February 27, 2015

Uncertified Play Yards Present Risk of Suffocation

Product safety advocates have long warned parents about the suffocation dangers of padding and bedding in a child’s crib. Earlier this month, a related warning was given about padding in a play yard.

The issue was raised by The Safety Institute, a nonprofit organization that promotes injury prevention and advocates for product safety. It noted that The Juvenile Products Manufacturers Association (JPMA) advises consumers never to add a mattress, pillow, comforter or padding to a play yard.

These products are equipped by their manufacturers with a mattress properly sized for maximum safety, and designed to meet a standard established by ASTM International, a global outfit that establishes standards companies voluntarily accept.

But some companies, according to the JPMA, sell mattresses as “replacement” or “supplemental mattresses,” and the buyer must beware: An “add-on” or replacement mattress or bedding is not safe.

Potential danger lies in the gaps between a mattress that is too small or too thick, or with bedding a child can get wrapped up in — they present an immediate risk of suffocation.

A JPMA certification guarantees that products with its seal meet ASTM International safety standards. So if you’re shopping for a play yard, make sure you see that seal, which shows that it meets the voluntary standard.

Many of the supplemental, risky replacement parts are sold over the Internet, but bricks-and-mortar retailers offer them as well. Per the institute’s alert, “When industry suddenly creates a supplementary product which conflicts with the warning labels on the primary product it can be confusing and potentially dangerous. Products such as play yards are tested for foreseeable risks, and to the extent feasible, controllable risks are engineered out of the product.”

But consumers as well are responsible for ensuring the safety of these products. Don’t put anything on top of the existing mattress. If you need to replace it, call the company from which you bought the play yard. As the ASTM explains, each manufacturer tests its play yard with the mattress it supplies, so if you’re buying a replacement mattress from some other company, it hasn’t been tested for use with the play yard you have, and might not be safe.

Although the dangers are similar, play yards are a bit tougher to ensure for safety because their sizes and shapes vary more than cribs. Review the ASTM specifications here, and those for cribs here.

For play yards, the standard for total thickness of the mattress, including all fabric or vinyl layers, filling and material any structural components such as wood or hardboard, should not exceed 1.5 inches. Supplemental play yard mattresses and second-party replacement mattresses are available in different thicknesses, and some could raise the floor high enough so that a kid could get out of the enclosure.

The Consumer Product Safety Commission (CSPC), a federal agency, is in sync with the JPMA and Safety Institute concerning these products. It endorses the Keeping Babies Safe initiative; Chairman Elliot Kaye has said, “CPSC staff will continue to support these efforts as we all try to address this hazard and protect babies while they sleep.”

For crib and play yard safety tips, see JPMA videos here. Find out more about injuries to babies and children here.

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February 20, 2015

Delay in Newborn Testing Can Be Life-Threatening

For a couple of generations, the U.S. routinely has screened the blood of newborns to identify rare genetic conditions. But a recent editorial in USA Today reminded readers that too many delays at too many hospitals and labs are undermining the system’s ability to protect babies.

Noah Wilkerson was one newborn harmed by a health-care facility that took too long. He seemed to be healthy when he was born in 2009 at a hospital in Colorado Springs, Colo. His blood was drawn the next morning, but it took two weeks later before his sample was sent to the state lab, which didn’t process samples on weekends.

A day before the results came back, Noah died of a genetic disorder called MCAD deficiency. It’s a condition in which the body can’t convert some fats to energy. As explained in the original story about Noah in the Milwaukee Journal, a newborn with MCAD deficiency can appear perfectly healthy, but fatty acids are building up in the body, and soon there’s a metabolic crisis.

If the baby goes too long without eating, he or she can die suddenly or end up brain damaged.

But the real tragedy is that if the disorder is detected early, parents can treat it by feeding the child every two hours. “That's often all it takes for a baby with the condition to grow up and lead a normal, healthy life,” the Milwaukee Journal said.

“In an era when overnight delivery is routine,” the USA Today proclaimed, “it is inexcusable that many hospitals fail to get life-saving samples to labs within the three days recommended by the American College of Medical Genetics and Genomics. And inexcusable that state public health officials let them get away with it.”

That pretty much says it all.

About half of all state-run labs are closed on weekends and holidays, according to USA Today. So if your baby has the bad luck to be born late in the week, he or she is even more likely not to get test results in timely fashion.

Many hospitals simply ignore state requirements that samples be sent to labs with dispatch. Some hospitals wait to send samples until they can do so in bulk, and instead of using overnight delivery, as they might be required to do, they use the U.S. mail. States with the worst records, the newspaper said, are Arizona, Mississippi, South Carolina and Texas, where at least 15 in 100 hospitals take five or more days to get samples to labs.

But it’s not easy to find out who’s prompt and who’s dangerously tardy. Public officials in more than 20 states refused to release information to USA Today about hospital timeliness. “Secrecy denies expectant parents the ability to choose hospitals that are speedy and eliminates public pressure to force improvement,” the paper pointed out.

This is inexcusable. Although genetic disorders requiring immediate attention are rare, affecting about 1 in 4,000 newborns a year, if that baby is yours would you want to wait? There’s a reason babies are tested routinely, and the system should address the most vulnerable patients.

In 2012, the paper reported, only two states, Delaware and Iowa, met the speed standard — 99 in 100 of their hospitals delivered samples to labs within three days. Five years after Noah Wilkerson died, Colorado still doesn't process samples on weekends.

Long before you arrive at the hospital to deliver your baby, make sure you know what its newborn testing timeline is, and make sure the staff knows you’re keeping track. After you deliver, ask when the baby will be tested, and when the sample will be sent. Follow up and get confirmation that the promises have been kept.

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February 6, 2015

Exposure to Certain Chemicals During Pregnancy Might Affect Fetus

Researchers have found a link between a fetus’ exposure to two common household chemicals and a lower IQ among the children several years later.

The scientists from Columbia University’s Mailman School of Public Health published their research in the journal PLoS ONE last month. In a news release, they described how children exposed during pregnancy to elevated levels of di-n-butyl phthalate (DnBP) and di-isobutyl phthalate (DiBP) had an average IQ score more than six points lower than children exposed to those chemicals at lower levels.

DnBP and DiBP are found widely in consumer products ranging from dryer sheets to vinyl fabrics to lipstick, hairspray, nail polish and even some kinds of soap. In the U.S., according to the Consumer Product Safety Commission, six kinds of phthalates are banned from toys and other child-care products. But no measures have been taken to protect a developing fetus, such as alerts to pregnant women about potential exposure. In fact, according to the Columbia release, in the U.S., phthalates seldom are listed in a product’s ingredients.

For the study, researchers followed 328 women and their children. They assessed the mothers' exposure to four phthalates — DnBP, DiBP, di-2-ethylhexyl phthalate and diethyl phthalate — during their third trimester of pregnancy by measuring levels of the chemicals' metabolites (signals of how a body processes a substance) in urine. When they were 7, the children were given IQ tests.

Children of mothers exposed during pregnancy to the highest 25% of concentrations of DnBP and DiBP had IQs 6.6 and 7.6 points lower, respectively, than children of mothers exposed to the lowest 25% of concentrations.

The pattern held when specific aspects of IQ were tested, including perceptual reasoning, working memory and processing speed.

The researchers found no associations between the other two phthalates and child IQ.

It’s especially worrisome that, as the study’s lead author said in the news release, "Pregnant women across the United States are exposed to phthalates almost daily, many at levels similar to those that we found were associated with substantial reductions in the IQ of children."

Another scientist involved with the research said, “A six- or seven-point decline in IQ may have substantial consequences for academic achievement and occupational potential.”

It’s impossible to avoid all phthalates in the U.S., but the researchers recommend that pregnant women try to limit their exposure by:

  • not using plastic when they microwave food;

  • avoiding scented products such air fresheners and dryer sheets; and

  • not using recyclable plastics labeled as 3, 6, or 7.

The Columbia results advance earlier research showing an association between prenatal exposure to DnBP and DiBP and children's cognitive and motor development, and behavior when they are 3. And a couple of months ago, Columbia researchers reported a link between prenatal exposure to phthalates and risk for childhood asthma

Although it's not clear how phthalates affect child health, numerous studies show that they disrupt the actions of hormones, including testosterone and thyroid hormone. So it’s best to avoid them if you can.

To see the degree to which pregnant women are exposed to all kinds of chemicals, see our blog of a few years ago, “Dangerous Products Found in Virtually All Pregnant Women.”

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January 23, 2015

Do You Have One of These Dangerous Crib Mattresses?

Last week, the Consumer Product Safety Commission (CPSC) announced that the manufacturer of certain baby mattresses was recalling them because of the potential for injury.

Nearly 170,000 mattresses are being recalled by IKEA because they leave a gap between the mattress and crib that could entrap or suffocate babies. Only a couple of problems have been reported, and so far no injuries have been sustained, but the company deems these mattresses unsafe: VYSSA style mattresses sold under brand names VACKERT, VINKA, SPELEVINK, SLOA and SUMMER.

The recalled mattresses were manufactured before May 5, 2014 and can be identified by the label attached to the mattress cover where the manufacture date is displayed next to the VYSSA name. They were sold exclusively at IKEA stores nationwide and online at www.ikea-usa.com from August 2010 to May 2014 for about $100.

If you have or think you have one of these products, call IKEA toll-free at (888) 966-4532 or contact the company online at www.ikea-usa.com; click on the recall link.

The guideline for crib mattress safety is simple: If the space between the mattress and the crib is larger two fingers, the child who sleeps there is in danger of being trapped.

As reported by AboutLawsuits.com, the feds have stepped up regulation of cribs and mattresses since the Consumer Product Safety Improvement Act (CPSIA) was enacted in 2008. And in 2013, the CPSC, the International Sleep Production Association (ISPA) and the American Society for Testing Materials (ASTM) set size requirements for cribs and mattresses. Their standard requires that crib mattresses include consumer safety labels to ensure a proper mattress fit, and warnings to help prevent Sudden Infant Death Syndrome (SIDS).

For more information about SIDS, link to our blog here.

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December 12, 2014

Don’t Rely on High-Tech Baby Monitors

Baby monitors are a wonderful parental aid … or are they?

Dr. David King, a pediatric researcher at the University of Sheffield in England, recently wrote about his baby monitor studies in BMJ (the British Medical Journal). They indicate that the information provided by newer, high-tech devices isn’t a reliable signal of danger, and that they don’t provide reliable information about your child.

"It's not a medical device; it's not registered as a medical device. It's just for fun, really," King said in an interview for NPR. "But if you look at the marketing so far, I don't think that's the message that comes across."

His point is that companies are very good at capitalizing on parents’ concern over their newborn’s health. High-tech monitors are developed less to impart useful medical information than to address parental anxiety by monitoring a baby's vital signs and sending them to a smartphone.

When King first heard a discussion about baby vital sign monitors on the radio, he told NPR, "I suspected there wasn't much evidence behind it, because I knew cardiovascular monitoring wasn't recommended in SIDS."

Sudden infant death syndrome (SIDS), also known as crib death, is the unexplained death, usually during sleep, of an otherwise healthy baby younger than 1 year.

Experiments in the 1980s and 1990s using monitors as an intervention for SIDS failed to reduce its incidence in healthy infants. They’re no longer recommended by the American Academy of Pediatrics and other medical groups. "Do not use home cardiorespiratory monitors as a strategy to reduce the risk of SIDS," the academy says, because "there is no evidence that use of such devices decreases the incidence of SIDS."

The newer monitors include the Mimo, which costs about $200. It monitors a baby's breathing, body position, sleep activity and skin temperature via a sensor attached to a special onesie. But if you read its website terms of service carefully, you find this disclaimer:

The Mimo baby monitor system is not a medical device, is neither regulated nor approved by the U.S. Food and Drug Administration, and is not designed to detect or prevent causes of sudden infant death syndrome (SIDS). The Mimo baby monitor system is intended to help you monitor your baby and is not to be used as a substitute for parenting or other adult supervision. Use of the services and any content is entirely at your own risk.

Promotional language for similar monitors suggests that tracking a healthy baby like Russia tracks spies is what all good parents do.

But some parents won’t know how to use data on an infant's heart rate and blood oxygen level as a way of ensuring a kid’s safety. What’s the point of information if you can’t apply it?

And, according to NPR, a big problem with SIDS monitors is false alarms, which serves only to panic parents.

As we’ve blogged, to reduce the risk of SIDS, put babies to sleep on their backs, keep soft bedding out of the crib and don’t let them sleep on couches.

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November 7, 2014

Don’t Let Babies Sleep on Couches

A recent study confirms that babies who sleep or nap on soft surfaces, like sofas, are at risk of dying.

According to the research published in Pediatrics, about 1 in 8 cases of so-called “crib death,” occurs among infants who have been placed on sofas. Crib death, also known as sudden infant death syndrome (SIDS), is the unexplained death, usually during sleep, of an otherwise healthy baby younger than 1 year.

Earlier research, according to the New York Times, showed that couches were hazardous for infants, and the new research set out to pin down all the factors contributing to these deaths.

Researchers analyzed data on 7,934 sudden infant deaths in 24 states. They compared those that occurred on sofas with those in cribs, bassinets or beds. Almost 3 in 4 deaths occurred among infants 3 months or younger.

Most parents in the study shared the sofa with the baby they placed there. But researchers said it was a mistake to believe that if you’re awake or watching the child, he or she is not at risk of SIDS.

Sleep-deprived parents, the thinking goes, are more likely to fall asleep on the couch next to their newborns. The design of the furniture can be a problem, too — some sofas slope toward the back cushions, and infants get wedged into a position where they can’t breathe.

Dr. Barbara Ostfeld, program director of the SIDS Center of New Jersey, told The Times, “Many parents think for safety, ‘I’ll put the baby between myself and the back of the sofa.'” But, “the unplanned and unexpected happens. The grief is beyond painful and endures for a lifetime.”

The lead researcher said that infants “need to sleep alone, on their backs and in a crib, and it doesn’t matter if it’s for a nap or overnight. And it doesn’t matter if the parent is awake or asleep.”

The New York Times has assembled a resource for SIDS information. See our blog about the Consumer Product Safety Commission and crib safety here.

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June 27, 2014

New Rules Should Protect Quality of Baby Formula

Earlier this month, the FDA finalized new guidelines for manufacturers of infant formula in order to better protect babies from contaminated products. The move is a response to several prominent nationwide recalls of different formula products in the last several years.

As reported by MSN.com, in 2010, 5 million containers of Similac were recalled by Abbott Laboratories because they might have been contaminated by insect parts. In 2011, powdered versions of Enfamil, made by Mead Johnson Nutrition, were yanked from store shelves over concerns of contamination, which later proved unfounded.

Still, the red flag was raised, and now companies that make baby formula will be required to test for the presence of two kinds of bacteria, salmonella and cronobacter, that pose serious health risks to wee ones. They’ll also have to monitor their products for a longer period.

Salmonella can cause diarrhea and fever, sometimes to a life-threatening degree; cronobacter, which prefers dry environments such as powdered formula, can cause swelling of the brain — meningitis — in infants.

Most public health officials and medical professionals say breast milk is best for babies, but for various reasons of both necessity and convenience, many mothers don’t breast feed. So, many infants get all or part of their nutrition from formula.

Baby formula is not subject to FDA approval prior to sale. But all formula sold in the U.S. must meet federal nutrient requirements, and they do not change with the new regs. Infant formula manufacturers are required to register with FDA, and notify the agency before they market a new formula.

The FDA conducts yearly inspections of all facilities that manufacture infant formula. It collects and analyzes product samples, and inspects new facilities. If the feds determine that a formula presents a risk to human health, its manufacturer must conduct a recall.

The new requirements, according to the FDA, are meant to establish the "good manufacturing practices" that many companies voluntarily follow. These regulations establish federally enforceable standards for safety and quality.

They apply to formula sold "for use by healthy infants without unusual medical or dietary problems," said the FDA.

Under the new rules, companies must test their products' nutrient content and prove that the formulas can "support normal physical growth," the agency said. They must test the nutrient content in the final product stage, before entering the market and at the end of the products’ shelf life.

According to FDA, about 1 million U.S. infants are fed formula from birth; by the time they are three months old, about 2.7 million rely on formula for at least part of their nutrition.

