Are you doing what you can to protect your child from sexual abuse? The standard advice is wrong: Here's what you need to know.

 copyright Jessica Snyder Sachs, as first published in PARENTING magazine

When I was 11, I kept a terrible secret from my parents. I feared their reaction if they found out what a neighbor and family friend had done in his home after turning off the lights and saying he loved me. Besides, it took me months to figure it out myself. Even then, I doubt that the term "molestation" had become part of my vocabulary.

My story wouldn't bear mentioning except that it continues to be horribly common. Although studies show a small but steady decline in substantiated child molestations over the past decade, conservative estimates still place the number of children who are sexually abused each year at around 200,000. Only about half of cases are reported, experts believe. And the problem extends into younger age groups than most people realize. In a national survey of adults molested as children, the median age of first abuse was 9 years, with one-fourth being violated before age 8 and nearly 15 percent before age 6.

Scarier still, conventional notions on how to protect kids is wrong. We rush to teach them about "stranger danger," but more than 80 percent of molesters know their victims, according to a study by the University of New Hampshire's Crimes Against Children Research Center. We instruct our children to "Yell and Tell," but such simplistic advice can backfire when youngsters face the typical offender  -- the outwardly caring teacher, coach, friend, or relative who's worked hard to win your child's trust  -- not to mention yours.

"In no other area do we give children the responsibility to stop or change the behavior of the adults in their life," says Elizabeth Ralston, Ph.D., executive director of Dee Norton Lowcountry Children's Advocacy Center, in Charleston, South Carolina. "The result is that often, kids who've been molested feel guilty for not having prevented the abuse and ashamed to tell anyone about what's happened to them."

Even lessons on "good touch/bad touch" can backfire because molestation doesn't always start out feeling "yucky." Nor does it necessarily involve physical contact, as is the case when adults expose children to sexually explicit pictures, talk, and behavior, or when they get them to expose themselves for photographs.

You're probably cringing right about now, but that discomfort is a part of the problem. "It's natural for parents to cling to the myth of the child molester as the dirty old man in the wrinkled raincoat," says Anna Salter, Ph.D., author of Predators: Pedophiles, Rapists, and Other Sex Offenders. "It's disturbing to think that people we know, or even love, could harm our children."

Your first line of defense, then, is to minimize the situations in which your child is left alone with an adult you don't thoroughly know and wholly trust  -- even if it's Grandpa. "This isn't about being paranoid," says Anne Lee, founder of the national child-protection campaign Darkness to Light and a survivor of sexual abuse herself. "Just as we're not being paranoid about the risk of an accident, so we buckle our kids into their car seats or hold their hands crossing the street, it's not paranoid to eliminate one-on-one situations that may put them at risk of abuse." These age-specific guidelines can help you keep your child safe.

Protecting Infants and Toddlers

It was the grandma who noticed. While diapering her 14-month-old granddaughter, she felt a roughened area between the baby's buttocks. The pediatrician said it was too calloused to be diaper rash and concluded it had been caused by chronic rubbing over a long period of time. It turned out, says Ralston, that the teenage boy who babysat the child had been masturbating against her.

Yes, babies get abused. A molester may masturbate against an infant or toddler, stimulate the child for self-gratification, or even attempt penetration. Red flags for possible abuse include abrasions, swelling, and skin tears around the genitals, anus, or mouth. If you notice such an injury, see your doctor immediately.

Ralston urges parents to screen any adult they're considering as a regular caregiver for criminal offenses through local law-enforcement agencies and the FBI. You'll need the person's birth date, social security number, and a list of the counties and states in which she's lived.

After you hire someone, make it clear to her that you're vigilant about your child's safety and then check in unannounced periodically. "If she complains, find somebody else," says Ralston.

Protecting preschoolers and grade-schoolers

"See. You're a dirty little girl. You like it." That's what Anne Lee's great-uncle told her when he began fondling her during summers at the family's vacation house. She was 4 years old.

"The tragedy is, I believed him and felt too ashamed to tell my parents," says Lee, who's now the mom of a 10-year-old daughter. At the same time, Lee's behavior was a cry for help: "Here we had this wonderful place on a beautiful crystal lake, and I was begging not to go."

