Resources
Q & A
What is your opinion of Craniosacral Therapy for children who have disabilities?
Dr. Mary Keen
That is a really interesting question and one that I have limited knowledge and experience with in my work with children. That being said, practitioners that use this form of therapy (Craniosacral Therapy or CST) generally have a variety of backgrounds which may include naprapathy, chiropractic, physical therapy and even occupational therapy. This form of therapy is generally considered alternative or complementary rather than mainstream health care. The therapy involves stretching of the neck and head with specific tilts and angles. The trained practitioner supposedly can feel pulsations of the cerebral spinal fluid/CSF which can be used to guide the treatment. That aspect of the treatment is especially controversial as the skull is solidly fused by around 12-18 months of age and CSF pulsations would be very subtle.
In principle it makes sense to me that craniosacral therapy could be helpful in conditions such as a whiplash injury, traumatic brain injury, especially brainstem injuries, in which there could be scarring or adhesions after trauma which interfere with normal smooth movements of nerve sheaths and/or the meninges which could be injured.
Utmost caution would be necessary in children, especially those individuals with Down syndrome who can be susceptible to injury with neck manipulation.
Do hot dogs and candies really pose a choking risk for young children?
Lisa Thornton, MD
I often see toddlers eating popcorn, taking a bite of a hot dog or sucking on a gel candy and I'm sure their parents aren't aware of the danger those foods can present. Such foods can quickly lodge in a toddler's windpipe and prevent oxygen from going to the brain, causing death or permanent brain damage quickly. In fact, choking is one of the leading causes of death among children 3 and under and the risk remains significant up to age 5.
Toddlers are at highest risk for choking for several reasons: they naturally put things in their mouths; they have good front teeth to take a bite, but poorly developed molars to chew with; they have a very small airway compared to adults, so small items get stuck more easily; and they have a weaker cough to dislodge items that do get stuck.
Latex balloons account for the largest numbers of deaths because pieces of a balloon can form an airtight seal in the windpipe. Other common choking hazards are foods (like grapes, hot dogs, sausage, nuts, popcorn, raw carrots, apples, hard or gel candy or gum), coins, toys (like marbles, beads and balls), and other small items (like safety pins, pen or marker caps and button-type batteries). Walking, running, talking or laughing while eating can increase choking risk, and games like throwing food in the air and catching it in the mouth can also be hazardous.
By law, small balls, balloons, marbles and certain toys and games must be marked as a choking risk, but toys re-sold at yard sales and second-hand stores are usually unmarked since they are not in their original containers. Many children choke on toys that belong to an older sibling who leaves them within reach or small items that have fallen on the floor.
Parents have to remain alert for possible risks and should know CPR and choking intervention.
Reprinted with permission of Dr. Lisa Thornton. This article appeared in the January 2011 edition of Chicago Parent.
My 18-month-old daughter seems to carry a cold all winter. She doesn't wheeze, have a fever, or get ear infections. She is otherwise healthy. How many colds are normal and should I be worried?
Dr. Jerold Stirling
The average toddler may develop up to 8 colds or upper respiratory tract infections in a year. Some children, particularly those in daycare, may contract as many as 12 colds in a year. These infections may last as little as 2-3 days or up to 14 days. Fortunately, most of these viral illnesses resolve all by themselves without the need for antibiotics. As colds tend to be more common in the winter, it may seem that your child is sick all season long. When a cold lasts longer than 2 weeks without any improvement of symptoms it is possible that the cold has developed into a bacterial sinus infection. If this is the case you should have your pediatrician evaluate your child.
Many parents worry that with so many infections in a relatively short period of time that their child may have a problem with their immune system. As pediatricians we become concerned about this possibility only when a child develops two or more serious bacterial infections such as pneumonia, skin abscesses, or bone infections to name a few or is not growing well. Fortunately, problems with the immune system or immunodeficiencies, are relatively uncommon.
My 2-year-old son loves juice and I let him drink what he wants because I thought it was better than pop. He seems to have really runny stools and someone told me he might have toddler's diarrhea. He is growing well and healthy at his recent checkup. What is toddler's diarrhea and do you think that the juice is responsible?
