Search for tag: "developmental"

Today, I'll discuss some questions I get about crying children.

So let's start with babies. Babies cry a lot. Babies cry because they have no other way to communicate. Babies cry when they want a clean diaper, they cry when they're hungry, they cry when they're tired, they cry when they're in pain, they cry when they're over stimulated and want to be left alone, they cry when they're scared. Basically, again, they cry a lot.

Babies from 2 weeks to 3 to 4 months cry even more sometimes because they are in the period of purple crying. They can cry and cry for what seems like no reason at all, and it's actually a normal developmental stage.

Then, on to toddlers, they cry mostly because they're trying to figure out their emotions. It seems like they are very stubborn and negative. And you can tell because their favorite word is "no," but they're learning how to get what they want. They're learning that if they're told no and they cry, sometimes they'll get what they want. Sometimes they won't. And it's almost as if they start training you as parents to give in to their cries to keep them quiet. Yes, toddlers are sneaky that way.

This is where trying to reason with a toddler is like trying to reason with a pet rock. You can talk to them, but they're hardheaded and often don't listen. Trust me, you'll get through that phase. Just be patient and do everything consistently. And eventually, they'll come through.

School-age kids cry too. Often, again, because their feelings are hurt or their bodies are hurt. These are legitimate tears. School-age kids cry for a reason. And often, they can tell you why. And this is good because they are learning the communication skills they didn't have as toddlers. As a parent, you know you can help them through whatever is causing their hurt.

Teenagers, well, often they'll either cry all the time or they'll hold their emotions in and never cry. Teenagers are harder to decode, but if you keep the lines of communication open with your teen, then when they do show emotion, you'll be able to start having more in-depth and maybe even adult conversations with them and try to help navigate them and navigate what is bothering them as they struggle through the teenage years and become those young adults we all want them to become.

Every age and stage has their own reasons for crying. If you have concerns about your child's crying, go ahead and ask your pediatrician. Chances are we've heard your concern before and are usually able to help.

Parents often wonder if their baby is lazy. I have parents use that term all the time. If their child isn't doing everything they think they're supposed to be doing, the parent labels their child as lazy.

For example, I have parents telling me a lot that their 12-month-old is lazy because they're not walking. Your child isn't lazy. Walking can start any time from 9 months until 18 months.

Parents will tell me their child is lazy because they want to be fed. If your child is under 18 months old and still learning how to use utensils, that's not lazy. They're just still learning. If they're 4 and they want you to feed them, that's not laziness. It's them being manipulating and trying to get you to do what they want.

Parents will also ask me about why their child isn't talking. They think that their 18-month-old should be saying sentences and instead only says about five words. Well, the biggest language explosion happens between 18 months and 3 years old. By 18 months, they should be saying four words, in addition to mama and dada. Boys tend to talk later than girls too. Not sure why, but that tends to be what I see. Girls tend to be more social. Boys tend to develop their motor skills faster.

I get the opposite too. Some parents think their children are developing completely normally when, in fact, they're behind on motor or speech milestones. This is one reason we do the autism screening at 18 and 24 months, to catch those kids that are behind and determine: Is this expressive speech delay? Are there not enough opportunities for motor development? Is there a concern for autism? Does the child have a different diagnosis that requires evaluation by specialists?

Now, I'll end with this as a heads-up. There was a recent article published in the "Journal of Pediatrics" outlining about how developmental guidelines for the first five years of life needed updating, and the Centers for Disease Control just adopted these new guidelines.

It will take a little while for everyone to catch up with these new guidelines when pediatricians do their screening evaluations at well-child visits. But we have a general good idea of where your child should be. As pediatricians, we are really good at figuring out if your child is on track developmentally, or if they need to see a specialist for a speech or motor developmental delay.

If you are concerned about a specific developmental issue with your child, be sure to discuss it with your child's pediatrician.

Learning disabilities are a common concern that parents bring to pediatricians. I'll be discussing those on today's Scope.

