Sensory Integration Dysfunction and Therapy

     In the 1970’s, an occupational therapist, Jean Ayres, PhD, studied the way that the body processes sensory input such as vision, hearing and the sense of balance. She felt that when the sensory nerves were not functioning properly, it could cause problems in development, learning and emotional control. She called this condition sensory integration dysfunction. Since that time, treatments such as sensory integration therapies and sensory diets have been developed. Sensory therapies often involve stimulating vision, hearing, touch, balance and coordination. They often use swings, balls, brushes and other equipment in the belief that they help to improve the functioning of the sensory system.

     The problem with the diagnosis of sensory integration disorder is that the signs used in making this diagnosis are present in other disorders such as autism, ADHD, behavior problems, anxiety and developmental delay. The American Academy of Pediatrics states: “Studies to date have not demonstrated that sensory integration dysfunction exists as a separate disorder distinct from these other developmental disabilities.” What is called sensory integration disorder may be one of these other more clearly identified childhood disorders.

    The effectiveness of sensory integration therapy is also difficult to measure. Although some children seem to improve with this treatment, studies have been inconclusive as to whether it is actually beneficial. It is important for parents to know this because the therapy can be long, expensive and involve a lot work on the part of the parents. Dietary therapy can be especially difficult for parents and children.

     The American Academy of Pediatrics offers the following cautions:  sensory integration dysfunction should not be used as a primary diagnosis alone. Other disorders like those mentioned above should be investigated and treated appropriately. Parents need to be aware of the limited data on the use and effectiveness of sensory-based therapies. If a parent decides to allow their child to undergo sensory-based therapy, they should set clear, measurable goals with the person administering the therapy and establish a clear time frame for re-measuring the child’s progress to evaluate whether those goals are being accomplished.

Using Antibiotics Sensibly

     One of the most exciting new areas of medical research is the Human Microbiome Project. Scientists are studying the bacteria that normally live on our skin, in our mouths, noses and in our gastrointestinal tract. They have found that we harbor 10 times more bacteria in and on our bodies than there are human cells in our bodies.

     These bacteria are living with us peacefully and, in fact, help our digestion, metabolism, immune function and other important body processes. They are the “good bacteria” that are often referred to when making a decision to start a child on antibiotic therapy.

     Doctors have been prescribing antibiotics for children less often over the last two decades. We no longer prescribe antibiotics for routine ear infections or fluid in the ear. We are more careful in treating children with antibiotics for “pneumonia” or “bronchitis” that may only be a viral infection that antibiotics don’t cure. Doctors and parents have become more concerned about what effects antibiotics might have on the bacteria that we need to have normally living in and on our bodies and what happens when we change or replace those bacteria.

     It is now clear that when a child gets diarrhea from taking an antibiotic it is because the bacteria in the gut have been changed. This is why replacing normal bacteria by giving probiotics has been found to decrease the risk of developing antibiotic-associated diarrhea by as remarkable 42%.

     Current studies are looking at how our normal bacteria help to protect us from infections with more harmful bacteria. Some disease processes such as colitis, cystic fibrosis, food allergies, eczema and immune disorders seem to be influenced by which bacteria are living in and on the child. In the future, part of the process of diagnosis of illness may include examining what kind of bacteria are living with a child. Part of treating illnesses may involve giving the child good bacteria to eliminate the bad bacteria.

     When as child has a serious bacterial infection, antibiotics are necessary and can be life-saving.  But for most of the fevers, coughs and colds that children suffer with, time and love are still the best cures.

When Parenting Doesn't Work - The Oppositional Child

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The Oppositional Child

     Some children don’t respond to normal parenting.. They don’t respond to rewards or punishment and they don’t learn from good discipline.  Repeated negative experiences often cause them to be angry and withdrawn. They are often aggressive and have a history of being kicked out of both daycares and schools.  They have low frustration tolerance, poor emotional regulation and hate to adapt to new situations. These children are diagnosed as having Oppositional-Defiant Disorder.

     Oppositional children can benefit greatly from individual therapy that emphasizes social skills training, behavioral therapy and anger control. Both the parents and the child benefit when the parents learn more effective parenting strategies such as collaborative problem solving.  This is s system that teaches parents how to initiate joint adult-child problem solving to resolve conflicts. The goal is to minimize negative interactions, strengthen parent-child relationships and help the child develop self-control.  “Think:Kids” is a web-based program at www.thinkkids.org that helps aggressive children. The American Academy of Pediatrics offers the “Connected Kids” program. Other resources are “The Explosive Child” by RW Green and “Helping the Noncompliant child” by RJ McMahon. Some schools also offer therapy programs to increase social skills and decrease aggressiveness.

