Autism

MEL THIS WAS A LECTURE FOR HUMANITY! True it wasn't ER medicine, but it goes to a much higher level. You and Dr. Weiner need to be congratulated. It was also my 4th time through the entire month's podcast before I picked up that someone has a child with autism.
thanks

Mel, vitamin B12 deficiency (which is a lot more common than most docs believe) can cause autistic-like symptoms (NOT autism) in children and in my opinion, should be ruled out in every suspected case of autism/developmental delay using serum B12, urinary methylmalonic acid, and if needed, holotranscobalamin II (HoloTC or active B12) tests. B12 deficiency is easy to diagnose and treat. Treatment with hydroxocobalamin consisting of and initial series of shots, daily for 7 days then weekly for 4 weeks, followed by bimonthly shots is also very cheap.....$35-40/year!

Hi, I just wanted to point out that there is currently research going on at SoundChoice Pharmaceuticals linking vaccines derived from fetal stem cell lines to increases in autism rates. The conclusions are based on change point analysis indicating close correlation of increases in autism rates with promotion and use of vaccines such as Varivax and MMR that contain fetal stem cell components from their production. http://soundchoice.org/autism/
Thank you for your excellent programs.

August 24, 2014
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Dear Fellow Doctors and Parents:
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My name is Christie del Castillo-Hegyi and I am an emergency physician with a background
in neonatal brain injury research. I am writing you because my child fell victim to newborn
jaundice due to insufficient milk production during the first days of life. As an expectant
mom, I read all the current guidelines on breastfeeding my first-born child. Unfortunately, following
the guidelines and our pediatrician's advice resulted in my child going 4 days with absolutely
no milk intake requiring ICU care. At 3 years and 8 months, he was diagnosed with
Autistic Spectrum Disorder. Being a physician and scientist, I sought out peer-reviewed
journals to explain why this happened. I found that there is ample evidence showing the links
between neonatal jaundice and autism. I wish to explain to you how I believe this could apply
to my son and the many children whose care you are entrusted with.
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My son was born 8 pounds and 11 ounces and had lost 1 pound 5 ounces at day 3 of life,
about 15% from birth weight. At the time, we were not aware of and were not told the percentage
lost, only the weight lost and having been up all night long trying to feed a hungry
baby, we were too exhausted to figure out that this was an incredible amount of weight loss
for our child. We were told by our pediatrician that we had the option of either feeding formula
or waiting for my milk to come in at day 4 or 5 of life. He was also jaundiced but his
bilirubin was not checked. Wanting badly to succeed in breastfeeding him, we went another
day unsuccessfully breastfeeding and went to a lactation consultant the next day who weighed
him before and after breastfeeding and discovered that he was getting absolutely nothing from
me. When I pumped, I realized I was not producing any milk. It was devastating to find out
that he had starved for 4 days and that being up all night for 2 days in a row was a sign that
my child was in distress and not getting food. We fed him formula after that visit and he finally
fell asleep. When we woke him up from his nap, he did not fully awake and we took him to
the pediatric urgent care. His bilirubin came back at 26 and his sodium was 155. He stayed
in the ICU for 5 days. We were reassured that we would have nothing to worry about, but
having done neonatal brain injury research, knowing how little time it takes for neurons to die
in response to hypoglycemia, I did not believe it, although I hoped it.
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At 3 years and 8 months, after over a year of worrying about his speech delay, our son was
diagnosed with autism spectrum disorder. I then thought back to his jaundice and did my
own research. I found that in a rare true prevalence study that included all children born in
Denmark from 1994 to 2004 (n=733,826), newborns who developed jaundice had a 67% increased
risk of developing autism. In a systematic review of 13 case-control studies, jaundice
was associated with a 43% increased risk of autism, the highest risk in this series being 6.9
times that of the non-jaundiced group. What this data shows is not only jaundice associated
with autism but that regardless of treatment with bilirubin lights, developing the diagnosis
alone can put a child at risk. It may be that jaundice is in fact a marker of starvation and by
the time it is apparent, the injury has already occurred. This data may suggest that the term
"physiologic jaundice" may be false and may be a term that resulted from lack of data rather
than lack of harm.
