Sunday, March 26, 2006

Risk factors in Autism?

I had a well-educated family whose kid was diagnozed with autistic spectrum disorder in my clinic yesterday. They were obviously devastated by the diagnosis and had a lot of questions. One of the questions that I felt unable to answer at that point was about whether they should try to have another baby, meaning thereby as to what were the chances of the second baby having the same disease.
Autism is a lifelong neurological syndrome that affects a childs ability to interact with the other people. It is characterized by the abnormal development of communication skills, social skills, and reasoning. Males are affected four times as often as females. Children may appear normal until around the age of 30 months.It limits their ability to interact with others socially, in fact many autism suffers avoid human contact.
Autism Symptoms vary widely in severity, include impairment in social interaction, fixation on inanimate objects, inability to communicate normally, and resistance to changes in daily routine. Characteristic traits include lack of eye contact, repetition of words or phrases, unmotivated tantrums, inability to express needs verbally, and insensitivity to pain.
There is a GENETIC component to autism, however since multiple genes are involved, the actual transmission in quite complex and difficult to predict in a particular family.
However a simplified answer to the question (chances of second baby having the disease) is as follows:
  • Overall incidence of Autism 1: 500 ( and possibly increasing!)
  • Chances of autism in identical twins 60-90 %
  • Chances of autism in fraternal twin 2-4 %
  • Chances of autism in a sibling 1: 20 (5%)
  • Chacnes of autism in the third child if two kids are autistic 1: 3 (35 %)
  • Chances in second degree relatives (aunts , uncles, grandparents, grandchildren) 0.18 %
  • Chances in third degree relatives (cousins) 0.12 %
Early intervention is the key to success in treating this condition and limiting the problems faced by these kids.


Social/Communication Red Flags:

If your baby shows any of these signs, please ask your pediatrician or family practitioner for an immediate evaluation:

  • No big smiles or other warm, joyful expressions by six months or thereafter
  • No back-and-forth sharing of sounds, smiles, or other facial expressions by nine months or thereafter
  • No babbling by 12 months
  • No back-and-forth gestures, such as pointing, showing, reaching, or waving by 12 months
  • No words by 16 months
  • No two-word meaningful phrases (without imitating or repeating) by 24 months
  • Any loss of speech or babbling or social skills at any age

Saturday, March 25, 2006

ELIDEL (Pimecrolimus) - Misleading claims for marketing in India

Elidel (PIMECROLIMUS) hs been launched in India for the first time by Novartis for treating Atopic Dermatitis.
I would like to highlight my concern about the marketing for this. The Medical reps and the product monograph state that this is 'safe' for children from 3 months onwards, and tout this as a major advantage over Tacrolimus.
However the international novartis website for ELIDEL clearly states that Elidel should not be used in children below 2 years of age.
Also FDA has recently (march 2005) instructed novartis to put warning labels on this drug in the US which clearly states that this drug is not to be used in children less than 2 years. Also more disturbingly this goes on to state that the long term safety of this drug has not been established and there maybe a small chance of skin and lymphoreticular malignancies in people using this drug, though a causal relationship has not been established. It also advises that this medicine should be used for short term only
This is in complete contrast to the product monographs (in india) which states (on page 53)that "Elidel has an excellent safety profile and induces no clinically significant adverse effects".
On page 54 the monograph further goes on to state that this drug is indicated for long term management of atopic eczema in infants above 3 months of age.
I think that at the very least these issues should be communicated to the pediatricians and the dermatologists who are going to prescribe the medicine to thier patients in good faith. There is no reason for the medicine to be available for infants in India till the time its safety is not proven, and definitely not if their are any concerns about its long term safety.

Thursday, March 23, 2006

Preventing asthma in your child - Precautions before and after birth

All of us who have strong family history of allergies, be it nasal allergy (allergic rhinitis), skin allergy or asthma have a higher than average risk of having kids with allergies. This is more so if both parents (& their immediate family) are sufferring from multple allergies.
In my practice I often find such parents worrying about how to prevent asthma in their newborn child, especially if they already have a child with asthma.
The truth is that we really do not know of any sure shot way to prevent this from happening, but here are a few things that can help;
  • breast-feeding- exclusively for 6 months
  • maternal dietary restriction during breastfeeding - avoiding foods with potential for allergy like milk, nuts, wheat, egg etc. (these maybe avoided during pregnancy also in certain cases with the doctor's consent)
  • late introduction of solids and allergenic foods (milk, nuts, wheat, egg) - again indtroduction of solids after 6 months and allergenic foods probably after 1 year
  • and the use of hypoallergenic infant formulas (this is a new concept, and is still not FDA approved)
As I said before, there is no guarantee that this will work, but it may improve the chances of your kid not getting any major allergies as they grow

Wednesday, March 22, 2006

Antibiotics in babies may cause asthma!

Antibiotics are the wonder drugs from the 20th century. However their success has also been their downfall.
Antibiotic misuse has lead to increasing drug resistance, and nowadays this has lead to a decrease in their prescription by many physicians. Now there is another reason to ask your pediatrician to think again before giving an antibiotic prescription.
A recent canadian study in Chest Medical journal has suggested that those children treated with even a single course of antibiotics under the age of one are twice as likely to develop asthma in childhood as kids who are not given any antibiotics!
It found that for each extra course of antibiotics during the first year of life a child was 1.16 times more likely to develop asthma. What pediatricians and parents need to remember is that most respiratory infections in this age are viral and do not require antibiotics. It is believed that this effect may be as a result of anitbiotics killing the beneficial bacteria in the intestine, leading to alteration of immunity, which perhaps leads to asthma.