Author: bebaks

What can you do if you or someone you know suffers from domestic violence in Kosovo?

There is no excuse for domestic violence. Ever.

Attitudes and responses to domestic violence are slowly improving in Kosovo. Police and the courts are better trained to respond and Victim’s Advocates, Centers for Social Welfare and shelters all appear to be doing a better job at dealing with this immense problem.

What should you do if you or someone you know is a victim of domestic violence?

If you experience or witness assault we encourage you to call the police, especially if it is an emergency. You can also call the free help line number: 0800 11112. This is run by the Victim’s Assistance and Advocacy division of the Kosovo Public Prosecutor’s Office. The people who answer help victims of domestic violence, or people who report any such violence, by supplying them with information and contact numbers.

Keep in mind that under Kosovo law “failing to report child abuse or domestic violence is a criminal offence, and anyone who fails to report criminal offences occurring within a domestic relationship can be held criminally liable.” (Kosovo Women’s Network 2015, ‘No More Excuses’, See Art. 385, failure to report preparation of criminal offenses, paragraph 3)

What are your legal rights?

Material courtesy of OSCE “Catalogue of Advice and Assistance for Domestic Violence Victims”

Under the Kosovo Law on Protection against Domestic Violence, acts of domestic violence are defined as intentional acts or omissions when committed by a person against another person with whom the person is in a domestic relationship. This includes anyone you currently share, or previously shared, a household with. These acts include, but are not limited to: a) use of physical force or psychological pressure b) inflicting or threatening to inflict physical pain or psychological suffering on another family member c) causing the feeling of fear or threat of dignity d) physical assault; e) insult, offence, calling by offensive names, and other forms of violent intimidation f) repetitive behaviours with the aim to denigrate the person g) non-consensual sexual acts h) unlawful limiting of the freedom of movement of the other person i) damaging the property or threatening to damage the property of another family member j) causing the other person to fear for his or her physical, emotional or economic wellbeing k) forcibly entering or removing from a common residence the other family member and l) kidnapping. (Law No. 03/L-182 on Protection against Domestic Violence, 2010, at: http://www.assembly- kosova.org/common/docs/ligjet/2010-182-eng.pdf. Art. 2, paragraph 1.2.)

The Law on Protection against Domestic Violence provides a set of legal measures aiming to protect domestic violence victims. The law defines concepts such as domestic violence and domestic relationships and explains which kind of protection measures and orders exist as well as the procedures to follow in order to obtain them.

How does the law protect you and/or your children against domestic violence?

Material courtesy of OSCE “Catalogue of Advice and Assistance for Domestic Violence Victims”

Protection measures are measures issued by a court or the police to protect a person who is exposed to violence by changing the circumstances which may allow the perpetrator to commit more acts of violence. Protection measures can limit perpetrators from visiting their places of residence and can prohibit perpetrators from seeing their children, in addition to other measures. These measures are issued for the duration of a protection order. Once protection measures end, they will no longer affect the property rights or the custody rights of the perpetrator.

A municipal court can issue protection orders or emergency protection orders containing one or more protection measures. Kosovo police can issue temporary emergency protection orders containing only some of the protection measures.

A petition for a protection order can be submitted by:

• A victim of domestic violence
• An authorized representative of the victim
• A victim’s advocate (upon consent of the protected party)
• A representative of the centre for social welfare of the municipality where the victim permanently or temporarily resides, when the victim is a minor
• A non-governmental organization (NGO) that is familiar with the situation of the victim.

Kosovo police are responsible for ensuring that the perpetrator obeys the protection measures. A violation of a protection order is a criminal offence and the violator will be sentenced to a fine and imprisonment.

To read the full report by OSCE, “Catalogue of Advice and Assistance for Domestic Violence Victims” go to: http://www.osce.org/kosovo/88708?download=true

What are the responsibilities of the police?

Material courtesy of OSCE “Catalogue of Advice and Assistance for Domestic Violence Victims”

Kosovo police are responsible for responding to any report of acts or threats to commit acts of domestic violence or to any violation of a protection order, an emergency protection order or a temporary protection order, regardless of who reports it. The police will complete an incident report whether or not a crime was committed or an arrest was made, and will provide a copy of the report to the victim or legal representative.

Apart from issuing temporary emergency protection orders, Kosovo police are responsible for using reasonable means to protect domestic violence victims and prevent further violence, such as:

• Establishing a special phone line for reporting domestic violence cases
• Providing the victim or the victim’s legal representative with the official contact of the investigating police officer in cases where the victim needs further assistance. In case there is no investigating police officer, any other officer will assist the victim.
• Informing the victim, legal representative or victim’s advocate about the rights of the victim pursuant the law on domestic violence, including the right to request a temporary emergency protection order
• Informing the victim about legal, psychological and other assistance available from government institutions as well as from the authorized network of NGOs
• Informing relevant service providers regarding the incident of domestic violence and facilitating contact with the victim, upon the victim’s request
• Providing transport for the victim and, when necessary, the victim’s dependants to:
  • An appropriate medical facility for treatment or medical examination
  • A shelter or other suitable safe haven, upon the request of the victim
• Providing protection to the person who reports the incident, if needed, in accordance with relevant legal obligations regarding the protection of witnesses
• Removing the perpetrator from the temporary or permanent residence of the victim or a portion thereof (in regard to the protection measure of removal from apartment, house or other living premises).

