Strollerderby : developmental delays

Medical Mystery: A Baby Who Won't Grow

Kate Tuttle — Wed, 04 Feb 2009 17:05:00 GMT

When Suraya Brown was born 14 months ago she was extremely small -- the four weeks premature baby weight just over two and a half pounds -- but doctors didn't anticipate how unusual her case truly was until months later, when her growth stalled completely. Today, according to ABC news, the British toddler is about the size of the average newborn at around seven pounds, and the medical professionals are baffled as to what is causing her small size and delayed development. Tests for various forms of dwarfism and other genetic differences have come back negative, leaving her mother, Atlanta Ruzman, wondering when, if ever, she will get answers about her daughter's condition -- and her future. For now, she says the toddler is a "cheeky monkey" who is happy and alert.

Perhaps clues to Suraya's condition can be found in the case of Brooke Greenberg, a Maryland teenager who was profiled in 1995 as part of a "medical mystery" series on another network (NBC's Dateline) when she was 12 years old but "frozen" at the size and developmental stage of a six-month-old baby.

Both these cases are fascinating, not least because they tap into something most parents say at one point or another during their baby's first year -- oh, I wish she could stay this small forever! -- it's something we say but of course do not really mean. The idea of a child who does not, cannot, grow and grow up, is so strange and sad it can seem like the stuff of fiction. In the real world, it's just another reminder of how lucky you should consider yourself if you have a child who is healthy and thriving.

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Pre-Term Elective C-Sections Are Dangerous: So Why Insure Them?

Miriam Axel-Lute — Fri, 19 Dec 2008 15:00:00 GMT

Michael McGuire is CEO of UnitedHealth, a health-insurance provider in New Jersey. In an op-ed in the Trenton Times recently he talked intelligently about the health dangers of elective pre-term c-sections.

The evidence keeps mounting—prematurity, even by a few weeks, means higher rates of breathing problems, cerebral palsy, NICU stays, etc. When the baby's not ready to come out, it's not ready, folks.

McGuire makes the impressive assertion that when he explained this carefully to a "pilot group" of physicians and hospitals and they stopped scheduling c-sections before 39 weeks, there was a 46 percent drop in NICU stays. Those are results to write home about. As he writes, "That's almost half the number of newborns with potential health problems, almost half the number of distraught parents, al most half the number of potential tragedies. The cost savings to these hospitals, the parents and the health-care system is enormous."

He notes carefully, as do I, that sometimes a pre-term c-section is medically necessary for health of mother and/or baby. Obviously, that is not what I'm talking about. But I would include c-sections that are planned for medical reasons,* but where there is no medical reason not to carry the baby to term. I think those are far, far more common than the over-hyped "too posh to push" phenomenon.

So here's what I want to know: If it's documented to be such a health risk, why don't McGuire and his colleagues just stop paying for c-sections that are unnecessarily scheduled at an unsafe time?

Insurers already go out of their way to not cover things they claim are optional (including some that are emphatically not), not to mention dangerous. Usually I question their judgment, but the evidence is pretty compelling on this one.

I'm all for educating docs, but it seems to me the insurers could stop this practice cold with their purse strings.

Photo by César Rincón.

*(Of course, many of those "medical reasons," like a previous c-sections or breech presentations, don't actually require a c-section, but that's a separate post.)

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They Say: Even Late Preemies at Higher Risk

Kate Tuttle — Mon, 15 Dec 2008 18:02:00 GMT

While it's long been known that premature babies face a much higher incidence of cerebral palsy and other medical problems, most of the infants thought to be at risk were those born before 34 weeks -- the tiny babies, notably premature, whose entire bodies can fit into the palm of their father's hands. But new research suggests that even bigger, healthier-seeming babies, when born before term, are much more likely to fall victim to the health problems of prematurity. And at a time when more and more women are giving birth early due to inductions or scheduled C-sections, that risk needs to be better communicated, according to the doctors who authored the study.

The study, which examined the circumstances of more than 140,000 babies born at 30 weeks or later, concluded that babies born from 34 to 36 weeks' gestation, although often appearing as big and healthy as full-term newborns, were three times more likely to have cerebral palsy than babies born at 37 weeks, and up to 25% more likely to face mental retardation and other developmental delays. Because the babies in the study have not yet entered elementary school, the authors point out, it's too early to know whether other learning-based problems will be detected.

While overall rates of prematurity are fairly steady, the number of babies born from 34-36 weeks is growing, and currently represents one in 11 births in the US. The study did not look into the reasons for the late preterm births, and some surely were medically indicated (pre-eclampsia, for instance, pretty much demands that a baby be born early, to save both lives).According to the study's authors, however, some of those "late preterm" births were due to early inductions or C-sections that were not medically necessary (remember that the next time a Hollywood starlet says she's due "sometime in the fall" and has a six-pounder).