Dr. Jerold Stirling
Toddler's diarrhea is a very common cause of diarrhea in young children between the ages of one and three. I agree that juice is a healthier choice than soda and does provide vitamins. However, most juices are comprised of high levels of the sugars fructose and sorbitol. Either of these sugars in excess can result in diarrhea in toddler Most pediatricians recommend that children should not consume more than 6-8 ounces of juice per day. The good news is that the treatment of toddler's diarrhea is very simple. Limit the amount of juice that your child consumes and increase the amount of fat in the child's diet just a little. The diarrhea will usually resolve within a few days.
Healing Touch: The Power of Infant and Child Massage
Lisa Thornton, MD
Sometimes the simplest things we do for our children are also the healthiest. Cuddling, stroking, and kissing your children may seem like a simple pleasure, but touch is essential to normal health and development and through touch the first seeds of love, security, and bonding between parent and child are born. Touch is as important to infants and children as eating and sleeping. Babies need touch to survive and thrive and those who don’t get it are often left with significant, lifelong emotional and psychological problems.
Almost every Pediatrician has seen a baby with a cold, distant, unattached mother whose baby isn’t gaining weight. Under the loving care of the hospital nurses the baby miraculously gains weight only to go home and again fail to thrive in the care of the neglectful mother. These babies don’t gain weight even though their mothers feed them. The mother provides food, but not love and the child’s poor weight gain is due to psychological deprivation not nutritional deprivation. Touch is fundamental to healthy development and may well be fundamental to life itself.
Today, the growing area of child and infant massage is helping parents harness the healing power of touch. Massage has many benefits that have been proven scientifically. In preterm infants massage can increase weight gain, decrease anxiety, and improve the baby’s clinical and developmental course. It can help soothe colicky babies and can improve mother-child interaction especially in mothers with post partum depression by reducing stress hormones and increasing mood elevating hormones. Massage relieves muscle tension and stress, increases circulation, aids digestion, and has positive effects on the respiratory system. It can boost the immune system, and reduce pain. There is even evidence that it helps to decrease aggression in adolescents with conduct disorder.
Maria Reyes is a pediatric occupational therapist at Schwab Rehabilitation Hospital, a certified Infant massage instructor (CIMI), and a licensed massage therapist. Maria often incorporates massage therapy into her treatment plan. She says that it relaxes the parents as well as the baby and it’s a great way for families to develop a nurturing routine.
Babies who are sick are often touched a lot, but the touch has a specific purpose (feeding, bathing, dressing, doing therapy). Massage provides an opportunity for parents to spend time with their sick child doing something that is enjoyable and has important therapeutic and psychological benefits. Maria says, “This kind of touch is just for touch.”
She encourages parents to read their baby’s signals and to change pace, and pressure based on the child’s tolerance. She emphasized that massage therapy isn’t just for sick children. Healthy children can benefit too.
The skin is the largest organ in the body and every inch of it has nerve endings that detect touch. Through massage therapy parents can nurture their children while also providing important health benefits. Touch is healing, calming, and restorative.
Reprinted from the October 2010 issue of Chicago Parent
Addendum to Dr. Thornton’s article: Aspire Children’s Services staff offer Classes in Infant Massage for parents/caregivers of babies who are not yet crawling as well as to expectant parents. Contact Evon Mucek-Kucharczyk at 708.236.0979 x105 or by email at emucek@aspireofillinois.org for more information.
Babies that are born premature are at risk of developing RSV. What exactly is RSV, and how can I minimize the risk for my child?
Dr. Christine H. Sajou
RSV (Respiratory Syncytial Virus) is a virus that causes respiratory infections in children. In the temperate areas like Illinois the virus is usually active between November and April. It comes back every year. We can have mild or severe RSV seasons. It varies every year.
All children are infected with the virus at least one time before they turn two. A child can have more than one infection per year. Most healthy children only have mild cold symptoms.
RVS is dangerous for very young babies and for the premature ones because they have underdeveloped airways and lungs. Also when babies are born early they do not get enough antibodies from their mother. Babies who go home on oxygen or have heart disease get very sick with RSV infection.