Although there are no numbers available regarding boys, the incidence of molestation and sexually motivated abductions of girls more than triples by the time children reach grade school. This isn't surprising, considering that as kids get older, they're out of their parents' sight more often. To protect them despite this change:

Reduce accessibility
There's no substitute for direct supervision. "Offenders look for ease of approach and ease of retreat," says Monique Boudreaux, Ph.D., a consultant with the Child Abduction and Serial Murder Investigative Resources Center, in Quantico, Virginia, and a mom of two. So plop down on a lawn chair when your kids play outside; take the phone along or let the voicemail pick up to avoid having your attention diverted.

Before your child visits a friend's home, get to know the parents or try to spend time there. If you're not comfortable, have them play at your house.

At your child's daycare or school, find out if there's an "open-door policy"  -- that is, an open door or unobstructed window should allow any classroom to be visible from the hallway at all times.

If you've chosen family daycare for your child, make it clear that she should never be left with anyone other than the primary caregiver without your prior approval. When babysitters come into your home, establish ground rules as to who else is allowed in the house while you're away.

Attend your child's practices, lessons, and other extracurricular activities, or send someone you trust. Relax on the sidelines, but be aware of how coaches and instructors interact with your child.

Never ignore the protests of a child who expresses reluctance or fear about spending time with a particular adult, even a relative or close family friend. Avoid leading questions, but assure your child that he won't get in trouble for telling you what's going on.

Reduce desirability
Advertising your child's name on the outside of backpacks and other personal items can draw unwanted attention. "We know that some offenders literally stalk children to gain information about them," says Boudreaux. "Knowing your child's name helps them." At the very least, it can make it easier for a molester to directly gain a child's trust.

In a more literal sense, reducing desirability means not dressing young children in alluring clothing, accessories, or makeup. Interviews with convicted child molesters suggest that a provocative appearance plays a significant role in the selection of victims.

Reduce vulnerability
Although it's important not to lay the responsibility of protecting themselves solely on the tiny shoulders of preschoolers, they are old enough to learn that their bodies are their own and that the parts normally covered by underwear or a swimsuit shouldn't be touched or seen by others, with the exception of a parent or trusted caregiver at bathtime or a doctor examining them with a parent or nurse present. They should understand that others should not be exposing or showing pictures of private parts to them. This sense of "owning one's body" begins with the child's privilege of saying no when he doesn't feel like hugging or kissing, even if that person happens to be Granddad  -- or you.

Similarly, don't tell your child to be a good boy (or girl) and do whatever his sitter (teacher/coach/neighbor) says. Boudreaux teaches her own kids reasonable and acceptable behavior while letting them know they have the right to politely but firmly say no if they're told to do something that doesn't seem right. It can help to playact nonscary scenarios in which your child should "talk back" to an adult.

Instead of teaching fear of strangers, Boudreaux also instructs her children to look for "a mommy with kids or a grandma" if they get separated from her in a store or elsewhere. (Recognizing a store clerk or security guard can be difficult for little ones.)

Reducing vulnerability means making sure your child feels safe coming to you about a disturbing or confusing situation or emotion. Tell her, in terms she can understand, that some adults  -- not very many, but some  -- try to touch or otherwise interact with children in inappropriate ways.

Protecting tweens and up

My daughter's now 11, the age at which I was molested  -- and I've gone through many a heart-clenching moment when she's been out of my sight. To protect maturing kids without smothering them:

Continue to get to know your preteen's friends, and if possible visit their homes.

Encourage supervised activities with kids her own age, explaining that while relationships with adults and older teens may be fun and exciting, she may find herself in a vulnerable position that can lead to abuse. Pay special attention to friendships involving older persons, even a 14-year-old palling around with your 10-year-old.

Kids approaching and passing through puberty also need help managing their own sexual feelings, setting boundaries with boy- and girlfriends, and handling peer pressure regarding pornography. Look for opportunities to talk about these issues and brainstorm ways for your child to avoid or get out of uncomfortable situations.

Finding a balance

Protecting kids from molestation requires being vigilant while giving them freedom to learn about their world, make friends, and become independent adults. For me, that's meant choosing a preschool with two teachers in every class; sitting in on music lessons; and having quite a few frank talks with my daughter about sexuality and molestation. Not as much fun as chatting about her interest in Shakespeare or horses, but vital to making sure she never has to experience the kind of shame and confusion that I did as a child.

Parenting contributing editor Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health & Survival in a Bacterial World (Hill&Wang/FSG) and Corpse: Nature, Forensics, and the Struggle to Pinpoint Time of Death (Perseus/Basic Books).