     After therapy and skills training, there is the option of medication. As with ADHD, parents often react negatively to using medication for oppositional children – “I don’t want to drug my kid” – but medication often allows the child to get the most benefit from the behavioral therapy.  Medication can help the child be less frustrated, less angry, and more receptive to the therapy. Children with ADHD often have some oppositional – defiant problems and stimulant ADHD medications improve both problems with minimal side-effects. Non-stimulant AHD medications such as clonidine and guanfacine also improve aggression.  If the child is being seen by a psychiatrist, antipsychotic medications like risperidone can be used to diminish aggression and anger but these drugs have side effects that need to be explained fully to parents.

Teaching Discipline and Good Behavior

     As a parent, you are the most important person in your child’s life and all children want to please and imitate their parents. Your love and attention are the things that children want more than any other reward.

     We praise our children for physical actions like taking their first steps and stacking blocks, but it is important to give the same positive response to behavior. Too often, parents think of discipline as a negative thing. Remember that the base word for discipline is disciple – someone who willingly follows a teacher. When parents think of themselves as teachers, they see that it is easier for the student to learn when teaching is clear, respectful and positive. Catching your child being good means clearly identifying the behavior that you want to see repeated and then giving praise for it – “ I love it when you ask so politely!” - “ It’s wonderful when you share with your brother!”.  Encouragement and praise for good behavior help your child to learn the kind of behavior you expect of him and starting it early in life (before 1 year of age) will make things easier later on.

      It is every bit as important to immediately let the child know when they do a behavior that is not acceptable. It is never too early to tell a child “No!” in a clear and serious voice. If the child stops the behavior, immediately praise him for stopping – I recommend saying “Thank You” whenever a child respects your saying “No”. If a young child does not immediately stop the behavior, think about your delivery – did you smile when you said “No”? or was your voice soft and sweet? In previous articles I have said that the right way to say “No” to a young child is to do it so that you see fear and a tear. Don’t let yourself become angry or frustrated if the behavior is repeated – few of us learn something the first time. It is as important to identify the bad behavior as it is to identify the good behavior. – “No biting!”. As a child gets older, other forms of discipline like time-outs can be used. But always remember to let the child know that you love them and make sure every interaction is done with respect and patience. When you find yourself getting stressed or losing control, step away from the situation and take a break.

     Some resources to help parents learn how to teach discipline are: The American Academy of Pediatrics “Connected Kids” program and “1-2-3 Magic” by TW Phelan.

A Rash When Taking Antibiotics - Is It Allergy?

     When a child develops a rash on antibiotics it is commonly assumed that the rash is from an allergy to the antibiotic and the parents are told not to give that antibiotic to the child again. However, allergy may not be the reason for the rash.

     Occasionally, the rash may be part of the disease. There are many viral illnesses that give a child a fever for the first few days (see the articles on “Fever”) and then give the child a rash. By that time, the parent’s concern about the fever may have prompted a visit to the doctor and the child may have been started on an antibiotic. Everyone thinks the rash is allergic and the antibiotic is stopped, but the rash was simply a part of the normal viral process.. Another cause of rash on antibiotics is a rash caused by the antibiotic itself. Some antibiotics can cause rash without it being an allergic reaction and if the child were to keep taking the antibiotic, the rash would go away..

     Finally, it is common for a child who has mononucleosis to develop a rash if the child is placed on antibiotics. We are not sure about why this happens, but it is a common reason for children to be mistakenly labeled as allergic to an antibiotic.

     When trying to decide if a rash is from allergy, look for raised, welt-like hives that itch lot and sometimes appear and disappear over different areas of the body. An allergic reaction usually develops shortly after starting the antibiotic – often after the first dose. If the rash develops after days on the antibiotic, is not raised and does not itch the rash is less likely to be from allergy.

Newborn Jaundice

     Jaundice –yellow discoloration- is the result of having too much yellow-colored pigment called bilirubin in the blood stream. First, the face and the whites of the eyes become yellow. Then the yellow coloration of the skin progresses down the body until finally the feet are yellow.  High bilirubin can leak into the brain and cause a severe form of permanent brain damage called kernicterus.  Rates of kernicterus have been increasing in this country with the increase of breastfeeding and the increase in early discharge of infants from the nursery. Breast milk often takes two or three days to get well established and, in that time, an infant can become dehydrated which makes the bilirubin levels higher.  Jaundice slowly develops over the second or third day of life and it is difficult for the parents at home to evaluate how much discoloration is present in their infant’s skin.

