Autism Linked to Being Firstborn, Breech or Moms 35 and Older Giving Birth

Children who are firstborn or breech or whose mothers are 35 or older when giving birth are at significantly greater risk for developing an autism spectrum disorder, University of Utah School of Medicine researchers have reported in a new study with Utah children.

In the April 27, 2009, online issue of the journal Pediatrics, the researchers showed that women who give birth at 35 or older are 1.7 times more likely to have a child with an autism spectrum disorder (ASD), compared with women between the ages of 20-34. Children diagnosed with ASD also were nearly 1.8 times more likely to be the firstborn child, the researchers found.insert beginning span tag hereAlthough they didn't identify a causal relationship between breech births and autism, children diagnosed with the disorder were more than twice as likely to have been a breech presentation, meaning they were not born head first.

"The results of this study give us an opportunity to look more closely at these risk factors for children across the autism spectrum, and not only those diagnosed with autism," said first author Deborah A. Bilder, M.D., assistant professor of psychiatry. "This shows that further investigation of the influence of prenatal factors is warranted."

Autism is a complex brain disorder that impairs social, communicative, and behavioral development and often is characterized by extreme behavior.

Bilder and her colleagues in the U medical school's department of psychiatry and the Utah Department of Health examined the birth records of Utah children who had been identified as having an autism spectrum disorder in a 2002 epidemiological study by the U.S. Centers for Disease Control and Prevention (CDC). That study looked at 8-year-old children in Utah's three most populous counties--Salt Lake, Davis, and Utah--and used nationally accepted criteria for an ASD classification. The researchers compared birth records for children identified with an ASD with unaffected children born in those three counties in 1994. Of that group, 196 were identified with an ASD. Birth certificates were available for 132 of those children, and the researchers examined those records for possible prenatal, perinatal, and neonatal risk factors related to ASD.

Their investigation showed that the mother's age when giving birth (older than 34), breech presentation, and being firstborn were significant risk factors for the development of an ASD. The researchers also identified a small but significant relationship between the increased duration of education among mothers of those children.

Further investigation would be needed to understand how these three risk factors may relate to ASD. But a possible explanation for the correlation of firstborn children might be that parents are reluctant to have a second child if the first is diagnosed with ASD. A possible interpretation of increased risk associated with advanced maternal age is that changes in genes occurring over time may contribute to autism spectrum disorders. The association found between breech presentation and ASD most likely indicates a shared cause, such as neuromuscular dysfunction. The vast majority of children born breech, however, are healthy.

This study follows several from the University in recent years, which found that Utah has one of the highest autism spectrum disorder rates in the country (one in 133 Utah children has the disorder), helped indentify a gene that may predispose people to autism, and showed that Utah adults with autism have a better quality of life than those in other studies.

For the next step in their research, Bilder and her colleagues want to repeat this study, using a larger population of Utah 8-year-olds from subsequent birth years, to see if it replicates the results of the current study. They also may study the subset of children with breech presentation to determine whether they haven a genetic vulnerability that put them at increased risk for developing an autism spectrum disorder.

The study's other authors are Judith P. Zimmerman, Ph.D., research assistant professor of psychiatry; Judith Miller, Ph.D., associate professor of psychiatry; and William M. McMahon, M.D., chairman of the Department of Psychiatry.

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Lack of Food Variety Puts Kids with Autism at Risk for Poor Nutrition

The strong preference kids with autism have for certain foods places them at risk for nutritional deficiencies because their diets lack sufficient variety, according to research presented at this year's Pediatric Academic Societies meeting in Baltimore.

Researchers said screening children for the amount of variety of food in their diets may be a good clinical marker to predict which children might be at risk for nutrition problems. Kids with low food variety scores who are at risk could then be referred to dieticians or therapists to help them expand food choices and improve nutrition, said Michelle Zimmer, M.D., lead investigator and a pediatrician in the division of Developmental and Behavioral Pediatrics at Cincinnati Children's.insert beginning span tag hereThe study is one of two presented by Dr. Zimmer and colleagues this year at PAS that deal with autism, the second one showing that the red blood cells of children with autism have low levels of a fatty acid linked to cognitive function. This finding, the researchers report, warrants further research into how the low fatty acid levels may trigger biochemical changes in the brain linked to autism.