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Antibiotic-resistant germs are showing up in hospitals, playrooms, and gyms around the country. Here's how to keep you and your family safe

By Jessica Snyder Sachs, as first appeared in PREVENTION magazine

One summer morning in 2004, Susanne Petrosky, 37, of Perkasie, PA, woke up feeling feverish. It was a month after she'd given birth to her third child, and one touch of her left breast--hot, swollen, tender--told her it was infected. She knew the drill, having been through it with her second baby. She called her doctor, picked up a prescription for the antibiotic clindamycin, and took it faithfully for the full 7 days. No more breast infection. 

Then the diarrhea started, with cramping so bad it made her recent labor pains seem mild. She made an appointment to see her doctor and got on the Internet. "I typed in clindamycin and side effects and it came right up--severe, sometimes fatal, diarrhea," she says. On the phone, her doctor was reassuring. That was on a Thursday. She spent much of the weekend lying on the bathroom floor; on Monday morning her sister drove her to the doctor. "He took one look at me," Petrosky says, "and told us to go straight to the emergency room."

Petrosky had picked up a dangerous new strain of an old bug: Clostridium difficile. The bacteria, which produces toxins in the intestine, is common--when people on antibiotics end up with diarrhea, C. difficile is often to blame. Generally, once they've finished taking the drugs, the diarrhea clears up on its own. But the new strain is much nastier than normal. It churns out 20 times the colon-damaging toxins as the older version, causing severe intestinal inflammation, or colitis, and is resistant to several important antibiotics. When Petrosky got sick, Canadian hospitals had already reported more than 200 deaths from C. difficile--toxins had eaten right through the walls of patients' colons. Many American hospitals were experiencing similar outbreaks, and the hypervirulent strain had begun to infect people in the general community. Since then, the situation has only gotten worse.

Experts have long warned against the overuse of antibiotics because of the possibility that bacteria would develop resistance to the drugs we use to kill them. Now, researchers say, some of their fears have come to pass. The CDC estimates that of the approximately 2 million bacterial infections Americans acquire in hospitals each year, 70% are resistant to at least one of the drugs commonly used against them. Why that's scaring the experts: If standard drugs don't work, doctors sometimes have to turn to more potent--and more toxic--alternatives. In some cases, those last-resort antibiotics have caused irreversible liver or kidney problems or lasting pain from nerve damage. In others, people have died for lack of an effective treatment. The CDC says that drug resistance kills 70,000 Americans each year--more than car accidents and homicides combined.

"The superbugs are here," says Martin J. Blaser, MD, president of the Infectious Diseases Society of America and the chair of New York University Medical School's department of medicine. "And it doesn't take a crystal ball to see that even more problems are coming." 

Scientists are trying to develop new bacteria-fighting drugs, but that process takes decades. In the meantime, we have to defend ourselves. It's crucial to be able to recognize the warning signs of a superbug infection, or, even better, prevent one. Here are four of the most dangerous of these germs and how leading experts say you can protect yourself.

Superbug C. difficile: A Toxic Intestinal Bug

When Petrosky got to the hospital, doctors immediately put her on extrapowerful antibiotics. She improved, but her right arm went numb from medicine-induced nerve damage; when her physicians switched drugs, she relapsed. It took more than 9 weeks to get her out of danger. After her recovery, her 4-year-old son and a neighbor went through similar bouts of illness. The neighbor had to be hospitalized.

The number of new cases of C. difficile-associated colitis among US hospital patients has doubled over the past 5 to 10 years, to as many as 500,000 a year, reports CDC medical epidemiologist L. Clifford McDonald, MD. The infection rate outside hospitals appears to have increased many times over, as well. And the death rate has skyrocketed: from less than 2% to as high as 17%.

Prevent It

Don't badger your doctor for unnecessary antibiotics. Remember: Antibiotics don't work against viral infections such as colds or flus.

Ask about alternatives if your doctor suggests long-term antibiotics for a chronic bacterial infection such as acne. (Try remedies like benzoyl peroxide cream instead.)

Avoid broad-spectrum antibiotics, if possible, when an illness requires an antibiotic. (Broad spectrum means they kill off good bacteria along with the bad.) The broad-spectrum antibiotics most associated with C. difficile infection are clindamycin (Cleocin), and the fluoroquinolones (Cipro, Floxin, and Levaquin).

Consider upping your intake of "friendly" bacteria, such as Lactobacillus and Bifidobacterium. They can be found in many brands of live-culture yogurt. Such a step can't hurt; research continues on whether it can help deny bad bugs a foothold in your system.