I have a lot of parents coming to me to see if their child has a learning disability. Usually it's dyslexia, which is a reading disability. But sometimes is dyscalculia, which is a math disability, or dyspraxia, which is a developmental disorder that affects motor skills like writing. Parents normally notice that their child is struggling in only one subject and does fine in others, or they notice that their child is writing letters, words, or numbers backwards. The teachers may be the first to recognize if there is a problem and tell the parents to have their child see their pediatrician for an evaluation.

Now, here's where it gets tricky. Yes, most of us can identify if there is a learning disability. However, we as general pediatricians are not the ones who can do a full evaluation and diagnosis. Even behavioral and developmental pediatricians are not usually qualified. Why? Because there is a lot that goes into determining if this is truly a learning disability or if there are other reasons for the difficulty in a particular area. We as pediatricians are the right place to start the process though. Schools also. School psychologists can actually do a lot of the testing to start the process, and that is what most of us recommend. While schools start doing the initial learning evaluations, pediatricians do full physical exams to rule out other medical reasons, such as ruling in or out movement disorders, ADHD, anxiety, depression, or speech issues.

The final evaluation and where the actual diagnosis is made is with a neuropsychologist. These are specialists who will do a huge evaluation with a lot of specialized tests, including IQ tests, standardized tests in reading, math, language skills, things like that, to get a good idea of how the brain itself is working, or not working, and be able to come up with the exact diagnosis specific for the child. This can be a long process, but it is necessary to get the correct diagnosis.

Once a child has been diagnosed with a learning disability, the next step is to notify the school and have them come up with an IEP or individualized education plan. This is a written contract stating what the child's disability is and what the school is able to do to help the child learn successfully. It's drafted with the parents, teachers, and school psychologists all involved and goes off of the results from the neuropsychology report. This IEP should follow the child all the way through graduation. It should be reevaluated every six months to make sure that the child's needs are being met and that there are not new issues coming up.

There are no medications to help with learning disabilities. As pediatricians, we can help direct you to resources that can help your child. Our relationship with your child will not change. And we too, like the schools can adapt if your child has problems with learning.

What your child needs most is encouragement and a lot of positive reinforcement when they get something right. Let them know that this is something that they can totally be successful with. Let them know some of the famous people that have had dyslexia, such as Keanu Reeves, Albert Einstein, Steven Spielberg, even Ozzy Osborne. They've all been successful. Henry Winkler had both dyslexia and math problems. Even Ben Franklin was thought to have a math learning disability.

Having a learning disability will make things harder, but not impossible. And often those who have a learning disability in one area often have exceptional abilities in other areas. Encourage your child to focus on what they are good at while they work hard things out that don't come easy. Remind them that they are not defined by their learning disability only by their abilities.

When you are expecting a baby, you have so many hopes for the future of your child. What if you learn that your child will have physical or developmental disabilities? I'll discuss your pediatrician's role in your child's care on today's Scope.

Often parents will ask me if I'm able to take care of a future sibling of one of my patients. The answer always is of course. Some parents will then get a little more quiet and say, "But my baby isn't normal." And I'm like, "Are any of us normal?" Seriously, if you've ever studied embryology and seen all the things that can go wrong during development, it's amazing any of us come out okay. When it comes to seeing new babies who may have some physical or developmental challenges, I honestly tell them I would be honored to be their new child's pediatrician.

When I was five, we moved to a house where the neighbors behind us had a son my age. His older sister had Down syndrome. In the five years that we lived at that house, his sister became one of my best friends. We would play school together, go to the pool together. She actually became a swimmer on the Special Olympics team. We did all sorts of things that friends do. Our families have kept in contact this whole time. And I've been so proud to see all she's accomplished.

I learned early on that just because someone has an extra chromosome and has some differences as a result, they're still an amazing person. They still have so much to offer. I mean, I was the asthmatic kid, allergic to everything. And I was in the school nurse's office all the time. So I also felt like I was a bit defective. We all are a little off in our own ways.

