Don’t Hesitate to “Bother the Doctor” During Holidays

CP Family Network Medical Director Giles Manley, M.D., encourages parents to trust their instincts and contact their doctor if something seems wrong with their unborn child or infant over the holidays. He described a recent case where delayed medical intervention resulted in cerebral palsy:

I settled a case recently where a pediatrician sent an infant with severe jaundice home on New Year’s Eve with instructions to the parents to “check back in 2-3 days.” The baby had elevated levels of bilirubin in the blood, which is a sign that the liver is not cleansing the blood like it should, and is a serious condition if not treated quickly. The delayed treatment resulted in brain damage to the child.

So I always remind expectant parents, stand up for your rights as a patient over the holidays. If you think there is an issue with your pregnancy or your newborn baby, don’t let health care providers put off tomorrow what should be addressed today. If your doctor will be out of town, make sure you have his cell phone number and the name and phone number of the doctor who will be filling in for him or her. Then, don’t hesitate to use it if anything seems unusual.

To see a list of symptoms that warrant contacting your doctor, read Don’t Hesitate to “Bother the Doctor” During Holidays.

For more information please visit:

http://www.cpfamilynetwork.org

Cerebral Palsy: Developmental Milestones Birth to 12 Months

By Lee Vander LoopCP Family Network Editor
Many children with cerebral palsy are diagnosed shortly after birth. Others, however, may go months or even years with no diagnosis. Without a diagnosis, valuable early therapies and treatments are delayed.
How is a parent struggling with the question “is my child developing normally?” supposed to tell? If you are concerned, you should not hesitate to talk to your doctor. Trust your hunches. According to research, parental concerns detect 70% – 80% of all disabilities in children. So if your gut is telling you something is not right, chances are, it’s not.
Meanwhile, there are guidelines known as “developmental milestones” to help parents determine whether or not their child is keeping up with his or her peers. These milestones are a set of functional skills or age-specific tasks that most children can do at a certain age range. For children who have suffered a brain injury at birth, however, these guidelines often don’t apply. Depending on the severity and location of the brain injury, some children experiencing developmental delays may be able to achieve milestones only through a variety of therapy and interventions. Others with severe brain injuries may never achieve some developmental milestones.

Signs of Cerebral Palsy in Infants Up to 12 Months

The signs of cerebral palsy vary greatly because there are many different types and levels of disability, but an early indication is a delay in controlling movement of the head or arms and legs. This list of cerebral palsy symptoms, divided by age range, is not comprehensive but serves as a good starting point to determine if your child may have developmental delays. If you see any of these signs, call your child’s doctor or nurse.

• 2 months and older:
  • Have difficulty controlling his head when picked up
  • Have stiff or shaky arms or legs
  • Have stiff legs that cross or “scissor” when picked up
  • Have oral motor difficulties and problems sucking and feeding
• 6 months and older:
  • Continue to exhibit poor head control when picked up
  • May reach with only one hand while keeping the other in a fist
  • Have problems eating and drinking
  • May not roll over without assistance
  • May not be able to push up with their hands when laying on their stomach
• 10 months and older:
  • Crawl by pushing off with one hand and leg while dragging the opposite hand and leg
  • Not be able to sit by himself or herself
• 12 months and older:
  • Not yet crawl or attempt to pull themselves up
  • Not be able to stand with support

Basic Developmental Skills

Cerebral palsy is caused by a problem in the brain that affects a child’s ability to control his or her muscles. Problems in different parts of the brain cause problems in different parts of the body. There are many possible causes of problems, such as genetic conditions, problems with the blood supply to the brain before birth, infections, bleeding in the brain, lack of oxygen, severe jaundice, and head injury. A child who lacks basic motor skills will have difficulty reaching subsequent milestones without help.
The Interdisciplinary Council on Developmental and Learning Disorders Outlines the six basic developmental skills which lay the foundation for all learning and development. Although all children develop at their own rate, growth can be defined in the following areas:

• Gross Motor – Gross motor enables your baby to achieve major milestones such as head control, sitting, crawling, maybe even starting to walk. Children exhibiting a delay in gross motor skills need to be evaluated as early as possible so they can start getting physical therapy to help them strengthen their muscles.
• Fine Motor – These skills allow a child to hold a spoon, or pick up a piece of cereal between thumb and finger. Children exhibiting delays in these skills will have difficulty holding a spoon, manipulating small objects or grasping items between their thumb and fingers.
• Sensory – Sensory skills include seeing, hearing, tasting, touching and smelling.
  A child with a brain injury may have trouble processing information from these senses, a condition known as Sensory Processing Disorder. Normally diagnosed by developmental pediatricians, pediatric neurologists and child psychologists, children experiencing difficulties with sensory processing may exhibit either a “hyper” (over) or “hypo” (under) sensitivity to stimulation of the senses.
An infant with hypersensitivity may:

• Dislike being touched or dressed
• Seem intolerant of normal lighting in a room
• Startle easily at small sounds
An infant with hyposensitivity, may:

• Seem restless and seek stimulation
• Not startle or respond to loud noises
• Language – A child with cerebral palsy may lack the muscle strength in the mouth and tongue to control sounds or may have trouble hearing or processing sound, all of which will delay language. An infant developing normally from birth to 5 months will react to loud sounds, turn her head toward a sound source, watch your face when you speak, make pleasure and displeasure sounds (laugh, giggle, cry, or fuss), and make noise when talked to. Other milestones are listed by the National Institute on Deafness and other Communication Disorders.
• Social and Emotional– Social and emotional milestones are often harder to pinpoint than signs of physical development. A child from birth to 12 months who has trouble processing sensory input or who has poor control of movement because of a brain injury may be delayed in:
  
  • Crying to express distress or to attract attention
  • Fixating on faces
  • Smiling purposefully at certain people (mom, for example)
  • Cooing or laughing to attract attention
  • Playing “peek-a-book” or other game
  • Responding to their own names
  • Developing stranger anxiety
  A full list of both social and emotional milestones is listed here.

An Important Note about Developmental Milestones

Developmental milestones are only guidelines. No two babies are alike and no two develop the same, though most reach certain milestones at similar ages. Every child develops at their own rate. If your child was born prematurely, you will need to look at the guidelines a little differently. Also, all human development depends on environmental stimulation. A child deprived of a loving, nurturing and stimulating environment will experience developmental delays.
Your baby’s physician will evaluate your child’s development at each well-baby visit. Don’t be surprised if the pediatrician tells you not to worry, to be patient, to give your child more time to develop. Often, that’s what parents hear, especially in the early stages of investigating their child’s apparent delays. And it’s often true. Children develop at different rates; the pediatrician is well aware that many children show sudden bursts in development rather than slow, steady growth.
On the other hand, your pediatrician may recommend that a developmental screening be conducted. Its purpose is to see if your child is experiencing a developmental delay. The screening is a quick, general measure of your child’s skills and development. It’s not detailed enough to make a diagnosis, but it will show whether a child should be referred for a more in-depth developmental evaluation.

Resources

You can find a wonderful interactive Milestone Checklist at the CDC, provided by the National Center on Birth Defects and Developmental Disabilities. It details specific developmental accomplishments and allows sharing of forms with other caregivers for their input. http://www.cdc.gov/ncbddd/actearly/milestones/index.html
The American Academy of Pediatrics offers a Parenting website, healthychildren.org: Ages & Stages:
http://www.healthychildren.org/English/ages-stages/baby/pages/Developmental-Milestones-1-Month.aspx
National Library of Medicine, National Institute of Health, Medline Plus, Infant and Newborn development
http://www.nlm.nih.gov/medlineplus/infantandnewborndevelopment.html
March of Dimes, Your Growing Baby
http://www.marchofdimes.com/baby/growing_indepth.html
Center for Disease Control and Prevention, CDC, Child Development
http://www.cdc.gov/ncbddd/child/

Toxic Baby Shampoo Report Stings Johnson & Johnson

By Elisha Hawk

The eyes of Johnson & Johnson executives must be stinging from today’s disclosure that its Baby Shampoo sold in the United States still contains a chemical that releases formaldehyde—a known carcinogen—even though the ingredient has been removed from shampoos sold in other countries.

A report issued by the Campaign for Safe Cosmetics, a coalition of some 50 non-profit health and safety groups, says its latest analysis of J & J’s Baby Shampoo shows the product sold in the U.S., Canada and China still contains quaternium-15, a chemical preservative that kills bacteria by releasing formaldehyde. Formaldehyde was recently added to the U.S. government list of known human carcinogens

The Campaign’s report triggered a statement from J&J that it is phasing out its products with formaldehyde-releasing chemicals in the U.S. and elsewhere. But according to the Campaign, the company already sells formaldehyde- free shampoo in Denmark, Finland, Japan, the Netherlands, Norway, South Africa, Sweden and the U.K.

“Clearly there is no need for Johnson & Johnson to expose babies to a known carcinogen when the company is already making safer alternatives. All babies deserve safer products,” said Lisa Archer, director of the Campaign for Safe Cosmetics at the Breast Cancer Fund.

We agree. Why the delay for U.S. babies? Is it profit? According to the Campaign, J & J’s “organic” brand of its baby Shampoo contains does not contain guaternuum-15 – but it costs twice as much.

I find it reprehensible that a corporation would so callously put infants and small children at risk to sell a little more shampoo. Johnson & Johnson’s reputation is on the line. It should immediately recall all its Baby Shampoo and any other products containing cancer-causing ingredients from around the world and replace them with safer alternatives.

Elisha is a attorney with Janet, Jenner & Suggs and focuses her practice on defective products liability and holding corporations responsible.