Expert: Valerie Herskowitz - 9/16/2010

Question
QUESTION: Hi, my son is almost 4 months old and displays some concerning behavior to my husband and I. On the positive side he makes good eye contact (when he is. not being held) and is in engaging to his surroundings and has a beautiful social smile. As for his behaviors that are concerning I will list them He does not like to be held much esp in the cradle position, He is very irritable (He does have reflux and is I think controlled with prevacid) He gets upset while playing with toys often and starts to cry. in fact he is always crying. Also he usually won't look at you when holding him but he will engage with others that are around. Is it really possible to have a baby on the spectrum that smiles, maintains eye contact and is very alert and engaged in his surroundings. I am very confused sometimes when he looks and smiles at me I become relaxed and think he is ok and then at other times I observe his behavior and I just know something is not right. We also have a six year old in which I was never concerned about his development. Also is it to young to get him evaluated and if not by whom. Thank you

ANSWER: Hi Susan

To answer your question, I believe it is possible to have a child on the spectrum that is alert and engaged, but in your son's case, you really didn't mention anything to me that is earthshattering in regards to autism. But you are the mom, and if something doesn't seem just right, you may be correct.Are their other behaviors that you didn't list? And- Have you had his hearing checked?

Having reflux can make a child very cranky. Possibly holding him in the cradle position increases the reflux.

How is this child different than your six year old was at the same age? He is probably too young to get him evaluated especially since you really haven't described anything too extreme.

Keep a little diary of this behaviors for two weeks and get back with me.

---------- FOLLOW-UP ----------

QUESTION: Thank you for responding so quickly. I forgot to mention a few other concerns/behaviors in my first question. I will list them as follows. He used to coo alot and take turns in cooing with others at around 2.5 months that stopped and now he only goes eh eh complaining like in quality it has been a while since I heard an ah goo, he also does not laugh yet or seem to get amused by my antics only responds by smiling. He has not rolled over from back to front yet. He did roll from tummy to back a few times. He has never really noticed his hands but does clasp them in front and place them in his mouth. when holding him chest to chest he will almost always turn his head and arch his back slightly so you have to support him from falling backwards. In addition we brought him to a neuro recently to rule out a possible seizure 3 days after his 2 month shots he was rhythmically moving his head from side to side like stevie wonder and had son staring spells. The neuro said that she saw no neuro deficets at the time and he acted age appropriate and lack of eye contact when being held could just be his temperament. (which would be fine with us). However she was concerned about his head size in the 90th% (@3 mo) and was 50% at birth and 2 month well. Well of course Iran him back to his pedi and he said it was more like 75%. Two problems here first don,t they use standardized head measurements and still 25% increase in 1 month isn't that significant (his height and weight are in the 50th) My husband has a big head as well as my other son but he was always in the 90% across the board. In closing and response to what my other son was like was a typical text book baby with the plus of always being happy and engaging and extremely social hit all milestone before schedule and never had any "off" behaviors that concerned me. With all fairness he was my first and I knew nothing and autism has seemed to make front page esp in the last 6 years. Thank you again your knowledge would again be appreciated.  

Answer
Hi Susan

I would find a qualified developmental pediatrician. They are really the experts that know exactly what a child should be doing at each age and can tell you what is normal and what is not. This is their expertise.

Good luck and let me know