Parents are often overwhelmed when they have a new baby with special needs. And as their pediatrician, I serve as sort of a gatekeeper for all the specialists. My job is to take care of the well child visits, the usual colds and ear infections, and help manage some straightforward issues that most pediatricians are comfortable doing.

When a child needs a specialist, I know exactly who to refer them to. And the specialists and I coordinate together to make sure the child has all their healthcare needs addressed. It's called the medical home model. It's basically a community of doctors all working together, like a wheel with all the spokes of the wheel being the specialists, and the hubcap being the pediatrician. Depending on the needs of the child, the pediatrician also gets home health nursing involved or speech or physical therapists. Often we're the ones that fill out a lot of the paperwork for the insurance companies too and refill prescriptions for supplies if a child has a feeding tube or needs diapers long term.

Often one of the specialists is a pediatrician who has had additional training and certification in complex care management. That is someone I routinely refer my patients to, because they are an amazing resource and also help coordinate the specialists. They often try to make sure that a patient, if they are coming for a visit, have all of the specialists in the visit at once, so it's easier to make sure everyone is on the same page and can get extra help from dieticians, care manager nurses, and social workers if needed. Again, all part of the community of doctors caring for special needs kids.

Trust me, we as pediatricians love your kids as much as you do. And when they make certain milestones, we celebrate with you. I get so excited when I see my cerebral palsy kids walk into a clinic on their own. And I know that every child I see with Down syndrome means I'm guaranteed extra hugs that day. Special needs doesn't always mean limited, negative quality of life. Although their care will be certainly filled with challenges, it's our job as pediatricians to help you along your child's journey to reach their full potential.

Interviewer: Why should autism be diagnosed early in life? We'll talk about that next on The Scope.

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Interviewer: I'm talking with Dr. Debbie Bilder. She's Principal Investigator of the Utah Registry Of Autism and Developmental Disabilities. We'll be talking about the need to diagnose children with autism spectrum disorder early in life.

So, Dr. Bilder, if I were sitting next to a three or four-year-old who has autism spectrum disorder, what might I notice about this child that may be a little different from a typically developing child?

Dr. Bilder: Well, that child may not be making eye contact or may be preoccupied with something that is really hard to separate them from, in particular something which is not a typical toy that a child that age might be interested in.

Maybe when you do talk with that child, that child would have a particular interest that that child would go on and on about regardless of whether you may share that interest or not. A child may also have self-stimulatory behaviors, like hand flapping or even looking at things through the corner of their eye.

Children with autism have a really difficult time connecting effectively with their peers. So that child may be sitting on the bench next to other friends or the other children are out playing on the playground.

Interviewer: And is it usually obvious? I mean, if I were a parent, would I just know that, you know, maybe there's something a little different about my child?

Dr. Bilder: For parents, particularly, you know, thinking about a parent in which that's the first child, so they don't have a child to compare their first child to, they might notice that there are significant delays. Some children with autism also have other delays as well. So there would be a delay in language that their pediatrician or family practice doctor would mention to them. They may have difficulty in interacting with other children or choose not to play with other children.

But the majority of children with autism who have normal [intellectual 00:02:06] ability, which is the majority of children with autism, it may not be apparent to a parent who does not have another child to compare that child to.

Interviewer: I think you would argue that it's important to make that diagnosis, to make that identification early on.

Dr. Bilder: Well, we know that children who are identified by two or three years of age and receive treatment right away, intensive treatment can really optimize their ability to function, optimize their ability to be in a school classroom with other neurotypical children.

And some children who receive this intensive intervention may even no longer meet criteria for autism when they get older, and even though that's a very small percentage, we want to give children whatever shot they can get to be able to develop these skills when their brain is most capable of learning them.

Interviewer: So it's more difficult to make this intervention effective later in life?

Dr. Bilder: Yes. There's a developmental window as we develop language, as we develop our interactive skills. Clearly, there's a time in which our brains are intended to develop these skills. And if we could take advantage of that in these children, even though they may not develop those skills inherently, they can be taught these skills and that is the time at which their brains are going to be most receptive to that education.

