“Cured” of Autism – What Does It Mean?

By Margaret Ninno, M.S. Margaret L. Williams Developmental Evaluation Center

One in 68 children in the United States have been identified as having an Autism Spectrum Disorder (ASD) according to the Center for Disease Control. ASD is usually considered a lifelong condition. However, a recent study, When an Early Diagnosis of Autism Spectrum Disorder Resolves, What Remains?, looked at 569 children who had been diagnosed with ASD at around 2.6 years old. They did a follow-up study 4 years later and found that 38, or 7%, the previously diagnosed children no longer met criteria for ASD when re-evaluated. All of these children were enrolled in an intervention program in the Bronx, and they came from diverse racial, ethnic and socioeconomic backgrounds. Does this mean they were free of any developmental problems? Not necessarily.

After reviewing the data, researchers found that 92% of these 38 “cured” children continued to experience different degrees of residual impairment and behavior issues. More than half of them had some type of language or learning disability. Almost half of them appeared to have attention-deficit hyperactivity disorder (ADHD). Most of the children who lost the Autism diagnosis continued to need some type of educational support in school.

It is important for children with ASD to receive the supports and services they need as early and as intensively as possible in order for them to be the most successful at home, at school and in the community. Intense early intervention is the only consistently validated strategy to improve a child’s developmental outcome. Providing these services and supports can make a world of difference for these children. The children can develop skills and abilities that overcome many of the classic symptoms of autism, but, most continue to have some learning and behavioral challenges as this research indicates.

Margaret L. Williams Developmental Evaluation Center at http://developmentalevaluationcenter.com/

Two articles discussing the study:

http://aapnews.aappublications.org/content/early/2015/04/26/aapnews.20150426-2

http://www.medicalnewstoday.com/articles/293079.php

To view the study abstract, “When an Early Diagnosis of Autism Spectrum Disorder Resolves, What Remains?” go to http://www.abstracts2view.com/pas/view.php?nu=PAS15L1_2750.2.

 

Center for Disease Control at http://www.cdc.gov/ncbddd/autism/data.html

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Viral Croup 101

by Jennifer A. Nead, MD Pediatric Hospitalist and Assistant Professor of Pediatrics

Croup is a common childhood illness and can sound very scary.  Children with more severe croup sometimes need to be treated in the emergency department and admitted to the hospital.  Here is some information on viral croup and what to expect if your child is evaluated at our hospital.

Viral croup commonly occurs in children 6 months-3 years (peak around 2 years) during the fall to early winter months.  At the beginning of the illness, children may have non-specific common cold symptoms such as runny nose, congestion, cough, sore throat and fever.  Eventually, irritation and swelling develop in the upper airway.  As a result, classic croup symptoms develop, including hoarse voice, dog or seal-like cough and stridor (high-pitched, noisy breathing heard during inspiration).  Some children will have high fevers.

Since viruses cause viral croup, antibiotics are not prescribed.   The best medicine is time and eventually, symptoms go away.   Children with more severe croup develop respiratory distress and struggle to breathe. Often, these children receive a breathing treatment called racemic epinephrine and a dose of steroids.  Both of these medications decrease upper airway swelling, making it easier to breathe.  Racemic epinephrine reduces swelling within minutes, but only lasts about 2 hours.  Steroids last much longer, but take up to 1-2 hours to effectively decrease airway swelling.   This is why children with more severe croup get both treatments.  The most commonly used steroid is dexamethasone because it is cheap and lasts in the body for up to 2.5 days.  Doctors prefer to give oral (by mouth) steroids.   Sometimes, doctors give steroids through an IV or IM route (which is a shot) because children are vomiting or are in too much respiratory distress and it’s unsafe to give them oral medication.  Usually, children who receive two or more doses of racemic epinephrine will be admitted to the hospital for observation.  In these cases, the doctors want to make sure their breathing remains comfortable.  Occasionally, these children require repeat racemic epinephrine treatments. At this time, research studies have not found humidified air, including steam or cool air, to be helpful in treating patients with croup.  This is why hospitalized children don’t get these treatments and why you will not see croup tents.   Since a dose of dexamethasone lasts for several days, a repeat steroid dose is not typically required.

