Autism affects one in 88 children, according to the Centers for Disease Control and Prevention. And a recently published study suggests one in three autistic adults lack a job or education. As the number of autism spectrum disorder (ASD) diagnoses increase, experts says early intervention and therapy are key.

Dr. Kathryn McVicar, a Le Bonheur neurologist, weighs in on ASDs below.

There are many theories, but no great answers as to why autism spectrum disorder diagnoses have increased.  Here are some of the possible contributors:

• Older maternal and paternal age at conception is thought to play a role.
• Increased awareness and recognition with more individuals who are 'mild' being diagnosed.

Early signs of an autism spectrum disorder (but also of other developmental and psychiatric disorders) include:

• A child who does not point with one finger by the age of 1 year.
• A child who does not recognize his/her own name.
• A child who does not like to be cuddled and becomes upset if shown affection.
• A child who does not look you in the eye.
• Speech delay of any type can be an early sign of an ASD.

There are theories proposed to explain why boys are more likely to have an ASD, but no definite answer.  Some investigators think it might be due to neuroendocrine influences on the developing brain. For example, some scientists believe that an ASD could occur as a result of testosterone acting in vulnerable developing brains or stress during critical times in brain development.

Popular DIY bloggers Sherry and John Petersik of Young House Love recently posed a question about the safety of some sandboxes. Their concerns were over certain types of sand -- commonly found in playgrounds or sandboxes -- that contain crystalline silica and asbestos tremiline-- both known to potentially put children at risk for developing cancer, says Susan Helms, Le Bonheur director of Injury Prevention and Safe Kids Mid-South.

Helms says the kind of play sand that can have both of these carcinogens is made from crushed rock,  so look for river or beach sand for your child’s sandbox.  These can usually be found at landscape or gardening stores.  Though slightly more expensive, Safe Sand sells carcinogen-free sand for sandboxes.

Helms also recommends following these guidelines from the National Health and Safety Performance:

• Sand play areas should be distinct from areas for any other equipment (such as swings, slides).
• All sandboxes should be kept covered when not under active adult supervision.  This area needs to be secured to prevent entry by children or animals, and sufficient to prevent contamination by liquids and solids.
• Sandboxes should be equipped with constant and effective drainage systems and made to present no safety hazards.
• Sterilized sand or very fine pea gravel may be used.
• Sand that becomes contaminated should be replaced.  Treatment of sand with chemicals is not recommended.
• Sand in sandboxes and play areas should be replaced as needed, but at least every two years.
  

The outdoors is exactly where children should be during the long days of summer. Running and playing in open fields and grass is what just about every child loves to do. But, those are also the same places where snakes inhabit, and if a child steps on or startles one, it might bite.

In the event you ever find yourself in a situation where a child has been bitten, Dr. Barry Gilmore, director of Emergency Services at Le Bonheur Children’s Hospital, tells exactly what you should do.

“Most importantly, parents should know that snakes are not usually agressive and won't strike unless startled, stepped on or feel threatened. In most cases, children who are bitten have been playing outdoors, hiking or walking in fields or near water. The most common area bitten are the limbs.

The first thing you should do if a child is bitten is stay calm. Allow the bite area to bleed freely for about 15 to 20 seconds, and then thoroughly cleanse the bite with antibacterial soap and water. Applying Betadine (Povidone – Iodine), an antiseptic, is ideal, however not necessary if you don’t have it on hand.

Keep the limb that has been bitten at or slightly below the heart.If it is elevated too high it could cause the poison to travel faster, and if it is too low it can cause swelling problems. Many times, parents put hot or cold packs on the area. This is not necessary and provides no benefit to the child or to the wound. There are some wives’ tales that say to suck the poison out of the fang marks by mouth or cut an incision on the site so that the poison can drain. Do not do this. Also, using a tourniquet, applying pressure or wrapping the area with bandages offer no benefit either.

After the first three steps of allowing it bleed, cleaning and keeping it at or below the heart, the next most critical thing is to get to an emergency room. The smaller the child, the worse the reaction to the poison can be, so it is very important to seek medical attention. Usually, a life-threatening reaction doesn’t immediately occur in most cases. I also encourage parents not to waste any time killing or catching the snake.It’s more important to have the bite medically assessed.