Infant formula comes in three forms:

  • powder — the least expensive of the infant formulas, it must be mixed with water before feeding;

  • liquid concentrate — must be mixed with an equal amount of water;

  • ready-to-feed — the most expensive form of formula that requires no mixing.

The protein source varies among the different types of formula. The FDA’s nutrient specifications are set to meet the nutritional needs of average, healthy infants. Manufacturers use nutrient levels that usually exceed the FDA minimum. So babies fed infant formulas don’t need added nutrients unless they are fed a low-iron formula.

The formulas currently available in the U.S are either “iron-fortified” — with about 12 milligrams of iron per liter — or “low iron” — with about 2 milligrams of iron per liter. The American Academy of Pediatrics (AAP) recommends that formula-fed infants be fed iron-fortified formula to help reduce the prevalence of iron-deficiency anemia.

To learn more about safety and infant formula, such as proper storage, visit the FDA website. To learn more about childhood nutrition, see our blogs on the topic.

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May 23, 2014

Ensuring the Safety of Baby Gates

Part of making your home safer for young children often includes installing a baby gate. But the risk of injury is high if it’s not set up right and used properly.

The Center for Injury Research and Policy at Nationwide Children’s Hospital conducted a study from 1990 through 2010 that was the first one of national scope to analyze injuries associated with the gates parents often install to keep the wee ones from tumbling down the stairs or entering a room where other harmful things pose a risk.

The rate of baby gate injuries more than tripled during the two decades of study, from nearly 4 in 100,000 children in 1990 to 12.5 in 100,000 in 2010. The researchers used data from the National Electronic Injury Surveillance System (NEISS), which is operated by the U.S. Consumer Product Safety Commission, and provides information on consumer product-related and sports- and recreation-related injuries treated in hospital emergency departments.

The study, published in Academic Pediatrics, showed that U.S. emergency departments treated about 37,675 kids younger than 7 for injuries related to baby gates. As explained on ScienceDaily.com, that averages out to about five injured children a day.

More than 6 in 10 of the injured children were younger than 2. The most common circumstance for injury was falling down the stairs after a gate collapsed or wasn’t closed. The problems range from soft-tissue sprains to traumatic brain injuries. Children between 2 and 6 were injured frequently because they were climbing on the gate and got cut on its edges.

To reduce the chances of your kid having an unpleasant encounter with the thing that’s supposed to protect her, make sure it’s the correct type of gate for the location where you want to install it. And check to see if it meets the industry’s voluntary safety standards.

Pressure-mounted gates should be used only to divide rooms or at the bottom of stairs, not to prevent falls; they’re not designed to withstand much force. If you want to bar access at the top of a staircase, use only gates with hardware that requires screwing into the wall or railing.

Although the voluntary standards set by the American Society for Testing and Materials have helped make baby gates less hazardous, as the researchers noted, there is no substitute for mandatory standards for demonstrating a true commitment to safety.

In addition to the tips noted above, follow these to minimize the chances of injury:

  • Install gates in homes with children between 6 months and 2 years old.
  • Remove the gate when the child turns 2, or when he or she has learned to open it or climb over it. If you still need the gate because there are other little ones in the home, use a model without notches or gaps that could be used for climbing.

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March 14, 2014

Sleep-Inducing Machines Might Invite Hearing Problems

It seems like such a good idea. As so many get-the-kid-to-sleep tricks do. But new research shows that using a machine that produces soothing sounds to lull a baby to sleep might damage his or her hearing.

A study published in Pediatrics last month analyzed 14 popular sleep machines at maximum volume and found that they produced between 68.8 to 92.9 decibels from 30 centimeters away. That’s about how far one might be placed from an infant’s head. Three of the machines exceeded 85 decibels, which is what the National Institute for Occupational Safety and Health deems the threshold of workplace safety for adults over the course of an eight-hour shift.

One of the baby machines was so loud that two hours of use would exceed workplace noise limits.

At 100 centimeters away, all the machines tested still were louder than the 50-decibel limit set in 1999 by an expert panel for an hour’s exposure in hospital nurseries in 1999.

“These machines are capable of delivering noise that we think is unsafe for full-grown adults in mines,” Dr. Blake Papsin told the New York Times. He is senior author of the study, and the chief otolaryngologist (disorders of the ear, nose and throat) at the Hospital for Sick Children in Toronto.

“Unless parents are adequately warned of the danger, or the design of the machines by manufacturers is changed to be safer, then the potential for harm exists, and parents need to know about it,” Dr. Gordon B. Hughes, the program director of clinical trials for the National Institute on Deafness and Other Communication Disorders, told The Times.

Newborn brains are learning to differentiate sounds at different pitches even during sleep, according to Lisa L. Hunter, scientific director of research in the division of audiology at Cincinnati Children’s Hospital. “If you’ve conditioned them to white noise, there’s every indication that they might not be as responsive as they otherwise should be to soft speech,” she told The Times.

The idea behind infant sleep machines is that their white noise or nature sounds drown out the normal ambient sounds that can disturb a baby’s sleep — voices, vehicle noise, music, etc. The machines come in many forms, including embedded in stuffed animals, and frequently are recommended by parenting books and websites.

Even some sleep experts advise parents to use them all night, every night, and many parents say their babies become so used to the sounds of rainfall or birds that they will not nap without them.

Despite their apparent potential to damage hearing, sleep machines can be used safely, according to the researchers. Papsin suggested placing the devices farther away, lowering the volume and using them for shorter periods to deliver less sound pressure to the baby. That means you should be wary of the models designed to be affixed to the crib.

The researchers also recommended that device manufacturers limit the maximum noise level of infant sleep machines.

Dr. Marc Weissbluth, a pediatrician and author of “Healthy Sleep Habits, Happy Child,” agreed that you don’t necessarily have to throw out the baby noise machine with the bath water. He told The Times that parents could use one, if they were careful. “If it’s too close or it’s too loud, this might not be healthy for your baby,” he said. But “a quiet machine that’s far away may cause no harm whatsoever.”

Maybe. But one Times reader posted an interesting comment to the story: “If the sound of a sleep machine is dangerously loud, I hate to think about all of the noise my premie was exposed to while in the n.i.c.u. [neonatal intensive care unit] for several weeks. Constant beeping, lights on, etc. I don't think she's worse for the wear, but hospitals need to be much more mindful about all of the environmental noise babies are exposed to in the n.i.c.u.”

To learn more about babies and sleep, see our blog, “Getting Your Baby to Sleep.”

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February 7, 2014

Potential Help for Colicky Babies … and Their Parents

Even with the best of babies, parents of newborns live in a state of exhaustion. If your kid has colic, you’re pretty much a zombie. But scientists have found a noninvasive treatment that might help everybody in the family to feel better.


Yes, it’s a trendy nutritional supplement, but according to a recent study in JAMA Pediatrics, as well as some previous studies in Europe, these “good bacteria” can reduce crying in colicky babies. The JAMA study suggests that probiotics might even prevent colic.

"We do find that the baby who took the probiotic since the first week of life, they develop less number of colic and constipation in the first month of life so they improve at least the symptoms," Dr. Flavia Indrio, a pediatric gastroenterologist at the University of Bari in Italy who led the JAMA study, told NPR.

What causes colic is not clear, but according to NPR, it affects between 8 and 15 out of 100 babies. It can be so bad as to cause depression in parents, and even thoughts of infanticide.

The babies in the JAMA study were given a form of Lactobacillus reuteri, a friendly bacteria that seems to help their digestive systems mature properly. There are countless ways to compound probiotics, and the trick is to find the right one.

"There are a number of effects that we know probiotics can have," Dr. Robert Shulman, professor of pediatrics at Baylor College of Medicine, told NPR. Many probiotics seem to affect the immune system, improve the lining of the intestine and influence the balance of bacteria living in the digestive system.

But "[W]e don't really know in babies with colic exactly how these probiotics are working," he said, and cautioned that much more research is required before babies are routinely given probiotics. The bacteria seem safe, but studies also must confirm that it’s too early to know for sure that their use has no long-term risks.

So if you see probiotics in your grocery story or pharmacy marketed as a colic remedy, be skeptical, but probably not alarmed — they’re more likely to be useless than possibly harmful.

Other than treatment for colic, probiotics are being studied to treat a range of conditions in adults from eczema to inflammatory bowel disease.

If you don’t want to take supplements but do want to boost your intake of these beneficial bacteria to help digest food, make vitamins and maybe help protect against, eat yogurt (with live cultures), sauerkraut, kimchi and other fermented foods.

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January 3, 2014

Baby Monitors Are Helpers, Not Caretakers

In the last generation, has there been a more pervasive new-parent product than baby monitors? Like cell phones and Miley Cyrus, you wonder how you ever got along without them.

OK, we’ll pass on Miley, but baby monitors have freed parents from much of the worry about what’s happening when their bundle of joy is out of sight.

Should they? Writing on KevinMD.com, Dr. Claire McCarthy questions our adoration for technology, and our willingness to surrender certain oversight to it.

“[W]hy not why not turn to technology?” asks the medical director of the Martha Eliot Health Center at Boston Children’s Hospital. “Why not wire your baby up and monitor their breathing and heart rate and movement? I mean, if doctors and hospitals do it, it’s got to be a good idea, right?

“Not so much.”

McCarthy understands new-parent fear, the reality that you’re suddenly responsible for the survival of an otherwise helpless human being. She gets that first-time parents, despite being as prepared as they possibly can be, often have no clue what they’re doing, no manual to read, no sense of competence at this new job.

She was that person. “Like every new parent,” she writes, “I went in to check my babies’ breathing again and again. I did it more with my first couple of babies, but didn’t stop even when I was a veteran parent. I’ve watched or felt for the rising chest, listened for that barely perceptible sound of air moving, felt a wash of relief when a hand moved or a head turned.”

And she’s a doctor! Like every parent, though, her sense that everything was fine was reinforced by seeing that everything was fine. She had a plug-in model of baby monitor that enabled her to hear the baby cry, but that covered only one sense — she still couldn’t see her kid.

Newer models are tiny, wireless and provide all kinds of information. They can offer a continuous video feed so that you never have to take your eyes off your kid.

But that’s not necessarily a good thing. Here’s why:

  • Technology fails.
    You shouldn’t refuse to rely on technology because it’s not perfect, but relying on it alone makes you vulnerably inflexible. You need to be able to manage without it. Part of that management is knowing how often to look at a baby and what to look for. Knowing how to create a baby-safe environment. You’re more likely to cut corners, McCarthy says, if you trust technology to recognize and alert you to every problem.

  • Technology is confusing.
    McCarthy uses medical machinery that spits out data she can’t figure out. “Sometimes,” she says, “a number can be off, but the child can be fine — or a number can be fine, but the child isn’t. Babies are more than their numbers and data — all of us are.”

    If you become fixated on the information you get from a machine, you won’t learn the rhythms of your child. You won’t learn how to read cues, which noises mean something, which you can ignore. You might not recognize the subtle signs of both illness and wellness.

  • Technology can make you anxious.
    If you feel like you have to be staring at some gadget every waking hour, if you have to know everything that is happening with your child every single second to be a good parent, you won’t be. You will have no life beyond that of child caregiver, and you will be less father/mother than smother. That’s not helpful, and it’s not healthful.

“Part of being a parent,” McCarthy concludes, “is figuring out how to handle not knowing everything that is happening every single second. Some of that is about preparation and safety and picking good caregivers — but some of it is about learning to take leaps of faith and about coming to peace with the fact that we can’t control everything in life.”

Technology is an aid; it’s not a replacement for common sense or the need to cultivate good parenting instincts. Those are gifts any kid would be lucky to get.

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September 27, 2013

How Big Pharma and the Feds Caused Infant Deaths Over Confusing Acetaminophen Dosages

For 15 years, McNeil Consumer Healthcare, a division of Johnson & Johnson, had sold two versions of Tylenol for young children even though the company knew that parents and doctors were confusing the two. They knew that confusion could have serious, even deadly, results. The FDA ignored the problem.

We’ve addressed the problem with dosing with acetaminophen, the active ingredient in Tylenol, and now a shocking story by the investigative news site ProPublica.org probes even deeper into the confusion over the two types of pediatric Tylenol, and why that’s so dangerous. Remarkably, the story says, “Drop for drop, the strength of Infants’ Tylenol far exceeded that of Children’s Tylenol.

“In addition, the active ingredient in Tylenol, acetaminophen, has what the FDA deems a narrow margin of safety. The drug is generally safe at recommended doses, but the difference between the dose that helps and the dose that can cause serious harm is one of the smallest for any over-the-counter drug.”

Other manufacturers’ products compounded the problem by also offering two children’s products with different concentrations of acetaminophen. Between 2000 and 2009, 20 reports of children who died from acetaminophen toxicity were filed with the FDA, which acknowledged that the figure probably “significantly underestimates” the true incidence.

Between 2001 and 2010, according to the American Association of Poison Control Centers, about twice as many deaths each year were associated with acetaminophen than with all other over-the-counter pain relievers combined, according to data from. Tens of thousands more are hospitalized for overdoses.

ProPublica tells the heartbreaking stories of babies who suffered unnecessarily. To see how the intersection of federal regulatory sloth and pharmaceutical company misbehavior conspired to harm and sometimes kill people seeking only to relieve pain, see our blog, “Acetaminophen Continues to Rack Up Casualties and Escape Regulatory Control.”

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September 6, 2013

Study Showing Association Between Induced Labor and Higher Autism Risk for Boys Is Sloppy Science

A study published last month in JAMA Pediatrics indicated that boys whose mothers needed help to initiate or move the process of labor along may have a higher risk of autism.

But there are several reasons why the research contributes less to the body of knowledge and more to the mass of misinformation.

As reported by Bloomberg.com, induced labor, which stimulates the uterus in order to prompt contractions, and augmented labor, which increases the strength, duration and frequency of contractions, showed a 35 percent greater risk of autism in boys than babies whose mothers didn’t need those procedures.

According to the Centers for Disease Control and Prevention, 1 in 50 U.S. children between 6 and 17 years old is diagnosed with an autism spectrum disorder (ASD). Few childrens’ psychological disorders have been given more attention recently than autism, leading to a breathtaking wealth of misinformation about its causes, from vaccinations to diet.

The study was published in JAMA Pediatrics, a prestigious publication that, suggests writer Emily Willingham, should know better than to publish such incomplete research as the induced labor-autism risk study … or at least fully explain its considerable shortcomings.

In her analysis of the study on Forbes.com, Willingham points out that the study “did not show a cause and effect between induced (initiated) or augmented (hastened) labor and autism. It found an increased odds that a child born following a labor induction and augmentation would later be labeled as autistic by special education services. Yet there are problems with reaching even that conclusion.”

Instead of the cause-and-effect conclusion the researchers drew, Willingham said, they could just as easily have said, “Labor induction risk may be raised when child is autistic.”

Willingham noted several possibly influential factors that weren’t included in the study, probably, she surmised, because they weren’t available: mother’s BMI [body mass index, a measure of fitness that identifies percentages of fat and muscle] from pre-pregnancy; father’s age; child head circumference; specific child birth weight; mother’s insurance status; presence of any sibling births in the cohort; and whether or not the child had autistic siblings. “Lack of availability of relevant data,” Willingham states, “can sometimes make a study untenable, at least, and at best should warrant considerable caution in interpretation and speculation.”

Willingham goes into interesting detail about the study’s take on chances of an autism diagnosis and whether or not the mother has a college degree, or smokes, demonstrating, again, that science isn’t simple. We’d go a step further: Social pressure can’t overcome our desire to make it so.

To be clear, the researchers didn’t conclude that standard clinical practices be changed as a result of their study. “The results,” the lead author told Reuters, “don’t dictate there be any change in any clinical practices surrounding birth. The dangers to the mothers and the infants by not inducing or augmenting far outweigh the elevated risk for development of autism.”

In some circumstances, of course, induced labor can help reduce deaths among mothers and babies. But more studies are required to understand more fully why such procedures might be associated with the risk of disorders as elusive as autism.