In addition, police must immediately report the incident to the centre for social welfare of the municipality where the person permanently or temporarily resides in the cases where:

• The victim is a person under the age of 18 or a person who does not have the capacity to act on his or her own
• The acts of domestic violence are so serious that they impact the safety or security of a person under the age of 18 or that of a person who does not have the full capacity to act and who is living in the same residence as the perpetrator.

What is a shelter and what are their services?

Material courtesy of OSCE “Catalogue of Advice and Assistance for Domestic Violence Victims”

A shelter is a safe place where domestic violence victims and their children can temporarily stay and which provides protection and other services. Currently there are shelters in Gjakova/Đakovica, Gjilan/Gnjilane, Mitrovicë/Mitrovica, Pejë/Peć, Prishtinë/Priština and Prizren that host victims from communities all over Kosovo.

Victims can stay in the shelter for six months. This can be extended upon agreement with the Ministry of Labour and Social Welfare.

Shelters usually provide victims with accommodation, food, clothing, counseling (psychosocial and legal advice), medical support, vocational trainings (language, computer, internet, reading and writing, sewing, cooking, hairdressing, tailoring), health education, job-seeking services, and activities for children (music, drawing, dancing) among other services. The shelters are patrolled by the police and have various other security arrangements.

Some shelters also contribute to preventing domestic violence by organizing awareness-raising activities and outreach visits to rural areas. Some shelters are also involved in monitoring and advocating for a legal and policy framework in Kosovo that is properly funded and that protects domestic violence victims. Some others conduct regular visits to the victims, once they return to their families or become independent.

How can I help a friend or family member who is a victim of domestic violence?

• Talk to the abuse victim person and ask how you can help. If old enough, encourage them to reach out for support and counseling. Remind them it is not their fault. No one deserves to be abused.
• Don’t judge and don’t tell the victim what to do. Listen to and believe what they say. Be patient.
• Often, victims of domestic violence are isolated and without support. Help to develop or keep their outside contacts.
• Help her and her children to stay safe. Talk to her about ways she can do this and encourage her to think of ways herself.
• Call the free help line, 0800 11112, to get more information about what can be done. This might be safer than trying to directly intervene, which can be dangerous for both you and the victim. If you are worried about reprisals, clear your phone call history after making any such calls.

For more information

• Call the free help line number: 0800 11112, run by the Victim’s Assistance and Advocacy division of the Kosovo Public Prosecutor’s Office for more information and contact numbers.
• You will find the address, email and phone number of all the public institutions (like Victims Advocacy Officers), shelters and NGOs working on domestic violence issues in each municipality of Kosovo on pages 24-54 of the OSCE’s “Catalogue of Advice and Assistance for Domestic Violence Victims”.
• Kosovo Women’s Network has been at the forefront of serving, protecting and promoting the rights of women and girls in Kosovo since 1996. You can read their report, “No More Excuses” by clicking here.

Can birth defects be prevented?

Most babies born with birth defects are born to two parents with no apparent health problems or risk factors. However, some birth defects can be prevented. Here’s how:

1. Take at least 400mcg of folic acid daily for at least one month before getting pregnant and 600-800mcg during pregnancy. You can typically find this in prenatal vitamins, but check the dosage. Foods high in folic acid include some fortified cereals, lentils and dried beans/peas, nuts, avocado, dark green vegetables (broccoli, spinach, collard or turnip greens, okra, brussels sprouts, and asparagus) and citrus fruit and 100% juice. Getting enough folic acid can reduce the risk of your baby having a neural tube defect, like spina bifida, by as much as 70%, and reduce the risk of your baby getting an oral clefts by 25%.
2. Visit the doctor when planning to get pregnant and as soon as you think you are pregnant. It’s essential to visit the doctor regularly throughout your pregnancy (at least four times). They will conduct important tests on you and your baby which will help to identify any possible complications, and they can also tell you how to best take care of yourself and your unborn baby during this important time.
3. Avoid alcohol when pregnant. Since there is no known safe amount of alcohol to use during pregnancy, experts recommend not to drink alcohol at all to keep risks to your baby to a minimum. Risks include miscarriage, stillbirth, and numerous physical, behavioral, and intellectual disabilities. The risks are greater the more you drink. Drinking heavily can cause fetal alcohol syndrome, which leads to lifelong issues with poor growth, facial abnormalities, and learning and behavioral problems. You might have drunk alcohol before even realizing you’re pregnant. There is no need to worry unnecessarily as risks to your baby are likely to be low, but you should avoid further drinking.
4. Don’t smoke and avoid secondhand smoke (when you inhale smoke from person/s smoking near you). Exposure to smoke can cause cleft lip/palate and other dangers like preterm birth and infant death. It’s best to quit before getting pregnant, but if you are already pregnant and smoking, you can still protect your baby by quitting as soon as possible.
5. Prevent infections by frequent hand-washing with soap, thoroughly cooking meat, and avoiding people who are sick. You should also be active to avoid sexually transmitted diseases and if you are exposed, get treatment immediately. Infections can cause a range of birth defects.
6. Manage any adverse health conditions, such as asthma, diabetes, high blood pressure, stress and weight. Talk to your doctor about how you can do this before and during pregnancy. This will reduce your risk of having a child born with a birth defect or other poor health outcome.
7. Avoid toxic substances before and during pregnancy. This applies to both the men and women as it may increase the risk of a large range of birth defects that affect many aspects of the baby’s development, including his brain, spinal cord, urinary tract, heart, nervous system, among others.
8. Avoid certain medications, including prescription and over-the-counter medications and dietary or herbal products. Check with your doctor before getting pregnant or as early as possible in your pregnancy. They might be able to recommend an alternate that is compatible with pregnancy.

