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In an interesting development in the ongoing saga of the alleged link between vaccines and autism, the medical journal The Lancet is retracting the original study that proposed the idea that the MMR vaccine could cause the disorder.

If you’ve been a BabyShrink reader for awhile, you know my stand on vaccines: They’ve saved millions of lives. It’s just like any medical advance: There’s a cost-benefit ratio to consider. And when you’re talking about saving the number of lives that vaccines have saved, SIGN ME UP.

In terms of the supposed autism/vaccine link, I’ve always been skeptical. I want to know more about possible environmental and genetic causes, but I believe the reams of research done that show NO CAUSATION by vaccines. And I’m still wondering about the issue of autism recognition, diagnosis, and the increase of cases: Clinically, I see a lot of pressure to diagnose autism, and much greater willingness to give the diagnosis. If you’re interested in more, here are a couple of links:

Here’s a link to my other posts on autism and vaccines.

Here’s a link to the CNN article on the retraction of the MMR/autism article by The Lancet.

Aloha,

Dr. Heather
The BabyShrink

Hi Dr. Heather,

Jennifer

Dear Jennifer,

I’m so glad you are aware of this crucial aspect of your baby’s cognitive development. I think most parents would be happy to have a “mellow and easy” baby who would happily sit in his bouncer all day. But you recognize that he might not be reaching out to you for the important “give and take” and communication that he needs to trigger important aspects of his development. He needs to engage with you and play “Baby Games” in order to solidify his relationship with you, which forms the foundation of his cognitive growth. What to do?

I understand that you want to be as proactive as possible, given your experience with your older son. And while there is a possibility that your baby may suffer some similar developmental issues, it’s also quite possible that everything you describe is well within the norm for typical development. First of all, try not to over-worry, but maintain the watchful engagement that led you to research your concerns. Your baby can pick up your fears and anxieties, and this can push him to be even more distant. There is some interesting psychological discussion and observation going on about this very basic “give and take” in the parent/infant interaction, and in the ability of a baby to pick up on his parents’ feelings. When a very anxious parent reaches out to a baby in a way that seems desperate or demanding, the infant can sometimes seem to feel pressured, and retreat even more. So, as with many aspects of parenting, containing and managing your own feelings is Job One.

That said, there are many things that ALL parents can — and should — be doing to maximize this incredibly important time in a baby’s development:

Carefully watch your baby’s sleep/wake/activity schedule for clues as to when he is most likely to be responsive to parent interaction. Sometimes he’ll be fussy, or seem overstimulated by your efforts. Other times he may be more receptive. Often, these receptive times are shortly after waking from a nap and having a feed. But you are your baby’s best expert; try to figure out when he’s most approachable.

Then, make a conscious effort to play “Baby Games” during these times of approachability. Try to match his energy level and catch his gaze. Follow his lead; if he coos and looks away, try to respond in kind. You want to reinforce any efforts on his part, even brief eye contact that might be just 1 or 2 seconds long. Each baby is different; perhaps your baby is more auditory and responds well to your cooing back, other babies might be better reinforced by a brief touch to the face or hand, or from a big returned smile. Experiment, and see which response generates another round of interaction from your baby.

Don’t give up if your baby continues to avert his gaze. Take a deep breath if you start to worry, and try to be as available as you can for “Baby Games”. Give him time and keep trying.

Jennifer, I have a 3-month old too. Although she does engage in periodic eye contact, coos and smiles, she is much more reserved than her siblings were at this stage. At first I also worried about her relative lack of eye contact and her willingness to hang out in her crib for long periods of time. I can’t help but think that the noise and chaos of our busy household causes her to be a bit more protective in her interactions; there’s a lot for a little baby to absorb in this household! But her Daddy and I have been engaged in the exactly these exercises with our little one, and I can see the difference in just a couple of weeks of consciously trying to engage with her.

Dr. T. Berry Brazelton has some excellent suggestions for engaging a baby who might have sensory issues or sensitivities. Use your parents’ detective skills to determine WHICH senses your baby tolerates — and DOESN’T tolerate — very easily. Use this information to “fine tune” your interactions with him. For instance, our baby seems to respond longer to us, and with more smiles, when I’m quiet. Responding both with my facial expressions AND my voice seems to be too much for her, and she turns away. But if I keep focused on giving her a big returned smile, maintain eye contact, and maybe even stroke her hand or her cheek, she’s much more likely to stay engaged in our “Baby Game” than if I coo or talk back to her. Eventually, she’ll develop the ability to tolerate my voice as well. But until then, I’ll hold back a bit. Experiment with using different modes of communication with your baby and maximize what works.

I also double-checked on the expected timeframe of infant response to parents’ voices, and most authorities agree that this isn’t regularly observed in most infants until 4 months. Our baby is 14 weeks, and only in the past few days has she started responding to our voices on a somewhat-regular basis.

Now, I’m not able to evaluate your little one, but there are many things you can do to maximize this important aspect to your son’s development. Over time, you can judge his progress and if you’re not satisfied, have him evaluated by the program you mentioned in your city. If they’re not yet able to enroll him due to his young age, perhaps their specialists can take a quick look at your son and make some further suggestions to you. I’m a firm believer in erring on the side of having a child evaluated early, not only for reassurance of an expert opinion, but for the often very helpful recommendations that the specialists can give you, even if there’s nothing really atypical with your child.