Interviewer: So you've been involved in some large-scale research recently, looking at the ages at which children are getting that diagnosis from autism spectrum disorder. What did you find?

Dr. Bilder: Well, as far as the diagnosis itself, as far as receiving a diagnosis, we did not see a reduction in the age at which that child first received a diagnosis. The median age, when we looked at this for children who were four years of age back in 2010, was about 35 months here in Utah, and similarly it was 35 months two years later.

And then this particular study actually extended over six years. We participated in two of those years that I just mentioned. But even looking across the six years, there was no significant difference in the median age at which these children across seven different sites were identified with autism spectrum disorder.

The focus of this study perhaps goes even a little bit before then. The real aim is to have these children recognized as having a developmental concern so that they then are able to access a comprehensive evaluation.

So for those children when they can access and they do access a comprehensive evaluation even before the diagnosis is made, the developmental delays will be identified and you can initiate treatment even before you have a clear diagnosis of autism.

Interviewer: And so you said that there was no change in these two years that you looked at the numbers of diagnoses. I mean, what does that mean to you? Why does that concern you?

Dr. Bilder: Well, there was no change in the age at which these children were identified with autism. And what concerns me is that we as medical providers, as medical professionals despite our best efforts and there is a lot of work going into early screening so we can subsequently have early identification of autism to give these children that opportunity.

Despite these efforts, that age at which they're first presenting for a comprehensive developmental evaluation is not going downward. So it makes me really wonder, well, what about the process we have in place, because we're working really hard to initiate this process, what about this is not ultimately leading to the goal in which it was established, which is to reduce the age at which these children can access treatment?

Interviewer: And do you have any insights into what barriers are in place there?

Dr. Bilder: Well, this particular study was an epidemiologic study. So its purpose was to look at this in a very systematic way across multiple sites so that we can say this is a problem, and with an epidemiologic study, it creates the validity that this really is a problem.

What's up to future research and we even have fabulous researchers here in our Department of Pediatrics, what's up for these researchers is not just to accept that there's a problem, but then to look to see, well, where is this process breaking down, and they're doing that. And I'm looking forward to seeing the results they come up with, because that's the type of research, even though not done at an epidemiologic level, but done on a more fine-tuned, kind of make more granular level to figure out what exactly needs to change so that we can be successful.

Interviewer: I'm wondering if you think part of the problem might be that there might be a reluctance of parents to admit that there's something different with their child.

Dr. Bilder: Part of this process is beyond the typical office setting in regards to the pediatrician or the family doctor. Part of this process in addition to identifying which children are screening positive and then making the referral for those children to obtain a comprehensive evaluation is the part about it which requires the parent to be able to do so.

And if that parent were having a difficult time accepting that there might be something wrong with their child, that can unintentionally affect their willingness and speed at which they access a comprehensive evaluation for their child.

So as we look at this bigger picture, recognizing and measuring the gaps between that positive screen and the time at which the child presented for a comprehensive evaluation could really help us get a sense for if there is a delay, what could be causing it?

Interviewer: Do you have a recommendation for parents in maybe looking at their child or thinking about their child or their future or being screened for autism spectrum disorder?

Dr. Bilder: Well, every child, regardless of whether there is a concern or not, should be screened by their pediatrician or family practice doctor at 18 months of age and again at 24 months of age.

My recommendation is that when that medical provider expresses concern and makes the recommendation of referral to allow themselves to ask that provider, you know what specifically are they concerned about to be able to have an opportunity to be convinced that this is important.

As far as red flags for parents, like things to look out for, you want to look for a baby at six months of age, they should be smiling, having a reciprocal smile. So the mother smiles or the dad smiles and they smile right back and expressing joy even their facial expression of joy by six months of age. You should be expecting back and forth sounds and other facial expressions certainly by nine months of age.

They should be babbling or at least pointing to objects by 12 months of age and indicating that desire to engage and initiate that interaction with the caregiver. Using single words by 16 months of age. And then if by 24 months of age they're not using two words together in a meaningful way, that also is a red flag that they need to be evaluated.