Willingham’s conclusion reinforces what we hope readers will always consider when reading about research studies, even in the original form:

“This study didn’t show that induction or augmentation during childbirth substantially increases the risk for autism, although it hints at a greater influence of socioeconomic status and by implication, healthcare access. If anything, based on earlier literature, it adds a slight if only mathematical confirmation of the perception that births involving autistic children can be associated with more complications, such as the presence of meconium [fetal defecation], gestational diabetes and fetal distress, than births involving nonautistic children. And that points to induction and augmentation as useful in these situations, not as problematic, and certainly does not affirm them as a risk.”

For more information, see our blogs, “Autism Rates Rise,” and “Helping Parents Through the Autism Maze.”

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August 5, 2013

Early Use of Antibiotics May Lead to Eczema Later

Antibiotics are often necessary to treat an infection, but kids who take them before they’re a year old appear to be more likely to develop eczema.

A report published in the British Journal of Dermatology resulted from a review of earlier research. It concluded that children who took antibiotics in their first year were about 40% more likely to develop the itchy skin disorder. As interpreted in a story by Reuters, the study supports the idea that antibiotics destroy intestinal microbes that contribute to the development of the immune system after birth.

Fetuses exposed to antibiotics taken by their pregnant mothers, however, were not at higher risk of getting eczema after birth.

The Dermatology report, the first to consolidate available results from several studies indicating that early-life exposure to antibiotics increases the risk of eczema, reinforces what’s known as the “hygiene hypothesis”—that babies and youngsters who are not exposed to a wide variety of microbes don’t develop immune systems as robust as those who are. The theory has been applied to immune overreactions such as allergies and asthma.

As we wrote a few months ago, the American Academy of Pediatrics issued new guidelines for diagnosing and treating children’s ear infections in an effort to reduce the unnecessary use of antibiotics because, in addition to helping bacteria develop resistance to the drugs, using antibiotics when they’re not necessary can cause stomach problems and allergic reactions.

For some infections, most kids improve within a couple of days without drug intervention.

As many as 2 in 10 kids will have symptoms of eczema; more than half of them continue to have symptoms into adulthood.

The new report analyzed results of 20 studies of antibiotic use, either prenatally or in the first year of life, and their association with later skin problems. The more antibiotics a baby took, the higher the risk. Each round of antibiotics bumped up the risk of eczema by 7%. Broad-spectrum antibiotics, or those that treat a wide variety of infections, like amoxicillin, seemed to have the strongest effect.

Some experts noted the possibility of "reverse causation”—that’s when a baby with eczema has more skin infections that might require antibiotics and confound the results of the studies. But the authors of the new review acknowledged that limitation and said the findings are still valid.

Another possible flaw in the review concerns when eczema symptoms began and when antibiotics were first administered. The onset of eczema often occurs before a baby is a year old, so if symptoms began before antibiotics were given, those children should have been excluded from the studies.

But even outside experts who pointed out that flaw agreed: Antibiotics should be given to anybody only when it’s necessary, and especially for wee ones whose immune systems are developing.

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July 19, 2013

Waiting Longer to Cut the Umbilical Cord Helps the Newborn

During a medical procedure, the difference between 30 and 60 seconds often is critical only for emergency situations. But a new study supports the idea that cutting the umbilical cord slightly later is better for the newborn baby and poses no harm to the mother.

Most doctors, as described by the New York Times, generally clamp and sever the umbilical cord within one minute of birth. This the-quicker-the-better approach has been thought to reduce the risk of the mother hemorrhaging. But the new study, published in The Cochrane Database of Systematic Reviews found that waiting at least a minute after birth to clamp the cord allows more blood flow from the placenta, improving the baby’s iron and hemoglobin. There was no additional risk of severe postpartum hemorrhage, blood loss or reduced hemoglobin levels to the mother.

The Cochrane review analyzed data from 15 randomized trials involving 3,911 women and infant pairs.

The Times’ story indicates that the timing of clamping—which occurs in two places along the umbilical cord, the cut to be made between the clamps—has been controversial for a long time.

The Cochrane paper showed higher hemoglobin levels 24 to 48 hour after birth in newborns whose cords were clamped later. These babies also were less likely to be iron-deficient three to six months after birth, compared with term babies who had earlier cord clamping. Birth weight also was significantly higher in the late clamping group, partly because babies received more blood from their mothers.

The World Health Organization (WHO) recommends clamping of the cord from one to three minutes after birth, according to The Times, because it “improves the iron status of the infant.” Sometimes, delayed clamping can cause jaundice in infants because of liver trouble or an excessive loss of red blood cells. The WHO says that where later clamping is practiced, jaundice treatment should be available.

As noted in our backgrounder, jaundice is an uncommon type of birth-related brain injury; the yellow skin signaling jaundice means the baby has too much bilirubin, the yellowish color in bile, in his or her blood.

A committee of the American College of Obstetricians and Gynecologists last year reviewed much of the same evidence as the Cochrane study, but came to a different conclusion from the WHO. It found the material “insufficient to confirm or refute the potential for benefits from delayed umbilical cord clamping in term infants, especially in settings with rich resources.”

The committee said that the risks of jaundice and the relative infrequency of iron deficiency in the U.S. meant that the long-standing practice of immediate clamping should not be changed.

There are circumstances in which early clamping is required—if an infant requires resuscitation or aspirates its own stool. The new analysis found a 2% increase in jaundice among babies who got delayed cord clamping. Those babies should tested three to five days after birth.

Dr. Eileen Hutton, a midwife who teaches obstetrics at McMaster University in Ontario and published a systematic review on cord clamping, said the Cochrane report was “comprehensive and well done,” but she would have preferred a conclusion that was even stronger in favor of delayed cord clamping.

“The implications are huge,” Hutton told The Times. “We are talking about depriving babies of 30 to 40 percent of their blood at birth—and just because we’ve learned a practice that’s bad.”

Dr. Tonse Raju, a neonatologist at the National Institute of Child Health and Human Development agreed: “It’s a good chunk of blood the baby is going to get, if you wait a minute and a half or two minutes,” he told The Times. “They need that extra amount of blood to fill the lungs.”

Healthy babies manage to compensate if they do not get the blood from the cord, Raju said, but researchers do not know how.

Because the Cochrane review had few subjects who had undergone Caesarean delivery, “We don’t have enough information on the effects of delayed cord clamping for someone undergoing a Caesarean delivery in terms of postpartum hemorrhage,” Dr. Cynthia Gyamfi-Bannerman, medical director of the perinatal clinic at Columbia University, told The Times. “Waiting 30 or 60 seconds in a vaginal delivery in a low-risk patient is probably something we could do and wouldn’t have maternal consequences, but in a Caesarean delivery, you’re cutting into a pregnant uterus that has a huge amount of blood.” In some scenarios, “there’s an increased risk of postpartum hemorrhage.”

Also, there was no data on long-term neurological outcomes. But, according to The Times, improved iron stores might help reduce the risk of learning deficiencies and cognitive delay in children. Those problems have been linked to iron-deficiency anemia in school-age children.

If you are expecting, discuss the timing of cord clamping and cutting well before your due date. Your doctor or midwife should give you as complete a picture as possible of the nature of your pregnancy, and whether you and your new family member are candidates for waiting just a bit longer to cut that cord.

For more information, see our backgrounder on prenatal care.

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June 7, 2013

Well-Child Visits Help Keep Kids Out of the Hospital

We have been among the voices raised against the overuse and abuse of medical resources (here and here, for example), but sometimes medical attention is wholly appropriate even without symptoms or complaints.

When it comes to kids, according to a new study in the American Journal of Managed Care, regularly scheduled doctor visits even in the absence of a problem might well be wise. Young children who missed more than half of their recommended well-child visits, the study concludes, had as much as twice the risk of hospitalization compared with children who attended theirs.

Not surprising was the fact that kids with chronic conditions such as asthma and heart disease and who missed their recommended appointments had as much as three times the risk of being hospitalized as those with chronic conditions who were seen as recommended.

The study involved more than 20,000 children enrolled in Group Health Cooperative, a large health-care system in Seattle, from 1999 to 2006. The study followed the subjects from birth to age 3 1/2 or until their first hospital stay, whichever came first.

As quoted in a story on ScienceDaily.com, lead study author Dr. Jeffrey Tom, said, "Well-child visits are important because this is where children receive preventive immunizations and develop a relationship with their provider. These visits allow providers to identify health problems early and help to manage those problems so the children are less likely to end up in the hospital."

It goes without saying (although the study made it clear) that regular, preventive care for children with special needs and chronic conditions is even more important because of possible complications.

Most children in the study—3 in 4—attended at least 3 in 4 of their recommended visits. But this could be such a high percentage because Group Health coverage required no copayment for such visits. The authors acknowledge that the lack of a financial burden, even a small one, is an important incentive to maintaining a recommended medical visit schedule.

Four in 100 children in the study, and 9 in 100 of them with a chronic condition, were hospitalized. The two most common reasons for hospitalization in both groups, according to Science Daily, were pneumonia and asthma.

Children who missed more than half of their visits had as much as twice the risk of hospitalization compared with those who attended most of theirs. Children with chronic conditions who missed more than half of their visits had nearly twice to more than three times the risk of hospitalization compared with those who attended most of their visits.

During the study period, Group Health recommended nine well-child visits between birth and 3 1/2 years of age: the first at 3 to 5 days old, then at 1, 2, 4, 6, 10 and 15 months, and at 2 and 3 ½ years.

Although the study is very clear about the value of well-baby visits, a huge consideration is that the findings might not apply to all health systems. Group Health is an integrated health-care system, or one where care is well-coordinated as a person ages or a disorder progresses. Also, most of the study’s subjects attended most of their well-child visits and belong to affluent, well-educated families. Although some research studies can adjust for certain variables within the population they study, this one couldn’t adjust for income, education, race, or ethnicity.

And of course there is no absolute cause-and-effect conclusion that missing well-child visits increases the chances of hospitalization. But it’s pretty clear that there’s an important association. In addition to well-baby visits providing the opportunity for preventive care, Science Daily notes that parents who miss well-child visits are probably less likely to manage their kids' illnesses and follow treatment regimens, which could result in higher rates of hospitalization for the children.

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May 17, 2013

Why the Pacifier Shouldn’t Be Too ‘Clean’

It’s a Pavlovian response—you lick your thumb to clean the pureed peas off your baby’s face. But licking her pacifier clean after she knocked it onto the floor? Ewwww.

Get over it. According to a new study in the journal Pediatrics, that’s exactly what you should do. Parents who perform this protective act might be reducing the kid’s risk of developing allergies.

As explained on MedPageToday.com, the study suggests that transferring the microbes in your mouth to your baby’s mouth could modify its population of bacteria and cultivate a broader immune response to future invaders.

The researchers looked at kids who were 18 months and 36 months. In the younger group, children born to parents who said they cleaned their child's pacifier with their mouths were less likely than those born to parents who cleaned it with water to have asthma and eczema. At 36 months, the association remained for eczema, but not for asthma.

The benefit of this “oral hygiene,” the researchers suggest, might extend to a kid’s nether regions—because the baby swallows the newly transferred parental bacteria, they could affect the microbiology in the intestines, which could improve general gut tolerance.

Infants with less diversity among their gut microbes, according to MedPage Today, are more likely to develop allergies. That suggests that exposing youngsters to a wider variety of microbes could promote immune system function.

As Dr. Amal Assa'ad of Cincinnati Children's Hospital Medical Center told MedPageToday, "[W]e have to let nature play out a little bit and not be too clean and not be forming artificial barriers in the connection between the mother and the infant and the parents and the infant."

"We have to at some point reach a balance where we're making sure we're not predisposing [infants] to infections at the same time [we're making] sure we're giving them what they were naturally expected to get from the parents ... so we end up with a balanced body that doesn't veer towards allergies and doesn't veer towards serious infections and harm."

It’s interesting that, according to the study, the method of birth (cesarean or vaginal) was related to the likelihood of a parent sucking on the pacifier. Vaginal delivery and parental pacifier sucking independently were associated with a reduced likelihood of developing eczema; babies delivered vaginally and whose parents licked their pacifiers had a lower incidence of eczema.

The theory is that vaginal delivery, which also transfers bacteria from mother to infant, has a beneficial effect on allergy resistance.

Regarding the “ick” factor, and the concern that transferring a pacifier from a parent's
mouth to a child's could spread respiratory infection, the study showed no difference in the rate of such infections based on pacifier cleaning practices.

Keep in mind that this study had a relatively small sample size (184 kids), and that it’s relatively difficult to diagnose asthma in early childhood. So a larger study also involving older children is necessary to replicate—and confirm—these results.

But, for now, if you think it’s better to wash your kid’s pacifier under the tap than in your saliva, it’s probably time to think again.

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April 26, 2013

Nursing Shortages in NICUs Promote Infection in Babies

Any parent whose newborn has spent time in the neonatal intensive care unit (NICU) has felt helpless and frightened seeing their tiny baby swathed in more medical paraphernalia than you’d think he or she could withstand. They’ve probably also felt grateful and in awe of the medical army charged with nurturing delicate new life into viability.

Neonatal nurses are truly on the front lines of their babies’ survival. And a recent study published in JAMA Pediatrics concludes that the warriors fighting for your kid are under serious attack from a lack of numbers. Depleted staffs raise the risk of infection in critically ill babies.

The study, as interpreted on MedPageToday, shows that infection rates for very low birth weight infants were 40% higher in NICUs that were understaffed with nurses.

The problem seems to be widespread: The researchers found that hospitals understaffed nearly 1 in 3 of their NICU infants and more than 9 in 10 of their high-acuity NICU infants, relative to staffing guidelines. (“High-acuity” patients are seriously ill and require medical interventions of an emergency and/or specialized or complex nature.)

National guidelines spell out optimal nurse-to-patient ratios. They’re based on acuity. Staffing for low-acuity infants is supposed to be one nurse per three or four babies; levels for the highest-acuity patients are at least 1 to 1.

When these levels aren’t maintained, studies show, the patients have a higher rate of nosocomial infections, especially infants with very low birth weights. “Nosocomial” means the infection was contracted as a result of the hospital setting—from a treatment or other exposure.

The study examined data from 67 NICUs from the Vermont Oxford Network, a nonprofit collaboration of health-care professionals working in more than 900 NICUs around the world. Measured by the national guidelines, hospitals understaffed nearly 1 in 3 NICUs infants in 2009 and nearly 5 in 10 in 2008, but the levels varied by acuity. Hospitals understaffed more than 8 in 10 high-acuity infants in 2008 and more than 9 in 10 in 2009.

The study did have limitations—it might not represent all hospitals with a NICU or consider other factors that might be important in NICU staffing decisions, including non-nursing personnel.

But the researchers’ conclusion was unequivocal: The "most vulnerable hospitalized patients, unstable newborns requiring complex critical care, do not receive recommended levels of nursing care."

Usually, parents don’t choose the NICU in which their ailing babies are assigned. So if yours is a NICU patient, find out if your child is considered a low- or high-acuity patient, and let the staff know you’re aware of the staffing recommendation for each. If the facility is understaffed, be extra vigilant about monitoring its infection-control measures. Find out more on our blog, “Controlling Infections in Pediatric ICUs.”

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April 19, 2013

Hospitals Show Progress in Clamping Down on Early Elective Deliveries

A few months ago, we recalled a case in which Patrick Malone represented a family who sued a group of obstetricians when their baby was delivered early and suffered brain damage. As we noted in that blog, except when there are real medical complications, the American College of Obstetricians and Gynecologists recommends against delivering babies or inducing labor before 39 weeks of gestation.

Earlier this month, a study published in the journal Obstetrics & Gynecology not only confirms the wisdom of waiting to full-term before delivering the baby, but shows that hospitals that promote full-term delivery can realize excellent results.

As described by KaiserHealthNews.org, the study profiled 25 hospitals in five states that were able to cut their rates of elective early deliveries from nearly 28 in 100 to fewer than 5 in 100 in one year.

Such efforts are critical to lowering the rates of deliveries, which can put babies at risk of serious health issues including feeding, breathing and developmental problems. The latter often turn out to be long-term problems—one study by researchers at Emory University found that babies born before 38 weeks had lower scores on standardized tests in first grade.

