What to Expect the Toddler Years (256 page)

Allergy shots for ragweed and possibly for other allergens. These can significantly reduce asthma symptoms, but are rarely appropriate for toddlers.

A nutritious diet (excluding potential triggers, of course) and an adequate fluid intake.

Recent research suggests that the use of intravenous immunoglobulin (IVIg) from nonasthmatic donors may be able to greatly reduce the need for steroids in children, and may even eliminate it entirely.

Once asthma symptoms flare, keep calm (as you become more experienced, this will be easier) and administer medication as instructed. If your child fails to respond to the medication as expected, head immediately for the doctor’s office (if the doctor is available) or the emergency room.

Prognosis.
Many children with mild asthma (fewer than three episodes a year) and many of those who develop asthma after age three “outgrow” the condition by late adolescence. Such a remission is less likely among children with moderate to severe disease. But even when asthma continues into adulthood, most asthmatics with good medical care can function normally in their chosen endeavors (including professional athletics).

What is it?
A condition that is part of a group of developmental disorders called Autism Spectrum Disorders (ASDs) that also include Aspergers Syndrome and Pervasive Developmental Disorder (PDD). Affected children display: a repetition of words they’ve heard elsewhere, such as from TV or books; an inability to interpret nonverbal communications (such as an angry voice or a big smile); markedly restricted interests; impaired social interactions (they don’t respond to verbal or physical overtures from others, and may resist physical contact—though some are inappropriately affectionate with strangers or may form an exclusive attachment to their mother); inappropriate behavior (some, for example, like to smell everything they encounter); and limited or intermittent eye contact (but they may gaze into space for hours on end). Autistic children may also be unable to respond to commands or carry out tasks; they may appear to be deaf even when their hearing is clinically fine. They often play with toys in ways other than the intended mode of play. They might be fascinated with parts of objects, such as a tag on a shirt. They tend to engage
less in imitative play and show little imagination. Head banging and self-biting to the point of injury, screaming, and other kinds of frenzied behavior, such as frequent and intense tantrums, are not uncommon. Autistic children often dislike loud noise, but are fascinated by many visual stimuli (a moving fan, for example). They are often described as remote, joyless, unreachable, unfeeling.

The autistic child sometimes appears to function as if other humans do not exist—parents may seem to matter little more than a broom or a chair. Sometimes it is clear early in infancy that something is wrong (the baby doesn’t focus on faces or babble or coo, for example); at other times, subtle signs are present (such as no pointing by 12 months) but the condition is not detected until later. Almost always, symptoms surface before the age of 30 months.

How common is it?
An estimated 1 out of every 150 children is diagnosed with an autism spectrum disease.

Who is susceptible?
Autistic children come from all backgrounds and ethnic groups but are four times more likely to be boys. Autism is more common in siblings of autistic children (1 in every 15). The American Academy of Pediatrics now recommends that every child be screened for autism two times before they are two years old.

What causes it?
Poor parenting is
not
a cause. The exact cause is not yet known, and is probably a variety of causative factors, possibly including maternal rubella during pregnancy, chromosomal abnormalities, and complications during pregnancy (it’s uncertain whether problems during birth or just after are also a factor). The fact that many more boys than girls are affected and that siblings of autistic children are at slightly higher risk points to a genetic component.

What is known is that study after study has shown that autism is not caused by vaccines.

Related problems.
Sometimes, mental retardation (though autistic children range from profoundly retarded to extremely gifted); learning disabilities, even in bright, verbal children; eccentricities in body movement (toe walking, jumping, grimacing, or arm flapping when excited, for example); epileptic seizures (these now believed to be an integral part of the syndrome in some autistic children with severe mental deficiencies); in older children, major depression or schizophrenia.

Treatment/management.
Should be individualized for each child, with the goal of fostering normal development (as much as possible) and promoting language development, social interaction, and learning. Hearing should be tested at the outset to be certain that hearing loss is not responsible for the symptoms. In most cases, however, an expensive battery of high-tech testing is not necessary for diagnosis of autism. There are a variety of treatment approaches; some are scientifically based, and others are alternative therapies. None cures autism; some help modify the condition, others don’t. What works for one child may not work for another. Treatments that have shown some success include: applied behavior analysis (which uses positive reinforcement and other principles to build communication), behavior modification (with rewards for appropriate behavior, denial of rewards for inappropriate); medication to treat specific symptoms; motivation (finding an area of interest to the child, such as music or art or science, and trying to make contact through this medium).

Excessive pressure to perform and unrealistic expectations are not recommended. Attempts at talking, for example, should be rewarded even if the
results are far from perfect. Such positive reinforcement encourages the child to try again rather than slip back into his or her shell of silence.

