Dr. Bob: My grandson is 6 years old and I think he is showing signs of being on the autism spectrum. Besides the flapping of his hands, nervous twitching, sudden outbursts and being very sensitive to loud sounds, he refuses to poop in the toilet. He has to poop in a pull-up, standing up. He will pee in the toilet both ways, standing and sitting but he will not poop in the toilet. If we refuse to give him a pull-up, he will hold his poop and not go for several days. Could this be a sign of autism or am I grasping at straws? Since he will be starting 1st grade this year I am very concerned for him. Any suggestions?
Answer: I tend to share your concern for the developmental status of your grandson. I cannot make a diagnosis of autism spectrum disorder (ASD) per se from your description, but the signs that you describe are worthy of further evaluation by the child’s pediatrician and probably a developmental pediatric specialist. The importance of such an evaluation is to get a professional assessment for any child with developmental concerns. When a diagnosis such as autism spectrum disorder is considered and then established, early intervention services before or after school age can begin and are usually of substantial benefit. Even without a diagnosis of ASD, some of the behaviors noted might signal the need to have other evaluations. That might include a genetic evaluation. (I have to remember my genetics roots!)
One should not be embarrassed or ashamed if a diagnosis of autism spectrum disorder is being considered. The most important thing is for the child to get the proper support and treatments and/or interventions.
Withholding of bowel movements can develop into a serious problem and will need long-term care. This sign alone concerns me and tells me that further evaluation is necessary.
The CDC recently published information about ASD (https://www.cdc.gov/ncbddd/autism/data.html) and noted that it is currently estimated that 1 in 36 children should be considered for ASD.
Every child is unique and deserves all the proper attention to maximize their potential. When concerns are raised, professional assistance (evaluation, support and treatment) is warranted and should be pursued.
Dr. Bob: What’s the latest thinking regarding using a sound machine/artificial white noise for newborns to promote better sleeping?
Answer: I am fascinated with this question. Many people in my family sleep with a sound machine at night and I never did.
Is it necessary? I am not aware of any information that white noise is necessary for infant sleep. White noise can be detrimental for hearing and auditory processing if too loud. In my experience of over 44 years, white noise was used by some families because they perceive the need to block other noises and improve the ability of their infant to fall asleep. Sometimes they have acknowledged that other (presumably unavoidable) noises in the house at night will keep their infant up, and they have used white noise to mask those noises.
There are certain guidelines for the use of white noise for sleep. 1) The machine should be no closer than 7 feet; 2) The sound should be set at less than maximum setting (and preferably not exceed 50 dB; 3) Parents can consider stopping the sound machine after the infant falls asleep; 4) When parents want to wean the child off the machine, they can simply turn down the volume in stages over a period of weeks.
I am not aware of any evidence that children become “addicted” to white noise. However, my personal preference would to use the white noise as a sleep soother in a limited capacity since we do not know if there are real long-term benefits or consequences of using sound machines.
Dr. Saul is Professor of Pediatrics (Emeritus) at Prisma Health and his website is mychildrenschildren.com. Contact Dr. Bob at askdrbobsaul@gmail.com