The team found that levels of docosahexanoic acid and total omega-3 fatty acids were significantly lower in the red blood cells of autistic children than in normally developing children. Omega-3 fatty acids are nutritionally important substances considered vital to the normal development of children.

Evidence of abnormal fatty acid metabolism in children with autism runs counter to at least one previous study that suggested no difference between normally developing and autistic children. The different results between studies may be explained by the current research focusing on an older group of children, Dr. Zimmer said.

"The fatty acid docosahexanoic is linked to other mental health issues, and this raises questions about whether there are functional issues in neural cells involving a deficiency of essential fatty acids," said Dr. Zimmer. "The main point of the study is we cannot rule that fatty acids are part of the story of what is going on with kids who have autism."

Dr. Zimmer said its possible older children with autism have had more time to use up their bodies' stores of omega-3 fatty acids and are unable to replenish those stores. The 21 children with autism in this study were between the ages of 3 and 18 years, as were the 20 age-matched normally developing children and 10 if their siblings who served as control subjects.

The research team is conducting a larger study with more children to verify its PAS findings. Dr. Zimmer said another study is also under design to give essential omega-3 fatty acids, such as docosahexanonic acid, to children with autism to see what impact it has on brain chemistry and/or the disorder.

Increasing foods rich in omega-3 fatty acids in the diets of autistic children has been suggested by some researchers as potentially beneficial, Dr. Zimmer said. Although doing so would not have a negative impact on the children, until studies are conducted it isn't known what affect, if any, it might have, she added. Also, given the findings of the previous study on the lack of food variety among kids with autism, augmenting their diets could be challenging.

Most of the 19 autistic children in the food study had much lower food variety scores in their diets than typically developing children. A majority of the children with autism also suffered from nutritional deficiencies. The researchers concluded children with autism and low food variety scores are at risk for mild and serious nutritional deficiencies.

Researchers participating in studies were from the division of Developmental and Behavioral Pediatrics and division of Neurology at Cincinnati Children's. Researchers from the department of Pathology at the University of Cincinnati participated in the study on food variety.

The PAS meeting is the largest international meeting focused on research in child health. It is sponsored by the American Academy of Pediatrics, the American Pediatric Society, the Society for Pediatric Research, and the Ambulatory Pediatric Association.

Cincinnati Children's Hospital Medical Center is one of America's top three children's hospitals for general pediatrics and is highly ranked for its expertise in digestive diseases, respiratory diseases, cancer, neonatal care, heart care and neurosurgery, according to the annual ranking of best children's hospitals by U.S. News & World Report. One of the three largest children's hospitals in the U.S., Cincinnati Children's is affiliated with the University of Cincinnati College of Medicine and is one of the top two recipients of pediatric research grants from the National Institutes of Health. For its achievements in transforming healthcare, Cincinnati Children's is one of six U.S. hospitals since 2002 to be awarded the American Hospital Association-McKesson Quest for Quality Prize (r) for leadership and innovation in quality, safety and commitment to patient care. The hospital is a national and international referral center for complex cases, so that children with the most difficult-to-treat diseases and conditions receive the most advanced care leading to better outcomes. Additional information can be found at www.cincinnatichildrens.org.

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Most Popular: Task Force Recommends Screening Adolescents for Clinical Depression

Adolescents should be screened for clinical depression, but only when appropriate systems are in place to ensure accurate diagnosis, treatment and follow-up care.  Clinical depression is an important cause of poor health and lower quality of life among children and adolescents.  Depression can cause difficulties in school and disruptions of family and social relationships

"Depression in adolescents has a significant impact on both mental and physical health, and adolescents with depression have more hospitalizations for psychiatric and medical issues than adolescents who are not depressed," said Task Force Chair Ned Calonge, M.D., who is also chief medical officer for the Colorado Department of Public Health and Environment.

Depressed children and adolescents are at an increased risk of suicide, which is the third-leading cause of death among people age 15 to 24 and the sixth-leading cause of death among those age 5 to 14. Adolescents suffering from clinical depression are also more likely to suffer from depression in early adulthood.