The best way to avoid RSV is with good hand washing before touching a baby. Also limiting the exposure of the premature babies to other young children during the winter months can help. This can be very difficult if there are other young children in the family or if the baby has to attend daycare.
There is an injection called Synagis that is approved for prevention of RSV in the very high risk babies. It is not a true vaccine because it has to be given every month during the RSV season. The American Academy of Pediatrics (AAP) has strict rules about who should receive the monthly injections. Each injection is very costly and has to be approved by the baby’s insurance company before it could be given. In general these injections are needed during the baby’s first winter. A few children will need them during their second one. Synagis does not always prevent RSV infection but the babies who get RSV are not as sick.
Finally many premature babies who have RSV during their first winter have wheezing for several months after.
I have been told that my baby has flat feet, but that I should not be concerned at this point. Is this common, and will his foot develop an arch?
Dr. Mary Keen
Flat feet are very common in little children; as matter of fact, it would probably be abnormal for a very young child to have an arch when standing until they are able to stand well, perhaps at 6 to 9 months of age.
At least until two and a half years of age most flat feet are “normal” and nothing to worry about.
However, if a child walks with feet so flat that the ankle bones are hard to see or are too close to the floor or if the big toe is pushed outward or inward rather than straight ahead there may be a concern.
Take Home Point:
Most often flat feet in little children are “physiologic” or normal for age, especially if there are no other developmental concerns.
Talk to your child’s pediatrician if you are concerned about your little one’s feet.
I have noticed that my son walks on his toes. What can that mean?
Dr. Mary Keen
Toe walking is a very common developmental difference in children. It can be a normal variant. One large study showed more than 50% of cases were idiopathic meaning no reasons were found. Interestingly, many of those had a family history of toe walkingin a parent.
One study found that children who are born preterm are more likely to walk on their toes; a pediatric physical therapist actually followed a group of children from the NICU and measured the angle of the ankles of these kids and found that were tighter than those of term infants from very early in age.
However, toe walking has also been associated in a few smaller studies with language disorders and in my clinical experience it has been associated with autism spectrum disorders on several occasions.
Other causes of toe walking include cerebral palsy and muscular dystrophy.
Therefore any child with toe-walking should be carefully assessed by his/her pediatrician and a neurological or developmental assessment should be considered.
There seems to be some controversy regarding immunizations for children. How safe are they, and what is the current recommended schedule for young children?
Dr. Christine H. Sajous
- All infants should receive their immunizations according to their age regardless of prematurity or birth weight. There are very few contraindications to the usual vaccines.
- Premature infants weighing less than 2 kg can receive their first Hepatitis B vaccine at 1 month of age or before discharge from the hospital. Live vaccines such as Rotavirus will not be given to the babies while they are still in the NICU because of the risk to the other very premature infants.
- There are currently many combinations of vaccines (1 shot for 4 to 5 diseases). Usually it is the pediatrician’s decision about which combination his/her office will use.
- Many controversies still exist about the risks of immunization. The main concern for parents is autism. Vaccines are safe and severe side effects are rare. There is no evidence that vaccines cause autism. The preservative Thimerosal has been removed from all vaccines produced for children.
- All infants 6 months or older should receive the annual flu shot. They need 2 shots the first year that they are immunized.
- Finally very small premature infants may be eligible to receive Synagis during their first winter to protect them from RSV, the most common cold virus during the first 2 years of life.
- Synagis is not a true vaccine. Some babies may receive up to 5 monthly injections from November to March.
- Since the rules change almost every year, each parent can find out from their pediatrician if their baby is a candidate.
- Immunizations are very important specially for premature infants since by being born early they have less protection against childhood diseases (they do not have time to receive their mother’s antibodies).
Click here to see the latest immunization schedule from the CDC.
How Do Children Grow?