Snake bites in our area are not uncommon. Iin summer months, we can see about one per week in the Emergency Department. The most common bites come from copperhead or water moccasin snakes. The only treatment is anti-venom, and this would be administered if the complications from the bite became life-threatening.

As we get into the full swing of summer, parents need to be mindful of snakes’ presence. Around boat docks, sheds, in fields and wooded areas are all ideal places for snakes to be. The best advice is to teach your children the importance of being careful and watching for snakes while they play. They also need to understand that the best thing to do if they see one is simply back up and walk away.”

Hospitals around the country have noticed a startling issue: teens drinking ethanol hand sanitizers to get drunk. It is a dangerous trend, and we found some great information worth sharing from the American Association of Poison Control Centers.
Symptoms from alcohol poisoning include confusion, vomiting, slow or irregular breathing, blue-tinged or pale skin, low body temperature or loss of consciousness.

Safe Kids Mid-South supports the following tips for parents:

• Talk to your teens about the dangers of drinking hand sanitizers.
• Explain why alcohol poisoning is not a laughing matter
• Buy hand sanitizers that don’t contain ethanol
• If you think someone has drunk hand sanitizer to get high, call 1-800-222-1222 to reach the experts at your local poison center. Don’t wait for symptoms to develop.
  

As we get closer to summer and outdoor activities, kids will be more likely to experience a tick bite. We talked to Dr. Sandy Arnold, infectious disease specialist at Le Bonheur Children’s Hospital, about what parents need to know. Here’s what she had to say – parents note, this one is definitely worth the read!

What are ticks?
Ticks are arachnids that live in wooded areas and fields.  You can be exposed to ticks by spending time in these areas but ticks can also be found around your home. Tick bites are most common in the summer months but in warm climates it is possible to be bitten year round.

How can I be harmed by a tick?
Different kinds of ticks transmit different diseases.  Ticks acquire and transmit these infections by eating blood from animals and the diseases ticks carry depends on the part of the country in which you live.

What should I do if I am bitten by a tick?
It is very important not to use any home remedies to remove a tick. Things like nail polish, petroleum jelly, heat or flames are not effective.

Use tweezers to grasp the part of the tick that is closest to the skin.  Apply steady upward pressure to pull the tick’s mouthparts from your skin.  If you pull too hard, the mouth parts may break off.  If this happens, you need to use the tweezers to pull out the remaining parts of the tick if possible. 

Once the tick is removed, clean your hands and the area well with soap and water or rubbing alcohol. The saliva from the tick can be irritating and cause some redness and discomfort at the site. However, this does not necessarily mean the site is infected. Some diseases transmitted by ticks will result in a lesion or rash at the site of the tick bite but some do not. If you develop an abnormality of your skin in the area from which you removed the tick, consult your child’s pediatrician.

What illnesses can I get from a tick in this region?
There are several important tick borne illnesses that are relatively common in the Mid-South.

Of note, Lyme disease is not transmitted in this region.  The tick that could carry the disease, (Black Legged tick) is found in this region, but its feeding habits make it unlikely to transmit Lyme disease.  The “bull’s-eye” rash at the site of the tick bite that occurs with Southern Tick Associated Rash Illness (STARI) is very similar to that seen with Lyme disease - these can be easily confused.  This rash may be accompanied by fatigue, headache, fever and muscle pains. The cause of STARI is unknown. As it appears very similar to Lyme Disease, most physicians will treat this infection with antibiotics.

Ehrlichiosis is transmitted by the Lone Star tick in this region.  The symptoms of Ehrlichiosis usually develop within 1-2 weeks after being bitten by an infected tick.  There are many symptoms associated with Ehrlichiosis.  These are similar to symptoms of Rocky Mountain Spotted Fever.  Patients with Ehrlichiosis have fever, chills, headache, malaise, muscle pain, nausea, vomiting, diarrhea, red eyes, confusion and rash (not at the site of the tick bite).
Rocky Mountain Spotted Fever (RMSF), caused by Rickettsia rickettsii, is an infection transmitted by the dog tick.  Symptoms can begin 2 to 14 days after a tick bite and include fever, rash (which appears 2-5 days after onset of illness), headache, nausea, vomiting, abdominal pain, muscle pain, red eyes, confusion and neck pain.