 Treat It

Contact your doctor if you have diarrhea or cramping and gas that lasts longer than a few days, and avoid antidiarrheal remedies, which can prevent your body from expelling C. difficile's tissue-damaging toxins. Instead, drink lots of fluids to stay hydrated and try the BRAT diet: bananas, rice, applesauce, and toast.

Superbug MRSA: Out of the Hospital and in your Community

On Christmas night, 2005, 14-month-old Bryce Smith had a stuffy nose and slight fever--his first cold, say his parents, Katie and Scott Smith of Santee, CA. Around midnight on New Year's Eve, Bryce began to struggle frighteningly for breath. The Smiths rushed him to the hospital, where a nurse checked his oxygen level. Within seconds, Katie recalls, at least 10 doctors and nurses had crowded around her baby, looking very scared.

X-rays and CT scans showed that Bryce's lungs were riddled with holes, and a team of surgeons hurried him into the operating room. Doctors told the Smiths that Bryce had the worst kind of lung infection, one caused by a particularly virulent variety of staph bacteria. Dubbed CA-MRSA, for community-acquired methicillin-resistant Staphylococcus aureus, the bacteria is resistant to penicillin, amoxicillin, and the other "cillins." And it produces poisons--which were chewing up Bryce's lungs.

Bryce lay in a medically induced coma for a month as doctors infused his body with a cocktail of antibiotics, sedatives, and other drugs. The medicines worked: After 40 days, the doctors brought him out of sedation and removed his tubes. But his parents have to be supervigilant now, because the treatment weakened his immune system, at least temporarily. "What would be an ordinary cold for us could prove deadly for him," his dad says.

Staph causes problems only when it slips past the body's defenses, through a cut or scratch or into lungs weakened by a viral infection. Close contact--on playing fields, in locker rooms and showers, and between children in day care and preschool--has been the key to many outbreaks. (Young children appear to be particularly at risk.)

MRSA made headlines in 2005 when Miami Dolphins Junior Seau and Charles Rodgers were hospitalized with limb-threatening skin infections and college football player Ricky Lannetti of Philadelphia died suddenly of MRSA pneumonia on the heels of the flu. And a study in the New England Journal of Medicine startled physicians by revealing that the bug now causes more than half of all skin infections treated in US emergency rooms. It's crucial, say researchers, for doctors to keep the possibility of MRSA in mind--the study found that most cases of MRSA were treated with drugs that don't work against the superbug.

How To Avoid MRSA

Prevent It

* Wash cuts and scrapes thoroughly with soap and water.

* Don't share personal items such as towels and razors, and just in case you have a scratch that would offer entry to MRSA, always keep your clothing or a towel between your skin and any shared surfaces such as workout equipment or locker-room benches. *

* Get vaccinated against the flu--the disease clearly raises the risk of the most severe kind of staph infections.

Treat It

* Don't ignore an infected wound or a pus-filled boil--not even a scratch, if it seems to worsen over the course of a few days. MRSA skin infections tend to be very red, swollen, and painful, sometimes with a raised bump resembling a spider bite. Getting the right antibiotic is critical, so ask your doctor to consider the possibility of MRSA.

* Be particularly vigilant about any chest cold or flu that takes a sudden turn for the worse, or a fever that spikes over 102 degrees F. "Every major medical center is now on the alert for MRSA," says John Bradley, MD, chief of infectious disease at Rady Children's Hospital--San Diego, where Bryce was treated. "But there's still a problem with general practitioners and small community hospitals, where doctors may never have seen a case."

Superbug E. Coli: Food's Dangerous Hitchhiker

Frightening news stories recently about the damage done by tainted spinach made it horrifyingly clear: Produce, like meat, can harbor lethal germs. The culprit in spinach, E. coli 0157:H7, is not antibiotic resistant (in fact, antibiotics are not used to treat this infection), but is indisputably extratoxic; the poisons it produces can cause fatal kidney failure. Strains of other foodborne bugs, Salmonella and Campylobacter, turn out vicious toxins, as well--and these bugs shrug off many drugs that once could vanquish them. All told, these pathogens sicken 3 to 4 million Americans each year and kill several hundred.

Prevent It

Be scrupulous about washing hands after touching raw meat or eggs, and cook these foods thoroughly. (More than half of all cuts of raw supermarket chicken carry Salmonella and Campylobacter, studies show.)

Use hot, soapy water to wash cutting boards and other kitchen surfaces that come in contact with raw meat or eggs.