Take 250mcg of iodine daily when pregnant. You can typically find this in prenatal vitamins, but check the dosage. Foods high in iodine include iodized salt, seafood and dairy products. But don’t take too much. Taking too much or too little iodine can increase the risk of thyroid-related disorders and mental delays.

The following information on specific birth defects is provided courtesy of March of Dimes (adapted for Kosovo). For more information on these and other birth defects, visit March of Dimes’ website. (links to http://www.marchofdimes.org/complications/birth-defects-and-health-conditions.aspx)

PREGNANCY COMPLICATIONS

Material on this page is courtesy of March of Dimes (adapted for Kosovo)

Pregnancy complications are health conditions that may need special care.

Throughout pregnancy, go to all your prenatal care checkups, even if you’re feeling fine. Getting regular prenatal care can help you spot complications early—and maybe even prevent them.

Learn about pregnancy complications, including anemia, gestational diabetes and high blood pressure. If you have one of these conditions, work with your doctor to keep them under control.

And if you had certain health complications before pregnancy, like preexisting diabetes or depression, find out what you can do to help you stay healthy during pregnancy. There also are ways you can protect yourself from common infections, like the flu and food poisoning, which can cause problems during pregnancy.

We have included details about the most common pregnancy complications. For a more detailed list (in English only), click here to visit March of Dimes.

http://www.marchofdimes.org/complications/pregnancy-complications.aspx

What is ovulation?

Ovulation is when a woman’s ovaries release an egg, usually 14 days before the first day of her period. When a couple has sexual intercourse and does not use birth control around the time of ovulation, a man’s sperm swim to meet the woman’s egg. When a sperm penetrates the egg, it’s called fertilization or conception. The fertilized egg (embryo) then travels to the woman’s uterus (womb), where it burrows into the lining of the uterus and begins to grow.

How do I know when I ovulate?

1. If your period is regular (it comes the same number of days apart every month): AMC’s ovulation calculator can help you find out the days you’re most likely to ovulate. It uses the first date of your last menstrual period and the number of days between your periods. The ovulation dates are an estimate. The best time to have sex is two days before and the day that you ovulate. The more often you have sex during this time, the more likely you are to get pregnant. Ovulation Calculator

For example:

• If you have 28 days between periods ovulation typically happens on day 14, and the most fertile days are days 12, 13, and 14.
• If you have longer cycles, say 35 days between periods, ovulation happens on day 21 and the most fertile days are days 19, 20, and 21.
• If you have shorter cycles, say 21 days between periods, ovulation happens on day 7 and the most fertile days are days 5, 6, and 7.

2. If your periods are irregular (the number of days apart varies from month to month): There are a number of fertility tracking methods that can help you determine when you’re ovulating. They are listed below. It’s important to talk to your doctor to learn more about the most effective way to use them.

• The temperature method: Use a basal body thermometer to take your temperature every day before you get out of bed. This is a thermometer that can measure really small changes in your temperature. You can buy one at a pharmacy. Your temperature rises about 1 degree just as you ovulate. Have sex as close as you can to this rise in temperature for your best chance of getting pregnant.
• The cervical mucus method: Pay attention to the mucus in your vagina. It gets thinner, slippery, clearer and more plentiful just before ovulation.
• Ovulation prediction kit: Ovulation prediction kits test urine for a substance called luteinizing hormone (LH). This hormone increases each month during ovulation and causes the ovaries to release eggs. The kit will tell you if your LH is increasing. You can purchase ovulation prediction kits at pharmacies.

If you use the temperature or cervical mucus methods, begin tracking changes a few months before you want to conceive. If you’re using an ovulation predictor kit, begin using it about 10 days after the start of your last period.

Depression after pregnancy/birth (postpartum depression)

Postpartum depression (PPD) is more common than you might think. Around 1 in 7 new mothers get PPD. It often starts within 1-3 weeks after birth but it can occur anytime within the first year. Symptoms differ but can include:

• Feelings of anger or irritability.
• Lack of interest in the baby.
• Appetite and sleep disturbance.
• Crying and sadness.
• Feelings of guilt, shame or hopelessness.
• Loss of interest, joy or pleasure in things you used to enjoy.
• Possible thoughts of harming the baby or yourself.

Don’t worry; postpartum depression is temporary and treatable. If you feel you may be suffering from it, know that it is not your fault, and there are things you can do to help cope and recover. If you think you have PPD, see a doctor or check with your local Beba-ks Center for a referral to a specialist.

Is there anything I can do to feel better?

