a smile way before Evan did . . . he was almost five months old." Which is it? Was he normal until his MMR vaccine or were some of the signs missed before he got that shot?

Ms. McCarthy also contends that mercury in vaccines caused damage to her son's gut and immune system, leading to autism. Yet the mercury preservative Ms. McCarthy assails was removed from the childhood vaccination series in 2001. Her son, Evan, was born in 2002. It's hard to trust Ms. McCarthy's medical degree from the University of Google -- she comments about the Hepatitis C vaccine that wreaked havoc on a friend's child. An inconvenient truth: There is no Hepatitis C vaccine.

Doctors do need to do a better job of guiding families through the maze of autism treatments. I also desperately want to know why autism happens and how to treat it. But let's put our energy into funding autism research and treatment, not demonizing our vaccination program.

Ms. McCarthy is in the trenches, fighting for her son. I, too, am fighting. I am on the front lines everyday, trying to keep our kids healthy and protected. And, after all I have seen, one thing is certain -- I've vaccinated my own kids and would do it again in a heartbeat.

Dr. Brown, a pediatrician in Austin, Texas, is a fellow of the American Academy of Pediatrics.

Infant cough and cold med recall

The major manufacturers of infant cough and cold preparations have voluntarily recalled 14 products from the market today, saying that there is too much risk of misuse or overdose of these products. They should be applauded for being proactive on this one.

This comes shortly before the Food and Drug Administration is scheduled to release a report next week about their investigation on these over the counter preparations.

The FDA was alerted to potential for overdose by the City of Baltimore Health Commissioner, who identified four children under three years of age whose cause of death was accidental overdose of cough and cold products.

As we all know, these products say "consult a physician" instead of offering a dosing guideline. Parents may then try to guess-timate what is the correct dose. To add to the confusion, some products are used to treat multiple symptoms and thus, contain two or even three different medications. If a parent then gives another medication, like a decongestant, the child may be accidentally be getting double doses of one product.

I, like most of my pediatrician colleagues, have never recommended these cough and cold remedies anyway. They have marginal benefit in relieving symptoms of the common cold or flu and don't make the disease go away any faster. And, clearly the risk outweighs the benefit.

I still recommend using saline nose drops (you can';t overdose on those!), a humidifier, and lots of TLC from Mom and Dad.

Reader Email: How do we give up swaddling?

Reader Joshua S. writes today:

I do have a question though that was not in the book, unless I missed it.  We have been swaddling our two month old son with one of those halo swaddles - the one that you put the baby in, zip it up, then there are wings that swaddle around the baby.  The baby sleeps really well in this.  We are trying to not swaddle him, but, it's not working (at all).  People say that I will know when he does not like to be swaddled anymore when he busts out of the swaddle.  The problem is that this swaddle zips and velcroes. It is impossible to bust out of.  Do you have any suggestions as to how to transition our son out of the swaddle and to sleep without it.  Obviously, he will grow out of the swaddle at some point, but I wanted to start doing the transition now.   If I unzip it, he constantly moves and then cries.  When I put him to sleep in the swaddle, he initially moves a lot in the swaddle, kicking his legs, and moving his hands (inside the swaddle).  Any suggestions are appreciated.  Thank you.

Happy to help. This is your homework assignment, due in the
next four weeks: get rid of it. Two reasons: 1. you want him to develop
sleep associations that you want to live with for a long time--so any sleep
crutches should be out of his world by three or four months of life. 2. if
he isn't moving around at night, the back of his head will become pretty
flat. So, while it is okay to continue it for a few more weeks, the
swaddler's days are numbered. Your son will be older in a few weeks and more
capable of soothing himself with fewer immature newborn reflexes.

The take home message: I would suggest quitting, cold turkey, by 3 months of age. Most babies like to move around at that point and have fewer of those newborn startle reflexes that wake them up when they move around. Your goal is to have the sleep habits you want to keep by 4 months, so transitioning to that goal is the plan. That will also help reduce the dreaded flat spot on the back of the head (plagiocephaly) that babies get when they are constantly sleeping in one position.