Rinse produce--even veggies and fruits with a thick rind, such as cantaloupe--with a strong spray of water. If produce is contaminated by irrigation water, as was the case with spinach, only thorough cooking will destroy the germs.

Wash your (and your kids') hands after handling pet rodents and reptiles or farm animals, which can spread Salmonella and Campylobacter.

Throw your kitchen sponges into the dishwasher daily and dishrags into the washing machine often; use hot water.

Treat It

 See a doctor for severe gastrointestinal distress that lasts more than a couple of days, especially if accompanied by fever. If your doctor prescribes an antibiotic, call back if symptoms worsen or don't get better within 24 hours.

Superbug UTI: Bladder Infections That Won't Quit

The first time Dena Kelley got a urinary tract infection, she ended up in the emergency room. It was the winter of 1999, and Kelley, now a 33-year-old store manager in Anchorage, was seeing what looked like tissue in the toilet bowl--the lining of her infected bladder. "It was unbelievably painful," she says, "and it scared the heck out of me."

The ER doc gave Kelley a powerful antibiotic--Cipro--to stop the infection fast, but 6 weeks later, Kelley got another UTI. Over the next year, she averaged an infection every 2 months. Finally, her doctors reluctantly turned to a drug to which she'd been allergic in childhood--amoxicillin, at four times the usual dose. Fortunately, Kelley had outgrown her sensitivity to the drug, which ended the agonizing bouts of UTIs. But she can no longer make it through the night without a trip to the bathroom. And her doctors have told her that permanent bladder damage may predispose her to chronic infections throughout her life.

Roughly half of all women get at least one UTI at some point in their lives. Until the late 1990s, doctors were able to treat the problem with trimethoprim-sulfamethoxazole (Bactrim), a narrowly targeted antibiotic with minimal side effects. But many UTIs have become resistant to Bactrim and other drugs. So doctors must use stronger antibiotics that can cause problems of their own.

"It's frustrating," says Gazala Siddiqui, MD, a urogynecologist at the University of Texas Medical School at Austin. "These powerful antibiotics increase the chances of a yeast infection, and also the chances that a woman's next bacterial infection--whether it's another UTI or pneumonia--will be drug resistant."

If a resistant UTI lingers, it can cause scarring--which predisposes a woman to even more UTIs. Some doctors try to stop the vicious cycle by keeping women on antibiotics for months at a time. But that virtually guarantees that any break-through infections will be impervious to antibiotics, says Siddiqui, who's sometimes had to admit patients to the hospital for intravenous treatment.

Prevent Antibiotic-Resistant Bladder Infections

Prevent It

Begin with good vaginal hygiene: Wipe from front to back after using the toilet and pee before and after sexual intercourse. Don't douche, and consider alternatives to spermicides; both can irritate the delicate tissue around the urethra, raising the odds of infection.

Discourage UTI-causing bacteria by making the urinary tract and vagina more acidic. "Cranberry juice is good at this. Cranberry capsules are better," says Siddiqui, who recommends two or three glasses or capsules a day for women who are prone to recurrent infection. Also helpful: acidifying vaginal jelly available by prescription (Acigel) or over the counter (RepHresh).

Try a low-estrogen vaginal cream if you're peri- or postmenopausal and getting lots of UTIs. It will keep the tissue of the urethra from thinning and becoming more vulnerable to infection.

Treat It

If you suspect a UTI, ask your doc to send a urine sample for analysis. Start antibiotics, but call back for results. If it turns out not to be a bacterial infection, stop the drugs and work with your doc to find the true cause. If a bacteria is at fault, check to make sure the drug you're on is effective against the bug you have.

3 Stay-Healthy Moves To Make Right Now

1. Scrubbing with old-fashioned soap and hot water is the best way to keep germs at bay. Do it before eating, after using the toilet or handling animals, and before and after preparing food. Wash vigorously for 20 seconds, experts say--about the time it takes to sing "Yankee Doodle Dandy."

 
2. If a sink isn't handy, clean up with an alcohol hand sanitizer. Studies show that when someone is sick in a household, classroom, or workplace, using a gel (between hand washings) reduces the spread of disease-causing bacteria and viruses. Be sure to choose a product containing 60 to 95% alcohol--some contain less and can actually help spread germs. Use a generous gob--enough so that hands still feel damp after rubbing them together for 20 seconds.

 3. Skip antibacterial soap. Household soaps and other products with antibacterial chemicals, such as triclosan and triclocarban, don't prevent infection any better than products without them, studies show. Worse, some experts worry that they may promote drug resistance. There's no proof yet that they do, admits resistance crusader Stuart B. Levy, MD, of Tufts University. "But why take the risk when they haven't been shown to be any more effective?"

