What's Inside

• 3 Signs Your Child May Be Autistic

• Helpful Autism Resources

• Facts or Fiction?

• What I’m Seeing In My Office

• Talk Like A Doctor: Phenotypic

• Recalls & Alerts: Vitamins, PJs, & Helmet

• Funny Things: How’d that get up there?

3 Signs Your Child May Be Autistic

I sometimes have parents who come into the office concerned their child might be autistic. Here’s what I tell them:

First, I define what autism is…and isn’t

The American Psychiatric Association (APA) defines autism, or autism spectrum disorders (ASD), as a complex developmental condition involving persistent challenges with social communication, restricted interests, and repetitive behavior.

The American Academy of Pediatrics (AAP) recommendation is that all kids get screened at the 18-month and 24-month well child checks. Of course, your pediatrician will be looking at every visit for any other signs of developmental delay or other signs that are concerning.

There are a handful of screening tools available. In my office, we use the M-CHAT (Modified Checklist for Autism in Toddlers). I’ve included a link to the test below so you can screen your own child. The goal of screening is early identification.

Studies show that the kids who get diagnosed and started early with intervention programs have better outcomes long term. Your child may qualify for services like early intervention (which addresses specific problem areas, like speech delays).

Here are the three areas to keep an eye on

1. Social interactions

   • Trouble with non verbal interactions (e.g., make poor eye contact)

   • Struggle to make friends their own age (or even interact appropriately with peers)

   • Lack empathy

   • Not interested in sharing interests or enjoyment with others

2. Communication

   • Delayed language skills without attempts to compensate

   • Can’t carry on a conversation

   • Repetitive use of certain words or phrases

   • Have trouble with the concept of “make believe” or social type play (e.g., playing house)

3. Behavior: “Restricted, repetitive, and stereotyped” (from AAP professional resources documents)

   • Very narrow range of interests

   • Intense focus on those limited interests (e.g., may be seemingly obsessed about trains)

   • Routines are not flexible (autistic children can’t “roll with the punches”)

   • Stereotypic motor mannerisms (e.g., rocking, hand-wringing)

   • Things have to always be the same

If your child has problems in only one of these areas, chances are he or she doesn’t have autism. However, I recommend you still discuss it with your pediatrician. Here’s the rest of the scoop on autism.

Get to know the M-CHAT-R autism test

Here’s the M-CHAT-R test I mentioned above.

Thanks to the good folks at AutismSpeaks.org for hosting the test with automatic scoring. If your child screens high, make sure and talk to your pediatrician about the results. You can access it by clicking the image 👇️ below:

Quick autism facts

1. Autism is on the rise. Prevalence is 1 in 36 (according to the CDC 2020 report), which is up from 1 in 150 in 2002

2. Rate is much higher in males than females: roughly 4 times more common

How do you get autism?

The unfortunate part of autism is that despite its prevalence, there is still a lot that is not known about it. Medically, we know that there is a considerable autism heritable factor (it can be passed down). It runs in families, so we sometimes see a higher recurrence risk if someone else in the family has autism.

Lots of genes are involved in autism, and lots of different variations in the whole spectrum, which make singling out the cause of autism rather difficult. We do know that there are a few syndromes associated with autism (including Fragile X, Tuberous Sclerosis, Phenylketonuria, Angelman syndrome, Rett Syndrome, and Smith-Lemli-Opitz syndrome).

A few convincing studies over the years show that, in some cases, there seems to be an environmental factor that plays into the diagnosis…or at least the “phenotypic presentation” (meaning how a particular person’s autism symptoms may present).

In medicine, we call this a “second-hit” phenomena. The way it works is that you have a genetic predisposition to something and when the circumstances are just right (an environmental insult of sorts), it makes the predisposition actually manifest.

How is autism treated?

Unfortunately, there is no cure for autism. All treatments are based on helping modify symptoms and improve quality of life. If language is a problem, we may get a child early speech therapy. The earlier a child can communicate, the happier the child and parents are. Depending on the situation, applied behavioral analysis (ABA) therapy may also be a good option for children with autism.

Children who are autistic should have an IEP (or individualized education plan) for their schooling. However, every child is unique and every child presents differently, so each child’s needs are different. A severely autistic child may be in a cluster class with only a few other children (who have similar limitations), while a child with only mild impairment may be in a mainstream classroom and only qualify for a small amount of resource help.

