Governor Andrew M. Cuomo has signed legislation requiring health insurance providers to offer coverage for the diagnosis and treatment of autism spectrum disorder.

The legislation will help families afford the expensive health care costs related to treating loved ones with autistic disorders. Under the new law, health insurance companies will be required to provide coverage for treatment of autism spectrum disorders, though coverage may be subject to deductibles, co-pays, and coinsurance consistent with those imposed on other benefits.

Previously, state law only required that insurance coverage not exclude the diagnosis and treatment of autism disorder. While some health insurers provide limited coverage for autism spectrum disorder (ASD) treatment, such as vitamins or occupational therapy, most do not offer coverage for treatments that are deemed not medically necessary. Families had little choice but to pay out-of-pocket for the necessary treatment, with costs sometimes more than $50,000 per year. Many families cannot afford to pay for treatment without a severe economic hardship and may have to forgo effective early treatment of ASD for their children.

New York is now the 29th state to require health insurance coverage for conditions relating to autism spectrum disorder. As with other states, this legislation caps the cost of services per year. The law takes effect one year after its enactment on November 1, 2012 and applies to insurance policies issued or renewed after that date.

Autism spectrum disorders are a group of complex, pervasive developmental brain conditions that are often characterized by difficulties in social interaction, impairments in communication, and repetitive patterns of behavior. ASDs occur in approximately one in every 110 children in all racial, ethnic and social groups, and studies suggest that it is four times more likely to occur in boys than girls. Early detection of ASDs, when followed by the right interventions, can lead to better outcomes in functioning. In New York, approximately 30,000 individuals under the age of 19 have been identified with an ASD.

New York State offers a number of services and supports to individuals with ASD and other developmental disabilities, including the Department of Health's Early Intervention Program, preschool special education services and special education services for school children under the auspices of the State Education Department, and an "Autism Platform," provided by the Office for People with Developmental Disabilities that offers certain services and support for individuals with ASD, most of which are Medicaid-funded and
provided in conjunction with an individualized service plan.

The cost of caring for a child with unique health care needs can be staggering. Parents can now be certain their autistic child will have the coverage they need to treat this serious developmental disorder.

Flu season is here again. While most cases are seen in the winter months, influenza starts appearing in October and continues through April.  The peak of influenza disease in the Northeast is typically in February, but cases will linger into early spring.  It is ideal to get your flu shot early in flu season!

Why should you get the flu vaccine? Influenza, or “the flu”, affects between 5 – 20 percent of our population.  It is responsible for 200,000 hospital admissions and 36,000 deaths each year.  It is the most common vaccine-preventable illness.

Influenza is a respiratory illness caused by influenza viruses. There are two main types of virus: influenza A and influenza B. Each type includes many different strains, which tend to change each year. This is why flu shots must be given every year. 

The 2011-2012 flu vaccine will protect against the three influenza viruses that research indicates will be most common during the season. This includes the H1N1 and H3N2 influenze A viruses, and an influenza B virus.

Influenza is extremely contagious and is easily transmitted through contact with droplets from the nose and throat of an infected person during coughing and sneezing. These viruses may also be spread when a person touches these droplets on another person or an object and then touches their own mouth or nose (or someone else’s mouth or nose) before washing their hands.

If you have ever had “the flu” you know it is no fun. Symptoms may include high fever, body aches, headache, dry cough, sore throat and extreme fatigue.  Stomach symptoms like nausea, vomiting, and diarrhea can occur and are much more common in children than in adults.

Although anyone can get the flu, there are some groups that are at high risk for complications.  The high risk groups include:

• Adults 50 and older, especially those 65 and older;
• Children 6 months – 18 years; 
• People age 6 months and older with chronic medical conditions, including heart disease, pulmonary disorders (including asthma), diabetes, kidney disease, hemoglobinopathies, and compromised immune systems (HIV or immunosuppressive therapy);
• People with certain conditions (such as neuromuscular disorders) that can cause breathing problems
• Pregnant women
• Residents of nursing homes and chronic-care facilities

Other individuals are at high risk of transmitting the flu.  These include:
• Health care workers involved in direct patient care;
• Out-of-home caregivers and household contacts of children aged < 6 months.

There are two vaccines available to prevent influenza.

The first is the "flu shot"— an inactivated vaccine containing killed virus.

The flu shot is approved for use in people older than 6 months, including healthy people and people with chronic medical conditions.

The second is the nasal-spray flu vaccine — a vaccine made with live, weakened flu viruses.  It is approved for use in healthy people 2-49 years of age who are not pregnant.

There are two common myths associated with flu vaccine.