Because 10 to 15 of 100 U.S. babies are delivered early without a medical reason, the value of full-term gestation needs to have wider appreciation among both parents and doctors. It is not uncommon for either party to opt for early delivery not because it’s optimal for the wee ones, but simply because it’s more convenient. That is, too often early delivery is a matter of scheduling preference than medical need.

Hospitals are starting to accept that they are on the frontlines of preventing the long-term negative effects of early delivery, and so must the rest of us. As the lead author in the hospital survey said, “This quality improvement program demonstrates that we can create a change in medical culture to prevent unneeded early deliveries and give many more babies a healthy start in life.”

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February 8, 2013

Electing Early Delivery Is Seldom Wise

It has been nearly 35 years since the American College of Obstetricians and Gynecologists (ACOG) recommended against delivering babies or inducing labor before 39 weeks of gestation, except when there are medical complications, such as the mother's high blood pressure (pre-eclampsia; see our recent blog on the Downton Abbey all-too-real plot line), diabetes or signs that the fetus may be in distress.

So why, then, are an estimated 10 to 15 out of 100 U.S. babies delivered early every year for no medical reason?

That reality is examined in a recent story by Kaiser Health News and the Washington Post. "After 37 weeks, patients really push for it because they are miserable and don't want to be pregnant anymore," Alfred Khoury, director of maternal-fetal medicine at Inova Fairfax Hospital, told KHN/Washington Post. "Or they say, 'My mother is here' or 'I have to be in a wedding.'"

Sometimes, it’s a matter of provider availability. Physicians who work alone or in rural areas might prefer to schedule deliveries before 39 weeks for time-management purposes. That’s a bad idea, but, said Helain J. Landy of the department of obstetrics and gynecology at MedStar Georgetown University Hospital, "The reality of caring for patients, or [doctors'] day-to-day needs, may sometimes interfere with following the guidelines."

In 2012, Patrick Malone represented a family in a medical malpractice lawsuit against a group of obstetricians for brain damage to a baby that resulted from misconceived plans for an early delivery. In that case, the doctor followed outdated medical literature that suggested babies of mothers with gestational diabetes should be delivered early even if monitoring shows the baby is doing fine. Mr. Malone's closing argument of the trial on behalf of both baby and mother can be read here.

Now, poor doctoring and patient ignorance are coming under the control of some government and private insurers, who are discouraging and sometimes penalizing doctors and hospitals for delivering babies early without cause.

It’s a good idea from both a health and financial perspective.

Often, prematurely delivered babies develop problems ranging from breathing and heart disorders to anemia and bleeding in the brain that land them in the neonatal intensive care unit (NICU) where, according to KHN/Washington Post, the average charge is $76,000 per stay. (Learn about NICU injuries in our backgrounder.)

The folks who pay most of that tab also want to avoid subsequent medical costs to treat problems including jaundice, feeding difficulties and learning and developmental issues. Sometimes the health problems of preemies last their whole life.

As reported in the story, UnitedHealthcare, the nation's largest private health insurer, pays hospitals more if they take steps to limit early deliveries without medical cause and show a drop in their rates. And as of July, Medicare, which pays for disabled women to give birth, will require hospitals to report their rates of elective deliveries before 39 weeks. Hospitals might be penalized beginning in 2015 if their rates remain high.

Some insurers refuse to pay for unnecessary early deliveries at all. The South Carolina Medicaid program and BlueCross/BlueShield of South Carolina don’t reimburse providers for performing early deliveries without medical cause. Those two insurers cover more than 8 in 10 births in that state. Several other states either have or are considering such policies.

We’re reluctant to endorse such sweeping measures because individuals have different needs. But unnecessary early delivery is never a good idea.

Even without official prodding, some hospitals have taken steps to curtail elective early deliveries, and some simply won’t perform them. After St. Joseph Medical Center in Houston stopped performing them in 2011, NICU admission rates for babies born between 37 and 39 weeks dropped 25 percent in the first year.

Unfortunately, sometimes brawn works better than brain in encouraging practitioners to curb elective early births. One study mentioned by KHN/WP found that educating doctors about the risks was less effective in reducing rates of early deliveries than having medical staff simply prohibit the practice.

But some physician groups don’t like being told how to practice medicine.

"We oppose the legislative control of medicine," said Jeanne Conry, president-elect of ACOG told KHN/WP. Conry says her organization has developed its own "clear, effective guidelines" laying out clinical markers for determining when early delivery might be appropriate.

And as one obstetrician noted, when states or insurers get involved, doctors may hesitate to deliver early even when there are clinical reasons to do so. "Outcomes are best when there is a doctor-led process, rather than a legislative or payment mandate," he said.

Even the March of Dimes, that notable champion of safe birth practices, is wary of using financial rewards or penalties. "Payment is a really big hammer, and we want to have a comfort level with a policy so we don't cause unintended consequences [such as making doctors reluctant to perform early deliveries even when they are needed],” Cindy Pellegrini, a March of Dimes executive told KHN/WP.

Some doctors welcome the oversight, as one obstetrician said, to help "us all do the right thing" and make it easier to educate women.

But decades after the ACOG guidelines, only 1 in 3 hospitals reports rates of elective early deliveries at or below the goal of 5 in 100, according to the Leapfrog Group, an organization of businesses focused on patient safety. Many still have rates higher than 15 in 100.

Some of the resistance, unfortunately, might be because NICUs are profit centers for many hospitals.

The best way to address the wisdom of full gestation is to educate patients. There’s some work to do there—one survey from a couple years ago involving 650 women who had recently given birth found that half considered it safe to deliver before 37 weeks.

If you are expecting, or expecting to be expecting, make sure you and your obstetrician are on the same page regarding the optimum time for delivery. Do not accept any reason other than medical necessity for inducing labor before the due date, or otherwise delivering prematurely. It’s bad medicine with potentially lifelong consequences.

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November 23, 2012

Study Supports Using the Toilet Training Method that Works for You

For a lot of parents, toilet training is an early focus of worry about inflicting psychological harm on a child. Everyone, it seems, has an opinion about how to accomplish human housebreaking, and all the things that can go wrong if you don’t do it their way. But relief is in sight: A recent study published in Clinical Pediatrics concludes that a kid’s urinary accidents are unrelated to the method his or her parents use for toilet training.

But they do recommend starting toilet training sooner rather than later.

“Our study,” the authors wrote, “showed that the method used for toilet training had no association with the development of dysfunctional voiding symptoms. This information may be helpful for parents of children with dysfunctional voiding who feel guilty for using the wrong training method. Further research should be conducted to [refine] the toilet training methods in order to find any significant difference, but as of now, parent-oriented and child-oriented toilet training should be considered equally effective.”

The researchers also concluded that earlier toilet training, between the ages of 24 and 32 months, is more important for reducing the risk of urinary concerns that whatever method parents use.

According to the study, children undergo toilet training at a later age now than in the past. In 1980, the average age was 25 to 27 months; in 2003, it was 36.8 months. Some studies have indicated that the later age has a negative impact, that late toilet training might be more difficult for parents because the child is more likely to resist their efforts to train. That can cause problems, such as constipation, daytime accidents (a “voiding dysfunction”) and infection.

One recent study showed that children with symptoms of voiding dysfunction (which also includes the frequent or urgent need to urinate) were toilet trained later than children who didn’t have these problems. But the delay can have a benefit—it produced the toilet training approach that follows a child’s readiness to participate rather than forced learning.

The study defines two broad categories of toilet training—parent-oriented and child-oriented. The former was more common before 1960; it supports early toilet training with firm parental direction, often using rewards to support the desired result and punishments or withdrawal of positive reinforcement to negatively reinforce accidents. The child-oriented approach is when a kid shows interest and willingness to learn to use the toilet, generally around 18 months of age or later. It praises success and avoids punishment. Both methods have myriad modifications, though, that might include rewards or the withdrawal of rewards to encourage kids to get with it.

The new study followed 215 children ages 4 to 12. Both genders were represented. Parental reports and medical examinations were included. The study compared the methods of training in two groups. The control group of 147 subjects had no urinary problems after training was completed. The other group of 58 subjects showed voiding dysfunction.

No association was found between the method used and urinary symptoms that may have followed training.

“Our study reveals that the decades of debate about the preferred method of training was not based on scientific evidence, but rather expert opinion,” said the lead researcher. “The evidence presented in our research should help ease parents’ concerns that if their child has urinary difficulties, it might be the result of incorrect training or the training method chosen. It isn’t.”

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September 27, 2012

Getting Your Baby to Sleep

Earlier this year, our post about infants with breathing problems during sleep cautioned parents to monitor the quality of their baby’s slumber. But simply getting a baby to sleep and keeping him or her in a restful state can be one of the more bedeviling challenges of early parenthood.

A new study published in the journal Pediatrics might save some parents from constant worry if they’re getting bedtime routine right.

As reported on MedPage Today, certain behavioral techniques for getting babies to sleep by themselves, such as initially remaining in the child’s room, can be effective without any adverse emotional outcomes in the long term for either the kid or the parents.

The study followed up with 6-year-olds who had been studied as infants. Any problems with the youngsters were not significantly more common among those who had been “trained” to sleep alone versus those who hadn’t.

Many parents worry about long-term harm if they don’t respond immediately to a crying baby in a crib, having been influenced by older practices of letting a kid “cry it out” that causes harmful distress.

But the study showed that "camping out" to get kids to fall asleep and "controlled comforting" to help learn how to settle down on their own by gradually lengthening intervals at which parents respond to crying improved infants' sleep. It also reduced depression among mothers by 60 percent.

Among the 225 families followed through the child’s sixth birthday, there were no differences between the group that underwent behavioral training and the one that didn’t in outcomes for:

  • sleep habits;

  • parent-reported psychosocial functioning;

  • child-reported psychosocial functioning;

  • chronic stress as measured by cortisol (a hormone produced in response to stress) levels on a nonschool day;

  • child-parent closeness;
  • conflict between parent and child;

  • overall quality of the relationship between parent and child;

  • disinhibited attachment (emotionally and socially remote behavior);

  • depression, anxiety and stress scores in the mother;

  • authoritative parenting (deemed the optimal parenting style demonstrating warmth and control).

The researchers noted that their inability to follow up on about one-third of the families initially involved with infants meant the study couldn't rule out small harms or benefits long term. But, they concluded, “Nonetheless, the precision of the confidence intervals make clinically meaningful group differences unlikely."

“…[P]arent education programs that teach parents about normal infant sleep and the use of positive bedtime routines could effectively prevent later sleep problems," they concluded.

For more information, see “Getting Your Baby to Sleep” on the website of the American Academy of Pediatrics.

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August 3, 2012

Genetic Disorders Study Shows Some Doctors Dehumanize Handicapped Babies

In a touching post on Neonatalresearch.org titled “Our children are not a diagnosis,” Dr. Keith Barrington, a neonatologist and researcher at Sainte Justine University Health Center in Montréal, responded to a recently published study in the journal Pediatrics about families with children who have trisomy 13 and 18.

Those are chromosomal disorders that cause significant neurodevelopmental disability. Fewer than 1 in 10 babies born with them survives to his or her first birthday. Trisomy 13 occurs in about 1 in 5,000 births. Trisomy 18 occurs in about 1 in 3,000 births, and predominantly among girls. Often, the disorders are treated with palliative measures only—that is, patients are made as comfortable as possible, but not given medical interventions.

Barrington was disturbed by the study’s results not because it challenged assumptions about life with such severely disabled children, but because of what the parents reported about the medical establishment’s attitude toward them.

Caveats about the study concern the fact that survey participants were found through Internet-based support groups and Facebook groups dedicated to trisomy 13 or 18. Surveys were emailed to parents of children born with full or partial forms of the chromosomal disorders. Clearly, they might not represent all parents of children with congenital disorders.

More than 330 parents completed the questionnaire. Some had been given a diagnosis before their babies were born, and others had not. So those with a prenatal diagnosis might have had the option to abort, but did not. The study included only parents whose babies had been born alive.

About half of the parents chose palliative care, one-quarter chose limited medical care after birth and one-quarter wanted full intervention. The length of the children’s survival didn’t differ much among all the families.

Among the study’s findings was that the parents who regretted their choices about the extent of medical intervention were overwhelmingly the ones who had chosen comfort care only. Also, the children did show signs of developmental progress, all were able to communicate with their parents at some level and most parents reported their child as being happy.

But most gratifying was that the parents overwhelmingly reported that the experience of living with their disabled child had made a positive contribution to family life, irrespective of how long their afflicted children lived. The fact that their disorder had created substantial financial stress was irrelevant.

Here’s the disturbing part: Although 2 in 3 of the families met at least one medical provider they described as helpful, most had been given misinformation, and many of those who had chosen active care felt that they were judged negatively by providers for making that decision. They reported that providers often referred to their baby in dehumanizing terms, calling him or her “it” or “a T18.” The parents told of interactions with providers who never learned their baby’s name, only the diagnosis.

To a parent, a child is a child. He or she might be brilliant, disabled, athletically gifted or socially awkward. He or she might be gorgeous or homely, able to engage or closed off in his or her own world. A child with problems is no less a human being than one fortunate enough to be perfectly healthy.

Although adults can make honest mistakes because of ignorance or discomfort, anyone with compassion makes an effort to connect with people not as lucky as they. A person who has chosen medicine as a profession and refers to another damaged person by diagnosis instead of name is less a human being than a wad of protoplasm in desperate need of re-education.
As Barrington concludes, the study highlights “the uniqueness of each of these children and the heterogeneity of condition and survival. …[W]e cannot be definite about the duration of survival or the capacities of an individual.”

The researchers concluded that parents who engage with parental support groups may discover a positive perspective about children with T13 and T18 that might stand in contrast with that of medical practitioners.

Here are Barrington’s guidelines for medical providers when talking with parents who have received a diagnosis, prenatal or postnatal of T-13 or T-18. If you’re a parent in this situation, and your providers fail to observe them, let them know of their deficiencies, and seek help from others who are not so afflicted.

1. Don’t say that this is “‘incompatible with life”; it’s callous, and it’s a lie.

2. Don’t say that if they survive “they will live a life of suffering;” parents do think that their child had more pain than others, but they also had many positive times, and their overall evaluation was positive.

3. Human beings are not vegetables. These children are conscious and interact, even if at very limited levels. Carrots don’t.

4. Don’t predict marital disharmony or family breakdown. There is no evidence that it occurs more when a family has a baby with severe impairments. Families find meaning in the lives of their children. Whether those lives are unimpaired or lived with severe impairments. Whether they are very short or not.

5. Don’t suggest that the child is replaceable. If parents initiate the idea that they can have another child, fine, but for you to suggest it indicates that you think this child is worthless.

6. Don’t say that there is nothing you can do for them. There is a lot you can do. Empathy and a positive attitude, finding resources, respite care and enabling appropriate medical care are among what you have to offer.

7. Be explicit about medical decision making; come to an agreement about the limits of medical interventions (if you can’t, then find them another doctor who can); be open to changing the plan as time goes on.

8. Refer to the child by name if there is one. Some doctors ask prospective parents if they have chosen a name, which demonstrates recognition that a fetus has potential as a human being.

9. Recognize that these babies will be loved, cared for and will leave a positive mark on their families.

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July 13, 2012

Trade Group Tantrum Undermines Play Yard Standards

In 1998, a 17-month-old boy confined in a folding Playskool Travel-Lite play yard at his day-care provider’s home died when the side rails collapsed around his neck. The play yard had been recalled, but the caregiver was unaware.

Last year, a 3-month-old girl was snoozing in a bassinet that was snapped onto the side of her play yard. Because the assembly was not proper, the bassinet somehow detached, tilted and pushed her face into the mesh side of the play yard. She suffocated.

We’ve written about injuries associated with cribs and playpens, and the tragedies noted above were remembered, according to a story in the Washington Post, when the Consumer Product Safety Commission’s (CPSC) mandated new safety standards for folding play yards last month. The problems that caused the first accident were addressed; the problems that caused the second were not.

The CPSC ensures the safety of approximately 15,000 consumer products. At least 19 deaths have been tied to the side rail defect that killed the little boy, and about 1.5 million portable cribs with the defect have been recalled. them. Deaths declined as the industry embraced stricter standards, but some of the pre-standard models remain unaccounted for, according to Kids in Danger, an organization founded by the parents of the little boy who died.