Make sure your pediatrician is aware of your child’s needs. A good doctor can be your best advocate in helping you get the resources you need for your child.

Good luck!

*from the AAP professional resources documents

The post 3 Signs Your Child May Be Autistic appeared first on Pediatric Answers.

Helpful Autism Resources

We need to support parents and caregivers of kids with autism. Here are some additional resources:

Links: What Are the Early Signs of Autism and How Pediatricians Screen for Autism.

Link: Milestone Tracker mobile app

Facts or Fiction?

Sooooo many research studies have shown that immunizations/vaccines DO NOT cause autism.

Straight from the AAP (Patient Education Jan 2021 Vaccine-Autism toolkit):

Despite all kinds of peer-reviewed research on the topic, a ton of misinformation is all over the internet. For this reason, I always tell my patients that where you get your information matters. Look to reputable sources like the American Academy of Pediatrics and CDC.

What I’m Seeing In My Office

There is a miserable vomit and diarrhea bug going around right now. 

The fancy, medical term for this is gastroenteritis. Unfortunately, this bug won’t let up. I’ve seen 1-3 cases a day for last 3 months straight! And I figure that for every case I see in the office, there are probably 20+ more that were managed at home and never came to my attention.

Here’s the scoop on the bug and hopefully we can prevent you from having to be the one who comes into the office.

What are the symptoms?

Well, clearly symptoms are vomiting and diarrhea. However, adults and kids present very different. While adults get vomiting for 1-3 days followed by diarrhea, kids can have “rebound vomiting.” This means that the child may vomit in the beginning for a day or two, stop vomiting for a day or two, and then vomit again. This cycle of vomiting followed by a period of looking better then vomiting again is usually what feels “wrong” to parents and drives them to bring the child to the office. Rest assured, this is very normal, especially in younger children. The diarrhea can be seen at any time during the course of the illness.

What to do?

The key is keeping your child hydrated. Your child’s appetite will likely drop. This is ok as along as he/she is staying hydrated. Now generally speaking, the younger your child, the smaller the nutritional and hydration reserve. While a teenager can go a day or two without hardly eating or drinking, an infant may only be able to go a few hours. Watch the urine output. If there isn’t enough fluid going in to generate urine every 8 or so hours, then you’ve got problems. If the child keeps vomiting and is struggling to keep anything down, try little, tiny sips of fluid (think 1-2 swallows) every few mins. This will prevent the stomach from getting stretched and initiating that vomit reflex. Ideally, use a balanced electrolyte solution like Pedialyte. However, if your child won’t drink it (the flavored varieties are slightly better tasting), water will do just fine.

When to seek medical help?

Sometimes despite doing everything right, it isn’t enough. Seek help if your child shows signs of dehydration:

1. Not peeing (less than 3 times/24 hours)

2. Dry mouth

3. Prolonged capillary refill (when you press on the nails it takes more than 2 seconds to go from pink to white and back to pink again).

4. Your child seems mentally out of it or lethargic

And what about the diarrhea?

Sometimes the diarrhea is the worst part and lasts significantly longer. As a general rule, go to the doctor if the diarrhea lasts more than 10 days as it may not be a straightforward virus causing the diarrhea.

Talk Like A Doctor: Phenotypic

Sometimes we use big, fancy words because we like to look smart. 😜 

Click the image below 👇️ to hear how it’s pronounced.

Recalls & Alerts: Vitamins, PJs, & Helmet

Tell your friends and family. I don’t want to see any kiddos get injured:

Funny Things: How’d that get up there?

The funny story this week came from a delightful 5 year-old during her routine well-child check. While examining her, I discovered a bright green foreign object lodged high up in her nose.

Dr. Wonnacott: “What’s that up your nose?”

5 year-old: Gives a quizzical look as if to say “Nose? What nose?”

After failed attempts to blow out the object, I finally reached in with a forceps and pulled it out. It was a large, green, craft pom-pom. I held the object in the forceps up right in front of her, so she could see.

Dad: “Why did you put that up your nose?”

5 year-old: “I didn’t do it.”

Dad: “Oh, really?”

5 year-old: (Firmly now) “NO, I didn’t do it.”

So if anyone happens to have any leads on who could have possibly stuck a craft pom-pom up this child’s nose, please let us know. It would be greatly appreciated.