Monday, June 05, 2006

Prematurity & ADHD

More premature kids have ADHD says new research. That's to be expected. Premature kids have more of everything bad. There is a reason why babies should stay en utero for 40 weeks.

The biggest cause I see of prematurity (not severe) but in the 34-37 week range earliness, is inductions. Some babies cook slower. Some parents have the conception date off--sometimes up to a month. And then parents want a certain doctor, or like a couple I know, wanted to take their vacation at a certain time, so induced two weeks early.

All this is insanity. A baby should, at the very least, be born when he or she is ready. These same parents will lament their child's immune system weakness (in the form of asthma, allergies, chronic ear infections, and general sickliness), their child's behavior problems (lack of attention, lower I.Q., hyperactivity, defiant personality), their child's motor function delays (trunk weakness, extensor bias--the baby needs to be balled up for long enough to develop properly, bilateral coordination required to crawl and walk, general floppiness) and cognitive delays. And they will have caused it, or their OB will have caused it by induction.

No one can be for certain when the baby is "done", but all the inductions for "insufficient pelvis" (completely bogus dx 90% of the time), "primagravida" (1st time mom), "geriatric mother" (mom over 30), doctor's vaction, parent's vacation, "overdue" (miscalculated dates), "ultrasound indicates large baby" (almost never true), blah, blah, blah.

The unconscious motivation on the part of the doc, is that C-sections are controlled--by him. He likes this even though complications are greater. He knows exactly when the baby will come. He knows how to plan his day. He can manage the liability risks (or thinks he can). A lot of mothers like this too. Childbirth is such an out-of-control experience. It feels crazy waiting for the day when the baby shows up. It's nice to plan. It is unnerving to see the calendar click by and those last few weeks are hell--but if you know the date, it's not so bad. For you.

The baby suffers with all this meddling. Small babies work harder and burn more calories to stay warm. Their suck reflexes are weaker. Their immune systems aren't fully developed. Their lungs are immature. They have less fat and so losing weight is dangerous and the parent may be encouraged to feed the kid formula. They must eat more often, tiring the mom out, because their stomachs are smaller. The list of potential down-sides for the baby is long.

Let the baby gestate. Let the baby have its own time table. Soon enough, he or she will be at the will of the world. It seems that at least one moment could be his or hers to decide. The baby benefits, and the parents will too.