These diseases can be difficult for physicians to diagnose because the symptoms overlap with many common, self-resolving, viral illnesses. It is important to note that not all patients have all symptoms and  some people have very mild or no symptoms.  Unfortunately, there is no test that your doctor can do to easily diagnose these infections so treatment must be started based on suspicion.  The infection may be confirmed by doing a blood test 10-14 days after the diagnosis but this will not influence the decision to treat.

Treatment should never be withheld pending the results of a blood test. Severe Ehrlichiosis or RMSF infection can be fatal if not treated appropriately. Prompt treatment is associated with rapid resolution of symptoms. The appropriate treatment for Ehrlichiosis and RMSF is doxycycline for children of all ages.  This is the drug recommended by both the Centers for Disease Control and the American Academy of Pediatrics. No other drug should be used to treat these infections.

Tularemia is a disease that can be transmitted by both the Lone Star tick and the Dog Tick. This disease is much less common than the others. While tick borne Tularemia can present in many ways, it may be associated with an ulcerated lesion at the site of the tick bite with or without a swollen lymph node nearby. If this occurs, you should see your child’s doctor.

How can I prevent myself from being exposed to these illnesses?
The best prevention for tick infections is the prevention of tick bites. To keep ticks out of your yard, you should remove leaves, tall grasses, brush and trash from the yard.

You can keep ticks off yourself and your family by avoiding wooded areas with tall grasses and staying on trails when hiking. Use insect repellents with DEET (20% or more) on exposed skin and Permethrin on clothing and gear.  Wear long sleeve shirts and long pants tucked into socks to avoid contact of skin with ticks.

You should also do regular tick checks after coming in from outdoors. Particular areas to check include:
• under the arms
• in and around the ears
• inside the belly button
• behind the knees
• between the legs
• around the waist
• and in the hair. 

Also check your gear and pets because ticks can come into the home then attach to you later.

Please consult the CDC website for more information.
http://www.cdc.gov/ticks/index.html

This week is National Playground Safety Week, designated by the National Program for Playground Safety. According to the Consumer Product Safety Commission (CPSC) more than 218, 850 children received emergency department care between 2001-2008 for a playground-related injury, and more than 60 percent of those injuries were due to falls or equipment failure. The CPSC says the top four playground equipment pieces associated with injuries are:

• Climbers
• Swings
• Slides
• Overhead ladders

Safe Kids Mid-South, led by Le Bonheur Children’s Hospital, offers important tips for staying safe on the playground.

• Look for playgrounds with shredded rubber, mulch, wood chips or sand. Grass and soil are not good surfaces.
• Playground surfacing material should be 12 inches deep and extend 6 feet in all directions around equipment.
• Make sure playground equipment is inspected frequently and kept in good repair. If it’s not, report this to your local parks and recreations office.
• Remove hood and neck drawstrings from children’s clothing and outerwear and don’t let kids wear helmets, necklaces, purses or scarves on the playground.
• Don’t allow your kids to engage in, or play near, any pushing, shoving or crowding around playground equipment.
• Keep toddlers younger than age 5 in a separate play area, away from equipment designed for bigger kids.
• Actively supervise kids on a playground. Just being in the same area isn’t good enough – they need your undivided attention while playing on or around the equipment.

Measles may sound like an outdated disease, but measles cases within the United States reached a notable 15-year high in 2011, according to the Centers for Disease Control and Prevention. In Tennessee alone, there were three reported cases in 2011, according to the Tennessee Department of Health. We asked Infectious Disease Specialist Keith English, MD, to weigh in. Why are we seeing so many cases? English says it’s because kids are not getting vaccinated as they should.