We know that viruses cause croup, but doctors don’t routinely test children because the virus test is expensive and the result usually doesn’t change treatment.   If your child is tested, parainfluenza virus is the most common virus that causes croup.  However, it is important to realize that numerous other viruses also cause croup.   In order for children admitted with croup to go home, doctors want to see children breathing comfortably and drinking fluids well.  At the time of discharge, some children will have mild stridor, especially with activity.  As long as these children are breathing comfortably, they are safe to go home.  After discharge, children should see their primary care physician in 1-2 days for a follow-up appointment.  At home, parents should make sure their children get plenty of rest and fluids.   Children should start to get better in 2-3 days and as in the case of any virus, it may take 1-2 weeks for symptoms to completely resolve.

For more information see: https://www.healthychildren.org/English/health-issues/conditions/chest-lungs/Pages/Croup-Treatment.aspx

 

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Keep Your Children Lead Safe Outdoors

by Dr. Howard L. Weinberger, Central New York/Eastern New York Lead Poision Resource Center, Professor of Family Medicine, Emeritus Professor of Pediatrics

Many parents are surprised to learn that childhood lead poisoning remains an issue for young children.  In New York State and around the U.S., exposure to lead and the developmental and learning disabilities that may follow, continues because of the high percentage of old homes containing leaded paint. 

The spring time brings warm weather and sunshine and the chance for the kids to play outdoors. In many neighborhoods, this brings the possibility that young children will accidentally be exposed to additional lead sources.

 

How does this happen?  Lead can be in the dirt outside in many ways:

For many years, cars used leaded gasoline and the residue from that old gasoline remains in the soil, especially in driveways or other places where cars were parked. Houses near highways that have been used for more than 30 years may also have leaded gasoline in the soil.

Any home built before 1979 may have lead in the house paint.  As the paint begins to chip and flake off the outside of the house, the particles land in the dirt.  Lead breaks down very slowly and can be found in the dirt around a house for many years. The spots most likely to have leaded dirt are an area 3 feet wide circling the house. This is called the “drip line” because rain and snow melt and drip down the sides of the house, carrying the old paint chips to the ground.  Over time, the paint breaks down into very tiny particles that are difficult to see in the dirt.

Small children often put their hands in their mouth and if they play in the dirt, it sticks to their fingers. When they put their fingers in their mouth, the lead is absorbed into their bodies.

How can you protect your child from outdoor lead poisoning?

Keep your children from playing in the dirt.  If there is grass in the yard, have them play in the grass.

 

All kids love to dig in the dirt- instead of dirt, buy them a small sand box and fill it with clean sand from the store.

If there is a neighborhood playground nearby, walk there to play and enjoy some outdoor fun!

Wash your children’s hands frequently, especially if they are little enough to have their fingers in their mouth often. You can carry wet paper towels in a plastic bag to clean their hands without needing to go into the house.

What should you do if you think your child has been exposed to lead, indoors or outdoors?

The best way to know if your child has too much lead is to have a blood test done.

Call your doctor’s office to find out how to have a blood lead test ordered.

You can also call the local Childhood Lead Poisoning Program.  You can find the phone number on line or in the telephone directory.

Keep your children lead safe for a healthy future!

 

Central/Eastern New York Lead Poisoning Resource Center

University Hospital, 750 East Adams Street, Syracuse, NY 13210
Phone: 315 464-7584

http://www.upstate.edu/gch/services/lead_poisoning/

 

 

 

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Corporal Punishment: Lessons Learned

By Ann S. Botash, MD

“This is lesson number two, this is what you should not do.” The Bike Lesson, by Stan and Jan Berenstain

When Papa Bear shows Brother Bear the rules of the road in this 1964 book from the Berenstain Bear series, he inevitably ends up with a twisted bike in a comical mess. Although the story is about a bike lesson, I have often thought that the real lesson for parents reading this book to their children is that children learn from their parents’ actions – even “what they should not do.”  I loved this book as a child and now find it makes a useful point to help understand the issues related to corporal punishment.