The first is that the vaccine will give you the flu. It is not possible to get the flu from the flu vaccine.  Side effects of the flu shot do include soreness, redness or swelling at the site of the injection, low grade fever and mild body aches. This is not the flu but your body’s response to the vaccine.  Side effects of the nasal flu vaccine in children can include runny nose, wheezing, headache, vomiting, muscle aches, and fever.  In adults, side effects can include runny nose, headache, sore throat, and cough. 

The second myth is that the vaccine does not work. In years when the vaccine and circulating influenza viruses are well matched, the flu vaccine can be expected to reduce laboratory-confirmed influenza by 70 – 90 percent.  In years when the viruses are not as well matched it will still lower incidence of disease as well as reduce severity in those who do get influenza.  We must remember that not all flu-like illnesses are influenza, and the flu shot can only protect us against influenza viruses.

So is it time for your flu vaccine?  Yes, flu vaccine is now routinely recommended for everyone, babies, children, and all adults.  It takes about two weeks for your body to make a response to the vaccine, so call your doctor and get your flu shot before peak flu season arrives.

Fatema Meah, MD, FAAP

Dr. Meah graduated from Albert Einstein Medical School. She continued her pediatrics residency at the same institution and went on to serve as chief resident at the Children’s Hospital at Montefiore. She is a board certified pediatrician and is an Assistant Professor of pediatrics at Albert Einstein. In addition to practicing general pediatrics, she is director of Undergraduate Medical Education at Flushing Hospital.

Peconic Pediatrics, a Division of Allied Pediatrics of New York, is located at 54 Commerce Dr., Suite 2, Riverhead, NY 11901 Tel. 631-722-8880

Think twice before transitioning your child to the next type of car seat.  With each transition--rear-facing seat to forward facing seat, forward-facing seats to booster seat, and booster seats to seat belts--you lose some protection for your child.

The new American Academy of Pediatrics (AAP) policy statement on Child Passenger Safety published in April 2011 focuses on delaying these transitions for as long as possible.  Given the fact that automobile accidents are the leading cause of death for children ages 4 and older, parents should be aware of the weight and height limits on their child’s car seat and should keep the child in that seat until he or she has outgrown those limits. 

Let’s review the types of car seats available for your child:

Infant-only seats usually have a carrying handle and can be snapped in and out of a base that is installed in the car.  These seats can only be used rear-facing.  Depending on the seat, the height limit is between 29-32 inches and the weight limit is 22-35 pounds.

Convertible seats can be used either forward or rear-facing and have higher limits than infant only seats.  Once your child outgrows his infant seat, he should be placed rear-facing in a convertible seat.  The rear facing height and weight limits are usually less than the forward facing limits.  However, most of these seats can accommodate a child up to 35 pounds in the rear-facing position.  They can accommodate a child between 40-80 pounds forward-facing depending on the model.

Combination seats can be used in the forward-facing position with a harness and then when the child exceeds the limits for the harness, the seat can be used as a booster with the harness removed.  Most of these seats have a weight limit of 65 or 80 pounds.

3 in 1 seats can be used rear-facing, forward-facing or as a belt-positioning booster.   These seats usually have higher weight height limits. A negative is that it cannot be removed from the car and used as an infant carrier.

Booster seats position the child so that the lap and shoulder portions of the vehicle seat belt fit properly.  They come in high-back and backless models.

Although parents view facing their child in the forward position in their car seat as an exciting developmental milestone, research suggests that it is safest to leave your child in the rear-facing position until the age of 2 or the highest weight or height allowed by the car seat manufacturer.  The weight limitation of 35 pounds for the rear-facing position for most seats will be appropriate for more than 95 percent of two year olds. Children in the second year of life that are in a rear-facing car set are five times less likely to die or be seriously injured in an automobile accident compared to those in forward-facing seats. 

This may raise the question of increasing the risk of leg injuries if a toddler is in the rear- facing position.  The answer is no.  Only 1 in 1,000 children who are rear-facing will suffer a leg injury.  This is much lower than the rate of leg injury for forward-facing children.

Children ages 2 and older or those who have outgrown the rear-facing weight or height limit should remain in a forward-facing seat with a harness (5 point is best) for as long as possible, up to the limits allowed by the seat manufacturer.

All children whose weight and height is above the forward-facing limit for their car seat should use a belt-positioning booster seat until the vehicle lap-and-shoulder seat belt fits properly.  This is typically when your child has reached 4 feet 9 inches in height and is between 8 and 12 years of age.

When your child is old enough and large enough to use the vehicle seat belt alone, he should always use lap-and-shoulder seat belts for optimal protection.  The rear seat of the vehicle is safest for all children no matter what the age.  However, he AAP has made an official recommendation that all children under the age of 13 should be restrained in the rear seat of the vehicle. 