"The increase in measles cases is a reminder of how important it is to vaccinate our children against measles,” said English.  “Though measles is no longer an 'endemic' in the United States, cases still occur when people from other countries who are infected with the measles virus come to the U.S.”

U.S. citizens who’ve traveled or lived in a foreign country can return with the virus, and tourists traveling to the U.S. from another country can bring the virus here, he says. And because measles is so highly contagious, unvaccinated people can become infected without direct contact with an infected individual.

"Most of the 222 cases reported in the U.S. last year could have been prevented by simply following the recommendations for universal immunization against the measles virus," said English.

More and more young children are injuring their ACL – a major ligament in the knee – says Orthopedic Surgeon Marc Mihalko, MD. These injuries have become more common in young children over the past few years, and he says it’s because younger children are participating in competitive sports. Sports training for younger kids has intensified, as well.

“Most ACL injuries occur in adolescents, but we are seeing injuries in children as young as 9 or 10,” said Mihalko.

Children may be more susceptible to this type of injury because their motor skills and coordination are not fully developed. Lack of muscle strength and flexibility may also play a role.

“Proper training, strengthening and stretching may help, but there is no way to really prevent these injuries. Braces do not help,” said Mihalko. 

In children with a torn ACL, treatment is focused on calming the inflammation, pain and swelling. We also try to restore range of motion. Long-term problems associated with this injury result from a instability – or abnormal motion – in the knee. These cause damage to the knee’s cartilage and meniscus.

In very young children, we try to delay surgery until their bones have grown to full extent, said Mihlako. This means no sports or contact activities, which can be really hard for kids. For these kids, surgery (which is normal treatment for adults with this injury) damages the growth. Those some surgical procedures avoid the growth plate, results from this type of operation are typically not as good. In adolescents (when bones are fully mature), surgery is done to repair the ACL. With six months of rehabilitation, the patient can expect a full return to sports.

Registration deadlines for many summer camps are fast approaching and deciding on the best type and length of camp can be a challenging decision. How do you know if your child is ready for an overnight camp? Dana Givens, MS, CCLS, NCC, a child life specialist at Le Bonheur, helps tackle this question, and more. She helps facilitate Le Bonheur’s Cardiac Kids Camp each year.

Is my child ready for an overnight camp?
Ask yourself these questions:

• How does my child tolerate being away from me for extended period?
• Has she been to sleepovers with friends, vacations with grandparents, etc.?

If your child has never been away from you for long periods of time, an overnight camp might be too stressful to start off with. Giving your child opportunities to be away from you is important to gain self-awareness and independence. He or she needs to be able to know what to do and how to interact when you're not around.

Also, look at how well your child makes friends and solves problems. Going to camp can make some children nervous about a new environment and making friends. Typically, children who have good problem-solving skills are able to control their emotions and talk themselves down or do relaxing activities that help them de-stress while at camp.

Look at your child's habits and temperaments: Does he or she know how to bathing and dress on himself?  Will he remember to take medication? These behaviors are important for an overnight camp.

Also, if your family has recently experienced a major change, such as a move, death in the family or divorce, it may not be a good time to send your child away to camp. During major life changes, most children need to be close to their parents of caregivers for support. In these cases, a day camp might be a better option.

How do I prepare my child for overnight camp?

• Before choosing to sign your child up for camp, talk with him or her about their level of interest in going. This should be a decision that the child makes together with parents. If the child is undecided about camp, arrange for your child to meet with some of the staff or a child that has been to the camp before to discuss some of his concerns or hesitations.
• Make sure that your child knows how long camp will last.
• Go over the list of items needed for camp, and let your child be involved in helping purchase items and pack their luggage. This usually will get him/her excited about camp.
• Have a check list, and mark items off of the list as you place them in the luggage, so your child knows where to find everything.
• Talk with your child about who to contact in case of an emergency.
• Remind him or her of the importance of staying hydrated throughout the day.
• To help prevent homesickness, encourage your child to bring keepsakes from home: his favorite pillow, blanket, stuff animal or picture of family, for instance.
• Make sure your child knows who will be there to pick him up when camp has ended and what time that person will be there.

