Autism And Vaccines

     Since the early 1980’s, there has been an increase in the number of cases of autism diagnosed each year and the CDC recently announced a more rapid increase in the last 10 years. These increases may reflect an actual increase in autism or it may be related to the improved recognition and diagnosis of autism, but, because this increase in autism has been during a time when the number of recommended vaccines for children has increased, many parents and some physicians have suspected a connection between vaccines and autism.   

      In 1989, an English gastroenterologist named Wakefield sent a letter to the British medical journal Lancet in which he reported 12 children with autism whom he felt had changes in their intestines that were related to the measles vaccine. This one, small report set off a firestorm around the world causing people to believe that the measles vaccine caused autism. On investigation, Wakefield was found to have financial ties with an anti-measles vaccine organization that was launching a suit against the vaccine manufacturers. In 2011, Lancet stated that Wakefield’s evidence had been faked and his report was a lie.

     Research in the last decade has suggested that autism may be caused by genetic problems in the development of the brain while the infant is still in the uterus. In the latest edition of The New England Journal of Medicine, a small but scientifically well-done study showed abnormalities in the brains of autistic children who had died from other causes. The researchers found abnormal groups of cells in the areas of the brain that control social functioning, emotions and communication. They felt that these abnormal cells may have developed in the second or third trimesters of pregnancy. The damage to the brain cells may have been due to something like an infection during pregnancy or it could be due to a basic genetic defect that was present from conception (studies have suggested that having an older father may increase the risk of a child having autism).

     Over the past 20 years, there have been hundreds of studies done on hundreds of thousands of children which have proven without question that there is no relationship between measles vaccine (or the combined measles, mumps, rubella (MMR) vaccine) and autism.  And, even though the number of vaccines that children receive has increased, there is also no evidence that the number of vaccines that a child receives or the order in which the vaccines are given is related to autism. Parents of children with autism are understandably desperate to know what caused their child’s problem and are sometimes willing to listen to anyone who offers an explanation. Much more research on autism is needed, but one thing is certain: it is time for people to stop claiming that vaccines are the cause of autism.

Common Medical Practices And Beliefs That Need To Be Abandoned

     It is a sad truth in America that we do not have the best medical care in the world - we only have the most expensive medical care in the world.

     The American board of Internal Medicine has begun a program called “Choosing Wisely” that challenges physicians in different specialties to examine the practices they commonly do and ask: Is this cost-effective? Is this the best medical practice based on science? Is this in the best interest of the patient?

     Each different specialty group has come up with its own list of things that need to change. On March 17^th 2014, the American Academy of Pediatrics came out with their list.  Parents should be aware of it because it includes common things that add to the cost of their children’s medical care without giving any significant benefit.

     The list starts with the statement that antibiotics should only be used when a bacterial infection is the cause of the child’s illness. Most infections that occur in children are viral and don’t need antibiotics, including most cases of sinusitis, sore throat and bronchitis.

     The second is that cough and cold medicines should not be given for respiratory illnesses in children under four years of age. These medications don’t offer young children much relief of symptoms and giving these medications can result in overdoses of some of their ingredients.

     Another is that CT scans of the head are not necessary in the immediate evaluation of minor head injuries. The decision to do a CT scan needs to be based on the results of a good examination, careful observation after the trauma and following specific guidelines for the evaluation of head trauma.

     CT scans, MRIs and head X-rays do not need to be done after a child has had a simple fever seizure (febrile seizure).

     Infants diagnosed as having gastroesophageal reflux because they spit up frequently or are colicky should not get upper GI X-rays and they should not be placed on reflux medication. Reflux is normal in infants and is usually not associated with any more serious symptoms.

     Children should not get general allergy blood tests for a variety of foods just because a food allergy is suspected. Many of these tests are falsely positive - 8% of children have a positive test for peanut allergy but only 1% are truly allergic to peanuts. Specific tests should be done only after a careful history is done.