There are three things you can start doing for yourself right away to feel better:

1. Stay healthy and fit:
   • Do something active every day. Go for a walk or get back to the gym.
   • Eat healthy foods. These include fruits, vegetables, whole-grain breads, and lean meats. Try to eat fewer sweets and salty snacks (even though that is what you might crave).
   • Get as much rest as you can. Try to sleep when your baby sleeps.
   • Don’t drink alcohol; it is a depressant, which means it can slow your body down and make you feel more depressed.
   • Don’t take street drugs. These affect the way your body works and can cause problems with the medicine you might be taking for PPD.
2. Ask for and accept help:
   • Keep in touch with people you care about and who care about you. Tell your husband, family, and friends how you’re feeling.
   • Take time for yourself. Ask someone you trust to watch the baby so you can get out of the house. Visit a friend, get outside, or do something you enjoy. Plan for some time alone with your partner.
   • Let others help around the house. Ask your friends and family to watch the baby, help with housekeeping, or go grocery shopping. Don’t be afraid to tell them what you need.
   • Join an online support group. You can get more information and talk to experts at Postpartum Support International and Postpartum Progress (both in English only).
3. Lower your stress:
   • Do the things you liked to do before you had your baby. Listen to music, read a good book, or take a class.
   • Do the things that used to make you feel good about yourself before you got pregnant.
   • Try not to make any major changes in your life right after having your baby. These include moving or changing jobs. Major changes can add stress to your life that you don’t need right now.
   • Talk to your boss about going back to work. Maybe you can work at home or part-time when you first go back to work.

If these things help, great! Keep doing them as if you stop you might find your symptoms return. If these things don’t improve your symptoms within two weeks, you should definitely see a doctor or check with your local Beba-ks Center for a referral to a specialist. You might need additional therapy, including prescription antidepressants. It’s very important you take PPD seriously as it can make it hard for you to take care of your baby and will only get worse if left untreated. If you have thoughts of harming your baby or yourself, see a doctor immediately.

How will a doctor treat your PPD?

They will first ask you some questions to help determine if you have PPD. They may do tests to see if you have other health problems that may lead to PPD. For example, they may check your thyroid hormones as low levels of thyroid hormones may lead to PPD. The sooner you see your provider about PPD, the better. You can get started on treatment to make you feel better so you can take good care of yourself and your baby. These are treatments your provider may suggest:

• Counseling: this also is called therapy. It’s when you talk about your feelings and concerns with a mental health professional. They help you to understand your feelings, solve problems, and cope with things in your everyday life.
• Medicine: PPD often is treated with medicine, including 1) Antidepressants – some have side effects and some are not safe to take if you’re breastfeeding so talk to your doctor to decide if one is right for you. 2) Estrogen – this hormone plays an important role in your menstrual cycle and pregnancy, but check with your doctor if you are breastfeeding.

Depression during pregnancy (antepartum depression)

Material courtesy of March of Dimes (adapted for Kosovo)

Major depression is more than just feeling down for a few days. You may have depression if you have any of these signs that last for more than two weeks or:

• Changes in your feelings
  • Feeling sad, hopeless or overwhelmed
  • Feeling restless or moody
  • Crying a lot
  • Feeling worthless or guilty
  • Changes in your everyday life
• Eating more or less than you usually do
  • Having trouble remembering things, concentrating or making decisions
  • Not being able to sleep or sleeping too much
  • Withdrawing from friends and family
  • Losing interest in things you usually like to do
• Changes in your body
  • Having no energy and feeling tired all the time
  • Having headaches, stomach problems or other aches and pains that don’t go away

If you’re pregnant and you have any of these signs, or if the signs get worse, call your doctor or contact your local Beba-ks Center. There are things that can help you feel better. If you’re worried about hurting yourself, call your doctor immediately.

Can depression during pregnancy affect your baby?

Yes. If you’re pregnant and have depression that’s not treated, you’re more likely to have:

• Premature birth.
• A low-birthweight baby.
• A baby who is more irritable, less active, and less attentive.

Being pregnant can make depression worse or make it come back if you’ve been treated and feeling better. If you have depression that’s not treated, you may have trouble taking care of yourself during pregnancy. For example, you may not eat healthy foods and not gain enough weight. You may skip your prenatal care checkups or not follow instructions from your doctor. Or you may smoke, drink alcohol, use street drugs or abuse prescription drugs. All of these things can affect your baby before he’s born.

If you have depression during pregnancy that’s not treated, you’re more likely to have PPD after pregnancy. PPD can make it hard for you to care for and bond with your baby. Treatment for depression during pregnancy can help prevent these problems.

What causes major depression?

We’re not exactly sure what causes depression. It may be a combination of things, like changing chemicals in the brain or changing hormones. Hormones are chemicals made by the body. Some hormones can affect the parts of the brain that control emotions and mood.

How is depression treated during pregnancy?

Depression can be treated in several ways. You and your doctor may decide to use a combination of treatments instead of just one:

• Counseling (also called therapy or talk therapy): This is when you talk about your feelings and concerns with a counselor or therapist. This person helps you understand your feelings, solve problems and cope with things in your everyday life. Check with your doctor or contact your local Beba-ks Center for a referral.
• Support groups: These are groups of people who meet together or go online to share their feelings and experiences about certain topics. You might find our online community helpful or contact your local Beba-ks Center to find out about local in-person meetings.
• Medicine: Depression often is treated with medicines called antidepressants. You need a prescription from your doctor for these medicines. You may be on one medicine or a combination of medicines. Some research shows that taking an antidepressant during pregnancy may put your baby at risk for some health conditions. But if you’ve been taking an antidepressant, it may be harmful to you to stop taking it. So talk with all of your doctor about the benefits and risks of taking an antidepressant while you’re pregnant, and decide together what you want your treatment to be. If you’re taking an antidepressant and find out you’re pregnant, don’t stop taking the medicine without talking to your doctor first. Not taking your medicine may be harmful to your baby, and it may make your depression come back.