What are the benefits of sending my child to an overnight camp?
Camps help foster a sense of independence, self-awareness, and self-care. Many kids also appreciate the change in atmosphere; it’s like vacation for most campers. Camp can also promotes lasting friendships.

As the time for final exams and TCAP nears, many kids are experiencing stress. We asked Ginger Joe, Ed.D., a teacher with our Child Life department, to weigh in on the topic of stress in kids. Stress isn’t always a bad thing, she says.

Stress is your body’s physical and emotional reaction to circumstances that frighten, irritate, confuse, endanger or excite us. Stress can be positive or negative. A normal amount of stress pushes you to complete a task or do something. For me it’s putting in that last half mile sprint in my 6-mile runs, for example. Negative stress and too much pressure get in the way.

No one is immune to stress; we are all living in stressful times. Everyone, including kids, feels stress sometimes. In preschoolers, separation from parents can cause anxiety. As kids get older, academic and social pressures (especially from trying to fit in) create stress. Because stress in children is often seen as an overt behavior, don't expect your youngster to tell you she feels over-stressed. Instead, you need to look for signs. Some of the most common symptoms of stress overload might include:

• Chronic stomachache
• Loss of appetite
• Unexplained irritability 
• Regressing to baby-like behavior
• Bouts of crying
• Teeth grinding
• Change in personality
• Bedwetting

Do take caution to rule out any medical issues associated with any of these symptoms. A chronic stomachache, for example, could be a legitimate medical condition. Likewise, teeth grinding could be a dental issue. As a parent, part of your job is to observe your child closely and keep channels of communication open. You may not be able to prevent your kids from feeling frustrated, sad or angry, but you can provide the tools they need to cope with these emotions. To help your child’s stress, parents can:

• Acknowledge their feelings in a supportive manner
• Just be there for them
• Be patient and understanding 
• Promote a positive environment at home

Do not let stress put you in distress. We just have to find our own ways to adapt, change and find methods to turn that bad stress into good stress.

Many parents might not know when to expect body odor to begin as their children grow up. Although it’s not the most pleasant topic in the world, it is a fact of life. In some cases, children -- particularly boys -- can begin experiencing body odor as early as the age of 7. We talked to Dr. Kip Frizzell, Le Bonheur’s director of coordination of care and local pediatrician, on the topic. Here’s what he had to say.

“Naturally occurring bacteria on the skin, not sweat, is what creates the dreaded stench commonly known as BO. As children approach puberty, hormones cause an increase in sweating which then results in body odor. There’s no reason for concern and parents can resolve the problem through good hygiene.

If you notice this smell on your child, you can begin to use a deodorant. Deodorants work by making the skin a more acidic, unfriendly environment for the bacteria. Non-natural commercial deodorants contain several ingredients that might be of concern to some parents. If that’s the case for you, you can always use a natural deodorant. Natural deodorants do not include any chemicals and are a great starting place for kids. They can be found at drug stores and health food stores.

In addition to using a natural deodorant, showering daily after outside play or sports is good practice. Another way to control BO is by having your child wear breathable cotton fabrics which absorb sweat in a way synthetics don’t. If your child still has BO after these tips, ask their physician to check for possible reasons.”

Around this time of year, traumas are more common, and Le Bonheur sees patients suffering from all types of accidental injuries. Injuries from lawnmowers and all-terrain vehicles (ATV) are especially common – and preventable, too. We want to remind parents how to prevent these accidents from occurring. It’s always good to brush up on safety tips!

ATVs
The American Academy of Pediatrics, the American Academy of Orthopaedic Surgeons and Safe Kids Worldwide all have issued formal policies recommending that children younger than 16 not be allowed to drive ATVs under any circumstance. The injuries sustained during an ATV accident are typically severe.

“An ATV crash is 12 times as likely to kill a child as a bicycle accident,” said Susan Helms, director of injury prevention and Safe Kids. “While very important, helmets provide only limited protection on an ATV. No safety device can protect against the spinal and abdominal injuries commonly caused by ATV rollovers, collisions and ejections.”