     There is no evidence that the use of home apnea monitors decreases the incidence of sudden infant death syndrome. They may be helpful in specific circumstances, but they should not be used routinely.

     The most difficult one involves the evaluation of a child’s abdominal pain. It is common practice to do an abdominal CT scan if appendicitis is suspected, however, this is expensive and can expose the child to a large amount of radiation. The new rule is that CT scans are not necessary in the routine evaluation of abdominal pain. Some experts say: if appendicitis is suspected after a careful physical exam is done, an ultrasound should be done (this involves no radiation) and if the ultrasound is questionable, an MRI should be done. Other experts say that the ultrasound is unreliable and the CT scan is the only accurate way to diagnose appendicitis. This controversy will continue for a while.

Angel Kisses And Stork Bites

     Newborn babies often have pink or red patches on the back of the neck near the hairline, on the forehead or on the upper eyelids. Doctors call these “salmon patches” but the more common names for them are “stork bites” for the ones on the back of the neck (It’s where the stork hangs on to the baby before dropping him down the chimney) and angel kisses for the ones on the face (The angels give a quick kiss on the forehead before sending the baby down to Earth).  In non-Caucasians, they usually have a darker color.

     Even experts are not quite sure what causes these lesions, but it is thought that they are small, superficial blood vessels that were more prominent when the baby was in the uterus. They can fill with blood and become more prominent when the baby cries or strains and they fade if the skin around them is stretched. They gradually go away by about 6 years of age, although the ones on the back of the neck can last longer. 

     Two other pink/red lesions that can resemble a salmon patch are a hemangioma and a port-wine stain.  Whereas salmon patches are flat, hemangiomas feel bumpy or raised. Salmon patches do not get bigger but hemangiomas do grow larger with time. A port-wine stain is a darker red discoloration that is usually on one side of the head or face rather than being in the middle like salmon patches. Port-wine stains do not grow, but they do not fade away like salmon patches.

     No testing or treatment is necessary when an infant has a salmon patch on the face or neck, but if an infant has one over his lower back, especially if it is in the middle of the back, the infant should have an ultrasound done to be sure the spinal cord under the lesion is normal.

How To Avoid Pacifier Problems

Pacifiers get a bad rap. They are indispensible in the difficult first six months of life because sucking is a normal form of self-quieting. Some babies like to suck more than others, but all babies settle down when they suck on a pacifier. Babies who are sucking aren’t crying. Pacifiers help babies fall asleep and there are even some studies that suggest young infants who use pacifiers have a lower rate of Sudden Infant Death. So, up to six months of age, use the pacifier as much as you want and whenever the baby wants it.

     The problem with pacifiers is when a two-year-old insists on having it in his mouth all day. But there is an easy way that parents can use a pacifier when the infant is young and still not get into pacifier problems later on. The easy rule is that after six months of age, the pacifier never comes out of the crib. A six-month-old chews on anything that comes within a foot of his mouth. If given a pacifier during the day, he’ll chew on the front, suck it, chew on the back, chew on the side and suck it again. If you put a small teething ring or teething toy on the pacifier strap that is clipped to his shirt, he’ll do the same thing with the toy. He’s at the age where he wants to chew more than he wants to suck.  But when he is tired, he wants to self-quiet by sucking again and the pacifier is a wonderful way to help him get to sleep.

     So, after six months of age, the pacifier never comes out of the crib. Baby can use the pacifier to go to sleep at both nap-time and night time, but, during the day, the pacifier is in the crib.  Parents have told me ”We only use the pacifier in the crib…….Oh, and in the car seat……..Oh, and in the stroller……..etc.”. Remember that your baby will learn anything that you chose to teach him. If you teach him that he needs a pacifier during the day, good luck when he is two. If the pacifier never comes out of the crib, He’ll never even think about using it when he is up during the day.

     The best way to deal with parenting problems is to see them coming and then avoid them. Pacifier problems in toddlers can be totally avoided.