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Looking back at the literature at risk factors for autism, I believe the answer to the epidemic
of autism is simple. The very first cognitive functions of the newborn brain are the ability to
make eye contact and to socially bond, functions essential for survival. These are exactly the
core deficits of autism. I believe autism is caused by injury to the brain during the perinatal
period. Other risk factors for autism in the literature include pre-term birth, multiple surrogates
of fetal hypoxia like low Apgar scores, fetal distress, cesarean delivery, threatened miscarriage
and labor complications, all of which point to brain injury as a cause of autism. In
many studies, older parental age and residing in areas of higher affluence in Los Angeles and
San Francisco, both factors that may lead to strict adherence to exclusive breastfeeding are
risk factors for autism. It has also been found in the literature that mothers over 30 produce
less breast milk than younger mothers. Although there are many causes of autism that we
have no control over, I believe we are regularly inducing hypoglycemia and brain injury to
newborns by asking mothers who may not be producing sufficient milk for the newborn's
physiologic needs to exclusively breastfeed. I believe my son was in distress by the third day
and I ignored it because I wanted to do what I thought was best for him at the time. Thousands
of mothers in the Western world are doing the same at this exact moment. We are potentially
putting ourselves at odds with a protective natural instinct to respond to a baby's cry
by telling mothers that their colostrum is enough (which it is often not) and by making them
fear failure by giving their child formula when they need it.
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I hope you feel the same sense of urgency that I do. Since we received our diagnosis, I have
come to know of 20 other mothers who has a child with autism or severe speech delay. All of
them have a perinatal distress story; all except one developed jaundice due to poor early exclusive
breastfeeding. The exception was a child who suffered from meconium aspiration
born with zero Apgars. I feel it is my duty to get the message out to as many people as possible.
I have contacted the CDC and they are currently investigating this phenomenon. (A link
to their letter is attached below.) But I believe the data is already out there.
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Please feel free to share this letter with colleagues. I have tried multiple times to contact the
presidents of the AAP and they have not acknowledged even receipt of my letter. I am writing
to let you know I believe the current practice guidelines are dangerous. My son suffered an
incredible amount of weight loss by the third day, which is often when mothers produce milk.
How many newborns are experiencing the same fate? I don't believe that the current 8-10%
weight loss cut-off for supplementation has been rigorously tested for safety. Ultimately,
when a newborn is crying continuously, it is signaling that a physiologic need is not being met.
I would like to advocate for a patient safety initiative asking hospitals to weigh exclusively
breastfed babies before and after breastfeeding while in the hospital so that mothers know
what they are providing with each nursing session and so that health-care providers can identify
the mothers who are most at risk of underfeeding after discharge. Exclusively breastfed
babies are the only patients in the hospital for which we have no information about the quality
and quantity of the food they receive. As you can see, if such a severe case of dehydration and
hyperbilirubinemia can occur to two physicians taking home their first child, it can happen to
anyone. I also advocate for next day after discharge follow-up with pediatricians with universal
bilirubin checks for exclusively breastfed babies, especially before lactogenesis. I know of
mothers whose first follow-up appointment was one week out from birth. This mother's child
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also ended up in the ICU with jaundice and is now diagnosed with autism. Also, the teaching
of jaundice above the chest as a reliable sign of benign jaundice is antiquated and proven to be
incorrect in the literature and the decision to check bilirubin levels should not be based on
level of jaundice.