Read more about ATV safety.

Bicycles
Always wear a helmet. Make sure the helmet fits and your kids know how to put it on correctly. A helmet should sit on top of the head in a level position and should not rock forward and backward or side to side. The helmet straps must always be buckled, but not too tightly. Safe Kids recommends the “Eyes, Ears and Mouth” test:

• EYES: Position the helmet on your head.  Look up and you should see the bottom rim of the helmet. The rim should be one to two finger-widths above the eyebrows.
• EARS:  Make sure the straps of the helmet form a "V" under your ears when buckled.  The strap should be snug but comfortable.
• MOUTH:  Open your mouth as wide as you can.  Do you feel the helmet hug your head?  If not, tighten those straps, and make sure the buckle is flat against your skin.

Make sure the bike is the right size for the child. There should be about one inch of clearance between the bike frame and the child’s groin when the child’s feet are flat on the ground. Also, make sure the bike is in good repair — reflectors are secure, brakes work properly, gears shift smoothly, and tires are tightly secured and properly inflated.

Read more about bike safety.

Lawnmowers
These tips are recommended by the AAOS:

• Children should be at least 12 years old before they operate any lawn mower, and at least 16 years old for a ride-on mower.
• Children should never be passengers on ride-on mowers.
• Young children should be at a safe distance from the area you are mowing.
• Pick up stones, toys and debris from the lawn to prevent injuries from flying objects.
• Use a mower with a control that stops it from moving forward if the handle is released.
• Never pull backward or mow in reverse unless absolutely necessary – carefully look for others behind you when you do.

Read more about lawnmower safety.

Most teens or adolescents get acne at some point, but some have worse cases than others. When usual medications or topical treatments don’t work, some doctors prescribe Accutane (Isotretinoin). Accutane is a prescription medication for adults and children older than 12 to treat severe forms of acne.  It has been known for some severe side effects, so we asked Le Bonheur pharmacist Rebecca Chhim, PharmD, to weigh in. Though are the certain significant risks to be aware of, she assured us that is safe to take.

When should I look into Accutane for my child? Does it work?
Accutane is used for severe acne -- large, painful nodules under the skin, covering a significant portion of the face, back, or other parts of the skin often affected by acne.  It does effectively improve severe forms of acne when other medications have not worked. Other acne treatments, such as creams or antibiotics, should be tried before using Accutane.  Your child will require close monitoring and enrollment in the iPLEDGE program (discussed below) while on Accutane.

How should you take Accutane?
Accutane is for adults and children 12 years of age and older. It is prescribed for 15 to 20 weeks and should be taken twice a day with meals and a full glass of water.  If you miss a dose, skip that dose and take your next dose at the normal time.  Let your doctor and your pharmacist know every prescription, over the counter and herbal medication you or your child takes while on Accutane.  Some medications and herbals may interact with Accutane.  It is important to avoid alcohol and vitamin A supplements while on Accutane.

What are the side effects?
Accutane can cause muscle, joint or bone pain more often in children than in adults.  It may also cause eye dryness or vision changes.  It is important to avoid driving at night until the full effects on your vision are understood.  Accutane has many effects on the skin including skin dryness, rash or extra sensitivity to the sun.  For this reason, patients on Accutane should limit sun exposure and wear sunscreen.  Accutane could cause hair loss, liver and blood disorders.  Accutane is associated with behavior changes, depression and suicidal thoughts.  Tell your doctor any behavior changes you may notice in your child while he or she is taking Accutane.

Accutane and Pregnancy Risk
Accutane can be harmful if taken while pregnant.  Accutane could cause a loss of pregnancy, premature birth, infant death or infant birth defects if taken while pregnant.  The risk of fetal harm is unknown when the partner of a male on Accutane becomes pregnant.  For this reason, in order to receive Accutane, every patient, male and female, must register with the national iPLEDGE program.  In addition, every doctor who prescribes Accutane and every pharmacy that dispenses Accutane, must also register with iPLEDGE.

iPLEDGE requires very strict rules for women who are able to become pregnant on Accutane, including the use of two forms of contraception while on Accutane, as well as one month before and after taking Accutane.  iPLEDGE also requires all patients to see their doctor every 30 days in order to get a new prescription.  Women must also take a pregnancy test every month while on Accutane.  iPLEDGE has many other regulations in place for patients, doctors and pharmacies in order to avoid pregnancy while on Accutane.  The risk of pregnancy while on Accutane must be taken very seriously.

