Category Archives: health

CMV: The Potentially Disabling Virus Your OB Isn’t Mentioning

The New York Times ran a moving story in their October 25, 2016 issue about children who contract cytomegalovirus (CMV)  from their mothers while in utero.  CMV is a Greater Threat for Infants Than Zika, but far Less Often Discussed reminded me of the children I have treated with CMV:  multiply-disabled, with parents that didn’t know what those initials stood for until they heard them from their child’s doctor at diagnosis.

Deafness, blindness, cognitive and motor delays; sometimes the whole enchilada.  All from a virus that may not be evident in the mother or her family.  It is rampant in toddlers, those adorable beings who pick their nose and then touch every cookie on a plate, who put toys in their mouth then want a sip of your drink.

The most likely carrier of CMV in your family is your toddler in daycare.  They are bringing home more than macaroni pictures.  They may not even spike a fever and still have CMV.

The NYT reported that the American College of Obstetricians and Gynecologists does not insist on obstetricians mentioning this virus to patients because no treatment is available and no action is an iron-clad preventive.  They believe that patients should initiate the discussion and discuss what their concerns are rather than be told directly about CMV.

That’s like saying that because I cannot promise that you will never be struck by lightening, I won’t mention that sitting under a tree in a storm means that you are taking a risk!  I will let you ask me about how to prevent electrocution.

This is a bit of effort, but there are simple things you can do to reduce but not eliminate your risk while pregnant by:

  • wash your hands well after changing a child’s diaper or wiping them after toilet use.  Don’t check your phone on the way to the sink; wash first.
  • Do not share drinks or food with your children while pregnant.  Serve them a bite on their plate, not by nibbling on your food.  Cheerfully pour them a fresh cup of what you are drinking.
  • Teach your children to wash their hands well, and encourage hand washing in the adults in your home.

I wash my hands as soon as I enter a family’s home for treatment, regardless of the age of the children.  I don’t know if that mom is pregnant.  She might not know yet either.

Wash your own hands like it meant the future of your unborn child; it could.

Special Needs Kids and Toothbrushing, Part 3; The Sensory-Motor Experience and the Behavioral Strategies that Support Success

Now that you know what issues your child have that made toothbrushing difficult, and you have made brush and paste/rinse choices, it is time to think about the influence of timing, the environment, and the approach to the task.

I often recommend that families practice skills outside of their natural timing.  Let’s face it; running off to school and bedtime are highly charged times of the day.  Almost any child is going to feel it, and certainly any rushed or exhausted parent.  No one is at the top of their game.  Try practice on an off-hour, make it short and if possible follow it up with something fun.  Human beings cannot help but associate events, and if brushing is followed by games or outdoor play, it is going to have a subconscious effect.  I really like the practice concept in “The Kazdin Method for Parenting the Defiant Child”.  Even though most of his techniques are more suited to a slightly older child, the idea that you can practice a skill at a calm time is a great one.  Both parties are in a different mindset.

Think of the bathroom the way a designer would.  No, you don’t have to buy new towels, but you might want to use a dimmer on bright lights and think about the noise the running water makes.  Sensory sensitive and poor modulating kids can be just stimulated enough to push them into irritability. I love the calming power of lavender, and your child might too.  There are children who cannot handle much in the way of scent, and even your plug-in deodorizer irritates them.  Move it out before starting your routine and see if that has a positive effect.  If you are not a sensory sensitive person, you might not even notice how odorous the dryer scent on the towels or the fancy soaps are.  Your child might.

Use softer tones in your voice, especially if there is an echo in your bathroom.  The same reason you sound so good in the shower could be a contributor to your child’s difficulties.  Sound bounces off tile in a different manner, and the lack of sound-absorbing carpeting and draperies could be a factor.  If your child has postural issues and is unsteady or is known to dislike his head tipped back, then re-think your position too.  A child standing on a wobbly stool with his head in your hands and tipped backward is likely to resist.  I know it sounds bizarre, but the first position and technique with a very upset toddler can be to cradle him in your arms, fully supported up to the top of his head, and use those xylitol wipes while terming it “toothbrushing”.  Do the singing, low lights, the whole deal.  You won’t be doing this when he is 12, but sometimes you have to make things really safe and comfortable to move forward.

Put a positive spin on toothbrushing.  Even if this has been a source of stress, your smiling face and positivity can help.  Do your best Oscar-winning performance if you can (another reason to practice on the off-hours).  At the very least, firmness and a sympathetic “Fast Food Rule” type response is useful.  For people who haven’t been reading my blog, that is the cornerstone of Dr. Harvey Karp’s Happiest Toddler on the Block approach.  You want your child to know that you understand what he is saying and feeling, but you don’t necessarily agree that we don’t do toothbrushing.  You acknowledge his aversion and express positivity and how there is something good at the end of the task.  If you are too emotional, even too sympathetic, you risk adding more emotion to the experience, something a sensitive and upset child really does not need.

