I remember when my first grandson was born that he cried constantly and was seemingly very irritable. Crying is the way a newborn baby has to express a need, whether the same is hunger or being sleepy.  However, what was really striking in the case of my grandson was that he never shed a tear while crying. This bothered my daughter who repeatedly brought this fact to the attention of the pediatrician.  Truthfully, newborn babies don’t shed tears. Although the tear ducts and glands are working, they produce just enough tears to lubricate and protect a baby’s eyes. Tears start flowing between 1 and 3 months.  Unfortunately, in the case of my grandson, the lack of tears and dry eyes was still apparent after several years. The cause for this wasn’t dehydration or that his tear ducts were blocked, but rather a mutation (NGLY-1) that prevented him from crying. He now has to regularly use lubricant drops as artificial tears.  It seems that my daughter’s concerns had always been right.  This has given me pause to think as to the many times parental concerns may clash with the opinion of a physician.

Having a child with autism increases the risk for younger siblings to develop the condition.  It is therefore usual for parents of at risk babies to be extremely vigilant as to any signs that may confirm such a diagnosis.  Why is my baby not smiling at my face? Indeed, many parents in this situation express some concerns about a lack of social smiling.  However, newborn infants have poor eyesight and little ability to focus beyond 12 inches away. Similarly, the amount of color vision in babies is difficult to judge, and they probably are not able to see subtle differences in color until 2 or 3 months of age. It is only after 6 to 8 weeks of life that babies develop intentional gestures, such as smiling, when they see a face. This is an important milestone, but one your pediatrician will only ask about after your two-month well visit.

A militant approach to diagnosis with early and sometimes multiple interventions usually provides for better outcomes in autism. Shouldn’t we try to improve language development in an at-risk autistic individual before a diagnosis is made?  Would exposure to elements of culture and foreign languages someway enhance cognition?  This view had a popular hold with parents who wanted to develop baby geniuses. Research now suggests that such videos may actually slow down development.  One company sponsored by Disney (Baby Einstein) was forced to recognize their lack of educational value and issue full refunds to all the parents that had bought them (http://www.slate.com/blogs/screen_time/2017/12/19/the_rise_and_fall_of_baby_einstein.html).  (Note: In similar fashion, motor development is not expedited by baby walkers but may rather serve to delay the same. Studies show thousands of children under 15 months of age are injured and treated in emergency rooms every year because of baby walkers. The American Academy of Pediatrics has called for a ban on the manufacture and sale of baby walkers).

In this era of the internet, many parents of at risk babies espouse common fears about nutrition and bowel habits. When should my baby start solid foods?  What about food allergies?  He hasn’t had a bowel movement all day, is it normal?  Solid foods are usually introduced when the baby has good head control and is able to sit well with little support.  The American Academy of Pediatrics recommends exclusive breastfeeding for the first six months of life. Exclusive means no additional food or fluid. Even babies that are exclusively breastfed may develop food allergies to the food the mother eats.

Poop is apparent the favorite subject of parent to talk about regarding their babies. Infants and children can have several BM a day or go for several days without one. Breastfed babies can go for many days, even weeks, without a poopy diaper and the best therapy is to keep breastfeeding them. When should you get worried?

• Constipation since birth
• Weight loss or poor weight gain
• Vomiting
• Dark sticky feces (they may contain blood; the medical term is melena)
• Distended abdomen
• Frequent urinary tract infections

A clinical visit for an at-risk baby may provide an opportunity to answer many questions about vaccines. Do they cause fever? In many cases the answer is yes. It begins within 24 hours of the vaccination and lasts 1 or 2 days. Vaccinations can also result in swelling, redness and pain. The inflammation usually lasts 3 to 5 days.  A delayed reaction can occur with the MMR and Chickepox shots.  Severe allergic reactions are very rare, but can occur with any vaccine.  In these cases symptoms are usually noted within 2 hours of vaccination.

There are several studies suggesting a higher prevalence of febrile seizures in autistic individuals.  Febrile seizures are not caused by high fevers but rather by the sudden elevation in body temperature. Children can have a febrile seizure before you even become aware that they have a fever. Children between the ages of 6 months and 5 years are most likely to experience  febrile seizures. About 40% of children who experience one febrile seizure will have a recurrent seizure. Children at highest risk for recurrence include those:

• Their first febrile seizure at a young age (younger than 18 months)
• Family history of febrile seizures
• A febrile seizure is the first sign of an illness.

As I said before, a child with febrile seizures is at a higher risk for developing epilepsy. The risk may be higher if they have a neurodevelopmental condition. Those interested in obtaining more information can read, “Febrile seizures, epilepsy and autism: Your questions Answered” by Jamie Capal and Autism Speaks (https://www.autismspeaks.org/expert-opinion/febrile-seizures-epilepsy-and-autism-your-questions-answered).