What are other signs and symptoms of autism spectrum disorder?

A child with ASD may have challenges in communication, social, and behavior skills, including:

Communication challenges

• Has delayed speech and language skills. Some children with ASD can’t speak at all or speak very little. About 40 in 100 (40 percent) children with ASD don’t speak at all. Other children with ASD speak well.
• Has trouble talking to other people, starting a conversation, and sharing his needs using typical words or motions. A child with ASD may talk a lot about something he really likes rather than have a conversation with another person.
• Doesn’t understand jokes, teasing, or sarcasm. Sarcasm means using bitter or teasing words to make fun of someone or something.
• Mixes up pronouns (says “you” instead of “I”)
• Repeats or echoes words or phrases
• Seems unaware when people talk to him, but responds to other sounds
• Talks in a flat, robot-like voice or talks in a sing-song or high-pitched voice

Social challenges

• Avoids eye contact or makes very little eye contact
• Doesn’t respond to his name by 12 months old
• Doesn’t respond to a parent’s smile or other facial expressions or makes facial expressions that aren’t appropriate
• Doesn’t look at objects when someone points to them or doesn’t point at objects to show interest (like pointing at an airplane flying in the sky)
• Has trouble understanding other people’s feelings or talking about his own feelings
• Is interested in people but doesn’t know how to talk, play, or relate to them
• Wants to be alone or play alone, has trouble making friends, or doesn’t have an interest in other people at all

Behavior challenges

• Doesn’t play “pretend” games (like pretending to feed a doll), or plays with parts of a toy instead of the whole toy
• Gets upset by changes in routines, like making an unplanned stop on the way home from school
• Has unusual interests or behaviors, like lining up toys or objects without playing with them or being really interested in vacuum cleaners
• Is very sensitive or not sensitive at all to the way things feel, sound, taste, or smell. Some children with ASD seem as though they don’t feel pain, heat, or cold, and some don’t want to be held, cuddled, or touched. Others are super sensitive to everyday sounds and cover their ears or hide from sounds. Some children need extra stimulation, such as firm hugs or the comfort of being covered by a heavy blanket in bed.
• Is overly focused on one thing or activity and does the activity many times during a day
• Is very interested in certain things, like numbers, symbols, or certain subjects, and remembers lots of information about these things
• Repeats actions over and over again, like flapping his hands, rocking his body, or walking on his toes

Other challenges

• Is hyperactive (very active) or has trouble sitting still or paying attention
• Is impulsive (acts without thinking first)
• Isn’t afraid of dangerous things but is very afraid of harmless things
• Is violent
• Has temper tantrums often or hurts himself, like by banging his head or biting himself
• Has different eating or sleeping habits. Some children with ASD may eat just a few foods. Others may want to eat nonfoods, like dirt or rocks. This kind of eating problem is called pica.

What is developmental monitoring?

At each well-child visit, your baby’s provider looks for developmental delays or problems and talks with you about any concerns you may have about your baby’s development. This is called developmental monitoring or surveillance. The provider monitors (checks) your child as a baby through school age and even later in life if he has problems with social, learning, or behavior skills. If your baby has any problems that come up during developmental monitoring, she needs developmental screening.

What is developmental screening?

Developmental screening is a short test that checks to see if a child is learning basic skills when he should, or if there are delays. During developmental screening, your baby’s provider does a short checkup to look for signs of problems. During screening, the provider may ask you some questions or talk and play with your baby to see how she plays, learns, speaks, behaves, and moves. A delay in any of these areas could be a sign of a problem. The American Academy of Pediatrics (AAP) recommends that all children be screened for developmental delays and disabilities during regular well-child visits at:

• 9 months
• 18 months
• 24 or 30 months

If your child’s provider doesn’t do this kind of developmental screening, you can ask the provider that it be done. Some babies may need extra screening if they’re at high risk for developmental problems because they were born prematurely or with low birthweight (less than 5 pounds, 8 ounces) or because of other reasons, like having a brother or sister with ASD. If the provider thinks your baby may have ASD, she needs a full evaluation before a diagnosis can be made.

How is autism spectrum disorder diagnosed?

Different health care providers evaluate your child to help diagnose ASD. Providers include:

• Developmental pediatrician. This is a pediatrician who has special training in child development and taking care of children with special needs.
• Child neurologist. This is a doctor who treats the brain, spine, and nerves in children.
• Child psychiatrist or child psychologist. These are mental health professionals who have special training to take care of children with emotional or mental health problems.
• Occupational therapist. This is a specialist who helps people learn to carry out everyday activities. For children, this may be things like brushing teeth, getting dressed, putting on shoes, or learning to use a pencil.
• Physical therapist. This is a specialist who creates exercise programs to help build strength and help with movement.
• Speech therapist. This is a specialist who helps people with speech and language problems.

To evaluate your child, the providers may:

• Talk with you about your child’s health and development history
• Watch your child play and interact with you
• Give your child a physical exam and hearing test. Any child with a speech delay or possible ASD should have a hearing test.
• Check your child’s developmental skills, including motor (movement) skills, language skills, social skills, and cognitive skills. Motor skills include walking and writing. Cognitive skills are learning, thinking, and problem-solving skills. A child may have ASD if her social and language skills are much weaker than her motor and cognitive skills.
• Evaluate your child’s language skills by checking her speech, pronunciation (the way words are said), and how she follows social rules for language (like using facial expressions and eye contact, or taking turns in conversation).