Lisa Thornton MD
from November 2009 Chicago Parent
For children, getting weighed and measured is a routine part of a visit to the doctor. It’s painless so most children don’t even pay attention except for the occasional child who wants to know “how tall am I?” Parents may notice that the nurse enters the information onto a growth chart where a little dot indicates where the child’s height, weight, and for babies, head circumference falls in relation to other children. Usually a single measurement isn’t enough to tell us much except how one child compares to others of the same age, but after a few visits a pattern develops that can tell us a lot. Since most children develop pretty much like other children the Pediatrician may not spend any time going over the growth chart with the parents. In general the growth chart is summed up in a phrase like “your child is doing fine.” End of visit.
But recently I saw an article on CNN.com that reported that there’s some confusion among parents about growth charts and how to interpret them. They can be a warning sign for illnesses and other health conditions like obesity so I hope this article sheds some light for baffled parents.
Pediatric growth charts have been around for many decades and were updated by the Centers for Disease Control (CDC) in 2000. They represent typical growth patterns for the wide diversity of children in the US. There are graphs for babies from birth to 36 months that include head circumference (the size of your baby’s head) in addition to height and weight. There are other graphs for children age 2 to 20 that only include height and weight since a baby’s head circumference doesn’t change much after age 3. There are also graphs to plot BMI (body mass index) an indication of whether a child is obese or underweight, and graphs that compare the various measurements to each other.
The growth chart looks like a series of lines that move up the page in a curve. Each line within the curve represents a percentile ranking (not percentage). Percentile tells us how children compare to each other. If your son’s weight is in the 10th percentile then he weighs more than 10% of other boys his age (but less than 90% of other boys). On the other hand, if your son’s weight falls at the 95th percentile then he weighs more than 95% of other boys his age. The highest you can go in percentiles is “above the 99th”. The 100th percentile is infinity.
It’s not only important to know about a child’s growth today, but also in the past. The charts can tell us whether a child is growing at the right pace. Usually a child grows along a percentile line so a child whose height is at the 25th percentile at age 4 is usually still at or near the 25th percentile at age 6. Sometimes a doctor will become concerned when children start “crossing percentiles”; going up from the 25th percentile to the 50th percentile in a short period, or going down in percentiles without explanation. By looking at the growth chart we can detect stunted growth, sudden weight loss, extreme weight gain, and many other concerning signs that may need more attention.
In babies we check the head circumference because head growth is an indication of brain growth. As long as a baby’s head is growing steadily along a percentile curve we tend not to worry about the brain. The head does not grow well in babies with severe brain damage and so the growth chart in those babies will often reflect a head size that falls below the bottom of the curve. Some babies naturally have unusually biggish or smallish heads (and generally so does one of the parents), but just like height and weight the head tends to grow along a percentile line. A baby’s head that goes from the 25th percentile to the 50th percentile to the 75th percentile in a few visits is a red flag to the Pediatrician who may investigate to find out why the head is growing so rapidly. Similarly, if head growth seems to be abnormally slow some testing may be needed.
Obesity in children is becoming more and more common so the BMI growth chart is something parents may want to see since it can tell when a child is overweight or obese. Many readers know that in adults a BMI of greater than 25 indicates a person who is overweight, but in children the normal BMI dips around age 4 when a BMI of 19 is the upper limit of normal and 20 is considered too high. After that a “normal” BMI changes every year so that even the Pediatrician may have to check the chart to know how your child is doing.
Growth charts can seem complicated at first, and it takes time to get used to using them, but with a little practice every parent can understand them.
For more information visit www.cdc.gov and search for “growth charts”.
What are some signs that I should look for to know if my child has a developmental delay?
Dr. Alan I. Rosenblatt
The wonder of normal child development unfolds in a predictable, orderly sequence at expected ages along the road to adulthood. In language, cooing comes before babbling, which comes before gestures and single words. Similarly, in motor development, rolling over comes before sitting, which comes before crawling, then pulling to stand and eventually walking. Other areas of development include cognitive, social-emotional and self-help skills. If your child is slow or different in any particular developmental domain compared to other children the same age, there could be a problem.
In general, the more severe the delay or the difference, the greater is the likelihood of a significant issue. For more specific information, I recommend the website of the Centers for Disease Control (CDC) for their program “Learn the Signs. Act Early.” You can go to the Milestones section and click on the age of your child to see the expected milestones. There is also a section at the bottom of the milestone page called “Developmental Health Watch” for specific behavioral and developmental concerns.