Corporal punishment is defined as the use of physical force with the intent to cause physical pain but not physical injury, for the purpose of correction or control of the child’s behavior. Methods include the use of an open hand, hitting with an implement and/or enforced standing, starvation, cold bathing, etc.

 

USA Today just reported that Adrian Peterson has been reinstated to the NFL (April 16, 2015). The highly publicized whipping of his 4 year old son and subsequent child abuse charges caused a national outrage as the Vikings lost sponsors when they allowed him to play. The graphic images of his son’s injuries, classic findings of excessive corporal punishment, were posted in news articles on the internet.  The public and the media were divided in their support of him and his actions. Adrian Peterson’s mother was quoted as saying, “It is about love, it’s not about abuse, it’s about love.” Corporal punishment is a risk factor for escalation to physical abuse and severe injuries, such as those observed in Peterson’s son. Research shows that corporal punishment has no benefits over spanking and that other means of discipline are more effective.

Surveys show that many Americans do spank their children. In New York State, corporal punishment is allowed in the home, but may be considered abuse, neglect or assault. It prohibited in day care, alternate care, and public schools. It is allowed in private schools, although usually requires consent.  The American Academy of Pediatrics recommends that parents not spank their children. There are more effective methods to teach children right from wrong without hitting them. We want to guide children to make appropriate decisions, be safe, and grow up to have good self-esteem. We want to do this all while also modeling good behavior.

Positive discipline is an approach to teaching that helps children to succeed, gives them information and supports their growth. It brings together what we know about children’s healthy development, research on effective parenting and children’s rights principles. It is a set of principles that can be applied in a wide range of situations. In fact it can help guide all parents’ interactions with their children, not just those that are challenging.  Methods for positive parenting are based on principles that are:

  •  Non-violent
  •  Solution focused
  •  Respectful
  • Based on child development

The first of ten principles of positive parenting, recommended by Dr. Katharine C. Kersey Ed.D, 2006, is called the “Demonstrate Respect Principle.” This principle encourages caregivers to treat children the same way that they treat other important people in their lives. Some people would refer to this as the Golden Rule –treat people the way that you would want to be treated.  If you treat children the way you would want to be treated, they will learn to do the same. This is not only the first principle, but I would consider it to be lesson number one! For more information on the other 9 principles of positive parenting, click on the Health Link-on-Air links below to hear Dr. Alicia Pekarsky.

What do children learn if we use physical discipline to correct their mistakes?  The research on corporal punishment is clear. Spanking children is linked to poor behavioral and cognitive outcomes. That is, children who are hit do not learn “love” but learn to be more aggressive and do not learn as well.   Using forms of discipline that utilize threats and corporal punishment can lead to bullying behaviors in older children. Studies have shown increased medical problems, depression, poorer parent-child relationships, increased delinquent behavior, poorer mental health and later physical abuse of a grown child’s own children or spouse.

 This is what we should not do, this is lesson number two: Don’t hit your children!

For additional information:

American Academy of Pediatrics Committee on Psychosocial Aspects of Child and Family Health Policy Statement: Guidance for Effective Discipline. Pediatrics 1998 Aug;101;723-728. http://pediatrics.aappublications.org/content/101/4/723.full.pdf+html

Bell  J. USA Today, Sports. http://www.usatoday.com/story/sports/nfl/vikings/2015/04/16/adrian-peterson-return-should-lead-to-record-season/25899397/

Botash AS. Bullies, Victims and Bystanders. http://blogs.upstate.edu/pedstoparents/2015/04/13/bullies-victims-and-bystanders/

Gershoff ET. Report on physical punishment in the United States: What research tells us about its effects on children. Phoenix Children’s Hospital, Child Abuse Prevention. 2008 http://www.phoenixchildrens.org/sites/default/files/PDFs/Report_on_physical_punishment_exec_summary.pdf