Your child’s providers may use medical tests to see if your child has a medical condition with signs or symptoms that are similar to ASD. These include:

• Genetic tests to check for conditions, like fragile X syndrome or Rett syndrome. Rett syndrome is a rare genetic disease that mostly affects girls and causes problems in development and the nervous system (brain, spine, and nerves).
• Tests to check the levels of lead in your child’s blood. High levels of lead can cause serious problems, like brain damage and developmental delays.
• Electroencephalogram (also called EEG) or magnetic resonance imaging (also called MRI). EEG records electrical activity in your baby’s brain. MRI is a medical test that makes a detailed picture of the inside of your body.
• Tests to check for metabolic disorders. These are health conditions that affect a body’s metabolism. Metabolism is the way your body changes food into the energy it needs to breathe, digest food, and grow. They can cause intellectual and developmental disabilities.

How is autism spectrum disorder treated?

There is no cure for ASDs. But some children can do well when they get treatment as soon as possible. In addition to early intervention services, children with ASD may need other kinds of treatment, including:

• Medicines. While medicines can’t cure ASD, certain medicines can help some children with ASD to function better. No two children with ASD are exactly alike, but talk to your child’s provider to see if any medicines may help your child.
• Behavior and communication treatment options and therapies. These include:
  • Applied behavior analysis (also called ABA). This is a treatment approach that encourages positive behaviors and discourages negative behaviors to help a child improve in certain skills. During ABA, a trainer asks a child to do something and gets a response (behavior) from the child. If the child responds with the right behavior, she gets a reward, like a toy or candy. Providers track and measure the child’s progress. Providers and therapists at many schools and clinics use ABA. There are different types of ABA.
  • Developmental, individual differences, relationship-based approach (also called DIR or “floortime”). This kind of therapy helps a child understand feelings and establish relationships with caregivers. It also focuses on how a child deals with sights, sounds, and smells. This therapy is done on the floor at the child’s level. Children play with therapists and parents to help develop their skills and relationships.
  • Occupational therapy. This helps a child learn skills like dressing, eating, bathing, and relating to people.
  • Sensory integration therapy. This is a kind of occupational therapy that helps a child deal with sensory information, like sights, sounds, and smells. It may help a child who is bothered by certain sounds or who doesn’t like to be touched. It can also help with feeding problems.
  • Speech and language therapy. This helps a child learn communication skills, like understanding language and being able to express himself through speech. Therapists often use picture boards and gestures to help a child develop these skills.
  • The picture exchange communication system (also called PECS). This uses pictures or symbols to teach communication skills. Children learn to use picture symbols to ask and answer questions and have a conversation.
  • Treatment and education of autistic and related communication-handicapped children (also called TEACCH). TEACCH uses visual cues to teach skills. For example, picture cards can help teach a child how to get dressed by breaking down the information into small steps.
• Complementary and alternative medicine. To help manage or relieve ASD symptoms, some parents and providers use treatments that are different from what a pediatrician typically recommends. These are called complementary and alternative medicine (also called CAM).
  • Special diets are one kind of CAM for children with ASD, but there isn’t enough research to recommend them. These diets are based on the idea that food allergies, food sensitivities, or not getting enough vitamins and minerals through food can cause ASD signs and symptoms. A food allergy is when you have an abnormal response to a food because it triggers your body’s immune system. Symptoms of a food allergy may include hives, rash, or itching or swelling in your mouth. A food sensitivity is when you don’t feel great or have a minor reaction after eating a food. A food sensitivity is less serious than a food allergy. Symptoms of a food sensitivity may include having stomach cramps or stomach pain. Some parents feel that changes in food make a difference in how their child acts or feels. Talk with your child’s provider before making any changes to the foods he eats.
  • Other CAM treatments have not been studied and may be dangerous. Before starting any treatment, talk to your child’s provider.

What causes autism spectrum disorder?

We don’t know all the causes of ASD. Research suggests that ASD may develop in a child around the time of birth—before, during, and immediately after. More research is needed, but these things may play a role:

• Having pregnancy complications. Some research shows that there may be a link between ASD and pregnancy complications that lead to low birthweight, premature birth, or cesarean birth.
• Taking certain prescription medicines, like valproic acid or thalidomide, during pregnancy. Taking these medicines during pregnancy has been linked with a higher risk of having a child with ASD.
• Having an older parent. Babies born to older parents are more likely to have ASD.
• Having genes linked to ASD. Researchers are studying a number of genes that may be linked to ASD. A gene is a part of your body’s cells that stores instructions for the way your body grows and works. Genes are passed from parents to children. Children who have a brother or sister with ASD are more likely to have ASD themselves.
• Having a genetic or chromosomal condition. A genetic condition is caused by a gene that’s changed from its regular form. A gene can change on its own, or the changed gene can be passed from parents to children. ASD happens more often in children who also have certain genetic or chromosomal conditions, like Fragile X syndrome or tuberous sclerosis. Fragile X syndrome is a condition that happens when the body can’t make enough of a protein it needs for the brain to grow and develop. Tuberous sclerosis is a rare genetic condition that causes tumors to grow in the brain and other organs.

Do vaccinations cause autism spectrum disorder?

No. Vaccines your baby gets do not cause autism. You may have heard about vaccines that contain thimerosal, a chemical that has mercury in it. Research shows that thimerosal in vaccines does not cause autism. Thimerosal is no longer used in vaccines, except in some flu shots. But you can get a thimerosal-free flu vaccine for your child if you want. If you need more information, talk to your baby’s provider.