If you have a concern, the best outcomes are achieved by acting early and getting appropriate professional intervention.
The first stop to express your developmental concerns should be at your pediatrician’s office. After eliciting a careful history and doing a preliminary evaluation, the pediatrician may decide to refer immediately to a specialist for a more detailed evaluation or to an early intervention program. Alternatively, if it is not obvious that the problem is significant, the pediatrician may decide to monitor the developmental concern over a period of time. In other instances, there may be ample evidence to reassure parents that the concern is not problematic.
If you should feel that the initial response of the pediatrician is not reassuring enough, or that even though you trust the pediatrician, you will not rest easily until a more thorough developmental evaluation is performed, then it might be prudent to see a developmental specialist for confirmation of the pediatrician’s advice. Check the CDC’s “If You’re Concerned” page.
Studies have shown that parental perceptions of their child’s development are highly accurate and constitute one of the best tools in screening for developmental challenges in infants, children and adolescents. If your child exhibits any of the warning signs, do not hesitate to pursue an appropriate evaluation. The sooner a developmental challenge is identified, the earlier it may be treated, and this could determine the adult your child ultimately becomes.
My child was born six weeks early. I have heard the term “catch up” development. What does that mean?
Dr. Christine Hudicourt Sajous
The term “catch up development” is not very correct. When a baby is born early (before 37 weeks), we should always consider him or her as a younger baby when we check his or her development during the first 2 years at least. For example a baby born 2 months early should behave like a 6-month-old at 8 months or like a 10-month-old at a year. But as the baby gets older, the few months of prematurity are not as important because after the first 2 years the monthly changes are not as big. Two children, 32 and 34 months old, may be doing exactly the same things and their development will be normal for their respective age. In other words, as the children get older, the weeks or months of prematurity should not affect their development as much.
What is sensory integration disorder and how it is treated?
Dr. Alan I. Rosenblatt
Sensory integration is the organization and interpretation of sensory information by the brain, which helps to shape our interactions with our surroundings. When this process is abnormal, it can lead to inappropriate behavior and difficulties functioning in normal daily activities. Sensory integration is what causes a child to be upset if the seams on her socks are not aligned just right or if the wrong type of music is playing in the background. Sensory integration can make ordinary experiences of daily life a struggle for the vulnerable child and his parents.
The goal of therapy is to create adaptive patterns of response to environmental stimulation to enhance a child’s overall functioning. Rarely are specific motor, language or self-help milestones targeted as goals of therapy. Instead, sensory integration therapy uses monitoring standards such as time engaged in interactive play, time participating in on-task activities, tolerance to given levels of specific stimulation and reduction in inappropriate behaviors.
Occupational therapists use interventions such as sensory diets, brushing protocols, therapeutic listening programs, swinging, deep pressure tactile stimulation and the like to increase tolerance of sensory input in those children who are too sensitive to ordinary levels of stimulation, and to provide the desired sensory input in those children who appear to be undersensitive. It is well established that desensitization therapy is useful for people with phobias and other anxiety-related disorders. Therefore, it makes sense to use desensitization techniques with children who have an overwhelming emotional response to ordinary environmental stimulation. Likewise, it makes sense to provide more adaptive types of stimulation to kids who, under ordinary conditions, are understimulated. It may reduce their need to engage in bizarre or destructive self-stimulating behaviors.
According to mainstream medical societies and organizations, sensory integration therapy is still considered experimental. There is a lack of good, controlled outcome studies. Consequently, school districts and insurance companies hesitate to pay for these services. Should you require assistance obtaining insurance coverage, your therapist will be familiar with successful strategies that have worked with other patients with similar needs.
I have heard that Botox is a drug used for children with cerebral palsy. What is Botox and is it helpful?
Dr. Mary Keen
Botox is a medication that has been around for about 20 years. It has been used to help children with Cerebral Palsy for about 15 years.
It is given by injection into muscles that have problematic stiffness or spasticity. It works by relaxing the muscle it is injected into and lasts for an average of 3 months, sometimes longer and sometimes shorter. Since it is given directly into the muscle the side effects are generally just local and where the injections are given and include temporary bruising, weakness and atrophy and of course some pain from the muscle injection/shot.
