Sleep is important to the health of children of all ages. Adequate rest helps to prevent illness, as well as improves mood and behavior. How much sleep does your child need?  How can you help your child get the best sleep possible?  How can you yourself get some sleep as well?  Read on for a better night’s sleep.

• Infants need 9 to 12 hours of sleep during the night and 2 to 5 hours of sleep during daytime hours (naps lasting from 20 minutes to 2 hours).
• Toddlers (1 to 3 years of age) need 12 to 14 hours of sleep over a 24 hour time period, usually a nap after lunch lasting 1 ½  to 3 hours.
• Preschoolers ( 3 to 5 years of age) need 11 to 13 hours of sleep; some need a day time nap and some outgrow the nap at 3 to 4 years old
• School age children (6 to 12 years of age) need 10 to 11 hours of sleep
• Teenagers need about 9 hours of sleep

Signs of sleep deprivation in a child can include:

• Mood.  Sleep deprivation may cause your child to be moody, irritable and cranky. In addition, he/she may have a difficult time regulating moods. Older children may become easily frustrated or be upset more easily. Infants and toddlers may be fussy or have more temper tantrums.
• Behavior. School-aged children who do not get enough sleep are more likely to have behavior problems, such as defiance and hyperactivity. Teenagers who are sleep deprived are more likely to engage in risk taking behaviors, such as drinking and driving fast.
• Cognitive Ability.  Inadequate sleep may result in problems with attention, memory, decision making, reaction time and creativity—all of which are important for school performance. Studies show that teenagers who get less sleep are more apt to get poor grades in school, have more tardiness/absences and fall asleep at school.

Here are some recommendations to help your child get the best sleep, to fall asleep easily, and maintain sleep.

• Sleep schedule. The bed time and wake time should be consistent from day to day, not more than an hour difference from school day to non school day.
• Bedtime routine.  A routine that last 20 to 30 minutes is best. Calm activities, books and reading are best. Avoid activities that require the parent’s presence, like rocking or holding to help the child get to sleep.
• Sleep environment.  Background noises, location, sleep partners, bedding, favorite toys, temperature of the room and lighting can all affect a child’s ability to fall asleep and maintain sleep.
• Sleep only zone.  Remove most toys, games, TVs, computers and video games from the bedroom.
• Caffeine.   Avoid drinks with caffeine after 3 p.m.
• Daytime routines.  Consistent schedules and regular mealtimes and playtimes also help to improve night time routines.
• Exercise.   Daily exercise also helps with initiating and maintaining sleep.
• Naps.  Nap times should be geared to your child’s age and needs. Long naps should be avoided.

Many children have nighttime fears at bedtime and most have these at some age. They are a normal part of development. Children have different fears at different stages of development, for example some young children are afraid of monsters. Young children have difficulty distinguishing the difference between real and imagined.  If your child is having difficulty with nighttime fears, your health care provider can help. Give us a call or come in for a visit.

Sleep or night terrors are common in children. They usually happen 1 to 2 hours after falling asleep and can last for a few minutes to an hour. Children who are having a sleep terror may have their eyes open, usually appear agitated, frightented, some may scream or cry or talk nonsense. Although difficult to watch, the sleep terror for the child is less traumatic than a typical nightmare or bad dream. Most children do not remember a sleep terror the next day.  Sleep terrors are not a sign of a traumatic event or psychological problem. Most children outgrow sleep terrors by adolescence, sleep terrors and sleep walking does often run in families. Stress, a full bladder, fever, illness, irregular sleep schedule, not getting enough sleep, some medications, sleeping in a different or noisy environment can all contribute to sleep terrors.

Contact your health care provider if you child has difficulty falling asleep, snores or experiences unusual awakenings or has sleep problems that are causing disruption during the day.

This blog was written by Genevieve Bastos, CPNP of Richland ProMed Peds. 269 552-2500.  For more information regarding sleep habits, bedtime routines or sleep problems, please call for an appointment.

Resources:  Mindell, JA & Owens JA (2003). A Clinical Guide to Pediatric Sleep: Diagnosis and Management of Sleep Problems. Phildelphia: Lippencott Williams & Wilkins. 

Influenza, commonly known as the flu, is a contagious respiratory disease. Causing mild to severe illness (and sometimes even death), influenza is not “the stomach flu.”

In the U.S., more than 200,000 people every year are hospitalized with flu-related complications, and thousands die. While 90 percent of those who die from influenza are over 65, the flu still poses a serious health threat to kids. From September 2010 through August 2011, there were 115 deaths in children under age 18 due to confirmed influenza. Almost half of those kids were under the age of 5 and had no underlying illnesses or risk factors.

