Signs of Autism in an Infant’s First Year

neighborsAs a neonatal-perinatal specialist, I have been responsible for the health of tens of thousands of the smallest, sickest, and most vulnerable patients. Plus, in the past decade, I have focused on learning about, diagnosing, and treating children who are affected with the newest childhood developmental epidemic, Autism Spectrum Disorder.

It is fair to say, then, that my observations have a degree of validity not necessarily found by simply shopping around town, when parents seek answers about their child’s condition. Special needs pediatric medicine is my natural state. little-leoSo, while walking our Yorkie recently, as I was exchanging pleasantries with a neighbor, I couldn’t help but ‘examine’ the infant in the carriage. “Is this kid developing correctly?” I thought. “Are there red flags? What further questions would I want to know, short of becoming a nuisance, to help the family?”

Here is my list of key questions to best assess whether I should encourage a parent to further explore their infant’s development:

Pregnancy:
What is the age of mother and father?
Perhaps it isn’t the assisted pregnancy (in-vitro fertilization, etc.) that is the problem, since that has not been scientifically proven. But, an advanced maternal or paternal age have been shown to represent a significant association.
little-thought-cloudNo need to ask, however; I can ascertain that information by checking with my wife.

Has there been any medication use, but especially tylenol and psychoactive substances, even if they were prescribed by a doctor.
little-thought-cloudMaybe that’s too nosy.

Labor & Delivery:
Was it a full term pregnancy?
Contrary to some theories, I do not believe that pitocin (intravenous medicine given to enhance contractions) is a related issue. Rather, the fact that labor is prolonged may be due to hypotonia in the fetus, and he/she is not contributing in the tug of war. So, ‘Failure to Progress’, and late deliveries are a particular concern. Conversely, if the child was preterm, that is a significant risk factor, as well.

Did the child go home from the hospital with Mom?
This information could open up a host of possible associations, from the early use of antibiotics to birth defects.
“Why are you asking so many questions, Doc?”

Newborn:
“Well, I’m just interested. Did the child breast feed?”
Answers in the negative that are due to ‘poor suck’, breast milk ‘intolerance’, or GERD definitely increase the number of red flags related to those children who demonstrate future developmental concerns.

Infant:
Does the child have to go to the doctor often?
Numerous visits to the pediatrician or specialists imply an underlying medical problem, including asthma, eczema, feeding and stooling problems, which are frequently associated in children with autism.

Did the baby have plagiocephaly (flat head), torticollis (wry neck), or a large head size? Does he make good eye contact and follow a moving human face? In the second half of the first year, does the baby crawl/walk OK? Is there vocalization?
little-thought-cloudSkip the interrogation, I can observe many of those signs for myself.

Conclusion:
When the majority of answers are of concern, there may be enough warning signs to warrant further exploration. On one single day last week, I took care of 16 children who had criteria consistent with ASD. We don’t need more patients with autism. Something is just wrong.

Your neighbor should not be making developmental assessments, even if he is TheAutismDoctor. Pediatricians can, and must, do more to examine your infant’s development and help stem the tide. The only question should be, “What does your doctor think?”

For the clinician who may complain that this line of questioning causes unnecessary apprehension for Mom and Dad, my reply is that they are worried, anyway. Rather than help, a practitioner’s cavalier dismissal that, “I wouldn’t be concerned about that,” carries little substance in the face of this wide-ranging malady known as ASD.

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Brian D. Udell MD
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