In order to be helpful for a child with cerebral palsy the problems with muscle stiffness have to be localized to a few areas due to us not wanting to give a child too many injections which would be scary and uncomfortable and to limitations of dosing based on a child's body weight to prevent overdose.
A child who is given botox injections must have a therapy plan in place so that the child can learn how to use a new balance of muscles. when the botox weakens a muscle we usually wnat to strengthen the muscle on the other side of the joint while it has the advantage of the other msucle being weaker.
Botox without therapy and or a home program of exercise is generally of no benefit unless the goal of the injection is simply to reduce pain from a very tight muscle contraction.
Vaccines and Autism
Dr. Lisa Thornton
It is scary to think that the vaccines we give to our children to protect them might somehow be dangerous and it’s even scarier to think that a parent might actually contribute to harming their own child. It is understandable that parents would want to be absolutely sure that vaccines are safe and that’s why the possible link between autism and vaccines has been studied extensively in many countries involving hundreds of thousands of children. The evidence has been reviewed by countless researchers in numerous scientific and regulatory organizations and all have come to the same conclusion: there is no evidence that vaccines cause autism. None.
So why is there still a controversy if the issue has been disproved? Probably the most important and understandable reason is that parents of children with autism want to know why their child has the disorder and medical science can’t answer that question yet. In the absence of a clear reason some parents blame immunizations because the diagnosis of autism is often made during the first two years of life when children are receiving immunizations. But just because two things seem to occur around the same time does not mean they are related. In this case science proves they are not.
Early in the immunization/autism debate it was suggested that the preservative thimerosol, which contains mercury, was to blame. Thimerosol had been used in vaccines since the 1930s, but erring on the side of caution the AAP and the FDA requested that vaccine manufacturers remove thimerosol and in 2001 they did. Some parents wondered why it was removed if it was truly harmless and the controversy grew. It should be noted that rates of autism did not go down after the removal of thimerosol, but the debate still remained and new arguments arose for why immunizations were to blame. After all, if it’s not thimerosol, it must be something else about immunizations so some parents began to suggest that it’s the number of vaccines that are given that are too blame. They feel that there are too many vaccines given all at once that overwhelm a child’s immune system and cause autism. Some parents go so far as to change the immunization schedule for their child or to forego immunizations altogether.
This may seem like a personal choice within a family, but in some cases a parent’s decision to under-immunize their children has led to disease outbreaks. In Britain because of under-immunization there were over 5000 cases of mumps in 2005 and 449 cases of measles in the first 5 months of 2006. The country reported the first measles-associated death since 1992 and two children suffered permanent brain damage. One in 5 children infected in the Dutch epidemic of 1999 and 2000 had serious complications. Five children were left with permanent brain damage and 3 children died.
My child was born premature and he is behind in his development. How do I know if he has a developmental delay or is it a developmental disability?
Dr. Christine Hudicourt Sajous
When a baby is born premature, the brain growth and development continues as if the baby was still inside the mother.
During the first few years we should always subtract the weeks of prematurity in checking the baby's development. For example, if a baby is born 15 weeks early and is now at his due date he or she should be acting as a newborn. If a baby born premature is now 6 months old but was due 4 months ago he should act like a 4-month-old. If the baby is only acting like a 2-month-old it is a true developmental delay. If the delay persists after therapy when the baby is 12 or 18 months after the due date he or she probably has a disability.
During the first year, babies who were very sick and were many months in the NICU may have mild delay but their development should improve with time and therapy. By the time a baby is 12 months after his or her due date, he or she should act like a normal 1-year-old.
The goal of early intervention is to help sickest and smallest babies reach a better development.
My child was just diagnosed with cerebral palsy. Will it get worse over time?
Dr. Mary Keen
Sometimes children are diagnosed with probable or possible cerebral palsy. It is not an easy diagnosis to make for several reasons. Cerebral palsy can result from dozens of differing reasons. No two children with cerebral palsy are exactly alike.