The flu season typically hits our area from November to March (peaking in January and February). The virus is spread mainly through tiny droplets (which become airborne when someone with the flu coughs, sneezes or talks). It’s possible to spread the flu before you know you’re sick. In fact, influenza is contagious one day before symptoms appear until five to seven days after becoming ill. Common symptoms of the flu include:

• Fever (unusually high) and chills
• Headache
• Sore throat
• Cough
• Runny or stuffy nose
• Extreme tiredness
• Nausea and vomiting (more likely in children)

Protection From Infection

Believe it or not, influenza has already been seen in Michigan—so put a flu shot on your to-do list today. The best way to protect yourself and your entire family from infection is to get the proper vaccination. The Centers for Disease Control and Prevention (CDC) recommends that everyone over the age of 6-months-old receives an annual flu vaccination. Getting vaccinated now will allow time for full immunity to develop before the flu season peaks. (Note: There is a small group of people who should not be vaccinated. Talk to your doctor before scheduling a flu shot to make sure you’re not in that group.)

This season’s vaccine protects against three flu strains: two influenza A (H1N1 and H3N2) and a strain of influenza B. There are three types of vaccines available:

• The traditional shot—approved for people 6 months and older. Containing killed viruses, the traditional shot sometimes causes soreness, redness or swelling (where the shot was given) and flu-like symptoms. Remember, these side effects are temporary and mild compared to suffering from a real bout with the flu. When given during pregnancy, the traditional vaccine protects the baby until 6 months of age, when the child can receive the shot.
• The nasal spray—approved for ages 2 to 49-years-old. While the nasal spray contains weakened viruses, it does not cause the flu. Mild and temporary side effects may include runny nose or nasal congestion, cough, fever, headache, muscle aches, abdominal pain and vomiting or diarrhea.
• The intradermal shot—approved for people 18 years and older. The intradermal flu vaccine is a shot that is injected into the skin instead of the muscle. A stronger dose is available for people over 65.

Along with vaccination, following these tips can also help you and those you love stay healthy throughout the flu season:

1. Sing “happy birthday” a lot. Washing your hands frequently with soap and water for at least 20 seconds (about the time it takes to sing “happy birthday”) reduces the spread of germs. 
2. Practice sneezing and coughing etiquette. To avoid spreading germs, cover your nose and mouth with a tissue or shirtsleeve when sneezing or coughing.
3. Keep it clean. Keep kitchen counters, bedside tables, bathroom surfaces and toys clean with a household disinfectant.
4. Schedule a sick day. If it’s at all possible, stay home from work (or school) if you have the flu.
5. You are what you eat. Eat a healthy, well-balanced diet rich in vitamins A, C and E. Foods that can boost the immune system include milk, eggs, citrus fruits, vegetables and nuts.
6. Get your z’s. Without proper sleep, you increase your odds of getting sick. Adults need at least seven hours of sleep per night (children need more).
7. Just relax. Find ways to reduce stress, including exercising, listening to music, practicing yoga, meditating or reading.
8. Kick the smoking habit. Smoking kills the fibers in your nose and lungs that help prevent mucus from clogging these airways. Breathing secondhand smoke is also unhealthy for those around you, particularly children.

About Medication

For the very ill or those at higher risk for complications, medications are available to relieve flu symptoms. Those who should seek treatment include:

• Children under 5 (especially under 2)
• People over 65
• Pregnant women and women who have recently given birth
• People with chronic conditions like asthma, or heart, lung or kidney disease
• People with weakened immune systems (such as those with cancer, diabetes, chronic infections and individuals on continued steroid therapy)
• People under 19-years-old who are on long-term aspirin therapy 

Medications, which work best if started within 48 hours of the start of symptoms, may shorten the time you are sick and can prevent complications. Side effects may include nausea and vomiting, and in children, confusion and abnormal behavior.

Lisa Kanwischer, P.A., is a certified physician assistant at ProMed Pediatrics.  For an appointment or more information, call ProMed Pediatrics in Richland at (269) 552.2500 or the Woodbridge location in Portage at (269)329-0944.

It may be nearing the end of summer in Michigan, but there’s still a great deal of discussion out there regarding sunscreen and its labeling.

In June of this year, the FDA modified its sunscreen labeling regulations. Unless they meet the FDA testing standards for protection against ultraviolet A (UVA) sunlight, sunscreens can no longer be labeled “broad spectrum.”