Source: https://www.marchofdimes.org/complications/autism-spectrum-disorder.aspx

What is autism spectrum disorder?

Autism spectrum disorder (also called ASD) is a developmental disability that can cause major social, communication, and behavior challenges.

People with ASD may communicate, interact, behave, and learn in ways that are different from most other people. Some people with ASD have strong skills in learning, thinking, and solving problems; others have severe challenges with these skills. Some people with ASD need a lot of help in their daily lives, but others need less help.

Premature babies (babies born before 37 weeks of pregnancy) may be more likely to show signs or symptoms of ASD than other babies. Health care providers can sometimes detect ASD in a child at 18 months old or younger. By the time a child is 2 years old, a provider may give an ASD diagnosis. But many children don’t get a final diagnosis until they’re much older. This delay means children with ASD may not get the early help they need.

It’s really important to learn the signs and symptoms of ASD and get help for your child right away if you think he has ASD. Getting early intervention services as soon as possible can help improve your child’s development. These services can help children from birth through 3 years old learn important skills. Services include therapy to help a child talk, walk, learn self-help skills, and interact with others. Visit the Early Childhood Technical Assistance Center to find your state’s contact information for early intervention services.

How common is autism spectrum disorder?

ASD affects about 1 in 68 children in the United States. It affects children of all backgrounds, but it’s almost 5 times more common in boys than in girls. More people are being diagnosed with ASD today than ever before. We’re not sure exactly why, but it may be because of several reasons, including:

• The way health care providers define and diagnose ASD has changed. A diagnosis of ASD now includes several conditions that used to be diagnosed separately, like autistic disorder, pervasive developmental disorder not otherwise specified (PDD-NOS), and Asperger syndrome. Now these conditions are all called ASD.
• In the past, only children with the most severe ASD symptoms were diagnosed. Today children with less severe ASD symptoms are diagnosed.
• People are more aware of ASD. More families know the signs and symptoms of ASD, so more children are checked for it. More providers are screening for ASD now than in the past.

How do you know if your child has autism spectrum disorder?

ASD can be hard to diagnose. There’s no medical test, like a blood test, to check for ASD. No two children with ASD have the exact same signs or symptoms. Providers diagnose ASD by looking at your child’s behavior and development.

Children with ASD usually show signs or symptoms when they’re 12 to 24 months old, but some may have them earlier or later. Some children with ASD develop normally until they’re around 18 to 24 months old, but then they stop gaining new skills or lose the skills they once had. This is called regression.

Babies may show signs of ASD before their first birthday if they have severe developmental delays. Developmental delays are when your child doesn’t reach developmental milestones when expected. A developmental milestone is a skill or activity that most children can do at a certain age. Milestones include sitting, walking, talking, having social skills, and having thinking skills.

Tell your baby’s health care provider if your baby isn’t meeting her milestones. It’s not unusual for a healthy baby to fall behind in some areas or move ahead in others. But babies who don’t meet these milestones need their development checked more closely by a provider:

• Babbling by 12 months
• Making gestures (like pointing or waving bye-bye) by 12 months
• Using single words by 16 months
• Using two-word phrases by 24 months
• Losing language or social skills at any age

Most children with ASD don’t have problems with early developmental milestones, like crawling and walking on time. But they may have delays in other areas, like communication, social, and behavior skills. If your child shows signs or symptoms of ASD, it doesn’t always mean he has ASD. Children with ASD may have different signs and symptoms, and they may not have all the signs and symptoms.

What is joint attention?

Problems with joint attention are one of the most early and common signs of ASD. Joint attention is when your child looks back and forth between an object (or event) and a person. When a child does this to share interest and interact with another person, he develops skills that help him connect with other people. Most children with ASD have delays in joint attention skills, or they don’t have any joint attention skills.

These are examples of how children with ASD may show different joint attention skills:

• At about 10 to 12 months old: When a parent points at an object (like a toy), most children quickly look towards the object and then look back at their parent. The child imitates (copies) the parent’s facial expression; if the parent is smiling, the child smiles back. Children with ASD may ignore the parent instead of smiling back.
• At 12 to 14 months old: If a child wants a toy or another object that they’re interested in but can’t reach, most children point to it. Instead of pointing to an object, a child with ASD may bring her parent to the object while avoiding eye contact. Or the child may take her parent’s hand and place it on the object, instead of pointing to it.
• At 14 to 16 months old: Most children can point at objects and look back and forth between objects and their parents. This helps them show their interest in an object and share the experience with a parent. A child with ASD doesn’t look at an object together with her parent. Instead, the child points to an object only so the parent gets it for her.

CLEFT LIP AND CLEFT PALATE

What are cleft lip and cleft palate?

Cleft lip is a birth defect in which a baby’s upper lip doesn’t form completely and has an opening in it. Cleft palate is a birth defect in which a baby’s palate (roof of the mouth) doesn’t form completely and has an opening in it. These birth defects are called oral clefts or orofacial clefts.

Birth defects are health conditions that are present at birth. They change the shape or function of one or more parts of the body. Birth defects can cause problems in overall health, how the body develops, or how the body works. Cleft lip and cleft palate are common birth defects. About 1 or 2 in 1,000 babies (less than 1 percent) are born with cleft lip and palate each year in the United States.