      There are different ways of measuring the amount of bilirubin in an infant’s blood stream. The classic way is to measure the blood directly.  Another way is to place an electronic monitor on the skin and measure the bilirubin level through the skin without drawing blood. The skin measurement is accurate as long as the monitor is working properly. Many doctor’s offices now have these machines but it is important that the machine routinely is compared to blood samples to ensure the accuracy of the machine..

     High bilirubin levels are treated with exposure to a specific kind of light that changes the bilirubin into a harmless chemical. The treatment can be done at home or in the hospital but the levels of bilirubin should be checked frequently to ensure that the treatment is working.

     Without treatment, bilirubin levels increase slowly over about a week and then drop. Breast –fed infants have jaundice for longer than bottle-fed infants.  If even a small amount of jaundice is noticed in the nursery, the infant’s bilirubin level should be measured at the time the jaundice is noticed. If it is elevated, the test should be repeated after the infant is discharged until the level starts to go down. If an infant is premature, if the infant’s blood type is different from the mother’s, or if the breast-feeding isn’t going well, the risk of jaundice is higher and the level of bilirubin should be monitored more closely. At no time should a parent be sent home and just told to “watch the infant” and return if they think the jaundice is worse. The bilirubin level needs to be checked until it starts to go down and it is certain that the infant is safe.

Thimerosal (mercury) in vaccines

     In 1999, the American Academy of Pediatrics recommended to the FDA that thimerosal be removed from pediatric vaccine bottles. The Academy was responding more to public sentiment than to actual scientific evidence.

     Thimerosal is a preservative that is used in bottles of vaccine that have more than one dose of vaccine in them. After this recommendation, vaccines were packaged in vials that only had one dose and didn’t need preservative.

   The public concern about thimerosal came from the fact that it is a form of mercury and people knew that mercury is harmful and can build up in the human body. Mercury actually comes in many forms – some are dangerous and some are not.  The methylmercury found in fish is dangerous and can build up in the body, but thimerosal is ethylmercury which has never been shown to be dangerous and is rapidly eliminated from the human body.

     The people who are anti-vaccine always wave the fear of autism in front of parents. Even though thimerosal has been eliminated in all vaccines except flu vaccine since 1999, the rate of autism throughout the country has continued to rise. There have been many studies that show no relationship between thimerosal and autism.

     None of this will make any difference for American parents because the vaccine manufactures will never sell thimerosal-containing vaccines in this country again. They don’t want the expense of dealing with the frivolous lawsuits. But in the summer of 2012, the United Nations will be voting on whether to use thimerosal-containing vaccines in third-world countries. The cost of the single-dose vaccine vials that don’t contain thimerosal is currently about $1apiece.  That $1 is what it now costs to give a third-world child ALL of the vaccines he needs. If these countries are not allowed to have multiple dose bottles of vaccine, they simply will not be able to afford to give their children any vaccines. Then the cost won’t be in dollars - it will be in childhood disease and death.

Circumcision

     The circumcision procedure that some cultures do on females is simply child mutilation and should never be performed.

     Circumcision of male infants is a different matter. There is a small but real risk of urinary tract and bladder infection in the first 1-2 years of life in males who are not circumcised. Circumcised males also have a lower risk of penis cancer later in life. Statistics show that if a circumcised male is exposed to sexually transmitted disease, including AIDS, he has a lower risk of getting that infection than an uncircumcised male. Uncircumcised males have risks of infection, adhesions and constriction of a too-tight foreskin. Often, an uncircumcised child will develop problems and need to be circumcised later in life when it is a painful, nasty experience.

     When circumcision is done in the nursery 1-2 days after birth, it is a safe and easy procedure. It can also be painless with the use of local anesthetic. An oral sugar solution is also given before the procedure to help quiet the infant. Early circumcision heals rapidly and is easy to care for.

     Some societies like the British and the Australians feel that male circumcision is barbaric and unnecessary. I have never seen a complication from a properly done circumcision but I have seen multiple problems when a child was not circumcised.  Because I only had daughters, I didn’t have to make the decision, but if I had a son, I definitely would have had him circumcised in the nursery.
     If you decide to have a circumcision done, talk to the doctor before the procedure. The Gomco clamp does the best circumcisions - not the Plasti-Bell and you need to be sure that the doctor will use a local anesthetic.
     Even though the scientific evidence in favor of circumcision continues to mount up, insurance companies continue to win the fight against paying for the procedure. Long before you go into the hospital to have the baby, check with your insurance carrier to see if they will pay for circumcision and how much, if any, of the bill you will be responsible for.