Even normal children do not have a "stable" neurological examination. Every time that a pediatrician sees a baby they are monitoring for expected changes in the neurological exam, as changes are necessary for normal development to proceed.
If the expected changes do not occur, a pediatrician is supposed to be worried. For children with cerebral palsy or possible or probable cerebral palsy, there should be improvements over time, or the child should stay the same, never worsen.
If a child’s neurological exam changes for the worse, some disorder OTHER THAN cerebral palsy must be suspected. Although cerebral palsy never worsens over time, the effect of abnormal muscle pulls on developing bones and joints can cause problems with developmental progress. The CP is not worsening in this case; rather the CP is causing problems with orthopedic development.
Because CP can affect the growth and shape of bones, it can also cause abnormal wear and tear on joints, even early arthritis, which can certainly make every day life more difficult as the person with cerebral palsy gets older.
One of the important things that doctors and therapists do for children with cerebral palsy is to try to prevent or minimize these problems.
My child has Down syndrome. I have heard about vitamin therapy, but I am unsure about it. What are your thoughts?
Dr. Jerold Stirling
The use of vitamin therapy for children with Down Syndrome has been advocated since the 1930s. Proponents of vitamin therapy have made claims that have ranged from improvement of intellectual ability, development, overall health, to a change of the physical features of children with Down Syndrome.
As a pediatrician who cares for a number of children with Down Syndrome, I am very much in agreement with the statement of the National Down Syndrome Congress. To summarize their position, despite the many advocates of the use of vitamin therapy, (including vitamins combined with minerals, amino acids or enzymes) this form of treatment has not been proven to be effective by scientific research.
I am concerned that children who receive these vitamin preparations may be exposed to dosages far in excess of those recommended ultimately leading to other medical problems. We know that some of the minerals that are mixed in vitamin supplement combinations are potentially damaging to the liver. Vitamins A and B6 in excess may cause neurological abnormalities. Vitamin C in excess may cause urinary tract irritation, and frequency. In addition, there are other ingredients in some of these preparations that are unknown and may potentially be damaging.
All of us who provide medical care to children and adults with Down Syndrome are looking for ways to improve the overall health and development of those with this problem. If you are concerned that your child may be deficient in vitamin please have your child evaluated by a Pediatrician. Clinical nutritionists are also very helpful in reviewing your child’s diet.
I hope that research in this area continues. I know that I and other medical professionals would be glad to recommend vitamin therapy if further research proves that vitamins are of benefit.
What is a developmental disability?
Dr. Alan I. Rosenblatt
A developmental disability is a condition resulting in impairment performing daily life activities because of a disruption to the normal process of child development.
Developmental disabilities are usually caused by abnormalities affecting the brain (cerebral palsy, cognitive impairment, autism spectrum disorders, learning disabilities, behavioral and emotional disorders), but may also be localized to the spinal cord (spina bifida) and other organs (visual and hearing impairments, neuromuscular disorders). There are many kinds of developmental disabilities, including those affecting intelligence, learning, language, motor function, sensory function, social skills and behavior.
Specific causes of developmental disabilities are often unknown or cannot be determined with certainty. Some potential causes may include problems during pregnancy, prematurity, lack of oxygen, physical trauma, illness, specific diseases, identifiable genetic disorders, heredity, environmental factors, toxins and nutrition amongst others.
Children may now be evaluated and treated for developmental concerns even during pregnancy, but usually begin the process when concern arises after they are born. Your pediatrician will monitor your baby’s milestones – skills that a baby should have by a certain age. If there is a large gap between the expected and achieved milestones for your baby’s age, or, if the baby is performing those skills in an unusual manner, a more detailed evaluation will be performed and appropriate treatment will be started.
As with all children, it is the role of parents to raise a child with developmental challenges to be happy, well-adjusted and performing to his or her full potential. We know that the best outcomes for kids with developmental disabilities are attained through early identification and intervention.
Since 1986, there has been federal legislation recognizing the right of children from birth through age 3 years to receive early intervention services for treatment of their special developmental needs. From the age of 3 years through age 21, children are eligible for special education services through their school districts.