Protection against UVA is not included in the sun protection factor (SPF) number. While SPF has been the gold standard for conveying the strength of sunscreens, this number only looks at the sunscreen’s protection from UVB rays. However, overwhelming evidence shows that UVA radiation also contributes to early aging of the skin, as well as skin cancers like basal cell and squamous cell carcinoma, and melanoma. Only sunscreens that meet both UVA sun protection standards and have a UVB SPF of 15 or higher can be labeled as “broad spectrum,” and claim they protect against skin cancer and early skin aging.

Combined with these new standards, the FDA has banned the use of terms like “waterproof,” “sweat-proof” and “sunblock,” as sunscreen cannot actually provide these benefits. Instead, “water resistant” or “water resistance” can be used if the duration of the effect (either 40 or 80 minutes) is specified. Because their application differs from that of creams, oils and lotions, spray sunscreen formulations must also now provide additional information. These new regulations and labeling guidelines will begin in 2012 and 2013.

Physicians see these changes as long overdue, as they allow consumers to become better informed when making sunscreen choices. Regardless of the type chosen, it’s important to emphasize that sunscreens are effective for only two to three hours and must be reapplied often. Sunscreens should also be used with other protection measures, including wearing appropriate clothing and hats, limiting outdoor activities during peak hours of UV intensity, restricting activities to shaded areas, and wearing sunglasses.

Prevention Through Protection

Sun-protective practices for infants and children have been endorsed by the American Academy of Pediatrics (AAP) and American Academy of Dermatology (AAD). The skin of infants is thinner and more sensitive to the sun than the skin of older children. To protect your kids (no matter their age) from the sun, follow these recommendations:

• Remember, avoidance is the best way to protect your infant/children from the harmful effects of the sun. For babies under 6 months of age, try to keep them in the shade and out of direct sunlight. If they have to be in the sun, use sunscreens, longer clothing and a hat with a brim. When adequate clothing and shade are unavailable, a sunscreen with an SPF of 15 or higher should be applied to areas of skin (e.g., face, back of hands) of all children, including children younger than 12 months of age.
• Keep in mind, dermatologists recommend sunscreens with an SPF of 30 or higher. This is also the recommendation of the AAP and AAD, even though the FDA hasn’t approved sunscreen use for those under 6 months of age.
• There are no reported harmful side effects from today’s sunscreens. However, it’s a good idea to use sunscreens that don’t irritate the skin and/or eyes. Look for broad-spectrum, unscented brands with ingredients like zinc oxide and titanium dioxide, which tend to be less irritating and ideal for infants.
• Apply sunscreen early and often. You should apply sunscreen to your child 30 minutes before exposure to the sun, and then reapply the sunscreen every few hours. No sunscreen is waterproof, and must be reapplied at least every 90 minutes to two hours, particularly if your child spends a lot of time in the water.
• Protect your child’s lips, nose and eyes by applying a lip coating that contains sunscreen. If the nose (or some other area) has been repeatedly burned during the summer, cover it with zinc oxide or titanium oxide ointment. Protect your child’s eyes from the sun’s rays with good sunglasses.
• If your child has red or blonde hair, fair skin, and/or never tans, he/she is at higher risk for sunburn. These children need to use a sunscreen even for brief exposures and should avoid the sun whenever possible. Keep them out of the sun during the peak hours of 10 a.m. to 3 p.m., when the sun’s rays are the most intense.

Hazy or Bright, The Sun Harms Young and Old

Young or old, everyone is at risk for sunburn and its associated complications. The incidence of skin cancer continues to rise, occurring in younger and younger age groups. Since most skin damage happens in childhood, kids especially need to be protected from the sun’s burning rays. Sun exposure early in life increases the number of moles with genetic mutations (potentially leading to cancer). UV radiation exposure during the first year of life can have especially damaging long-term effects.

Think the sun is only dangerous when it’s bright out? Wrong. The harmful UV rays of the sun are invisible. Because he/she may feel cooler, and therefore, stay outside longer, your child may be exposed to more UV rays on foggy or hazy days. Exposure is also greater at higher altitudes. UV rays reflect off sand, water, snow and other surfaces, so even a big hat or an umbrella doesn’t offer absolute protection.

Relief for Sunburns

No matter how diligent we are about protection, most of us will suffer at least one sunburn during our lifetime. Leaving the skin pink/red, warm and painful, sunburns are typically first-degree burns. Prolonged sun exposure can cause blistering and a second-degree burn. In severe cases, sunburns can cause blistering, fever, chills, headache and a general feeling of illness.

