KRT
During a fertility technique known as intracytoplasmic sperm injection, doctors inject a sperm into an egg. If the fertilization is successful, the egg begins to divide and quickly becomes a tiny ball of cells.
By
msnbc.com contributor
updated 1/5/2005 3:14:35 PM ET 2005-01-05T20:14:35

Do children conceived through fertility techniques face greater health risks? And what's the best way to deal with a shy child? Growing Up Healthy answers your queries. Have a question about children's health and well-being? Send it to us atchildrenshealth@feedback.msnbc.com. We’ll post select answers in future columns.

Q:I have fraternal twins who are now just over age 5. They were born with the help of a fertility treatment called intracytoplasmic sperm injection. Both have developmental delays. For example, they are still in diapers and don’t speak except for a few words. One child was also born with a cleft palate. Both arrived prematurely via C-section and weighed around 5 pounds each. Has there been any research that links birth defects or developmental delays with fertility treatments?

A: You’re not the only one wondering about the well-being of babies conceived with the help of in vitro fertilization (IVF) or other forms of assisted reproductive technology (ART). The American Academy of Pediatrics and the American Society for Reproductive Medicine co-sponsored a panel to review published studies that have reported on malformations and genetic anomalies, cancer, psycho-social and developmental outcomes, and health status beyond one year for ART children.

The panel, chaired by Kathy Hudson, director of the Genetics and Public Policy Center at Johns Hopkins University, announced its findings late last year.

“After evaluating all of the studies thus far, what we found was basically reassuring,” says Hudson.

Sifting through hundreds of studies and looking at how they were conducted and how the conclusions were drawn, the panel ultimately found no substantial link between ART and developmental delays, and they found little evidence that ART was responsible for most malformations or health concerns.

However, there are certain extremely rare genetic conditions, such as Angelman syndrome and Beckwith-Wiedemann syndrome, that do seem to be more common -- yet are still very rare -- in ART children. And the panel is currently reevaluating the data on hypospadia, a condition where the urethra opening doesn’t wind up where it’s supposed to be on the end of the penis. Some researchers still believe hypospadia may be more prevalent in ART boys.

If you’re looking for an explanation, though, the fact that your children were lower birth-weight multiples may provide some of it. Of course, ART results in far more multiples than would otherwise be conceived. All multiples -- conceived traditionally or with ART -- are at increased risk for premature delivery and low birth weight, conditions that can lead to further complications and developmental delays, says Hudson.

“Roughly 25 percent [of ART] offspring are twins or triplets. Ninety percent of the triplets, in fact, are due to in vitro or other fertility treatments. That’s a problem,” says Dr. Arnold Strauss, another member of the panel evaluating the studies.

The panel is in the process of making recommendations to the medical community, and Strauss says the most important recommendation is that the rate of multiples needs to be reduced.

Fertility specialists often implant several embryos in a woman's womb to increase the chances of success and lower the costs. However, that also increases the odds of multiples -- and possible complications.

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“I don’t think fertility doctors shouldn’t be implanting more than three embryos at once,” he says.

All of this is valuable information for couples considering ART. But for parents of children who are already here, Hudson and Strauss have a different message. “Birth defects or developmental problems are usually not the fault of the parent or because of anything they did,” says Hudson. That includes fertility treatment.

Furthermore, says Strauss, who is chairman of pediatrics at Vanderbilt University Medical Center in Nashville, Tenn., the reasons behind the problems may be intriguing but your children need something else: help.

“The quicker and the more aggressively any child with developmental delays is involved in special education that addresses his specific needs, the better the possible outcome,” says Strauss.

SHYNESS
Q:
I have a three and a half year old daughter who is incredibly shy. She’s so shy she won’t even say hello to the people she sees each week at church. I don’t want these friends to think I allow my daughter to be rude. What can I do?

A: Stop worrying, for starters. If friends, family members or strangers think a three and a half year old should be anything but what she is, they’re the ones with the real problem, says Bernardo J. Carducci, a professor of psychology at Indiana University in New Albany, Ind., and author of "The Shyness Breakthrough."

“Children simply develop at different rates,” says Carducci. Some children may be socially adept as toddlers but many won’t be. And, in fact, some children may never be the outgoing type.

“As a parent it’s extremely important to develop an appreciation for diversity,” he notes.

Yet, that said, it doesn’t hurt to work on also developing social skills with any child. With time and practice most become less reserved. Here’s what Carducci recommends:

  • Model good social interaction. Your daughter should see and hear you being polite and open in social situations.
  • Prepare and practice. Make sure your child knows what the appropriate response is when someone asks her any number of questions. Practice at home or in the car.
  • Build confidence gradually. Have your child hand your credit card to the cashier, for example. Or ask her to introduce herself to younger children. Of course, kids -- especially younger ones -- are less intimidating than adults. These small, simple interactions build valuable social confidence.
  • Try not to speak for your child. If a colleague says hello to your daughter and asks her name and age, it may be tempting to answer and say that she’s “just shy.” It’s wiser, though, to engage the other person in some friendly dialogue instead. For example, if you’re at a store picking out a gift for your daughter’s grandma, tell him this. The idea is that talking about the gift and what you’re doing acquaints your daughter with the person and gives her the opportunity to warm up a bit. You may eventually steer the conversation back to your daughter and see if she’ll then tell the person her name or how old she is. If she doesn’t, though, don’t dwell on it. There’s always next time.

Victoria Clayton is a freelance writer based in California and co-author of the new book "Fearless Pregnancy: Wisdom and Reassurance from a Doctor, a Midwife and a Mom," published by Fair Winds Press.

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