Prognosis.
Varies with the degree of autism and the seriousness of related conditions. It is difficult to predict during the toddler period. But with extensive, intensive intervention by both parents and professionals, and with a multifaceted approach (possibly including medical treatment, psychological counseling, speech therapy, physical therapy, and special education), many children are helped to improve their communication and social skills. Though some children require life-long protective care, others make remarkable progress and are able to be mainstreamed in school, get a good education, and hold jobs later in life (though the type of job may be limited by poor social skills and a lingering difficulty dealing with abstractions). Improved treatment may continue to better the outlook for today’s autistic children.

Keep in mind, the earlier your child is able to begin treatment and interventions, the better the prognosis, so early diagnosis is crucial. If you suspect there is something wrong with your child, talk to your doctor as soon as you are able.

What is it?
Not a single entity, but a group of more than one hundred different diseases, all characterized by the runaway proliferation of abnormal cells. Symptoms vary widely depending on the type of cancer.

How common is it?
Relatively rare in children, particularly toddlers. Cancers occur in just about 11,000 children under fourteen in the U.S. annually.

Who is susceptible?
Those with an inherited gene for a specific cancer (such as Wilm’s tumor, a cancer of the kidneys that can occur in both hereditary and non-hereditary forms); those with a family history of cancer; those with immune deficiencies; those with certain chromosomal disorders (such as Down syndrome) or congenital malformations (such as aniridia, a defect of the iris of the eye); possibly, those who have been exposed to cancer-causing agents (teratogens). Genetic tests are now available that can predict a small number of inherited cancers; such testing allows individuals to take preventive measures and to be on the alert for the development of the particular malignancy.

What causes it?
Probably 5% to 10% of all cancers are directly inherited (from an affected parent to a child). Genetic mutations, chromosomal abnormalities, and interactions between genes and environmental factors (including certain viruses, such as the human papilloma virus) also come into play. Though environmental factors—including tobacco, alcohol, high-fat/low-fiber diets, and probably to a lesser extent exposure to chemicals (in pesticides, foods, the air)—have been linked to adult cancers, they are unlikely to be responsible for many in childhood, since long-term exposure is generally necessary for a malignancy to develop.

Related problems.
Suppression of the immune system and a subsequent increased susceptibility to infection are often side effects of treatment.

Treatment/management.
Depends on the type of malignancy, but may include surgery (conventional or laser), chemotherapy, radiation, and/or bone marrow transplants. In some cases, an experimental procedure undergoing clinical trial may be recommended. The best treatment is usually found in pediatric cancer centers. As an adjunct to treatment,
good nutrition (such as the recommendations in The Toddler Diet) may strengthen the immune system in its fight against a malignancy.

Prevention.
Nothing we presently know will absolutely prevent someone from ever developing cancer, but you can stack the odds in your child’s favor by taking sun-protective measures (see page 466); serving a diet high in fiber, appropriately low in fat, and rich in antioxidants (such as vitamins C and E and beta-carotene); and limiting exposure to environmental pollutants (including tobacco smoke; see
Chapter Twenty-one
) and to potentially risky chemicals in food and water (see
Chapter Eighteen
).

Prognosis.
Childhood tumors are much more responsive to therapy than adult tumors. Survival rates for most childhood cancers have risen dramatically in the last decades, but the prognosis in each case depends upon the type of cancer, how early it is diagnosed, and how well it is treated. In general, better than 4 out of 5 children with cancer survive; for some forms of the disease, the survival rate is greater than 90%.

Long-term survivors (five years or more) generally do well once the ordeal of diagnosis and treatment is over; special attention to helping these children catch up socially and academically can help prevent problems in these areas. Since new malignancies are somewhat more common in cancer survivors than in the general population, careful follow-up is also important.

What is it?
Also called celiac sprue or gluten-sensitive enteropathy (GSE), this is an autoimmune disorder in which there is a sensitivity (
not
allergy) to gliadin (found in gluten, a component of wheat, rye, barley, and oats). When the gluten comes in contact with the small bowel during digestion, the bowel loses its villi (tiny hair-like projections that facilitate the absorption of nutrients) and becomes smooth. This interferes with food absorption. GSE can begin anytime in childhood or adulthood. The most common symptom in infants and young toddlers is the passage of frothy, liquidy, foul-smelling stools; a distended abdomen; pallor; and failure to thrive. In older toddlers there may be poor appetite; a cessation of weight gain (or even weight loss); irritability; and bulky, foul-smelling diarrhea-like stools. Fat globules may appear in the stool because fat isn’t being absorbed properly. Sometimes there is also a history of vomiting (often forceful) and/or extreme susceptibility to infection. In some children there may only be constipation or recurrent abdominal pain. Occasionally, the only symptom is failure to thrive.