Expert: Catherine Ridenour - 7/27/2005

Question
My grandson was born @ 32 weeks gestation on April 24, 2005.  He was transferred to a nicu immediately and was placed on a ventilator.  Of course, he was given the hep b vaccination at birth (WHY???)before he left one hospital for the other.  He does not make much eye contact, and if you force him to look at you, he gets very upset and cries.  He does not smile often, rarely at people, and usually only at inanimate objects like the wall, the ceiling fan, light coming through windowshades.  He still cannot roll over.  Is this (hopefully) just from being a preemie, or should we look further.  I feel sick about this, but I want to do anything possible to help him asap.  I do not think his mother can see these things, maybe because this is her first baby and she doesn't know it is abnormal; or being a nurse, she is totally frightened and doesn't want to acknowledge any problem, hoping it won't be true.  What are your thoughts.  I don't want to be an alarmist, however, I do know my children were not this way.  Thank you in advance.

Answer
Hi Robyn,

Let me calculate... 13 weeks means a little over 3 months.  I have read that premies need 2 months outside the womb for every month they miss on the inside.  At 32 weeks gestation, he had 2 months to go.  So, he won't even be "newborn" until he's 4 months old.  Does that make sense?

I would not expect 3 month old behavior out of him, yet.  Rolling over is a very individual thing.  Some babies do it much sooner than others even if there are no problems at all.  Social smiling is definitely a skill not seen until about 3-4 months of age in full term infants.

You don't say if your grandson rejects physical contact.  In "classic" autism, babies generally arch their backs and stiffen when held.  If he snuggles well and takes comfort in human touch, that is a good sign.

I think you can relax and let him develop a while before you get worried.  Premies ARE different.  

By the way, I do not believe vaccinations cause autism.  Rather, I think it is the coincidence between the timing of vaccinations and the stages at which autism begins to show up that makes it appear so.  

Certainly, if your grandson does not show development appropriate to his "adjusted" age.  That is, his age now minus the 4 months catch-up time, that would be a concern that should be discussed with his pediatrician. For instance, full term babies average sitting up about age 6 months.  If he is not able to do so at 8 to 10 months, that would be a clue he may have a problem. Also, if he does not respond to sounds, particularly the human voice, his hearing should be evaluated.  Deafness can mimic autism.

There is no rush in diagnosing him, even if he does have an autistic spectrum disorder.  Treatment for these disorders centers on speech and occupational therapy.  Social skills training is also included as the child grows.  If he is diagnosed by age one, that would be earlier than most.

For now, let him lead you in the ways he wishes to interact.  Get down on the floor with him and help him build muscle tone by lieing on his tummy and lifting his head to look at toys.  Talk to him, carry him, do all the loving grandma things.  Don't force him to make eye contact for any longer than he is comfortable.  

Feel free to write me again in a month or two, if you are still worried.

Best wishes,
Catherine