Kersey, K. The 101 Principles of Positive Discipline. http://teachtrainlove.com/the-heart-of-positive-discipline/

Pekarsky A. Parenting in a positive way. http://blogs.upstate.edu/healthlinkonair/2014/12/03/parenting-in-a-positive-way/

Pekarsky A. Part II. Parenting without mistreatment. http://blogs.upstate.edu/healthlinkonair/2015/03/19/positive-parenting-part-two-discipline-without-mistreatment/

Sege, R.  Is Spanking Your Child Ever Okay? http://radiomd.com/show/healthy-children/item/23214-disciplining-your-child-is-spanking-ever-ok .

Staying Positive While Parenting Tips http://champprogram.com/pdf/Staying-Positive-While-Parenting-pamphlet-cny.pdf

Strauss MA, Steward JH. Corporal punishment by American parents: National data on prevalence, chronicity, severity, and duration, in relation to child and family characteristics. Clinical Child and Family Psych Rev. 1999; 2(2): 55-70. http://pubpages.unh.edu/~mas2/CP36.pdf

 

 

 

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The Dangers of Cleaning with Bleach in the News

By Lee Livermore, Public Education Coordinator, Upstate New York Poison Center

Recently a news story was circulating amongst the news media stating “cleaning with bleach may lead to childhood infections”. The stories stated that “a splash of bleach can kill germs on a counter, but it may also cause health problems in children, a new study finds”.

While there is some truth to the stories, it is important to explore the facts. Chemical exposures can be toxic, even when they are household chemicals. Household bleach refers to a number of chemicals which remove color, whiten, or disinfects, often by oxidation. Chlorine is the bases of most common household bleach, which is about 93 percent water and less than 10 percent Chlorine.

According to The American Cleaning Institute (ACI) response to the study,” bleach is a relatively inexpensive and highly effective disinfectant. It not only cleans up dirt and mold, but also kills some of the most dangerous bacteria, including staphylococcus, streptococcus, E. coli and salmonella as well as viruses like the flu and the common cold”.

Back to the headlines, does cleaning with bleach lead to an increase in childhood infections? The answer, it depends. The study, entitled Domestic Use of Bleach and Infections in Children: a multicentre cross sectional study published April 2, 2015 in Occupational & Environmental Medicine Journal, suggested that, “passive exposure to cleaning bleach in the home may have adverse effects on school-aged children.” However, consistent exposure to most any chemical product may be harmful over time.

A different point to consider is, there is a theory in medicine; the hygiene hypothesis is a hypothesis that states that a lack of early childhood exposure to infectious agents might suppress the natural development of the immune system. What this theory is suggesting is some homes might be too clean and that some exposure to bacteria allows the body to learn to build up an immunity to fight off harmful bacteria.

Another point to consider is the exposure to bleach and other antibacterial products. The Upstate New York Poison Center recommends that when using cleaning products they should be out of the reach and exposure of children. An unintentional exposure happen when the product is breathed in, sprayed or splashed on the skin or in the eyes, or is ingested. Bleach might cause breathing problems if ingested or breathed in.

The Poison Center recommends to:

  • Always read the label, for ingredients and proper usage
  • Avoid over use
  • Limit exposure by diluting the product and use in an open ventilation
  • If you think some has been exposed to a toxic chemical call the Poison Center at 1-800-222-1222

Upstate Poison Control Center  http://www.upstate.edu/poison/

Link to study Domestic use of bleach and infections in Children http://oem.bmj.com/content/early/2015/02/20/oemed-2014-102701.full

Link to primary source use and defintion of hygiene hypothesis http://medical-dictionary.thefreedictionary.com/hygiene+hypothesis

Link to The American Cleaning Institute (ACI) response, http://www.cleaninginstitute.org/aci_responds_to_study_on_household_use_of_bleach

Link to local news coverage http://www.localsyr.com/story/d/story/study-cleaning-with-bleach-linked-to-child-illness/36895/X6nysRsFCUa3uG9Ktl89Nw

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