Since 1985, according to The Post, there have been 20 recalls of play yards—also known as pack-and-plays—representing numerous deaths. The play yard safety standards approved last month require that portable cribs be tested to ensure such serious hazards have been addressed, but in certain quarters, the bassinet accessory dangers aren’t considered serious enough.

“It’s disheartening that we couldn’t get this taken care of,” Nancy Cowles, executive director of Kids in Danger, told The Post.

Congress approved a bill in 2008 that added muscle to the CPSC. One element requires the agency to strengthen some voluntary standards. The play-yard standards were among them, and regulators had been working with the industry to effect the necessary product changes.

Shortly after the CPSC heard about the baby girl’s death, the relationship between the guards and the guarded deteriorated. The CPSC added language making it more difficult to assemble a play yard with missing parts, which contributed to the baby’s death last year. One proposal required manufacturers to stitch all the parts together so that none could go missing.

In May, the Juvenile Products Manufacturers Association (the industry’s trade group) requested that the provision take effect later than originally intended. The CPSC agreed. In June, however, half an hour before the commission held a briefing on the standards, it received a letter from the JPMA accusing the CPSC of violating the law because it hadn’t solicited public comment on that provision.

The commission now plans to deal with this issue separately, and in a statement after the decision, the JPMA said it is pleased with that outcome. It also promoted itself as a guardian of kid safety:

“Each year, JPMA sponsors Baby Safety Month in September to educate parents and caregivers on the importance of the safe use and selection of juvenile products. Baby Safety Month 2012 is dedicated to helping educate parents and caregivers on the importance of safely using second hand, hand-me-down, and heirloom baby gear.”

This expressed concern for child safety would have more credibility if those articulating it would do the right thing instead of standing on ceremony.

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June 21, 2012

Teething Products Can Be a Mouthful of Danger

It seems simple: A teething baby cries and a parent rubs the baby's gums with an analgesic to relieve the pain. But a recent FDA statement warns that this can lead to a serious disorder.

Methemoglobinemia, as described in a story on MedPage Today, can lead to oxygen deprivation and even death. Benzocaine, which is found in many over-the-counter products to relieve the pain of teething and toothache, is the source of concern. The greatest risk is for children younger than 2, who are also those most likely to get teething pain.

Methemoglobinemia is also known as “blue baby syndrome.”

This is not the first time the federal agency has warned about products containing benzocaine. In 2006 it issued a warning about such products, which include Baby Orajel, Orabase, Orajel, Anbesol and Huricaine. Since then, it has received 29 reports of benzocaine gel-related cases of methemoglobinemia. Nineteen of them were among children, 15 of whom were younger than 2.

A second warning was issued last year, and we wrote about it then. Given the dire nature of the disorder, the warning bears repeating.

FDA officials are concerned that parents might not be aware of the symptoms of methemoglobinemia. They include:

  • pale, gray, or blue-colored skin, lips and nail beds;

  • shortness of breath;

  • fatigue;

  • confusion;

  • headache;

  • light-headedness;

  • rapid heart rate.

Symptoms can occur shortly after use, or maybe not for several hours. A child can experience symptoms after the first use or not for several subsequent uses.

Parents have options for teething pain relief. The American Academy of Pediatrics (AAP) suggests a chilled teething ring or gum massage using your finger. If those don’t work, consult your pediatrician before using a topical agent.

Benzocaine is also used by physicians and dentists to numb parts of the mouth and throat before performing procedures such as transesophageal echocardiograms (in which an ultrasound probe the size of a small finger is inserted into the esophagus to view the heart), endoscopy (in which a scope is used to view the interior of a hollow body organ, such as the stomach) and feeding tube insertions.

If you are or a loved one is scheduled for any of these procedures, discuss the risk with your health-care provider.

Anyone can be at risk from benzocaine; the risk is higher for people with heart disease, asthma, bronchitis or emphysema, and for anyone who smokes.

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March 26, 2012

Early Sleep Problems Signal Later Emotional Troubles

A milestone in child development, at least for many parents, is when the kid finally sleeps through the night. But a recent study suggests that it’s a good idea for parents to monitor how the wee ones are sleeping as well as how long.

Published in the journal Pediatrics, the study shows that children who have problems breathing while they sleep are more likely to experience behavioral problems such as hyperactivity and aggressiveness when they get older. They’re also more likely to have emotional issues such as difficult peer relationships.

Researchers from the University of Michigan and the Albert Einstein College of Medicine at Yeshiva University followed the sleeping patterns of more than 11,000 children for six years. They found that kids who snored, breathed heavily through their mouths and experienced apnea—long pauses between breaths during sleep—were at risk.

Collectively known as sleep-disordered breathing (SDB), the problem peaks when children are between 2 and 6 years old, but can occur when they are younger. Approximately 1 in 10 children snores regularly and 2 to 4 in 100 have sleep apnea, according to the American Academy of Otolaryngology–Health and Neck Surgery (AAO-HNS). Common causes of SDB are enlarged tonsils or adenoids, but be wary of the “quick-fix” of tonsillectomy—as we have reported, that surgical procedure is often unnecessary, and to conclude that tonsils contribute to sleep disorders requires careful diagnosis.

Quite simply, the study’s authors said, “Parents and pediatricians alike should be paying closer attention to sleep-disordered breathing in young children, perhaps as early as the first year of life.”

Although earlier studies indicated sleep problems could signal later difficulties, they involved only small numbers of patients, short follow-up of a single symptom or limited control of individual traits such as low birth weight that could be responsible for some symptoms.

In the new, more substantial study, children whose symptoms peaked between the ages of six and 18 months were much more likely to experience behavioral problems when they were 7 compared with children who breathe normally during sleep. Children whose SDB symptoms persisted throughout the evaluation period, and were most severe at 30 months, expressed the most severe behavioral problems.

Researchers theorize that SDB might be responsible for behavioral problems because of its effect on the brain. Decreased oxygen levels and increased carbon dioxide interrupts the restorative process of sleep and disrupts various chemical systems. Such malfunctions can impair one’s ability to pay attention, plan ahead and organize. They also impede one’s ability to regulate emotions.

To learn more about SDB and treatment options, consult the AAO-HNS fact sheet.

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October 27, 2011

Stripping Down the Crib to Cut the Risk of Sudden Infant Death

When it comes to babies and sleep, the American Academy of Pediatrics (AAP) has made it official: Less is more.

Its new guidelines call for cribs empty of everything except the baby and the tightly sheeted mattress. No blankets. No bumpers, pillows or toys. They’re all hazardous for babies because they present a risk of suffocation, entrapment and asphyxia.

In a report for NPR, pediatrician Rachel Moon, chairwoman of the AAP Task Force on Sudden Infant Death Syndrome (SIDS), said, "Babies can roll into [anything] soft and suffocate against it, and babies can crawl under it and suffocate. Even the hard bumper pads are a problem because babies can scoot in and get their head wedged in between the mattress and the bumper pad and can't get out."

In the last two decades, the incidence of SIDS has fallen dramatically, thanks to the academy’s evolving understanding of the syndrome. All parents now are schooled in the "Back to Sleep" idea: Put your baby to sleep on her back, not her stomach; the admonition to keep cribs clear is another effort to address SIDS, which still causes about 2,300 babies to die every year in the U.S.

Some products claim they can help prevent SIDS, but that’s bogus. In fact, the FDA has issued a consumer alert about such claims.

The only proven methods to reduce the chances of SIDS are proper sleeping posture and clear cribs. In addition, the academy recommends that cribs be located in the parents’ room -- but babies should not sleep in the same bed – and that babies be breast fed and immunized to prevent infant death. The latter two help prevent infection, which often precedes an incident of SIDS.

Other habits pregnant women indulge that appear to increase the risks are smoking, drinking alcohol and taking illicit drugs.

Still, accidental suffocation may account for some SIDS casualties, and some babies are particularly vulnerable because their brains haven’t fully matured and they don't wake up easily when faced with an obstacle.

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August 28, 2011

A Simple Heart Test for Newborns

One in 100 newborns has a malformed heart. It's the most common birth defect. Now, a federal advisory panel recommends a simple and painless test for all newborns to detect such defects before the babies are released from the hospital.

Pulse oximetry measures the amount of oxygen in the blood via a small light sensor taped to a baby's wrist, hand or foot. It's inexpensive ($5-$10), fast (five minutes) and can detect a life-threatening condition otherwise difficult to find in a physical exam. An infant's cardiovascular system might appear normal in the first few days after birth, even though it continues to mature.

According to WebMD, only two states -- Maryland and New Jersey -- legally mandate the test. Some hospitals elsewhere do it voluntarily, but it's not in widespread use.

The federal panel's advice has been endorsed by the American College of Cardiology, the American Heart Association and the American Academy of Pediatrics.

If you're expecting, and you don't live in Maryland or New Jersey, make sure your hospital knows you want the test to be performed before your bring junior home. The chances of heart problems are low, but it's better know if there is one -- and to address it -- before it presents far from where it can be treated.

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August 4, 2011

Bed-Sharing with Mom and Dad Doesn't Hurt Toddlers

Few things are as satisfying in the parent-child relationship as affectionate physical contact. But some psychologists have drawn the line at parents sharing their bed with their children. As noted in a story on WebMD, the American Academy of Pediatrics advises parents not to sleep with their infants because of an increased risk of sudden infant death syndrome, but what about toddlers, who often are the ones seeking the comfort of the parental bed?

Not to worry. New research published in the journal Pediatrics says that toddlers who share a bed with their parents do not face increased risks for behavioral or learning problems at age 5.

"The idea that bed sharing may be bad for toddlers is mostly based on folklore," researcher R. Gabriela Barajas of Teachers College of Columbia University told WebMD. "From what we see, there is no additional risk of behavioral and cognitive problems among toddlers who share a bed with their parents."

The study involved children from 944 low-income families who were assessed at ages 1, 2, 3, 4 and 5. Nearly 50% of families said they had shared a bed at least once; 73% of the families in the study were living below the poverty line. The study did not look at why the children were sleeping in their parents' beds, information that could be critical.

"In some higher socioeconomic groups, co-bedding can be a parenting-style issue and in others, it may be trouble-shooting a sleep problem," said Nanci Yuan, M.D., of the Pediatric Sleep Center at Lucile Packard Children's Hospital at Stanford University.

"If it is because you feel like it is bonding and your child is otherwise healthy, growing, and thriving, then bed sharing is not associated with cognitive and behavioral problems," she said.

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July 20, 2011

Secondhand Smoke Poses Yet More Risks to Children

Because nicotine is possibly the most difficult addiction to kick, because inhaling smoke carries so much destructive potential, you can never try too hard or too often to quit. Now another study shows why smoking around children is a terrible idea.

“Not only are children who are surrounded by secondhand smoke at greater risk for asthma and other health problems,” says the Los Angeles Times, “but they may be more likely to have attention-deficit/hyperactivity disorder or learning disabilities too.”

Researchers at the Harvard School of Public Health found that children who lived with smokers were 50% more likely to suffer from a learning disability, a behavioral or conduct problem or attention deficit disorder/attention deficit hyperactivity disorder (ADD/ADHD).

Although the study was less than scientifically ideal—it was a phone survey of parents—and some variables were not considered, such as whether the mothers smoked during pregnancy, this is not the first study to connect mental health problems and secondhand smoke.

Another study published in Archives of Otolaryngology–Head and Neck Surgery concludes that exposure to secondhand smoke is associated with increased risk of hearing loss among adolescents.

Fetuses and young children exposed to secondhand smoke are vulnerable to an array of possible problems, including low birth weight, respiratory and ear infections and behavioral problems. Now evidence suggests that adolescents are at risk of compromised hearing.

In the new study, adolescents who were exposed to secondhand smoke showed higher rates of hearing loss than teens who weren’t exposed.

If your teens have been exposed to secondhand smoke, the researchers suggest they be closely monitored for hearing loss, and informed that noise from recreational or occupational endeavors can further impair hearing, even if the kids aren’t aware of it.

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July 18, 2011

Signs of Allergy Can Appear Early

The kid who started sneezing and itching and was diagnosed with an allergy when he was 3 might well have communicated sensitivity to the responsible allergens even before he could roll over.

A study in the American Journal of Respiratory and Critical Care Medicine indicates that an allergic future can signal itself within the first month of life, long before symptoms develop.

A certain protein expressed in infant urine predicted lung, nasal and skin irritation by the time children start school. The findings are useful, the researchers wrote, for prevention and to customize treatment when symptoms do manifest.

All of the infants in the study were symptom-free when they were tested at 1 month old. By the time they were a year old, 4% developed chronic respiratory problems (wheezing, coughing), and 27% developed eczema. By the time they were 6, 17% and 15% respectively developed those symptoms.

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July 10, 2011

Test for Newborns Is Questionable Medicine and Bad Policy

One health-care analyst takes issue with the groundswell of states considering a mandatory test for newborns that looks for signs of congenital heart disease. Writing on Medpagetoday, Gary Schwitzer says, "The tests aren't always accurate ... and some doctors say they will prompt follow-up tests that could prove expensive -- perhaps as much as $1,500."

He quotes physicians concerned not only about cost, but who question that the tests will even have a positive effect on outcomes. "Politicians love screening tests," Schwitzer writes, "[w]hether evidence supports the tests or not."

For example, he says that at least 28 states have enacted laws requiring insurers to include coverage for prostate-specific antigen (PSA) testing, never mind that the U.S. Preventive Services Task Force (USPSTF) disagrees. He also cites the new federal health-care reform legislation, which ignores the U.S. Preventive Services Task Force recommendations on mammography.

"In the apparent attempt to look like do-gooders, politicians may inadvertently cause harm by legislating screening mandates that don't reflect all of the available evidence."

The trouble with both prostate testing and mammograms is that they produce a lot of false alarms that lead to further testing and sometimes harmful treatment, with no eventual upside in lives saved or lives prolonged.

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May 31, 2011

Finally, FDA may require Tylenol dosing information for children 2 and under

An FDA advisory panel has voted 21-0 in favor of adding dosing instructions to Children’s Tylenol and other products containing acetaminophen for children between 6 months and 2 years.

Currently, the liquid formulas do not contain dosing information for children under 2. Panel members said the lack of information can lead parents to give their kids an incorrect dose of the drug.

Acetaminophen-related overdoses are most common among children younger than 2, and have increased over the past decade, according to FDA data. While safe when used as directed, acetaminophen has long been subject to warning labels because it can cause serious and even fatal liver damage when overused.

Dosing errors with children’s acetaminophen products accounted for 7,500 of the 270,165 emergencies reported to poison centers last year, according to the American Association of Poison Control Centers.

Overdoses can be caused by parents not reading the label, misinterpreting the dosing instructions or using a spoon or other container instead of the cup included with the product.

The panel also voted unanimously that medicines should include dosing information based on children’s weight, and to limit cup measurements to milliliters, because having both teaspoon and milliliter markings can cause confusion.

The proposed changes have been discussed at FDA meetings since the mid-1990s. FDA is not required to follow the recommendations of its advisory panels, though it often does.

Source: Associated Press

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May 17, 2011

Pediatricians recommend rear-facing car seats until age 2

The American Academy of Pediatrics has new advice for parents about how to buckle their children in their cars. In a new policy published last month, the AAP advises parents to keep their toddlers in rear-facing car seats until age 2, or until they reach the maximum height and weight for their seat. In addition, it recommends that children ride in a belt-positioning booster seat until they have reached 4’9” and are between 8 and 12 years of age.

Previously, the AAP advised parents to keep infants and toddlers rear-facing up to the limits of the car seat but also set a minimum of age 12 months and 20 pounds, which resulted in many parents turning the seat to face the front of the car when their child celebrated his or her first birthday.

“Parents often look forward to transitioning from one stage to the next, but these transitions should generally be delayed until they’re necessary, when the child fully outgrows the limits for his or her current stage,” said Dennis Durbin, MD, FAAP, lead author of the policy statement and accompanying technical report.

“A rear-facing child safety seat does a better job of supporting the head, neck and spine of infants and toddlers in a crash because it distributes the force of the collision over the entire body,” Durbin said. “For larger children, a forward-facing seat with a harness is safer than a booster, and a belt-positioning booster seat provides better protection than a seat belt alone until the seat belt fits correctly.”