If your child’s burn is minor (i.e., red, warm and painful), you can most likely treat it yourself using the following methods:

• Ibuprofen: Start ibuprofen (Motrin) or acetaminophen (Tylenol) for pain relief as soon as possible. Ibuprofen also treats the swelling from a sunburn. You may continue giving your child Motrin or Tylenol for two days.
• Steroid Cream: Apply 1-percent hydrocortisone cream as soon as possible. Use the cream three times a day for two to three days.
• Cool Baths: Apply cool compresses to the burned area several times a day to reduce pain and burning. To avoid a chill, limit cool baths (for larger sunburns) to 10 minutes. If possible, avoid using soap.
• Extra Fluids: To replace fluids lost and prevent dehydration, offer extra water during the first day of the sunburn.
• Blisters: Do not touch or attempt to treat blisters to prevent infection.
• Antibiotic Ointment: For large, open blisters, apply an antibiotic ointment.

Pain will usually stop after two or three days. Your child’s skin may peel at the site of the burn between day five and seven. If the pain becomes severe, the sunburn looks infected,  or your child develops a fever or becomes ill, call your doctor or seek medical attention.

A Seagull Named Sid

When it enlisted the help of a cartoon seagull named Sid, Australia created an effective public-health campaign. Sid encouraged Aussies to “Slip, Slop, Slap.” The message encouraged people of all ages to slip on a shirt, slop on the sunscreen and slap on a hat to protect themselves from the sun’s harmful rays. Today, the message now includes “Seek Shade” and “Slide on Some ‘Sunnies’” (an Australian term for sunglasses). The Slip, Slop, Slap, Seek, Slide message is a catchy way for you to teach your family how to stay safe from the sun.

Thomas Akland, DO, is a board-certified pediatrician. For an appointment or more information, call ProMed Physicians-Pediatrics in Portage at (269) 329.0944.

Common in children and infants, eczema (atopic dermatitis) is a chronic and recurrent condition of the skin caused by hyper-sensitivity (immunoglobulin E-mediated response). Children with eczema typically have family members who have a history of allergies, asthma or eczema. Those with eczema are more prone to skin irritation, dryness, barrier abnormalities and infections. While some little ones will only have eczema during their childhood years, others will continue to have symptoms into adulthood.  

Key triggers for eczema include fabrics (especially wool), foods, alcohol, exposure to dry, cold weather, or very hot, humid conditions that cause sweating. Children with eczema have higher incidences of allergies and asthma. In 30 percent of infants with eczema, certain foods will lead to “flare ups.” Eczema can be mild, itchy, dry and localized or severe and extensive. Severe cases may be accompanied by unrelenting itching, sleepless nights and secondary bacterial infections.

Skin affected by eczema is usually dry and itchy, with red or salmon-colored patches. Known as the “itch that rashes,” eczema is often found on the neck, creases of the elbows and knees, ankles, wrists, and hands. The more a child itches, the worse the rash can become. Substances like perfumes, as well as dyes in lotions, moisturizers, soaps and detergents, can exacerbate the condition. If itching is very severe, open sores and infection can occur.

About Bathing

Keeping the skin clean is an important part of managing eczema. Luke-warm bath water is best. Because it helps remove crusts and irritants, provides pleasure, relieves stress and hydrates the skin, bathing should not be restricted. As an alternative to oral antibiotics and to decrease the possibility of secondary infections, some doctors recommend giving a bleach bath. (Only use one to two teaspoons of bleach in a tubful of water.)   

After bathing, towel dry and apply moisturizers or ointments within minutes. Lubriderm, Nivea, Aveeno, Cetaphil, Eucerin or Vaseline Intensive Care are ideal options. Above all, stick with moisturizers and lotions that are free of dyes and perfumes. If moisturizers aren’t enough, or there are red, dry patches, try applying an ointment (e.g., Vaseline or Aquaphor) twice a day. 

Preventing Infection

• Keep fingernails cut short
• Discourage scratching (it is okay to rub with the pads of the fingers)
• Cover “problem areas” at night
• Use Benadryl or Atarax at night to help prevent itching, which can lead to secondary infections

Medications

• For mild eczema, over-the-counter hydrocortisone or itch-x can be used (available in 1/2 or 1 percent ointments and/or creams). Administer these once or twice a day. Stop when the skin looks clear. If symptoms don’t improve within a week, take your child to his/her primary health care provider for a visit. 
• For severe eczema, a health care provider can prescribe a stronger steroid cream or ointment. Keep in mind: long-term use of stronger steroid creams may cause thinning of the skin. Steroids should be administered in small amounts, as directed by your child’s provider.
• Other medications, such as Protopic or Elidel, may be used to block the inflammatory response caused by eczema. If your child has severe and/or chronic eczema, discuss these drugs with his/her provider.