I think the big red flag that's important for parents to be aware of because primary care providers go through these developmental milestones routinely during their well-child visits, the particularly important red flag for parents to be aware of is that if their child loses any social skills or language skills, then they really need an immediate visit with their primary care doctor even before the next well-child check. That is not normal. That itself should initiate a visit to their primary care provider for further screening.

Interviewer: And what's next for your research?

Dr. Bilder: We are excited to have received a four-year grant from the Centers for Disease Control and Prevention through the Autism and Developmental Disabilities Monitoring Network. We are thrilled to be part of this. What this funding does it allows us, the University of Utah, along with the Utah Department of Health and the Utah State Board of Education, to really enhance our case finding for children who are affected by autism as well as allowing Utah to be part of these national prevalence numbers that are established for the U.S.

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Dr. Gellner: A lot of children have learning disabilities that can make school time tricky. What are learning disabilities, really, and how can you help your child? We'll discuss those on today's Scope. I'm Dr. Cindy Gellner.

Announcer: Keep your kids healthy and happy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: So, many kids struggle in school. Sometimes it's because they don't understand the material or they find it boring, so they don't care to learn it. Sometimes it's because they're acting up or they don't like their teacher, so they don't pay attention. And sometimes it's because they have chronic medical conditions and miss a lot of school. These aren't learning disabilities. These are barriers to learning.

A true learning disability is a disorder that affects the way the brain receives, processes, stores, and responds to information. Learning disabilities usually involve problems with reading, writing, math, and information processing. We don't know what causes most learning disabilities, but we do know that they tend to run in families, and can also be attributed to circumstances before or surrounding a child's birth, such as being born premature or if mom used drugs or alcohol during the pregnancy.

Cultural differences and poor parenting are not causes of learning disabilities. There are many types of learning disabilities, and there is a big range of how they affect individual kids.

There's a language disability where kids may have problems following directions or may mix up words. These kids have a hard time telling stories, because the words get all jumbled up in their brains.

There's visual processing disability where kids see words backwards, such as seeing "was" where the word is "saw" or switch the b's and d's around if they're older than first grade. It's normal until then. They may also write very slowly as well.

There's auditory processing disability where kids have trouble focusing on people talking to them or listening to important sounds, because they cannot distinguish those sounds from background noise. They also have a hard time following instructions.

Another common disability is fine motor disability. These kids have a hard time with buttons, zippers, or even holding a pencil.

To find out if your child has a learning disability, you will need to talk to their school, as the school psychologists are often the ones who do the screening evaluations. If your child is not yet in school, your pediatrician can help you find a developmental pediatrician who can do the more in-depth screening. If your child does meet the criteria for a learning disability, then the school and you will put together an Individualized Education Plan, or an IEP. This IEP outlines goals for your child to meet, what services they qualify for, and who will provide them, and frequently measures and updates how your child is making progress.

What can you do as the parent of a child who has a learning disability? A lot. First, your child will probably feel self-conscious about having a learning disability. Remind them of all the things they are good at and that everyone has different ways of learning. You can even tell them about famous people that had learning disabilities like Walt Disney, Tom Cruise, Whoopi Goldberg, and even Justin Timberlake.

Have them meet other children with learning disabilities, so they understand they're not alone. Make sure you have a nice quiet place for your child to do homework, and don't overload them with extracurricular activities. Most importantly, be an advocate for your child with their school, and remind your child that they may learn a little differently than other kids, but with the right help, they can achieve anything they set their mind to.

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Dr. Gellner: Your child's speech development is something your pediatrician checks at toddler and preschool well visits, so how do you know if you should be concerned or not about your late talker? I'm Dr. Cindy Gellner and today we are talking about delayed speech and language development on The Scope.

Announcer: Keep your kids happy and healthy. You are now entering the Healthy Kids Zone with Dr. Cindy Gellner on The Scope.