Disability 101:
A Dialogue About Developmental Disabilities
Dr. Lisa Thornton
My girlfriend’s son, Sam, is a cute, happy, energetic 6 year old. He loves dinosaurs, Sesame Street, and grilled cheese sandwiches. Sometimes he gets really mad and throws awful tantrums. Other times he’s so sweet his mother wonders how she got so lucky with such an amazing child. When he grows up he wants to be a fireman and an astronaut and a doctor. Sam also has cerebral palsy. The funny thing is that a lot of people have a really hard time getting past Sam’s wheelchair. They see the chair, not the child and it’s really too bad because Sam is a terrific kid!
In my medical practice all of the children I treat have a disability of one kind or another so I’m around wheelchairs, walkers, crutches, and artificial limbs all day everyday. I realize this is not a common experience and recently I began wondering how many people have even one friend who has a disability? Do you? Does your child? Have you ever made small talk with a person in a wheelchair or had coffee with someone who had an obvious impairment? It’s my hunch that most people will answer no to these questions. It’s normal to feel uncomfortable when things aren’t familiar so I’ve decided to open the dialogue about this seldom discussed topic.
1. One of the strangest things that happens to a person with a disability is that sometimes they’re treated as if they’re invisible. Let me give you an example. I was with a group at a very nice restaurant as the guest of the CEO of a well respected non-profit organization. He makes a good living, is intelligent, and does a great job of running the charity, but he was born with almost no arms and legs so he uses hooks on his arms, has artificial legs, and uses a scooter to get around. He was our host, he made the reservation, he paid for dinner, but during our entire evening together the waiter looked past our host to the person seated next to him and asked what our host would like to eat, or drink, etc. When the CEO spoke up for himself the waiter raised his voice and spoke more slowly. Maybe the waiter thought that this man was so unusual that his brains had been located in his missing limbs. It made me wonder where the waiter’s brains were. The big message is: talk to a person who has a disability just like you would anyone else.
2. A lot of people say that when someone uses wheelchair they are “bound” to it. A child who uses a wheelchair isn’t “bound” to it anymore than I am bound to my glasses. I definitely need them because I can’t see well without them, but my glasses don’t bind me, they assist me. The same is true for a child who uses a wheelchair.
3. I know the name game can be confusing for people outside of a particular group who are trying their hardest to keep up. Things can change so quickly, but the preferred description is “a child with a disability” or “a child with autism” instead of “a disabled child” or “an autistic child.” The first description makes the disability only a part of the child’s experience, the second description makes it the entire child. The language changes as the disability community grows and becomes more self-empowered. So mentally retarded became cognitively impaired which became intellectually disabled. Crippled became handicapped which became disabled which became a person with a disability. The easiest way to know what language to use to discuss a child’s condition is to listen to the words the parents use to describe it.
4. One of the most difficult things for parents who have a child with a disability is watching their child’s peers pass them by. Parents often feel a loss when other children walk, but their child doesn’t, or other children talk, but their child doesn’t, or other children start to read, but their child doesn’t. For some parents early childhood seems like a series of losses but there are some amazing breakthroughs. My girlfriend’s son started talking after four years of using sign language, gestures, and guessing. One of my patients became potty trained after 7 years of diapers and pull ups. Seven years! Sometimes the child who you see in the grocery throwing a tantrum is the same child who couldn’t have held it together for 5 minutes in a convenience store a few months before. This time it took a full 20 minutes before the tantrums started. The child may look disruptive to other shoppers, but it’s a victory for the parent who sees progress. For parents who have a child with a disability it’s patience, and baby steps, and celebrating small, but significant accomplishments.
I once heard someone say that everyone has a disability, some are just more visible than others, and if you think about it it’s true. Having a child with a disability isn’t what Sam’s mom hoped for during her pregnancy, but he’s the child she got and she wouldn’t trade him for anything. There are over 4.5 million children growing up with a disability in our country and their parents don’t want pity, just understanding. When it comes to their child they may have to change their expectations or at least modify the timeline, and by doing that they create a new normal for their family and carve out a space for their child to reach his or her full potential. And that’s what every good parent wants.