Allergies

Allergies can make eczema flare up. If your child has seasonal allergies, his/her eczema may be worse during that season. If you notice that foods, clothing or detergents irritate your child’s skin, eliminate them. Common food triggers for eczema include eggs, milk, milk products, soy, peanuts and other nuts, wheat, and chocolate. Environmental irritants include dust, mold, stuffed toys, wool clothing or blankets, pets, feathers, some soaps and perfumes.

To Learn More

Children with severe and/or chronic eczema may benefit from an allergy/dermatology referral. To learn more about managing your child’s eczema, visit:

• www.nationaleczema.org
• www.webmd.com/skin-problems-and-treatments/eczema/default.htm

Genevieve Bastos, MSN, is a certified pediatric nurse practitioner (CPNP). For an appointment or more information, call ProMed Physicians-Pediatrics in Richland at (269) 552.2500.

Primary Characteristics

Autism results from a type of abnormal brain development. The main features of autism include poorly developed social interactions, difficulties with speech and communication, and repetitive and restrictive behaviors. Generally, these features are present before a child is 3-years-old.

Parents of autistic children often notice normal development at first, but then sudden regression. The regression in the development of autism is an expected aspect of the disorder.

Other Characteristics

While it isn’t always the case, autistic children usually have mild to severe cognitive impairments (developmental delays and mental retardation). They might also exhibit significant sensory symptoms, including eating disorders. Many children with autism suffer with heightened anxiety, with or without obsessive-compulsive behaviors (e.g., lining up toys in a strict row). Attention deficit hyperactivity disorder (ADHD) and learning problems are more prevalent in autistic kids than in the general population. Temper tantrums and moderate-to-severe behavioral problems (sometimes including the destruction of property) are common as well.

Other features may include:

• Poor eye contact and facial recognition
• Distress from loud noises
• Failure to point at things that should offer interest
• Finger, hand or arm flapping, especially when excited
• Repetitive or rocking behaviors
• Increased incidence of seizures with regressions in speech and other areas of development
• Insomnia
• Motor and vocal tics (signs of Tourette syndrome)
• Narrowly focused interests, sometimes with the ability to greatly excel in the specific area of interest (i.e., “savantism”)

Since the signs of autism are highly variable, these secondary features aren’t seen in all autistic individuals. However, when they are present, these characteristics frequently create challenges.

Social Development

The social problems experienced by autistic patients may begin quite early and progress with the child’s development. Poor eye contact and lack of facial recognition may show up in infancy. There may be perceived attachment difficulties. Children may fail to turn to things pointed out to them. A child may have severe tantrums and act aggressively toward others.

Recognition of social cues may not develop on time. For example, the autistic child may not understand the concept of taking turns or rules for games. Autistic kids may not share well with others, and often have trouble making and keeping friends. As they gain awareness of their differences, autistic children can become very lonely.

Communication Problems

Difficulties in speech and communication may also show up quite early. Autistic children may fail to recognize their own name by 10 months of age. There may be delays in babbling or gesturing (e.g., pointing or waving bye-bye) until after 12 months. Normal back and forth in vocalizations between parent and child may not be present. There may be no single words until after 16 months and no two-word phrases uttered independently until after 24 months. Delay in language development is a serious warning sign, as is the regression of language or social skills at any age.

Autistic children may repeat what others say without meaningful interaction. They may mix up pronouns, or talk nonstop and repetitively about an area of narrow interest without pause or meaningful two-way conversation. Typically, they don’t understand jokes or sarcasm. Autistic kids frequently just “don’t get” other people, leading to difficulties in making friends.

Repetitive Behaviors

The repetitive behaviors of autism may have many manifestations, such as rocking back and forth, or finger/hand/arm flapping.

Autistic children may strongly dislike change in routine, preferring ritual and sameness. They can be compulsive, lining toys up or drumming fingers or spoons. Sometimes autistic children injure themselves with behaviors like repetitive head banging or picking at their skin.

Sub-Types of Autism

Asperger’s syndrome is a sub-type of autism in which speech and cognitive (thinking) difficulties are not as severe. As a group, patients with Asperger’s are found to have a higher level of functioning. Pervasive developmental disorder (PDD) is a term reserved for children who have many of the features of autism, but who do not meet strict criteria.