And I can’t stress this enough: At 3 months of age, you should be aiming for interactions measured in SECONDS, not minutes. Feel good if you generate a few “rounds” of interaction between you and your baby at this age. Over time, you’ll both want to stretch these interactions to last longer and become more complex. But at 3 months of age, your baby is still very young and new to the world of interaction. A 3-month-old is only recently “hatched” — our psychological term for the opening of awareness that marks the end of the “squirrelly newborn” phase. So manage your expectations accordingly.

Jennifer, thanks for the opportunity to write about this extremely important topic. I hope you’ll write back to update us on your progress!

Aloha,

Dr. Heather
The BabyShrink

There’s a lot of confusion out there about illness, the flu, vaccines, medications, and autism. This poor Mom is terrified that her son may have contracted Autism from a bout of Swine Flu. Here’s her email to me:

Dear Dr. Heather,

Please help. I saw your article on autism, and I am very intrigued and impressed by your knowledge and insight.

I don’t know what to do. I have two beautiful, 91/2 month old identical twin boys who were always very social, smiley, interactive, looking directly into the face, etc. The one I am most concerned about would turn his head and smile at his brother in their crib, smile at everybody, I would play the ‘up’ game with him and he would gaze into my eyes, smile, and giggle… and they both almost always responded by looking when I said their names.

Then one of them got sick with Swine Flu on August 6th. His brother got sick on August 8th. I will never forgive myself as the last time I remember him (the baby who got sick on the 8th) acting distinctly like himself was the 6th when I went to pick up his sick brother at daycare… he looked right up into my eyes, threw up his arms, smiled, and said ‘Mommmmm’…. And I barely paid attention to him, I rushed to his sick brother… I should’ve thrown my arms around him and hugged him and praised him…. I have such guilt and keep worrying/wondering what if that is the last time he ever does that?

They were both put on Tamiflu due to being high-risk (they have asthma symptoms). The baby I am most concerned about didn’t get as high a fever, but the virus infected his eye, and we think he also got a bacterial infection, so he got eye-drops and Amoxycillin as well. He was miserable and cranky for days. I know he can hear (by testing by loud noises, etc.) and he doesn’t have an ear infection, as he’s seen a doctor.

Now he is not himself. I first noticed this as he got better. He is not responding when I say his name, hardly ever. If he does he just looks for a second. He will make eye contact, but only for a second or two. He looks away when I try to play the ‘up’ game with him. He is still babbling, but not as much. He did this weird whisper-babbling this morning and smacked his lips. He is still playing with his toys, but is also playing with non-toy objects like straps and blinds.

The doctor has an ear test set up for him, but I have to wait two weeks just for a call to make the appointment.

Can a virus or antibiotics trigger autism? Does a flu ever attack the ears, eyes, or brain which might cause sudden symptoms? What are the other possibilities might be going on if he doesn’t have an ear infection? This is a very, very abrupt change.

What tests should I push for to find out what is wrong as soon as possible? What are the possibilities?

So far his brother is acting normally, but I am terrified as I’m worried about it affecting both twins eventually.

Please, I would love a response. We have (mega-large HMO) and it is hard to get tests/things done. I am eagerly awaiting your response and guidance.

Very, very sincerely,
Concerned Mom

Obviously, this mom is in a state of desperation, so I responded immediately:

Dear Concerned Mom,

Of course I cannot evaluate your son myself and as such, I can only provide some educational information for you. But I did want to respond right away because you sound so very upset and worried.

First of all, please know that autism is thought most likely to be a genetically-related developmental issue, and I have seen no convincing information that it can be caused by a simple flu or other virus in a child, nor by antibiotics or antivirals. Additionally, the timeframe you mention of the abrupt changes in your son do not sound like the onset of autism. After all, it’s been barely 2 weeks since the onset of his flu symptoms.

A (temporary) step backwards in response to illness
However, it is VERY common to see temporary developmental regression in response to illness. This means that your child can take several steps BACKWARD developmentally — in response to illness and/or stress — and then “bounce back” days or weeks later. It’s all part of the normal developmental process,which is full of starts, stops, and reversals — the old “one step forward, two steps back” thing. Young children don’t understand that the course of illness is temporary; that they will get better. They simply know they feel lousy. They are not up to showing off all their “best” developmental skills. They commonly regress to earlier stages of development, temporarily, until they feel better. And often times, symptoms of illness can linger for WEEKS in children — especially for something as yucky as a flu. If he is showing regression in response to illness, the regression itself can linger for weeks as well, past the time that he gets better. This may vary from child to child and from illness to illness, so his brother may be fine (at least this time).

Personalities vary in response to illness and stress
I don’t know about your husband, but when mine gets sick, he just wants everyone to GO AWAY. (is this a guy thing?) He’s crabby and won’t talk to me and is just a completely different personality than when he’s feeling well. Everyone is different, and your boys also will have different responses to stress and illness. The point is that there are very reasonable possible explanations as to why your son is acting so differently than his usual self, for this relatively short timeframe.

It’s important that you respond in a positive and supportive way, and not convey to him that you’re so worried. He’s able to pick up your anxieties, and internalize the message that “something must be wrong with him”. He needs reassurance that he WILL get better, and WILL feel better, but for now he still feels lousy and needs to be babied — and that’s OK.

As I said, however, I cannot evaluate your child from afar, so it’s important you get your doctors’ advice, as it sounds like you are doing. But since you have to wait for appointments, I would take this time to hang out with your boys in a relaxed way, giving them the chance to fully recover.

Please let us know how you’re all doing in a few weeks’ time.

Aloha,

Dr. Heather
The BabyShrink