While the death rate of children in motor vehicle crashes dropped by 45% between 1997 and 2009, it is still the leading cause of death for children ages 4 and older. Counting children and teens up to age 21, there are more than 5,000 deaths each year. And for each death, about 18 children require hospitalization and another 400 need medical treatment.

Source: The American Academy of Pediatrics

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May 2, 2011

New York creates fund for babies with brain damage from malpractice errors

New York state has created a new fund to pay medical expenses for infants who are neurologically damaged as a result of malpractice and other medical mistakes, but opponents say it means families will have to fight with state authorities to obtain treatments as their children age.

The fund, which is due to go into effect on Oct. 1, 2011, allows medical costs to be provided on an annual basis to injured parties. Parents or guardians can still pursue medical malpractice actions on the basis of emotional distress and other losses.

Between 150 and 200 babies are expected to qualify annually for the new fund, according to Jason Helgerson, Gov. Andrew Cuomo's chief Medicaid reform adviser. Participation in the fund is mandatory for those seeking either Medicaid recompensation or filing medical malpractice suits.

Helgerson says the fund will offer a more accurate means of providing care for injured infants because it isn’t subject to inaccurate estimates made by judges and juries trying to arrive at an accurate figure for health-care costs under the current malpractice award system.

But opponents of the fund maintain that the system was championed by health-care providers and will subject the families of neurologically damaged infants to on-going battles with the state for treatments as their children age.

Under the new statute, the fund describes "birth-related neurological injuries" as "an injury to the brain or spinal cord of a live infant caused by the deprivation of oxygen or mechanical injury occurring in the course of labor, delivery or resuscitation or by other medical services provided or not provided during delivery admission that rendered the infant with a permanent and substantial motor impairment or with a developmental disability."

Medical care will be decided on a case-by-case basis. In the event the fund is reduced to 20 percent or less of its annual size, the law contains a default stipulation allowing suits to be brought for medical expenses.

The establishment of the fund was included in a host of recommendations by a Medicaid Redesign Team (MRT) appointed by Gov. Cuomo to halt escalating Medicaid costs. Another recommendation from the task force called for capping noneconomic damages in medical malpractice cases at $250,000. That proposal was fiercely opposed and eventually scrapped.

Source: New York Law Journal

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March 9, 2011

Preemies exposed to excessive radiation at Brooklyn hospital

Technicians at a Brooklyn, N.Y. hospital exposed premature babies to dangerous levels of radiation, according to a recently published report in the New York Times.

Technologists with the radiology department at the State University of New York (SUNY) Downstate Medical Center routinely gave premature infants whole-body X-rays when physicians ordered only a chest X-ray. They also failed to shield the infants’ reproductive organs as required by New York state health codes.

(The photo at the top of this blog entry shows a whole-body X-ray of a baby from a textbook, intended to show how to use X-rays to detect child abuse. This practice is now out of favor with up-to-date doctors due to the radiation risks, but as the article shows, medical practice is sometimes slow to catch up with knowledge.)

The errors were first discovered by the chairman of the SUNY Downstate Department of Radiology, Dr. Salvatore Sclafani. In a letter to colleagues, Sclafani wrote that he was “mortified” after finding the “full, unabashed total irradiation of a neonate” when examining the chart of a premature baby in his care. A pediatric radiologist Sclafani brought in to evaluate the hospital’s procedures found other “alarming” practices: In addition to frequently performing whole body X-rays, known as babygrams, technicians were performing CT scans on infants using the wrong settings, resulting in excessive radiation.

Although new, tighter procedures for radiological imaging of infants were instituted and babygrams were halted altogether, the hospital never reported the errors to N.Y. state officials as required by law. State officials now are investigating the claims in the New York Times article.

With technologists in many states either lightly regulated or unregulated, their own professional group is calling for greater oversight and standards. The American Society of Radiologic Technologists has been lobbying Congress for 12 years to pass a bill that would establish minimum educational and certification requirements for technologists, medical physicists and 10 other occupations in medical imaging and radiation therapy. However, Congress has yet to pass such a bill, leaving regulation up to individuals states. And in many states, radiation therapists (15 states), imaging technologists (11 states) and medical physicists (18 states) remain unregulated.

“It’s amazing to us, knowing the complexity of medical imaging, that there are states that require massage therapists and hairdressers to be licensed, but they have no standards in place for exposing patients to ionizing radiation,” said Christine Lung, the technologist association’s vice president of government relations.

Source: The New York Times

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February 21, 2011

Almost 10,000 crib and playpen injuries a year, study says, but will Congress roll back safeguards?

Nearly 10,000 infants and toddlers are hurt in crib and playpen accidents each year, according to a recent study.

The release of the study coincides with a U.S. House subcommittee hearing on February 24 on consumer product safety issues during which the subject of cribs is expected to come up. The American Academy of Pediatrics opposes loosening crib regulations and is concerned that the industry may seek to roll back parts of a 2008 law which called for mandatory crib standards, including more rigorous safety testing, noting that this peer-reviewed study indicates why such a rollback would be a step backward.

The study, which was released in the journal Pediatrics, examined 19 years of Emergency Department data and is the first nationwide analysis of ER treatment for crib and playpen injuries. Researchers found a gradual decrease in the injury rate between 1990 and 2008; they also found that recent safety measures including a ban on drop-side cribs appear to be having a positive impact.

Still, better prevention efforts are needed since, even in the most recent years examined, an “unacceptable” average of 26 infants daily were injured in crib-related accidents, says study lead author Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio.

Most injuries were from falls in toddlers between ages 1 and 2. According to the study, 181,654 infants were injured between 1990 and 2008, though most children were not hospitalized. The data also reveal 2,140 deaths, not including crib-related deaths in children who didn't receive treatment in the ER.

The 2008 law called for mandatory crib standards, including more rigorous safety testing. The federal Consumer Product Safety Commission mandate, which takes effect in June 2011, bans the manufacture and sale of traditional drop-side cribs with side rails that move up and down to make it easier to place and remove infants. The movable rails can become partially detached, creating a gap between the mattress and rail where babies can get stuck. Dozens of injuries and deaths including suffocations have been linked with drop-side cribs, and millions of such cribs have already been recalled.

Source: Washington Post

You can view a copy of the study abstract here.

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February 18, 2011

Fetal heart rate monitoring significantly cuts baby deaths

The use of fetal heart rate monitors lowers the rate of infant mortality, according to a new study. Previous studies were too small to definitively prove the effectiveness of fetal monitoring, and some obstetricians maintained that the technology had been adopted too quickly.

But the new study, which was presented at the Society for Maternal-Fetal Medicine's (SMFM) annual meeting in San Francisco, used data from the 2004 National Birth Cohort to get a large enough sample (1,945,789 singleton births that met the studies inclusion criteria) to gauge its effectiveness.

The study found that in 2004, 88% of singleton pregnancies had fetal heart-rate monitoring and associated the monitoring with significantly lower infant mortality (3.8 per thousand live births without monitoring vs. 3.0 with monitoring), which in turn was mainly driven by a 53% decrease in early neonatal mortality. The decreased risk was associated with both low- and high-risk pregnancies.

Source: Science Daily

You’ll find an abstract of the study here.

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February 8, 2011

Caps threaten $19.2 million jury award to family of preemie who received overdose

A jury recently awarded $19.2 million to a Florida couple whose premature infant daughter received a massive overdose of nutrients at a Fort Myers hospital, but the family may never see most of it due to a cap on liability. The little girl is in a wheelchair for life and nearly blind due to the negligence of the hospital staff.

The cap, which is based on the concept of “sovereign immunity,” applies to public institutions, including public healthcare systems. (HealthPark Medical Center, where the event occurred, is part of the Lee Memorial Health System, a public health care system created by a special act of the Florida Legislature.) Sovereign immunity means that an employee, officer, or agent of the state and local governments is not held personally liable for negligence committed during the scope of his or her employment or function, unless the employee acts in bad faith or with malicious purpose. Instead, the state takes the place of the employee and defends the claim.

In Florida, sovereign immunity also limits the amount of recovery in any claim against the state to $100,000 per person and $200,000 per incident. (Effective Oct. 1, 2011, the limits will rise to $200,000 per person and $300,000 per incident.)

The verdict came after a two-week trial for medical negligence brought against the Lee Memorial Health System by the parents of Kiarra Summer Smith, who was born in 2007 weighing 1.5 pounds and 3 months premature. Kiarra was give a formula of neonatal nutrition including amino acids and carbohydrates as well as vitamins and trace minerals based upon her body weight. When she was 15 days old, the pharmacy misread an updated physician order sheet and calculated the dosage of trace elements as if it were for a person weighing about 160 pounds. As a result, Kiarra received a dose of trace elements, including zinc, copper, manganese and others, about 100 times larger than she should have.

The lawsuit states Kiarra’s body fluids became highly acidic and she went into cardiac arrest, requiring cardiopulmonary resuscitation and transfusion of all the blood in her body. She also suffered a brain hemmorhage. The long-term result is Kiarra has permanent neurological damage, a type of cerebral palsy where all four extremities are spastic, and is nearly blind. She also is completely disabled and in a wheelchair.

Lee Memorial admitted negligence but denied the overdose caused damage. “Although Lee Memorial Health System accepts responsibility for this unfortunate event, we believe the verdict is excessive and against the greater weight of the evidence,” a Lee spokeswoman said after the trial. “We admitted error in administrating nutrition but we believe strongly that this was not the cause of the child’s condition.”

To overcome Lee Memorial’s sovereign immunity protection, a specific bill would have to be passed by the Florida Legislature, which could only happen after all appeals had been exhausted, which could take years.

Source: Fort Myers News-Press

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December 23, 2010

Feds finally ban drop-side cribs

The federal government has finally banned the traditional drop-side crib. In a unanimous vote, the Consumer Product Safety Commission (CPSC) voted to ban the manufacture, sale and resale of the cribs.

Drop-side cribs, so-called because they have a side rail so that the side of the crib can move up and down, making it easier for parents to lift their babies out of the crib, are believed to have caused the deaths of more than 30 children over the past decade. During the same period, millions were recalled over safety concerns.

Effective June 1, a new standard takes effect that requires cribs to have fixed sides. Hotels and childcare centers have 2 years to purchase new cribs. The new rules also mandate more stringent safety tests that mimic how children of different ages behave in cribs. Older children typically apply more force to the crib by shaking, running around and jumping in it. The new tests will ensure cribs can take the additional pressure. In addition, better labeling on crib pieces will also be required.

CPSC Chairman Inez Tenenbaum called the new rules some of the strongest in the world and predicted they will significantly cut crib-related accidents.

Anticipating the ban, crib makers have been phasing out drop-side cribs for the past few years. Last year, ASTM International, the organization that sets voluntary industry standards, approved a drop-side ban.

However, many parents still have drop-sides in their homes. They also can be found in secondhand stores.

Source: Associated Press

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December 16, 2010

Firefighters rescue 2-year-old trapped in vending machine

The mother of a Pittsburgh-area toddler who became trapped inside a toy crane vending machine and had to be rescued by firefighters is calling for changes to how the machines are manufactured.

The woman’s 2-year-old daughter managed to crawl through the hole where the toys exit to get a closer look at the stuffed animals and other toys inside the machine. Once inside, however, she was unable to crawl back out.

The child remained calm during the 15 minutes she was stuck in the machine before firefighters pulled her out uninjured, but her mother now says the holes in these machines need to be made much smaller. Meanwhile, the vending machine has been removed from the mall.

It’s not the first time a small child has become stuck inside a vending machine. In October, a 9-year-old boy became trapped in a similar machine, and over the past decade, there have been several such stories, leading to calls for vending machine manufacturers to make design changes to ensure these incidents no longer happen.

Source: Gather Blog

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November 18, 2010

Big recall of Roman shades, roll-up blinds and roller blinds because of strangling hazard in small kids

In conjunction with the U.S. Consumer Product Safety Commission (CPSC), Hanover Direct Inc. (also known as Domestications, The Company Store and Company Kids) has recalled nearly 500,000 Roman shades, roll-up blinds and roller blinds because of strangulation hazards to small children.

In October 2009, about 90,000 Roman shades were recalled due to strangulation fears. Strangulations can occur when a child places his/her neck between the exposed inner cord and the fabric on the backside of the blind or when a child pulls the cord out and wraps it around his/her neck.

The latest recall of about 495,000 items came after a 22-month old boy was found hanging from his neck from the outer cords of a Roman shade in May. The outer pull cords were knotted at the bottom. The child was rescued by his father but later died in a hospital.

To date, no injuries or incidents attributable to rollup or roller blinds have been reported. However, strangulations can occur with roll-up blinds if the lifting loops slide off the side of the blind and a child's neck becomes entangled on the free-standing loop or if a child places his/her neck between the lifting loop and the roll-up blind material. With roller blinds, strangulations can occur if the blind's continuous loop bead chain or continuous loop pull cord is not attached to the wall or the floor with the tension device provided and a child's neck becomes entangled in the free-standing loop.

The new recall involves all styles of Roman shades with inner cords, all styles of roll-up blinds, and roller blinds that do not have a tension device. A tension device is intended to be attached to the continuous loop bead chain or continuous loop pull cord and installed into the wall or floor.

The blinds were sold at Hanover Direct/Domestications, the Company Store/Company Kids; online at www.domestications.com and www.thecompanystore.com; and through catalog sales nationwide from January 1996 through October 2009 for between $20 and $579. They were manufactured in China, the United States, and other countries.

Consumers should immediately stop using all Roman shades with inner cords, all roll-up blinds, and all roller blinds that do not have a tension device, and contact the Window Covering Safety Council at (800) 506-4636 anytime for free repair kits or visit www.windowcoverings.org.

Consumers who have roller blinds with a tension device should make sure the tension device is attached to the continuous loop bead chain or continuous loop pull cord and is installed into the wall or floor.

Source: Babyzone.com

You can view the original CPSC recall report here.

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November 3, 2010

Three drop-side cribs are recalled as CPSC joins child safety groups in crib education campaign video for new parents

The U.S. Consumer Product Safety Commission (CPSC) recently joined three child safety organizations to release "Safe Sleep for Babies," a new crib safety video aimed at helping all new parents avoid suffocation, strangulation and entrapment risks. CPSC also announced three new recalls of dangerous drop-side cribs.

Collaborating with CPSC on the video, which is moderated by TV journalist Joan Lunden, were the American Academy of Pediatrics (AAP), Keeping Babies Safe (KBS) and New York-Presbyterian/Morgan Stanley Children's Hospital.

Meanwhile, CPSC recently recalled nearly 40,000 drop-side cribs due to concerns about “entrapment, suffocation and fall hazards.” More than 34,000 of these were for Heritage Collection 3-in-1 drop-side cribs, which were manufactured in Vietnam and retailed at K-Mart nationwide from February 2007 through October 2008 for about $130.

The remaining recalls were for drop side cribs (a) manufactured in China and sold online at Ababy.com, Babyage and other Web Retailers from December 2004 through January 2009 under the “Longwood Forest” or “Angel Line” label for about $140; and (b) manufactured in the United States and China and sold at Ethan Allen stores from January 2002 through December 2008 for between $550 and $900.

The "Safe Sleep for Babies" video, which aims to educate new and expectant parents and caregivers on crib safety while they are at the hospital or visiting their pediatrician's office, is part of CPSC's Safe Sleep Initiative, a multi-pronged effort aimed at reducing crib deaths and injuries. In addition to this education effort, CPSC's Safe Sleep Initiative includes the development of new crib standards, warnings about drop-side cribs, sleep positioners, and infant slings, and the recall of millions of cribs in the past five years.

CPSC will distribute the video online and through its network of about 100 hospitals nationwide. NewYork-Presbyterian/Morgan Stanley Children's Hospital plans to make the video available to all families as part of their parent education programs, and provide copies to hospitals in the NewYork-Presbyterian Hospital Healthcare System. The American Academy of Pediatrics will promote the video to its 60,000 members and will feature it on AAP's parents-focused website, www.healthychildren.org, where it will be available for download.

Source: Consumer Product Safety Commission
For more information on the crib recalls, go here.
You can view the video here.