Cleft lip and cleft palate happen very early in pregnancy. Your baby’s lips form between 4 and 7 weeks of pregnancy, and the palate forms between 6 and 9 weeks of pregnancy. Oral clefts don’t have to happen together—a baby can have one without the other. Boys are twice as likely as girls to have cleft lip with or without cleft palate. Girls are more likely than boys to have cleft palate without cleft lip.

How do cleft lip and cleft palate affect a baby’s face?

Some babies with a cleft lip have just a small notch in the upper lip. Others have a larger opening or hole in the lip that goes through the lip and up into the nose. A cleft lip can happen on one or both sides of a baby’s lip. Having a cleft in the middle of the lip is rare.

A cleft palate can affect the soft palate (the soft tissue at the back of the roof of the mouth) or the hard palate (the bony front part of the roof of the mouth). In some babies with cleft palate, both the front and back parts of the palate are open. In other babies, only part of the palate is open.

What causes cleft lip and cleft palate?

We don’t know for sure what causes cleft lip and palate. They may be caused by a combination of things, like genes and things in your environment, like what you eat or drink and medicines you take. Genes are parts of your body’s cells that store instructions for the way your body grows and works. Genes are passed from parents to children.

These things may increase your chances of having a baby with cleft lip or palate:

• Family history of cleft lip and cleft palate. Family history is health conditions and treatments that you, your partner, and everyone in your families. If others in your or your partner’s family have cleft lip or cleft palate (they run in your family), you’re more likely to have a baby with these birth defects. Cleft lip and cleft palate are more common in families who are Asian, Hispanic, and Native American. If you have a family history of cleft lip or palate, tell your health care provider and a genetic counselor. This is a person trained to help you understand about genes, birth defects, and other medical conditions that run in families, and how they can affect your health and your baby’s health.
• Smoking or drinking alcohol during pregnancy. Women who binge drink during the first weeks of pregnancy are more likely to have a baby with a cleft lip or cleft palate than other women. Binge drinking is when you drink four or more drinks in 2 to 3 hours.
• Not getting enough nutrients, like folic acid, before and during pregnancy. Folic acid is a vitamin that every cell in your body needs for healthy growth and development. If you take folic acid before pregnancy and during early pregnancy, it can help protect your baby from cleft lip and palate and birth defects of the brain and spine called neural tube defects.
• Having diabetes before pregnancy. Diabetes is a condition in which your body has too much sugar (called glucose) in the blood. Diabetes before pregnancy is also called preexisting diabetes or type 1 or type 2 diabetes.
• Taking certain medicines during pregnancy. If you have epilepsy and take anti-seizure medicines (like topiramate or valproic acid) during the first trimester of pregnancy, you’re more likely to have a baby with cleft lip (with or without cleft palate) than women who don’t take these medicines. Epilepsy is a seizure disorder that affects how the nerve cells in your brain work. A seizure is when the whole body or parts of the body move without control.
• Being obese during pregnancy. If you’re obese, you have an excess amount of body fat and your body mass index (also called BMI) is 30 or higher.
• Having certain infections during pregnancy, like rubella (also called German measles).

What can you do to help prevent cleft lip and cleft palate in your baby?

You can’t always prevent cleft lip and cleft palate in your baby. But there are things you can do to help reduce your baby’s chances of having these birth defects:

• Take folic acid. Before pregnancy, take a multivitamin with 400 micrograms of folic acid in it every day. During pregnancy, take a prenatal vitamin with 600 micrograms of folic acid in it every day.
• Don’t smoke or drink alcohol. Alcohol includes beer, wine, and liquor.
• Get a preconception checkup. This is a medical checkup you get before pregnancy to help make sure you’re healthy when you get pregnant.
• Get to a healthy weight before pregnancy and talk to your provider about gaining a healthy amount of weight during pregnancy.
• Talk to your provider to make sure any medicine you take is safe during pregnancy. You may need to stop taking a medicine or switch to one that’s safer during pregnancy. Don’t stop taking any medicine without talking to your provider first.
• When you do get pregnant, get early and regular prenatal care. Prenatal care is medical care you get during pregnancy.
• Protect yourself from infections. Talk to your provider to make sure all your vaccinations are up to date, especially for rubella. Vaccinations help protect you from certain infections. Stay away from people who are infected. Wash your hands often.

How are cleft lip and cleft palate diagnosed?

Most babies are diagnosed with cleft lip or cleft palate after birth. Some babies with certain types of cleft palate may not be diagnosed until later in life. But during pregnancy, your provider may see your baby’s cleft lip or palate in an ultrasound. Ultrasound is a prenatal test that uses sound waves and a computer screen to show a picture of your baby inside the womb.

What problems can cleft lip and cleft palate cause for your baby?

Babies and children with cleft lip or cleft palate may have:

• Dental problems
• Ear infections and hearing problems
• Feeding problems
• Speech problems

How are cleft lip and cleft palate treated?

In most cases, your baby can have surgery to repair oral clefts. Each baby is different, but it’s usually best if a baby has surgery for cleft lip before he’s 1 year old and surgery for cleft palate by the time he’s 18 months old. Surgery can help improve the look of a child’s face, and it may help with breathing, hearing, and speech and language development. Many children need more surgeries for oral clefts as they grow. They also may need care from several providers, like dentists, doctors, speech therapists, and surgeons who specialize in taking care of babies with problems caused by cleft lip and palate.