Dr. Gellner: Some kids are early walkers and some are early talkers. Some are late walkers and some are late talkers. Unless a parent observes other areas of slowness during early development, they may be hesitant to seek advice. Knowing what's normal and what's not in speech and language development can help you figure out if you should be concerned or if your child is right on schedule.

So what are developmental normals for speech and language development? Before age 12 months, kids should be watched to see if they are using their voice to relate to their environment. Cooing and babbling are the early stages of speech development. As babies get older, usually around 9 months, they begin to string sounds together, incorporate different tones of speech, and say words like "Momma" and "Dadda" even though, until they are about 12-15 months old, they sometimes don't realize what “Momma" and "Dadda" really are. Before 12 months old, babies should also be attentive to sound and begin to recognize names of common objects like bottle, binky, and especially their name, by 9 months old. Babies who watch intently, but don't react to sound, may be showing signs of hearing loss.

By 12-15 months, kids should have a wide range of speech sounds in their babbling, like the p, b, m, d, or n sounds. They should begin to imitate sounds and words modeled by family members, and typically say one or more words other than just "Momma" and "Dadda." Nouns usually come first, like "baby" and "ball." Other things would be things like "uh-oh" or "wow" or "no," which is a very popular first word.

From 18-24 months, there's a lot of variability. This is when we talk about the language explosion. Most toddlers are saying about 20 words by 18 months and 50 or more words by the time they turn two. By age two, kids are starting to combine words together to make two word sentences such as "baby crying" or "come help." A two year old should be able to identify common objects as well. If you point to a picture in a book of an object that they know, like a baby, they should be able to tell you that. They should also be able to point to their facial features when asked, and follow two step commands like "please pick up the toy and give it to me."

From ages two to three, parents also see a huge gain in their speech. Your toddler's vocabulary should increase to too many words to count, and he or she should routinely combine three or more words like "please come here" or "mommy I want." Comprehension should also increase. By three years old, a child should begin to understand what it means to put something on the table or put it under the bed and they should start to be able to identify simple colors and comprehend descriptive concepts such as big versus little.

What is the difference between speech and language? They're often confused but there is a distinction between the two. Speech is the verbal expression of language and it includes articulation, which is the way sounds and words are formed. Language refers to the entire system of expressing and receiving information in a way that's meaningful. That's why sometimes your child may have receptive language skills that are good, they understand what you're saying, but they have expressive language problems, meaning they cannot get the words out that they are trying to say. A child with a language problem may be able to pronounce words well, but unable to put more than two words together. A child's speech may be difficult to understand, but he or she may still use words and phrases to express ideas.

If you're concerned about your child's speech and language development, there are some things to watch for. An infant who isn't responding to a sound or who isn't vocalizing by six to nine months of age is a particular concern. Between 12 and 24 months, other reasons for concern include children who are not using gestures, such as pointing or waving "bye, bye," by 12 months, prefers gestures over making words and vocalization to communicate by 18 months, has trouble imitating sounds by 18 months, and has difficulty understanding simple verbal requests.

If your child is over two years old, you should have your pediatrician evaluate them and refer them for speech therapy and a hearing exam if they can only imitate speech or actions but don't produce words or phrases by themselves, they say only certain words and only those words repeatedly, they cannot follow simple directions, they have an unusual tone to their voice such as sounding very nasally, they're more difficult to understand than expected for their age. And here's an easy way to understand how a child's speech should be understood. At two they should understand half of what their child is saying. At three, they should understand three quarters of what they're saying, and by four they should understand 100% of what a child is saying.

So what can you do to help with your child's speech development and also try to help them if you notice that they have a speech problem? First you can spend a lot of time communicating with child, even during infancy. Talking, singing, and encouraging imitation of sounds and gestures with your child goes a long way.

One of the most researched ways of improving speech and language skills is reading. You should start reading to your child as early as six months old. Start with an age appropriate soft or board books or picture books that you can point out what the pictures are and have your child feel the pictures. You can use books with textures that they can touch and learn the difference between soft or fuzzy or rough. Later let your child point to recognizable pictures and try to name them.