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October 25, 2010

Stroller recall due to strangulation risk: What parents need to know

The Consumer Product Safety Commission (CPSC) has recalled two million older model Graco strollers after four children were strangulated and five others became entrapped in the strollers and sustained cuts and bruising.

According to the CPSC:

Entrapment and strangulation can occur, especially to infants younger than 12 months of age, when a child is not harnessed. An infant can pass through the opening between the stroller tray and seat bottom, but his/her head and neck can become entrapped by the tray. Infants who become entrapped at the neck are at risk of strangulation.

Various product numbers from the following four Graco models were recalled: Quattro Stroller, Quattro Stroller Travel System, MetroLite Stroller and MetroLite Stroller Travel System. The strollers were sold at Babies R Us, Walmart, K-Mart, Target, Sears and several other large retailers between November 2000 and December 2007.

Parents who discover they own one of the recalled strollers should stop using them at once and contact Graco toll-free at 877-828-4046 for a free repair kit.

Newer models aren’t included in the recall because updated voluntary manufacturing standards went into effect in January 2008 that increased the space between the stroller tray and seat bottom, lessening the risk of harm. For example, the Graco MetroLite stroller now on the market carries a best buy rating from Consumer Reports because it passed the tougher safety standard, says Don Mays, senior director of product safety for Consumer Reports in Yonkers, N.Y.

“People who have these old strollers in their homes and pass them down from one child to the next, they’re the ones at risk,” Mays says, adding that the danger only exists if children aren’t buckled in every time they ride in the affected strollers.

Source: Marketwatch

For more recall details, including a complete list of affected model numbers, visit the CPSC page here.

To contact Graco online, go here.

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October 12, 2010

Florida child safety advocates ponder vehicle alarm law after death of infant in daycare van

Some child safety advocates in Florida are calling for special vehicle alarms following the death of a 2-year-old strapped and forgotten in her car seat for nearly 6 hours in the back of a Delray Beach daycare center van.

A few other states already have laws mandating that all vehicles from childcare providers that transport six or seven (depending on the state) or more passengers have a child safety alarm system that prompts the driver to inspect all seats before leaving. Mary Sachs, a state representative, said she will sponsor a bill next spring requiring the alarms in Florida.

The alarms work as follows: After the driver turns off the vehicle, an alarm goes off and continues to sound for one to four minutes, which forces the driver to walk to the back of the van to turn it off. If the driver ignores the alarm, an external car alarm sounds, thereby alerting others that the vehicle hasn’t been checked.

While no one keeps specific data on how many children die from being left in childcare center vehicles, dozens of children die after being left in cars every year. According to Jan Null, an adjunct professor of meterology at the University of San Francisco and author of “Hypothermia death of children in vehicles,” 49 children have died forgotten in cars so far this year.

The driver of the van was charged with negligent manslaughter and the owners of the day care lost their license after losing more than $200,000 in state funds following the incident.

Source: The Palm Beach Post

You'll find more information about deaths of children in vehicles from hypothermia here.

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September 21, 2010

Child safety seat inspections: Get one free this Saturday

Motor vehicle crashes are the leading cause of death in the U.S. for children ages 3 and older, and one contributing factor is that nearly 75% of child car seats aren’t installed or used properly.

As part of its continuing mission to correct this situation, the National Highway Traffic Safety Assocation (NHTSA) established Child Passenger Safety Week, an annual campaign to bring public attention to the importance of properly securing children in appropriate child safety seats, booster seats or seat belts at all times.

This year, Child Passenger Safety Week runs from September 19 to 25, culminating on September 25 with “National Seat Check Saturday," when certified child passenger safety technicians will provide free advice and hands-on child safety seat inspections across the U.S.

Currently, all 50 states, the District of Columbia and Puerto Rico have laws requiring that children be restrained in motor vehicles. According to the NHTSA, child restraints have saved a total of 8,959 lives over the past 30 years. And a recent NHTSA study indicated that in rollover crashes (which had the highest incidence rates of incapacitating injuries for children), the estimated incidence rate of incapacitating injuries among unrestrained children was almost three times that for restrained children. In near-side impacts, unrestrained children were eight times more likely to sustain incapacitating injuries than children restrained in child safety seats.

Source: National Highway Traffic Safety Association.

Find out where to get your child’s safety seat or booster seat inspected here.

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July 24, 2010

Getting the Word Out on Dangerous Kids' Products

Many kids' products -- cribs, high chairs, strollers and more -- last for years and years, which can be a tragic problem if the product turns out to have a hidden danger that only becomes obvious long after purchase. Now there's a law intended to deal with the issue.

As of this summer, manufacturers of children's products have to comply with new safety requirements per the “Danny Keysar Child Product Safety Notification Act,” named after a child who was strangled to death in a defective crib. The act requires manufacturers of children products to “establish and maintain a registration card program,” reports Lisa Parker of NBC Chicago. The registration cards will be included with the product and the program will keep records for at least 6 years of consumers who do register. This will facilitate notification of any recalls or safety concerns regarding the product.

The act, which took effect on June 28, 2010, affects the following product categories, according to Parker: Full-size and other cribs, Toddler beds, High chairs, Booster chairs, Hook-on chairs, Bath seats, Gates, Play yards, Stationary activity centers, Infant carriers, Strollers, Walkers, Swings, Bassinets, Cradles, Children’s folding chairs, Changing tables, Infant bouncers, Infant bathtubs, Portable toddler bed rails, and Infant slings.

An announcement of the act going into effect can be found on the Kids In Danger website.

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June 23, 2010

Infant Onesies and Rompers Recalled

The Consumer Product Safety Commission (CPSC) announced a voluntary recall of infant onesies and rompers that are manufactured by Holtrop & McIndoo, dba Kiwi Industries. The recall followed two incident reports the manufacturer received. Although no injuries have been reported, the CPSC cautions that the snaps on the apparel can detach and pose choking hazards to infants. See the CPSC’s recall on its website here.

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June 22, 2010

Liquid Vitamin D: Too Much of a Good Thing for Babies

In a recent news release, FDA warns parents and caregivers of the risk of overdosing infants with liquid vitamin D. The liquid supplement is administered with droppers that are sold with the supplement itself. However, some of the droppers hold more vitamin D than is appropriate for babies.

Vitamin D supplements are recommended for some children to promote growth of healthy and strong bones. However, if fed with excessive amount of vitamin D, infants experience a myriad of symptoms ranging from nausea to muscle weakness, and sometimes even kidney damage.

Here are the FDA’s recommendations for parents whose children receive vitamin D supplements:

* Ensure that your infant does not receive more than 400 international units (IUs) of vitamin D a day, which is the daily dose of vitamin D supplement that the American Academy of Pediatrics recommends for breast-fed and partially breast-fed infants.
* Keep the vitamin D supplement product with its original package so that you and other caregivers can follow the instructions. Follow these instructions carefully so that you use the dropper correctly and give the right dose.
* Use only the dropper that comes with the product; it is manufactured specifically for that product. Do not use a dropper from another product.
* Ensure the dropper is marked so that the units of measure are clear and easy to understand. Also make sure that the units of measure correspond to those mentioned in the instructions.
* If you cannot clearly determine the dose of vitamin D delivered by the dropper, talk to a health care professional before giving the supplement to the infant.
* If your infant is being fully or partially fed with infant formula, check with your pediatrician or other health care professional before giving the child vitamin D supplements.

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June 14, 2010

Muscle Spasms: Uncommon but Dangerous Condition in Infants

Infantile spasm is an uncommon condition in babies between 4 to 8 months that, if untreated, can lead to irreversible brain damage. Babies suffering from the condition stop developing and can even regress. They can lose abilities to sit, babble or roll over. Although infantile spasm is a serious condition, it is often misdiagnosed as gas or colic because its symptoms mimic these other less serious problems.

Infantile spasm (IS) presents itself in the form of muscle contractions. Different from other conditions, IS occurs in clusters: “Babies can have clusters of 100 spasms or more at a time, dozens of times a day,” according to Jeanne Milsap in her article for Sun-Times Media. Milsap describes the spasms as “a sudden bending forward of the body with stiffening of the arms and legs. Some babies arch their backs. Most typical are little flexion jerks similar to the startle reflex.”

IS can be diagnosed simply with an EEG that would show chaotic brain waves. It is treated with anti-convulsants, hormonal injections, diet change, or surgery in more serious cases.

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June 3, 2010

Watch Out for Button Batteries and Kids

Tiny lithium batteries the size and shape of buttons can kill or cause severe injury in a child who swallows one, doctors are reporting.

The batteries, which are found in remote controls, watches, and other home electronics and toys, cause a chemical reaction when swallowed that can burn through the delicate tissues in the neck. Kids sometimes swallow them when they take apart a toy, find the battery, and think it's candy.

While rare, a death was reported in one child where the battery burned through the esophagus and attacked the aorta. Another child was left with a lifelong whisper from vocal cord damage. Another had to have feeding tubes and multiple surgeries for the damage to the gastric tract.

The journal Pediatrics reports the dangers of ingestion of lithium batteries by infants, which can and has caused deaths, writes Tara Parker-Pope of the New York Times.

The lead author of the medical journal article on this subject, Dr. Litovitz, says there is a “tight timeline” in which to rescue children from the injuries caused by lithium ingestion: while the batteries start causing severe damages as quickly as within 2 hours of ingestion, the problem is difficult to be diagnosed because small children cannot verbally communicate, and their symptoms (which can be loss of appetite, vomiting, coughing up blood) are nonspecific.

Pediatricians and parents are working to raise awareness of the dangers of small lithium batteries and to urge manufacturers of electronics to secure the battery in all electronic devices, not just toys. A woman whose 18-month-old daughter died after ingesting a lithium battery said that “there should be warnings on every item the batteries are in. They are in greeting cards and children’s books that talk. They’re everywhere.”

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June 1, 2010

Warning Labels Urged on Foods that Can Choke Children

Popcorn and hot dogs can pose a deadly choking hazard for children under four, and the risk isn't lowered by parents monitoring their kids' eating of these foods, says the official group representing American pediatricians. So experts are saying the best thing is to avoid risky foods before age four. According to the American Academy of Pediatrics’ policy statement on the prevention of choking among children, choking is a leading cause of death in children and is most frequently caused by food, coins and toys. However, unlike with toys, there are not yet requirements for warning labels on foods that present choking hazards. The Academy’s new policy statement urges the Food and Drug Administration to impose safety requirements on foods that are known to be choking hazards, Laurie Tarkan reports in a New York Times article. In addition to putting warning labels on food packaging, the Academy also suggests that manufacturers redesign the foods to reduce dangers of children choking on them. Toddlers, especially those under 4 whose throat at its narrowest has the diameter of a straw, easily choke on small pieces of foods, among which popcorn and hot dogs are considered high-risk foods. The risk is not reduced by parents being present and watching when children ingest these foods. “The only way” to prevent kids choking on small objects and food is to keep the items out of their mouth, according to Chrissy Cianflone, director of programs for Safe Kids USA, an advocacy group. Currently, only two-thirds of hot dogs have warning labels on the packages, says the National Hot Dog and Sausage Council. And even on the packages that do carry warning messages, the labels are not always obvious to consumers. The FDA in a statement indicates that “it was reviewing the pediatrics academy’s new policy and was considering steps to prevent further deaths,” according to the NY Times story. Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children’s Hospital in Ohio, suggests that parents wait till children turn 4 or 5 years of age to allow them to eat high-risk foods such as popcorn, hot dogs, and grapes.

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March 26, 2010

C-Section versus Vaginal Births: What Is the Safest?

The rate of C-section births in the United States has been increasing every year since 1996 for women of all ages and racial and ethnic groups, and now the procedure is the most common operation in the country. In 2007 alone, 1.4 million Caesareans were performed, representing 32 percent of all births. However, although C-sections can be life-saving in some instances, experts are concerned with the ever-increasing number of the procedures, reports Denise Grady of the New York Times.

Joining other critics, Dr. George Macones, spokesman for the American College of Obstetricians and Gynecologists, is worried that the rise in number of C-sections “is not going to be good for anybody.” The procedure, a costly major surgery, poses health risks to the mother as well as the baby:

Risks to the mother increase with each subsequent Caesarean, because the surgery raises the odds that the uterus will rupture in the next pregnancy, an event that can be life-threatening for both the mother and the baby. Caesareans also increase the risk of dangerous abnormalities in the placenta during later pregnancies, which can cause hemorrhaging and lead to a hysterectomy. Repeated Caesareans can make it risky or even impossible to have a large family.

The new report notes that Caesareans also pose a risk of surgical complications and are more likely than normal births to cause problems that put the mother back in the hospital and the infant in an intensive-care unit.

According to Grady, the reason for the rising popularity of the procedure is manifold: doctors fearful of malpractice liability should babies be born injured with vaginal delivery; women requesting the procedure even when it’s not medically warranted, not understanding its risks; increased tendency to induce labor for reasons of convenience. Also, many hospitals have banned vaginal births for women who have had Caesareans, adhering to the obstetricians’ college’s guidelines.

In light of the many risks of Caesareans, expecting mothers should educate themselves about their delivery options and consult their doctors to decide whether the procedure is medically necessary.

The bottom line is to find the best way to ensure the baby's health. Sometimes that is with vaginal delivery, but sometimes not. In our law firm's practice, for example, we have represented several families whose children suffered terrible injuries because the mother's uterus ruptured during a VBAC delivery (Vaginal Birth After Caesarean), and all of those mothers would have skipped the effort at vaginal birth if they had known the risk of catastrophe. Our firm's website has extensive information about birth injuries here and here.

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December 10, 2009

Infant Deaths Prompt Baby Hammock Recalls

This week the Consumer Product Safety Commission announced a voluntary recall of 24,000 motion beds for babies, writes Jennifer Kerr of the Associated Press. Manufactured by Amby Baby of USA and sold online through its website since 2003, Amby Baby Motion Beds consist of a steel frame and a fabric hammock that has mesh sides and hangs from a spring. The bed gently swings as the baby moves, a feature designed to resemble babies’ motion in the maternal womb.

Although many babies have found comfort in these hammock beds, there is a hidden risk of suffocation: as the bed moves back and forth, babies could roll and become trapped or wedged against the fabric or the mattress pad. In fact, as Jennifer Kerr reports, two infant deaths in the United States have been associated with Amby Baby Motion Beds, which prompted the CPSC’s recall of the product.

In her story, Jennifer Kerr quotes Nancy Cowles, executive director of Kids In Danger, “There is currently no safety standards that would cover hammocks.” Kerr says that safety advocates maintain that it’s safest for babies to be “in cribs or bassinets with a firm bottom support and no soft bedding, gaps or other points where they could become trapped.”

The CPSC urges parents to immediately stop using the hammock beds for the safety of their babies.

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December 4, 2009

Are Your Children's Toys Safe?

According to a Consumer Product Safety Commission (CPSC) report, in 2007, there were 22 toy-related deaths in the United States, and in 2008 there were 19. That translates to at least one death every month in from dangerous toys – toys that should provide enjoyment but instead have hidden death traps.

The causes of deaths include, among others, airway obstruction, strangulation, and blunt force. Dangerous toys also account for other serious injuries like laceration and burns, as well as more than 170,000 emergency room visits annually for injuries to children 15 years or younger, according to Don Keenan, Atlanta attorney and child advocate.

Don Keenan has put together a list of Top 10 Dangerous Toys for 2009, available on his website, Keenan’s Kids Foundation. He also has a link to CPSC’s list of recalled toys.

Notably, in Don Keenan’s introduction to the Top 10 Dangerous Toys list, he cautions consumers that many of these dangerous toys, although banned or recalled by the CPSC, still made their way onto the shelves in stores like Target or Walmart. The recalled toys are also easily available on the Internet at sites like eBay or in used toy stores. Other toys that were not recalled also may not be completely safe – in February 2009, the government enacted stringent standards, but Keenan’s Kids Foundation estimates that as many as 5% of toys currently on the market probably do not meet the new safety standards (such as requiring all children products to be tested by a third-party lab to ensure they meet safety standards, and banning the use of phthalates, a plastic softener, or products that contain trace amounts of lead).

Therefore, in this holiday gift-buying season, parents are urged to use extra caution in selecting safe toys, by carefully reading the safety warning label to see if the toy is age-appropriate for your children, and comparing against the CPSC’s recall list.