Some children really love to hear you sing a brushing song, some like to use a sticker reward chart, some like a felt board where they move completed activities to the other side of the board.  It is risky to reward a child for something that is really a daily life skill, but at first some parents give it a try and then fade out the reward.  Every family is different.

This is my final post on the subject of toothbrushing.  I hope this helps some families turn around a common source of frustration and have a better day!

Massage With Your Special Needs Child

When parents hear that I am a licensed massage therapist as well as an OTR, they often ask how massage can help their child.  They seem to assume that I would recommend massage only to calm a child on the spectrum, or help a child sleep.  Actually, massage can be great preparation for getting a child moving as well, and supports focused thinking and communicating.  Massage doesn’t just have to be about relaxation.

Massage techniques range from sedating to invigorating.  Children with low muscle tone are especially helped by quick strokes and moving vibration.  They need more information about where they are in space, and where their muscles are around their joints.

Children with spasticity certainly benefit from stretching and relaxing tight tissue, but the best results are when they get up and move purposely.  Their brains note the changes in posture and range of motion, and build new neural connections for easier and efficient movement. Combining massage techniques with movement is like adding one and one and getting three!

Massage with children on the spectrum can range from quiet to more stimulating, based on their current state.  These children get extra support to learn that touch can be acceptable and enjoyable. Reducing a fear response to approaching touch from another person is a worthwhile goal.

Massage is so many things to children, and can support all the other therapies they receive.  Find a great therapist, and learn how to use massage on your own child to help them grow!

Baby Wearing for Premature Babies

As a nationally certified Happiest Baby on the Block educator, I think that baby wearing is a great way to nurture your preemie, and I approach this topic as I do all the Happiest Baby training: parents need to know why wearing their baby is helpful and why correct technique matters so much.  The government’s Consumer Product Safety Commission has a short list of safety recommendations for baby wearing, but they do not explain why they should be followed nor do they explain the benefits of using wraps or slings for any baby.  There are many websites that either explain all the benefits, sell you products, or help you find a trained educator in your area.  But none seem to take a look at the special needs population.  My guess is that in this litigious age they don’t want to take responsibility for accidental misuse with the most vulnerable population.  Neither do I, but as a professional, it seemed an important topic to cover.  So let me say up front that I am not instructing you on how to wrap your baby or which carrier to use, but I will highlight specific considerations for the parent of a special needs child that wants to use baby wearing safely after they have been cleared by their pediatrician to do so.

The reasons to consider baby wearing are numerous.  The deep emotional connection between adult and baby (dads and caregivers can and probably should try wearing babies), the movement stimulation for balance and self-soothing, and the support for nursing are fairly obvious benefits.  Baby wearing can even help your little one sleep better Baby Wearing For Better Infant SleepThere is substantial research that babies need the stimulation received when moving inside a progressively tighter womb, and even passing through the birth canal.  These experiences are huge sources of tactile, vestibular, and propriocpetive input (touch, movement and pressure) to the sensory system.  Premature birth with a C-section delivery deprives a growing brain of that information.  Preemies have no alternative but to gain more learning outside the womb after birth.  I think baby wearing a preemie correctly and frequently is possibly the most powerful thing that you could do to give them this missing sensory input.

An important but less obvious benefit is that the baby who is worn correctly is one more baby that isn’t resting his head flat on a mat or strapped into a carrier for more than 30 minutes.   As an occupational therapist, I have treated too many toddlers whose infant siblings have been wedged in carriers for my whole session.  Every session.  And they are probably in there much longer and more frequently than those 45 minutes.  When I am the occupational therapist treating a child, the physical therapist and I often struggle to figure out how to get special needs children into safe and dynamic  positions that do not put them at risk for positional plagiocephaly (flat head caused by positioning).  You just cannot do tummy time all day.

The family of a special needs infant can still use baby wearing and foster all those wonderful experiences.  But please consider the following issues and get professional advice if possible:

  • Position your baby tightly, so that she doesn’t slide around as you move.  Recheck and re-position after nursing.  Many wrapping fabrics stretch, so that must be considered.  But tight doesn’t mean compressed.  If your child has a history of respiratory problems, difficulty expanding their ribcage or filling their lungs when lying flat, you really need to clear any tight wrapping with your pediatrician first.
  • Make sure you can see your baby’s face and your baby can see you.  You would never cover her face with a cloth in any other position, and so make sure that the wrap/carrier never covers her face.
  • Preemies and low-birthweight newborns may be too small for the structured front-facing carriers, or take a while to develop the necessary head control.  Use a wrap for a more custom fit, and one that fits both of you well.  Never use a back carrier for a medically fragile infant.
  • Only use the upright or vertical position with their chin up; the cradled or horizontal hold puts a medically fragile or very young child at greater risk for struggling to clear their airway.  A word about seeing your child struggle to breathe: they can be getting less air but not gasping at all!  Compression of their ribcage or airway can be just enough that they slowly become unresponsive.  This means that you watch their face, their color, their respiratory rate, and their activity level.  If you are really tuning into them, you know what “bad” color looks like, and what is normal for them.
  • Baby wrap advocates often recommend the warmth of wrapping, but just like swaddling, you want to match the fabric, your activity level and the length of time you wrap with the environment.  Medically fragile babies lose heat rapidly but they also cannot get rid of excess heat, and sleeping too warm is a risk for SIDS (sudden infant death syndrome). Choose your wrapping based on logic.
  • Think before you move.  Even with a well-wrapped infant, bend from your knees and be very aware of your movements and anything else you carry.  But that is not where movement concerns end with NICU graduates.  Special needs infants can sometimes become overwhelmed with the normal movement of a busy parent, or the common noises of daily life.  Sensory sensitivity doest just disappear once they are out of the NICU.  Some babies just can’t handle being that close to the blender to make your smoothie or listen to lost of talking.  A child who can’t handle the typical stimulation from an all-day wear deserves respect.  Watch for signs that he is shutting out stimulation or becoming fussy after lots of movement or location changes.  Your baby will still get the benefits of baby wearing for shorter or quieter periods, and his tolerance should increase over time.  And don’t fear swaddling, even though some baby wearing sites will show an awful swaddle with the legs jammed together.  A correct swaddle doesn’t restrict any leg movement and is approved by the American Pediatric Association.  Again, if you understand the swaddle and use it correctly, it is as safe as well-planned baby wearing.
  • If you are exceptionally concerned about using baby wearing techniques, ask either your pediatrician or an occupational or physical therapist that works with your child for some advice that pertains to your baby before beginning to use a wrap.

Healthychildren.org Has AAP Tips And An E-zine For Parents

There are so many sites out there, and busy parents aren’t sure what to look at first when researching health issues.  The American Academy of Pediatrics (AAP) has a website with a newsletter and an e-zine that can be a place to start.  They write a monthly newsletter on a wide range of subjects, and the e-zine is published much less frequently but goes into more depth on the issue’s theme.  Their advice sounds like the responses you would receive from your seasoned pediatrician, if they had the time to answer all of your questions.  Sometimes with a fussy child you just need to get in and out before things get truly ugly.

Do not expect in-depth research or much of a mention of alternative health ideas.  This is mainstream medicine.  But they do a nice job of organizing their information and the pieces are short and to the point.  When you have a quick question, that can be enough!

Epigenetics and Infant Development

The Wall Street Journal ran a short piece last week on recent research into epigenetics and the effects of childhood poverty. Alison Gopnik was the author of “Poverty’s Vicious Cycle Can Affect Our Genes”. Some scientists believe that the chronic limited security and support many children experience in poverty changes their genetic makeup to bias them for depression and difficulty handling everyday stress later in life. This is different from saying that you didn’t learn effective coping skills to manage stress, this is saying that your biological ability to deal with stress is impaired by your early experience. And that your altered genes get passed onto your children. And their children. The thought that only poverty affects genetic responses is short-sighted. The effect of interpersonal stressors, absent of poverty, has to have strong effects as well.

If you haven’t heard of the field of epigenetics, then expect to hear about it soon. The study of how our genes change with the effects of our environment and our experiences is new, exciting, and a bit frightening. Simply put, there are scientists working on studying how positive nurturing can change our ability to turn on or turn off genes that control important functions like protecting us from toxins. They are also looking at how exposure to environmental toxins and stress in the womb affect the development of disorders such as autism. Epigenetics is huge.

The WSJ piece reported on the research, and did not offer recommendations for living. But it does make me think that my diet, my exposure to chemicals, and my behavior could change more than my appearance or my attitude. It makes me reconsider my choices for the very long run.

Do Fathers Matter? NYT Reviews the Question

The NYT has reviewed a new book, “Do Fathers Matter” by Paul Raeburn. The assumption is that they make unique contributions to their children’s lives before, during, and after conception.

This book explores the science behind this belief. Some researchers are studying the benefits that come from having involved and caring men in children’s lives. Equally interesting are the effects of paternal age and health at conception. New studies suggest that male health is an important consideration in fertility and risk for a wide range of issues. The effects of a fathers’ parenting style in early childhood to affect behavior in adolescence and adulthood is worth considering. No one doubts this, but seeing the research clarifies why we should care deeply about a father’s role in a child’s life.

This book appears to bring social, psychological and biological research together in a readable form, so I will be eager to take a look this summer!