From the article:

The U.S. Preventive Services Task Force now recommends screening adolescents for clinical depression only when appropriate systems are in place to ensure accurate diagnosis, treatment and follow-up care. This applies to all adolescents 12 to 18 years of age. In a separate recommendation, the Task Force found insufficient evidence to assess the balance of benefits and harms of screening children 7 to 11 years of age for clinical depression. The recommendations and the accompanying summary of evidence appear in the April issue of Pediatrics.

The Task Force reviewed new evidence on the benefits and harms of screening children and adolescents for clinical depression, the accuracy of screening tests administered in the primary care setting and the benefits and risks of treating clinical depression using psychotherapy and/or medications in patients 7 to 18 years of age. Clinical depression is an important cause of poor health and lower quality of life among children and adolescents. Depression can cause difficulties in school and disruptions of family and social relationships as well as diminished quality of life.

"Depression in adolescents has a significant impact on both mental and physical health, and adolescents with depression have more hospitalizations for psychiatric and medical issues than adolescents who are not depressed," said Task Force Chair Ned Calonge, M.D., who is also chief medical officer for the Colorado Department of Public Health and Environment. "It is important that adolescents are diagnosed and treated for clinical depression in order to improve their health and quality of life, especially if they have a family history of depression."

There is adequate evidence that treating adolescents with selective serotonin reuptake inhibitors (SSRIs), psychotherapy or combined therapy (SSRIs and psychotherapy) result in decreased clinical depression symptoms. Treating clinically depressed youths with SSRIs is associated with an increased risk of suicidality (suicidal thoughts, preparation and attempts of suicide) and, therefore, should only be considered if careful clinical supervision is possible.

Depressed children and adolescents are at an increased risk of suicide, which is the third-leading cause of death among people age 15 to 24 and the sixth-leading cause of death among those age 5 to 14. Adolescents suffering from clinical depression are also more likely to suffer from depression in early adulthood. Nearly 6 percent of adolescents 13 to 18 years of age are clinically depressed, and it is more common among girls than boys.

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Caution Urged When Giving Kids Cold and Flu Meds

It's cold and flu season, which means misery for kids and the parents trying to help them. But doctors are asking parents to resist the urge to give children under the age of 6 over-the-counter cough and cold medication.

Such drugs can have serious side effects on the smallest of children, the Food and Drug Administration warns. Side effects include hives, drowsiness, difficulty breathing and even death.

"Some 7,000 children end up in the emergency room each year because of problems associated with these medicines," says Esther Yoon, M.D., general pediatrician in the Department of Pediatrics and Communicable Diseases at the University of Michigan Health System.

Roughly two-thirds of incidents occurred after children drank medication while unsupervised, according to the Centers for Disease Control and Prevention. Most problems have occurred as a result of dosing errors.

To ease pain from a harsh cough or throat pain, doctors recommend using over-the-counter acetaminophen and ibuprofen in age-appropriate doses, Yoon says.

To relieve symptoms, doctors recommend the following:

• For blocked noses, parents should use nasal saline drops and a bulb suction to loosen up and remove mucus or have the child blow their nose.
  
• For coughs, the child should be given a teaspoon of honey or corn syrup if over the age of 1. Have the child drink warm fluids like water, apple juice and chicken broth to help with coughing.
  
• Take the child into the bathroom and run a hot shower. The steam relaxes the airways and helps with coughing spasms.
• Increase the humidity in the home to help reduce nasal congestion and coughing.

Parents can help prevent colds by washing hands frequently, using instant hand sanitizers, teaching children to cover their mouth and nose when they cough or sneeze, and making sure children are well hydrated, have good nutrition and are getting enough sleep.

"Other good tips include disinfecting the home, kitchen countertops, door knobs and toys," Yoon says. "Children should get plenty of vitamin C and E to help fight germs and a multivitamin is also helpful."
Cold symptoms caused by a virus typically last between four and five days. But if they continue for more than five days, Yoon recommends taking the child to a doctor.

If a child is having difficulty breathing or is wheezing, he or she should be seen right away. Infants younger than 3 months old with a fever should also be seen right away.

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