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November 12, 2009

False Assurance from Home Fetal Heart Monitors

Home fetal heart monitors allow pregnant women to listen to their baby’s heart beat and have the assurance without a visit to the doctor’s office that the baby is healthy and well – but is this assurance always reliable?

A true story that happened in Britain recently suggests that the heart monitors shouldn’t replace a trip to the obstetrician if there is any concern for the baby’s health, writes Tara Parker-Pope of the New York Times.

According to a commentary published at BMJ.com by doctors of the Princess Royal Hospital in Britain, a woman who was nearly full-term at 38 weeks noticed one day that the baby wasn’t moving. Instead of seeking medical advice, she turned to a home fetal heart monitor and heard what she thought was the baby’s heartbeat. After three days when she finally went to a doctor, an ultrasound scan showed the baby had already died.

Although the doctors cannot know for sure in this case that the baby would have been saved had the mother sought medical advice earlier, they said the monitors should never be used for reassurance. Dr. Chakladar, one of the authors of the BMJ commentary, said that it takes experience to determine the baby’s health. Sometimes what sounds like a baby’s heartbeat may be the mother’s own heart. And even when parents can pick up the baby’s heartbeat, it is still difficult to determine if the baby is healthy or distressed. “If a mother is concerned and feels she needs reassurance, she should immediately consult her doctor,” writes Parker-Pope.

So what is the bottom line? Dr. Chakladar advised, “On their own, these monitors are harmless; it is their improper use by parents to reassure themselves which can be dangerous…they are dangerous if they are used by untrained people as an alternative to seeking medical advice.”

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May 15, 2009

Chicago Bans Baby Bottles Made with Dangerous Chemical

Bisphenol-A, a chemical used to harden plastics, is found in many plastic containers even though it’s known to be linked to diseases. Bisphenol-A, or BPA, have been found in animal studies to accelerate puberty and increases risks of cancer. Babies can be exposed to traces of the chemical when it gradually leaks into the fluids from the plastic containers. BPA exposure can also result in health problems in adults, such as elevated risk of heart diseases and diabetes.

On May 13, 2009, Chicago’s City Council joined a handful of other jurisdictions in a unanimous decision to ban the sale of baby bottles and sippy cups that are made with BPA and intended for children under the age of 3, reports Karen Ann Cullotta of the New York Times.

One of the reasons why not more jurisdictions are banning BPA use in plastic containers is the lack of direct evidence that human exposure to this chemical is harmful to our health. So far, all the evidence for the adverse effects of exposure to BPA comes from animal research studies. FDA said last year that BPA levels found in products appeared to be safe – a conclusion condemned by a panel of scientific advisers to the agency, saying the FDA “ignored crucial studies and used flawed methods.”

To protect their children from exposure to BPA and its potential dangers, parents can turn to the BPA-free products that are already available at retailers.

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May 13, 2009

Third Jardine Crib Recall in a Year

On May 1, 2009, the U.S. Consumer Product Safety Commission announced another recall of cribs made by Jardine Enterprises, the third safety recall since June 2008, reports Patricia Callahan of the Chicago Tribune. All three recalls involved cribs made in China and Vietnam.

The Jardine cribs in the recalls, mostly sold at Toys R Us and Babies R Us, are responsible for more than 30 reports of broken slats, one of the deadliest hazards of baby cribs. When a slat breaks, babies’ bodies slip through the gaps but their heads get stuck, resulting in strangulation and even death.

Parents can access a full list of recalled models at www.cpsc.gov. For those who bought one of the recalled cribs, a credit is available toward the purchase of a replacement.

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May 4, 2009

Infant Car Seats Failed Safety Standard Tests

The Chicago Tribune uncovered federal safety test results of infant car seats that were never publicized or even made known to some of the infant-seat manufacturers, reported Chicago Tribune’s Patricia Callahan. In the frontal crash tests, a video showed the car seats flying off their bases, throwing baby dummies face-first into the back of the driver’s seat. The test reports also documented that almost half of the 66 seats that were tested in front crashes “either separated from their bases or exceeded injury limits.”

As a result of the Chicago Tribune’s investigations, the National Highway Traffic Safety Administration has ordered a thorough review of safety regulations for car seats and taken steps to make the safety test results more available to consumers. Before, parents could compare safety ratings for cars, but would have no way of comparing which car seats do better at protecting their babies. They would not have known that more expensive car seats are not necessarily safer, or that some smaller cars performed better than the larger ones in these collision tests.

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February 18, 2009

Growing Consensus on Genetic Risks of IVF

In vitro fertilization has generally been considered safe since the first IVF baby was born more than 30 years ago. But recent studies unveil a number of risks that couples considering the procedure should be aware of, reports Gina Kolata of the New York Times.

These IVF-related risks may include increased risk of low birth weight and premature birth, as well as severe birth defects like “a hole between the two chambers of the heart, a cleft lip or palate, an improperly developed esophagus, and a malformed rectum.” Studies indicate that IVF possibly give rise to abnormal genetic expression patterns that are responsible for these genetic disorders.

In addition to the more common birth defects, children born by IVF are also suspected to be at greater risk for other genetic disorders that are much rarer: Beckwith-Wiedemann syndrome (children with this syndrome are much more predisposed to childhood cancers of kidney, liver or muscle) and Angelman syndrome (severe mental retardation, motor defects and inability to speak).

Although certain risks of in vitro fertilization are beginning to surface, no finding is conclusive yet – these are preliminary studies that show “comparative risks,” but no “absolute risks” are known yet. Researchers are still in the process of discovering exactly what the risks are and what can be done to minimize them. More research reports will be available as scientists track the development and growth of babies born by IVF, and couples interested in fertility treatment should educate themselves about the risks in order to make informed decisions.

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February 2, 2009

DC Children Affected by High Lead Levels in Drinking Water

Researchers at Virginia Tech and Children’s National Medical Center found in a recent study that many young children in the District of Columbia may have been exposed to dangerous levels of lead during the water crisis from 2001 to 2004, reports the Washington Post’s Carol Leonnig.

The study, published last week in Environmental Science and Technology, contradicts the federal and DC health officials' repeated assurance that there was “no identifiable public health impact from elevated lead levels in drinking water.” The US Environmental Protection Agency and the DC Water and Sewer Authority cited a 2004 report issued by the Centers for Disease Control and Prevention, which found no increased blood lead level in households where high levels of lead were found in tap water.

The problem in the District of Columbia is that many homes still have lead pipes that run from the water main under the street to the home.

Lead-poisoned children are at risk of many permanent neurological damages, including irreversible IQ loss, developmental delays, aggression, and difficulty focusing in school. D.C. residents whose children were two-years-old or younger during the water crisis are encouraged to monitor their kids. To reduce the impact of lead poisoning, doctors recommend “healthful, calcium-rich diet and an enriching educational environment that includes reading to them regularly.”

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January 26, 2009

Bed-Sharing May Be Responsible for Surge in Infant Suffocations

A nationwide study found that the rate of infants died of unintentional suffocation and strangulation in their first year of life has quadrupled between 1984 and 2004, reports Rob Stein of the Washington Post. Federal health officials are concerned that this surge of fatalities may be due to the increased number of mothers sharing beds with their babies.

Although bed-sharing fosters mother-child bonding and facilitates breastfeeding, it poses serious risks to babies. Deaths can occur when the adult rolls over a baby, or when blankets or pillows get in the baby’s airway.

A national survey found that bed-sharing was more common among younger and poorer women; another study shows that death rate from accidental strangulation and suffocation was three times as many among African Americans as Caucasians. This difference can be due to "economics" or "cultural beliefs," Stein quotes Clinton-Reid, chairperson of a committee that reviews infant deaths for the District's medical examiner. Some mothers just cannot afford a crib, and others believe that babies are safer sleeping with them.

For those who would like to have a crib for their babies but cannot afford one, there are nonprofit organizations that give away free cribs. As for mothers who want to continue bed-sharing with their babies, they should consult with their doctors for safer ways to sleep with their babies. Some general rules of thumb include the following (a more extensive list can be found on kidshealth.org):
• Put babies to sleep on their backs. (This has helped cut the number of deaths from Sudden Infant Death Syndrome.)
• Leave the baby’s head uncovered.
• Keep the bed away from draperies or blinds to prevent the baby from getting strangled by the cords.
• Ensure the mattress fits snug in the bed frame to prevent the baby from getting trapped in between.

It used to be taught that babies should be put to sleep on their stomachs, the thought being that they would be less likely to choke on regurgitated stomach contents. But the latest advice from the American Academy of Pediatrics is to lay the baby on its back. The educational program is called "back to sleep." Experts now recognize that many deaths from Sudden Infant Death Syndrome happened when babies turned their faces into their bedding and suffocated.

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November 20, 2008

Recent Surge in Crib Accidents Prompts Safety Reform

Next time you think it’s safe to leave your baby unattended in a crib, think again.

Design flaws and confusing instruction manual – among other factors – contribute to the rising number of crib accidents in the past two years, resulting in the federal government’s recall of 3.6 million cribs. That’s more than the number of recalled cribs in the last 30 years combined.

Some of the problems recurrently reported by parents include:

(1) Mattress platforms that drop and form a gap that can entrap and strangle babies;
(2) Bars too far apart, allowing babies’ small and flexible bodies to slide through;
(3) Confusing installation manuals that allow parents to misassemble;
(4) Flawed designs that allow cribs to operate even when misassembled, albeit dangerously.

Injuries from crib mishaps can become terrible tragedies, with children dying or even suffering brain injury.

Before the government puts in place new and stricter safety regulations, what can parents do to minimize the chance of their babies getting injured in the cribs? They should always make sure the cribs are assembled properly and securely, and never assume that nothing will happen to the babies simply because they’re in the cribs -- check up on them frequently!

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October 1, 2008

Government Experts Urge Flu Vaccination For Infants

Until recently, public health officials only recommended flu vaccinations for children two years old or older.

But now, as flu season approaches, the Centers for Disease Control and Prevention (CDC) have recommended that babies as young as six months get the vaccine.

From the article:

The flu vaccine is recommended for people 50 years and over, people with certain chronic medical conditions, people in nursing homes, pregnant women, and children 6 months to 18 years old unless they have a serious egg allergy. The vaccine is also recommended for health workers, and anyone in close contact with infants or others at-risk.

For further information, go to www.cdc.gov and check out the links about the flu.

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August 31, 2008

D.C.-based Commission Warns Against Simplicity Inc. Bassinets

The U.S. Consumer Product Safety Commision has issued a warning against the popular "close-sleeper/bedside-sleeper" bassinets made by Simplicity Inc., after two babies were trapped and strangled to death by the bassinet's metal bars.

According to the article, these are the most popular bassinets in the country. The Commission says that the spacing of the metal bars is what makes the bassinets dangerous:

It said the two bassinets contain metal bars spaced farther apart than 2 3/8 inches, the maximum distance allowed under federal crib safety standards. Federal regulations make such standards voluntary for bassinets.

The article notes that those who bought the bassinets from Target can return them for a refund, and that anyone with questions about them can call the Commission's hotline at 800-638-2772. It would be advisable to avoid not only these bassinets but also others with similarly spaced metal bars.

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August 31, 2008

FDA Revisits Cold Medicine Standards for Infants

We have discussed concerns over the efficacy and safety of cough and cold medicines for very young children many times in the past.

Now, in reaction to these concerns, the FDA plans to take another look at the reasons why these cough and cold medications were approved for toddlers and infants in the first place. From the article:

In response to rising concerns that the products are ineffective and could be unsafe, the agency said it will revamp the criteria that have allowed the products to remain on drugstore shelves for the first time in decades.

"Modern science has advanced since, and this is an opportunity to apply modern science to evaluate these products,” said Janet Woodcock, director of the FDA’s Center for Drug Evaluation and Research.

As the first step in that process, the agency will hold a special hearing Oct. 2 to begin to consider a series of questions, including: What types of studies should be done to evaluate the products? Should the products remain available without a prescription? How should the doses be determined? Should products that combine different ingredients remain available?

One problem that has led to preventable tragedies is that parents sometimes inadvertently overdose their children. A particular problem has been with concentrated Tylenol infant drops. Due to confusing instructions from pediatricians and to labeling that wasn't always clear, some parents have not realized that the infant drops contain much more of the active ingredient, acetaminophen, then regular children's Tylenol. An overdose of Tylenol or acetaminophen can cause liver poisoning which requires liver transplant. After years of complaints, the Tylenol manufacturer took the concentrated infant drops off the market in October 2007.

The FDA's new look promises to go beyond the infant drops issue and look at the appropriate place of cough and cold medicines in treatment of infants and toddlers.

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August 16, 2008

Highway Proximity and Infant Health

A recent Canadian study shows that pregnant women who live near highways are more likely to give birth to premature or low-birth-weight infants--but only among wealthy mothers. Pollution from the highways is what causes these effects, researchers say. The reason why these results are not found among poorer mothers is, says lead researcher Dr. Melissa Generoux, because poorer mothers have so many more risk factors that this particular single factor has less of an obvious effect. Wealthier mothers, safe from other risks, are more likely to be noticeably affected by this one factor.

Expecting mothers are bombarded with advice and even lectures on the minutest details of what they consume during pregnancy, and are often overcome with anxiety over these matters. Yet they and their children are still powerfully affected by factors outside their personal control, such as the level of pollution near residential areas.

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August 16, 2008

Common Baby Bottle Ingredient Safe, says the FDA

As we have previously discussed, there has been a furor over bisphenol A or BPA, a common ingredient in the plastic used to make baby bottles.

Now scientists from the FDA have issued a new report declaring that the chemical is safe
, after revisiting the issue because the National Toxicology Program said that there was "some concern" about its effects on infants.

The reason why the FDA now considers it safe is because the amount of BPA needed to be dangerous is thousands of times greater than the amount actually contained in any baby bottle.

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May 16, 2008

Senators Weigh In on Baby Bottle Ingredient

Senate Consumer Affairs subcomittee members sharply critized federal agencies for a slow reaction to the problem of bisphenol A (BPA) in baby bottles and water bottles and other plastic drinking containers. As the linked blog post and article both describe, the National Institutes of Health found cause for "some concern" that BPA has a harmful effect on very young children.

The Food and Drug Administration does not recommend that consumers immediately cease using products with BPA. Some Senators, however, are pushing for legislation that would ban BPA in products intended to be used by children aged 7 or younger.

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April 18, 2008

Common Baby Bottle Ingredient Linked to Problems; Company Ceases Use

Previously, we blogged about a link between bisphenol A and problems in human development. As the article says, the advisory panel to the National Toxicology Program (part of the NIH) had previously dismissed all concerns about this as "minimal." This new report concludes that there is reason for "some concern." Bisphenol A can cause problems for fetuses, babies, and young children, but apparently not for adult humans.

Plastic industry representatives argued that there are no "serious or high-level concerns", and the National Toxicology Program concedes that more research is needed.

Nevertheless, the bottle maker Nalgene Outdoor Products has decided to stop using plastic containing bisphenol A . This may have something to do with the new report, and may also be related to Canada's plans to declare bisphenol A toxic. In any case, hopefully more studies will be done to determine how much of a threat this is to young children.

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April 17, 2008

Seizure Medications While Nursing Do Not Harm Infants

Given the frequent confusion over what drugs and foods are and are not dangerous to breastfeeding infants, mothers will be relieved to kow that breast-feeding while on seizure medications does not have any apparent harmful effects on children. From the article:

"Our early findings show breast-feeding during anti-epilepsy drug treatment doesn't appear to have a negative impact on a child's cognitive abilities," study author Kimford Meador, of the University of Florida at Gainesville, said in a prepared statement. "However, more research is needed to confirm our findings, and women should use caution due to the limitations of our study."

The study will follow up on these children until they reach the age of six.

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March 21, 2008

Black Infant Pre-Term Birth and Mortality Much Higher than for Whites

Black infants are twice as likely to die as white infants and have a much higher-than-average rate of pre-term birth.

Researchers have suggested many possible causes for this, including the following:

-lack of pre-natal care

-lack of health insurance and health care generally

-physiological impact of the chronic stress of racism

This statistic is just one of many that indicates a highly disturbing healthcare apartheid for children in America.

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