For a helpful resource on car seats please visit www.healthychildren.org/carseatlist.  Here you can find information on the products, height/weight limits, and prices.  A list of car seat inspection stations is available at  www.seatcheck.org.  If you cannot find an inspection site in your community, you can find a local technician through the National Child Passenger Certification program.

In summary, children should remain in the rear-facing position until the age of 2.  Once they are forward-facing, they should remain in their seat with a harness until they outgrow the weight and height limits.  Only then should they start to use a booster seat where they should remain until they are at least 4 feet 9 inches tall.  All children younger than 13 years should be restrained in the rear seat of the vehicle for optimal protection.  So tell your school aged child that you are going to be their personal chauffer for a while!

Dr. Jennifer Pantiliano, a board-certified pediatrician, is Associate Chairperson of the Department of Pediatrics at Coney Island Hospital in Brooklyn and a physician with Peconic Pediatrics, 54 Commerce Drive, Suite 2, Riverhead.

Summer! It's finally here and kids are participating in more outdoor activities — but with the fun come concerns about how to keep your family safe.

Sun Safety
Sun safety is critical. Severe burns can result from sun exposure. The American Academy of Pediatrics recommends preventing sunburn by avoiding sun exposure in babies under 6 months and using sunscreen for all those over 6 months. Infants should be dressed in lightweight garments that have long sleeves and long pants. Wide-brimmed hats can shade the neck.
For older children, there are many sunscreens available for safe use. Pick one that offers UVA and UVB protection, one that has a SPF of 15 or higher, especially if your child has light skin. Apply the sunscreen in a thick coat at least 30 to 45 minutes before going outside, even on cloudy days, and reapply every two hours or more often if the child is swimming or perspiring heavily. If your child has sensitive skin, use a sunscreen with ingredients such as zinc oxide or titanium dioxide, which physically block the sun's radiation. And don't forget to have your child wear sunglasses that protect against UVA and UVB radiation.

Pool Safety
Pool safety is another critical area. The U.S. Consumer Product Safety Commission reports an estimated 260 children under age 5 drown each year in residential swimming pools and spas. Another 3,000 under age 5 are treated in hospital emergency rooms following submersion accidents each year. Some of these submersion accidents result in permanent brain damage.
Unfortunately, there are drowning deaths every summer on Long Island. All pools must be fenced! Fences should be at least four feet high around all four sides of the pool. The fence should not have any openings or protrusions that a child could get over, under or through. The pool gate should open out from the pool and should self-close and self-latch at a height a child cannot reach. Never leave children alone in or near a pool -- even for a moment. Keep rescue equipment and a portable telephone near the pool. Make sure your rescue equipment is made of fiberglass or other materials that don't conduct electricity. Avoid inflatable swim aids. They are not a substitute for approved life vests and can give children a false sense of safety. Whenever infants or toddlers are in or around water an adult should be within arm's length. All parents should consider learning CPR.

Insects
Insects commonly bite children and can make them miserable. Avoid areas where insects nest, such as standing water, uncovered foods and gardens with flowers in bloom. Avoid using scented soaps, perfumes or hair spray on your child. As for insect repellents, there are many safe and effective products available to protect your child, including those with DEET, picaridin, citronella, oil of lemon eucalyptus or soybean oil. Insect repellents containing DEET are the most effective against ticks and mosquitoes. Although it's absorbed through your child's skin, it's generally safe as long as the product contains less than 30 percent DEET. You should apply the DEET product to all exposed skin, except near the eyes, mouth, open cuts or hands of children, who may rub their eyes or put their fingers in their mouths. You may want to limit how much you put on younger children and wash it off as soon as possible, and apply it more to clothing than skin. Products containing DEET are not recommended for use in children less than 2 months old.

Bicycle Safety
Bicycle, scooter and skateboard safety requirements include never riding near traffic and always wearing protective gear, such as helmets and wrist guards. When purchasing a helmet, look for a label saying it meets the CPSC safety standard. Set an example for your children - adults need helmets and other protective equipment too.

Visit aap.org for more on summer safety tips.

Fatema Meah, MD, FAAP

Dr. Meah graduated from Albert Einstein Medical School. She continued her pediatrics residency at the same institution and went on to serve as chief resident at the Children’s Hospital at Montefiore. She is a board certified pediatrician and is an Assistant Professor of pediatrics at Albert Einstein. In addition to practicing general pediatrics, she is director of Undergraduate Medical Education at Flushing Hospital.

Peconic Pediatrics, a Division of Allied Pediatrics of New York, is located at 54 Commerce Dr., Suite 2, Riverhead, NY 11901 Tel. 631-722-8880