Finally, you can progress to books that are more age appropriate for toddlers, like the Hungry Caterpillar, where kids can actually predict what's going to happen. Dr. Seuss is also wonderful for children to learn speech patterns because of the rhyming that's in there. So your child is also able to start predicting what types of words come next. As your child gets older they will love reading on their own and will have their own favorite stories as well.

You can also use everyday situations to reinforce your child's speech and language. In other words, talk your way through the day. Point out objects around the house. If you're driving, point out the things you see along the road. Keep things simple, but never use baby talk. Always use good pronunciation so your child learns that as well. Whatever your child's age, recognizing and treating problems early is the best approach to help with any speech and language delay.

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Interviewer: It's summertime, and pool safety can be a big enough challenge, let alone if you have a child with developmental disabilities. We're going to find out what you need to look out for coming up next on The Scope.

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Interviewer: Pool safety. We're with Dr. Kyle Bradford Jones. He's at the Neurobehavioral Home Program here at the University of Utah, Family Medicine doctor. And for a parent that has a child with developmental disabilities, pool safety is a little bit more of a challenge. Let's talk about some of those things. These are conversations you have with most of your patients?

Dr. Kyle Jones: Absolutely. All the time. You know, individuals with developmental disabilities such as autism or intellectual disabilities, etcetera sometimes have a harder time around the pool. They need to be watched a little bit more closely because sometimes they don't understand the risks. They don't understand the dangers. So, it makes it much more important to keep a close eye on them as they're playing around the pool. Do your best to either avoid the deep end or to stay close by them when they are there.

Interviewer: What about even the shallow end?

Dr. Kyle Jones: You know, even the shallow end, it's true. Make sure that they're playing appropriately. What I mean by that is that they're playing safely. They're not continually hitting other children. They're not causing problems in that sense. They are able to play with others and play safely within the water environment.

Interviewer: Gotcha. What's one of the hidden dangers that a parent might not realize?

Dr. Kyle Jones: Individuals with autism, specifically, have difficulty with sensory issues. So they may not want to wear a floatation device or a life preserver. So you may put it on them and they go out to play, and then they don't like the way it feels, so they take it off.

Interviewer: That's pretty common?

Dr. Kyle Jones: Exactly.

Interviewer: Yeah. Excuse my ignorance. Is it an inability to swim that makes it a big danger for individuals with developmental disabilities around the water?

Dr. Kyle Jones: That's part of it. Especially at large pools where there's lots of other kids or lots of other people, sometimes they don't understand exactly how to interact with others. They can sometimes get into trouble in that sense.

Interviewer: So, for example, they don't understand the dangers of water, so they might put somebody under the water?

Dr. Kyle Jones: Exactly.

Interviewer: And not even realize that, that could be a dangerous situation?

Dr. Kyle Jones: Exactly.

Interviewer: Okay. Other situations like that?

Dr. Kyle Jones: Beware of the diving board or the slides for the same reasons: to watch out for other people but also make sure they can swim so that they can do OK once they're in the water.

Interviewer: What other concerns?

Dr. Kyle Jones: Obviously, sun safety, so making sure they're wearing sunscreen, keeping the skin covered up as much as you can while still allowing them to go out and have fun.

Interviewer: What's one of the most common injuries you see as a result of individuals with developmental disabilities at the pool?

Dr. Kyle Jones: One other safety thing to watch out for is it being slippery around the pool. Sometimes they don't understand that they need to slow down in order to keep from falling. And sometimes you see them come in with anywhere from a scrape to falling and hitting their head and having a head injury. So that's something to be very careful with.

Interviewer: What's the one take away that you would want to have somebody after they heard this walk away from?

Dr. Kyle Jones: If you have a child who has a developmental disability such as autism, keep a close eye on them and try to be as patient as you can with them in the pool so that they can play safely. If you don't have a child with a developmental disability and you're at the pool with one, again, please be patient and do the best you can to let them have some fun, too.

Announcer: We're your daily dose of science, conversation, medicine. This is The Scope, the University of Utah Health Sciences Radio.