Incidence

The incidence of all forms of autism combined in the U.S. is now observed to be about 1 in 110 children, representing a significant rise over the last few generations. This perceived increase in incidence might be due to better techniques for recognizing the disorder or factors not yet identified (or perhaps both of these reasons).

Causes

While the exact cause of autism is unknown, progress has been made in understanding its roots. Most likely, there isn’t a single cause, but rather, autism should be thought of as a final common pathway that is entered by a variety of means.

For example, it is likely autism has a strong genetic component (there is increased incidence within family units and in twins). With greater detail possible from gene mapping, an increasing number of autistic children have been shown to have one of a variety of genetic defects. Abnormalities in specific genes reveal deletions (a copy or copies of the gene are missing), duplications (there are extra copies of the gene on one or more chromosomes) and inversions (the gene is basically upside down on the chromosome). These defects can be found in autistic patients for an increasing number of genes.

Some toxins, including lead and other heavy metals, and ingestion of alcohol and certain seizure medications during pregnancy, have also been implicated as possible causes of autism. Fetal alcohol syndrome patients seem to share many behavioral features with autistic patients.

The theory that some vaccines or their preservatives cause autism has been thoroughly and completely ruled out. According to an article published in The Wall Street Journal in January 2011, the original research implicating vaccines as a cause of autism was fabricated by a British scientist who was subsequently stripped of his medical license.  Many of the other original authors have withdrawn their names from the study and The Lancet  (the medical journal where the study was published) has issued a formal retraction. The damage to the reputation of vaccines and the resulting public health problems are truly unfortunate.

An older theory that autism is caused by cold-hearted, unfeeling mothers has also been debunked. Parents of autistic children are typically kind, caring and concerned people who love their kids very much.

The Importance of Early Screening

On average, kids in the U.S. are officially diagnosed with autism at around 5 or 6-years-old.  However, many autistic children are formally diagnosed even later. Because the earlier the diagnosis, the better the outcome, the American Academy of Pediatrics recommends an autistic screening for all children at their 18 and 24-month or 30-month physical examinations.

When autism is suspected, children should be tested with an age-appropriate screening tool (regardless of their age). Psychologists trained in diagnosing autism should complete extensive follow-up testing if screening tests show any signs of the disorder.

The Value of Treatment

Placing a child in an intensive special education program with personnel specially trained to teach autistic children is one of the most valuable and important treatment options. Special education programs may offer applied behavioral analysis (ABA), structured teaching in very small classroom settings, frequent and intensive speech therapy, occupational therapy, social skills classes, play therapy, and counseling. If the school doesn’t provide complete services

or is unable to offer services on a regular basis, parents might wish to consider evaluating a private center for autism (e.g., The Envision Center in Battle Creek).

Currently, there are only two medications approved by the U.S. Food and Drug Administration (FDA) to treat autism: Abilify and Risperdal. Both of these drugs are powerful anti-psychotic medications that have side effects. They are generally used in autistic children to help control aggression and severe behavioral problems. Abilify and Risperdal may stabilize mood, decrease anxiety and depression, alleviate motor and vocal tics, and improve sleep. As with all medications, your health care provider should help you weigh the risks and the benefits.

Other medications may sometimes be used in a targeted fashion to treat specific, associated conditions (called co-morbidities). For example, ADHD is treated with ADHD medications. Non-stimulants, such as Strattera and Intuniv, are preferred for the treatment of ADHD symptoms in autistic patients, as stimulant medications (e.g., Ritalin and Adderall) can sometimes make anxiety worse.

Autistic children also have an increased incidence of depression and may require specific medication to treat this aspect of the disorder. Antidepressants like Prozac, Celexa and Zoloft are used most commonly for depression, as well as moderate-to-severe difficulties with anxiety and obsessive-compulsion problems. Melatonin and Clonidine may be used to relieve insomnia.

Outcomes

Predictors of better outcomes include early age at diagnosis, IQ above 50 and acquisition of language by 6 years of age. Most autistic patients will need significant help befriending others, holding down a job and living semi-independently. However, the range of outcomes is broad, from requiring full-time institutional care to living in a more sheltered environment to becoming a fully functional member of society. Each autistic child needs and deserves intensive, personalized therapy, so that he/she can reach his/her maximum potential.

For more information on autism, or to make an appointment with Eric Slosberg, MD, call ProMed Physicians-Pediatrics at (269) 552.2500.