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In addition, I advocate for mothers to be informed of the possibility that their child can become
dehydrated, underfed and jaundiced from insufficient breast milk intake. Signs of this
are a child that is not sleeping or crying repeatedly after breastfeeding then latching on again
and most importantly, breasts that are not producing milk when pumped or a child not gaining
weight after each feeding. Mothers are going home believing that they will uniformly be
able to produce enough colostrum for their babies needs and will feed them day and night for
weeks if necessary without question if their doctors and lactation consultants are telling them
they are getting enough and that they should not give formula. But as you have witnessed as a
matter of routine, breastfeeding jaundice is very common and mothers do not uniformly produce
enough milk for their babies needs. Mothers deserve to know what they are feeding their
child. The current recommendations can be summed up by the words of a lactation consultation
who advised a friend's daughter with the following: "Your child will never learn to breastfeed
properly if you give her a bottle." This mother went on to feed her daughter day and
night for two weeks until a pediatrician intervened when she was found to be underweight.
Exhausted and discouraged, this mother stopped breastfeeding altogether.
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With that, I also advocate for more liberal use of supplementation before lactogenesis and that
we scrutinize the science behind the current guidelines of supplementation at a threshold of
10% weight loss. I do not believe the current recommendations to exclusively breastfeeding
moms respect the physiologic requirements of a newborn baby as evidence by story after story
of new moms who I have spoken with who have stood by confused and exhausted at their
hungry-appearing child who they have breastfed day and night upon taking them home from
the hospital. Thousands of years of evolution have wired mothers to respond to the need of
their child and we are potentially interfering with a biologically protective instinct by telling
mothers that their child is getting enough when it is apparent to them that they are not. If you
observe non-Western traditional cultures all around the world, mothers know that they may
not produce enough milk in the first days after birth and routinely give "pre-lacteal feeds,” often
scoffed in the breastfeeding literature as something that requires education and intervention.
I believe that it is possible that the Western world may be wrong in its perception of
feeding in the first days of life.
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I am aware that too liberal use of formula can compromise breastfeeding success. But there
are ways to promote breastfeeding while providing for a newborn's physiologic needs. The
main factors that promote milk production are time at the breast and milk removal. Whether
or not a child receives formula has no direct connection to whether milk comes in. If a mother
puts her child to the breast for 20 minutes every 2-3 hours regardless of whether the child is
hungry, pumps to make sure she is fully empty then feeds her child the well-deserved supplemental
milk, she will stimulate her breast enough to produce milk.
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In summary, I hope you would consider publishing strong recommendations to pediatricians
and to the medical community as a whole to perform the following patient safety interventions:
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1) Pre- and post-breastfeeding weights before discharge for exclusively breastfeeding mothers.
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2) Thorough counseling on the possibility of underfeeding and jaundice and giving mothers
permission to supplement if it appears that their child is hungry and not doing well with nextday
follow-up with a pediatrician if such event arises. Such mothers can be advised to pump if
necessary.
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3) Uniform daily bilirubin checks for exclusively breastfed infants before lactogenesis, regardless
of physical exam findings.
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4) Detailed instructions on the above-described protocol of breastfeeding before bottles until a
mother's milk comes in.
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The time for magical thinking has ended. Parents are looking for miracles in dietary supplements,
no-MSG diets, unmonitored home births and vaccination refusal to prevent autism.
Most breastfeeding books suggest that “there is always enough colostrum to meet your baby’s
needs.” Those who take care of the complications know there is no such certainty. We are
spending extraordinary resources on finding new and mysterious causes of autism while ignoring
the causes that are known, sitting idly for the experts to tell us what to do instead of
doing everything we can to prevent those known causes.
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To all doctors and parents, my message is simple. Feed your baby. Provide your baby its
physiologic needs every minute, including the days before milk production. I hope you join
me in informing your colleagues, friends and family of the data and make changes to your
practice. Please feel free to share this letter with whomever you wish.
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Respectfully,
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Christie del Castillo-Hegyi, MD
cdelcastillohegyi@gmail.com
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P.S. Attached are the studies I have referenced and the letter from the CDC: https://www.-
dropbox.com/sh/i3sirz0awxrn3km/AAAAoZH84JWIwW49-tTCYw2oa?dl=0
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Or type in this condensed link:
http://tinyurl.com/prnt9dc
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