Pre-term Elective C-Sections Are Dangerous: So Why Insure Them?

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They Say: Anesthesia Can Cause Trouble Down the Road

Amy Kuras — Thu, 23 Oct 2008 17:32:00 GMT

As if watching your kid get wheeled away for surgery isn’t bad enough, today comes news that anesthesia can cause developmental problems in children.

A preliminary study by Lena S. Sun, professor of anesthesiology and pediatrics at the Columbia University found that children who were exposed to anesthesia were about twice as likely to be diagnosed with a later behavioral or developmental disorder.

Sun looked at a database of Medicaid patients in New York. The Columbia team studied a group of children born between 1999 and 2000 who had received general anesthesia for hernia repair and a group of 5,000 children who never had the surgery.

After adjusting for other factors associated with such disorders, such as low birth weight and gender, 30 anesthesia-exposed children, or 4.8 percent, were found to have developmental and behavior disorders during follow up, compared with 75 unexposed children, or 1.5 percent.

Because all of the kids in the study would be considered to be economically disadvantaged, that may have led to the higher levels of developmental or behavioral delays as well. Even the lead researcher is cautioning that these findings are preliminary and need to be looked at further.

Still, as someone whose baby just had surgery, which was thankfully minor but still required general anesthesia, UGH. It was hard enough to watch my little guy get carried away for surgery knowing they would put him under, but to know I may have put him at higher risk for more problems down the road is just upsetting.

They Say: Babies Need More Tummy Time

Jen Chaney — Wed, 06 Aug 2008 22:25:00 GMT

Sometimes it seems like we parents can't do anything right. First the "Back to Sleep" campaign urged us to make sure our babies sleep on their backs to avoid the risks of SIDS. So we dutifully followed those instructions and methodically laid down our little ones facing upwards instead of down. Which was, and remains, the right thing to do.

But it turns out all that "Back to Sleep" stuff has made us less diligent about ensuring that our children spend time on their tummies during the day. The American Physical Therapy Association reports that therapists have noticed an increase in motor delays among infants during the past six years. The No. 1 cause: Not enough tummy time. The APTA also notes that in recent years, care centers and providers have cited a whopping 600 percent increase in referrals for misshapen heads, another side effect of a lack of on-the-belly QT.

Judy Towne Jennings, an APTA spokeswoman, told Marketwatch that, "Ideally, babies should be placed on their tummies after every nap, diaper change and feeding, starting with 1-2 minutes."

Now, all of this probably doesn't come as much of a surprise to anyone who recently dealt with a newborn. (Yeah, my son only wanted to turn his head a certain direction. As a result, I feared he would turn into a Conehead. Thankfully, he did not.) We know that making sure the kids sleep on their backs is important. We also know that tummy time is, too. Which is why, at the end of the day, we sometimes feel like we're flipping our babies around like cute, little sizzling omelets on the frying pan of life. Or something.

The APTA's information is helpful, for sure. And all we can do as parents is try our best to take it to heart without turning into rampaging, infant-flopping, baby-head-twisting psychopaths. I've met people like that. And let me tell ya, they're not pleasant.

Image: iparenting.com

Could Your Kid Be Behind? New Tool Better Identifies Delays

Karen Murphy — Fri, 14 Sep 2007 13:24:00 GMT

Denial. I think most of us are pretty good at it, but I have to say that regarding my son Eric and his developmental delays, I was Champion of Denial. As a parent, one of the hardest things is seeing and acknowledging that your child is delayed in some area. We all see the perfection of our children; how can this perfect and beautiful child be (gulp!) "delayed"? Believe me, denial is usually the way to go here, except it's also the way to go if you want it to come back later and bite you in the butt. When Eric was an infant I held out the hope for months that he'd somehow magically jump ahead and be "okay", but he didn't and he wasn't and eventually I had to reconcile with that and accept the help that's given to kids who need it. But by then he had lost a fair amount of valuable time.

So don't do that.

A questionnaire called "Ages and Stages" (ASQ) has been developed by the University of Eugene in an effort to try to catch possible delays sooner. Pediatricians give the questionnaire to parents who complete it at home while observing their children, up to age 5. Eric's delays were obvious, but they aren't in every case, and having a questionnaire to fill out helps you be more objective.

An estimated 12% to 16% of U.S. kids have delays, but it's also estimated that 80% of those aren't caught as early as they could be. You can actually complete the questionnaire online also and be part of the accompanying study. There are other developmental questionnaires out there, but the study conducted to determine the efficiency of ASQ indicates that it's more effective than other questionnaires available.

Seriously. Don't paint your kid through rose-colored glasses (how's that for mixing metaphors?). There's nothing wrong with having a delay, and in most cases, kids who are delayed in one area or another often manage to meet their potential with some time and a little help.