The teenage brain is very different from the adult brain. In fact, our brains are only 80 percent developed by adolescence, says Dr. James Wheless, co-director of Le Bonheur Children's Neuroscience Institute. Our brains develop at different rates from birth to adulthood, and understanding typical brain development helps us comprehend why kids do and say the things they do. In connection with Brain Awareness Month, Wheless helped explain brain development.

First Few Years of Life
At birth the brain has 100 billion cells -- more than the number of stars in the Milky Way, says Wheless. By age 2, the brain has many connections as an adult brain, and by age 3, it has twice as many. The brain develops most rapidly between the ages of 2 and 3, so this is why it’s important for parents and caregivers to stimulate their child’s mind. Reading, singing and interacting with your child help strengthen these brain connections.

Childhood
From ages 5 to 12-14 in girls (and two years later for boys) gray matter increases in the brain. Gray matter are the brain cells that do the work, or serve as the "hard drive." After age 14 (or 16 in boys), white matter in the brain increases. White matter forms the cabling or connections in the brain -- similar to wires in a computer -- so various parts of the brain can connect and communicate to each other). In the past, the brain was thought to have matured by age 10 or 12, but that’s not the case.

Adolescence
Teens have more neurons than their adult parents, which is why they can learn very complex material quickly. But the wiring or connections are not fully refined. This is why teens can make apparent poor decisions and differ in emotional response from adults. The prefrontal cortex, which has to do with judgment, organization and self-control, is the last part of the brain to develop.

Most importantly, as teens’ brains develop, they can be easily influenced. Getting adequate sleep and not overloading the brain allow it to make better connections during this critical time period in adolescence. Also, because final connections are being made, the brain is more susceptible to toxins (e.g., alcohol) than the adult brain. Teenage brains can take days to weeks to recover from the effects of alcohol, so drinking on the weekend can affect their test performance the next Thursday --  something that would not occur in an adult.

If your child is having trouble reaching certain developmental milestones, hypotonia may be to blame. A child is said to have low muscle tone — hypotonia — if muscles are on the loose, floppy side, says Danielle Keeton, MACCC-SLP, director of Le Bonheur Early Intervention and Development.  Children with low muscle tone often have delayed motor skills, muscle weakness and coordination problems. 

Hypotonia is often associated with diagnoses like Down syndrome, Hypothyroidism and other genetic or neurological impairments. This type of hypotonia is more easily identified. However, mild hypotonia, often noticeable to parents, may not be noticed by others.

The research is also mixed about the effectiveness of intervention for children with only mild hypotonia. Some pediatricians may prefer the “wait and see” strategy, while others may seek evaluations by professionals, like physical therapists.

As a parent, it’s always important to trust your instincts.  You know your baby better than anyone else and can have a “sixth sense” when something just doesn’t seem right. 

Early motor milestones to watch for include:

By 3 months

• Lifting head and chest while lying on tummy
• Wiggling and kicking arms and legs

By 6 months

• Sitting with only a little support and holding head steady

By 12 months

• Crawling on hands and knees
• Pulling up to stand and moving around while holding on to furniture

By 18 months

• Walking without any help
• Running stiffly with eyes focusing on the ground

By 24 months

• Bending over to pick up toys without falling over
• Walking up steps without help
  

If your child’s floppy muscles are creating delays in early motor milestones, it may be beneficial to obtain an evaluation from a professional. An evaluation can provide you with a piece of mind; even if you discover during the process that there was nothing to worry about. You can discuss your preference for an evaluation with your pediatrician and can also contact the local early intervention system. Each state has an early intervention system for infants and toddlers that can assist you in finding a professional to evaluate your child’s condition.