Barbara Latterner raises some interesting points in her June 5 post about the
IUGR breech infant.

I am by no means an expert on this topic, but in my experience, and research,
children starting out in the world with all the disadvantages Barbara
described are at a higher risk for later being diagnosed with developmental
delays, speech and communication disorders and neurological disorders.

I think she is very right to be concerned about this baby's development and
need for an assessment.  For example, no eye contact, even when alert, may be
nothing to worry about to some people, but for someone with experience with
autism, it throws red flags up all over the place.  Considering the difficult
pregnancy, IUGR, slow weight gain and feeding issues on top of that, it is
difficult for me to understand why, or how, a doctor could not put those
pieces together and recommend further evaluation.

Babies who have sucking difficulties, sensory integration issues, poor eye
contact, and/or excessively difficult behavioral issues are not "normal",
because the majority of infants do not exhibit these behaviors.  The problem
I have encountered is that few pediatricians (and even fewer GP's) are
willing to acknowledge this.  Better in their minds, I think, to put a
Band-Aid on the problem by bottle feeding, or waiting to see if the child
'grows out of it', and not worrying the mother.  As long as the child is
gaining weight, it seems that everything else can be shoved under a rug.

Yet it is often the mother herself who first realizes that her child is
'different'.  Mothers who say things like "my baby is seven weeks old and his
suck has never been right", "when my baby nurses, he clamps down like a vice
on my nipple", and "no matter what I do, I cannot comfort him", are telling
us that they are worried.  They are telling us that their baby is not
behaving normally.  They deserve to be heard.  They deserve to have their
concerns followed up.  In many cases, the "symptoms" may indeed be fleeting
in nature and have no long-term effects.   But in just as many cases, these
symptoms could well be the first indications of developmental disorders.
Children who are already at risk due to their antenatal or familial history
deserve more than waiting around to see what happens.  Research across the
fields of infant development, OT, speech pathology, and autism all point to
early, specific intervention as a key to helping the child achieve the best
possible outcome.

When infants have or physicians suspect they have physical problems such as
heart conditions or diabetes, physicians do not withhold this information
from the parents because it will upset them.  They recommend further tests,
refer to specialists and address the issue forthrightly.  It is time that the
medical community looked at the issue of early identification of learning
disabilities, developmental delays and autism in the same light.  Doing less
than that, in my view, constitutes a violation of the Hippocratic oath.

Some LACTNET readers might recall that I am particularly interested in the
topic of autism, being the mother of two autistic boys myself.  And I freely
acknowledge that with every child I assess, the issues above are in the back
of my mind.  That does not mean I assume every child with a sucking problem
or who is difficult to console has a developmental disorder until he proves
otherwise.  Maybe it's a case of "knowing too much".  But maybe it's not.
Maybe we as a profession, perhaps we need to be more knowledgeable and more
proactive about developmental delays and disabilities.

Of course this is tough stuff.  No one wants to raise these possibilities
with a new mother.  And it would irresponsible to do so.  But through our
reports to physicians, referrals to OTs and SLPs, we can express our concerns
and try to bring more attention to this issue.

Barbara Ash, MA, IBCLC
Canberra, Australia

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