Have A Healthy Hospital Stay

Ironically, "A hospital is not a good place to be when you're sick," says Curtis Donskey, MD, chief of infection control at the Cleveland VA Medical Center. Filled with the sickest patients on the strongest antibiotics, they're breeding grounds for superbugs. Unfortunately, many doctors neglect the steps that can reduce patients' risk of picking up nasty germs during their stay, says Donskey, who has spent a decade raising awareness among his colleagues. Enlist a friend or family member to help ensure that doctors and other medical personnel follow these guidelines.

* Ask your doctor to remove invasive devices such as catheters and IV lines as soon as it's safe--they provide a pathway into your body for dangerous bacteria.

* Request the most highly targeted antibiotic if you require one. Remind your doctor to take you off the drug as soon as possible.

* Demand to know more about infection rates. Few states now require hospitals to release this information, so it's next to impossible to "shop around" to avoid particularly risky facilities. That may be changing: New York recently passed a law requiring hospitals to make public their rates of hospital-acquired infection, and a number of other states are considering similar legislation.

Writer Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health & Survival in a Bacterial World (Hill&Wang/FSG) and Corpse: Nature, Forensics, and the Struggle to Pinpoint Time of Death (Perseus/Basic Books).

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How to prevent obesity -- for babies on up

Copyright Jessica Snyder Sachs, as first appeared in Parenting magazine

At 7 months, Zachary Miller was a happy and healthy, but not especially active, baby. "The pediatrician told me, 'The big ones don't like to move,'" says Zach's mom, Ellie, of Somerset, New Jersey. "She told me to put him on the floor and on his tummy as often as possible. He hates that. But it does get him to push up on his arms and roll over."

At 20 pounds and 27 inches long, Zach was already overweight. His height was in the 50th percentile for boys his age, but his weight was in the 75th (pediatricians like both numbers to be close together). But does it really make sense to be so concerned about a baby this young?

Yes, say an increasing number of health experts. The more weight a baby gains before age 2, the heavier she's likely to be as an older child and adult, studies show. If one or both parents are overweight, the concern is even greater.

And the eating and activity patterns learned in childhood -- for good or ill -- tend to persist for a lifetime. Some overweight kids as young as 3 or 4 can already have elevated levels of cholesterol, insulin, or blood pressure.

But many people miss the signs that a child (especially a boy) is too chubby. In one study, only 21 percent of the moms of overweight preschoolers knew it. As more and more kids get heavier -- the average child's waist has gone up two sizes in the past 20 years -- kids who are overweight increasingly look "normal" to us.

Pediatricians can miss the signs, too, even though the American Academy of Pediatrics (AAP) recommends that they check a child's body mass index (BMI) -- a measure of fatness -- annually starting at age 2.

So it's up to you to be alert to the signs that your child's overweight or gaining too quickly. "Our current lifestyle is putting kids at risk for serious health problems," says pediatrician Sheila Gahagan, M.D., of the University of Michigan's Department of Pediatrics and Center for Human Growth and Development in Ann Arbor, "but we can turn it around." The hard part: Improving their lifestyle usually means changing yours, too.

That means neither obsessive eating nor quick weight-loss plans, which are especially dangerous for children, whose growing bodies require nutrients from a broad variety of foods, including healthful fats. Instead, what's needed is a return to good nutrition centered on family meals, says Naomi Neufeld, M.D., a pediatric endocrinologist and director of KidShape, a family-based pediatric weight-management program in four states.

Here, what you need to know to set your child -- from birth through grade school -- on a path toward maintaining a healthy weight:

Babies: 0 to 1 year

Eating well: Nursing reduces the risk of obesity in later childhood and beyond. Not only do compounds in breast milk help regulate appetite and body fat, but breastfed babies also take in only as much as they need, and milk production adjusts accordingly.

For a bottle-fed baby, resist the urge to encourage him to finish that last ounce -- whether it's formula or expressed breast milk -- after he's signaled he's full. And whether you're nursing or bottle-feeding, don't automatically feed your baby every time he cries, says Dr. Neufeld: "Sometimes all he needs is attention."

Nor should you rush solids. While it's acceptable to start as early as 4 months, it may be best to wait until 6 months -- especially if your baby's a little heavy to start with. When you do start, don't invite him into the clean-plate club. "When he turns his head away, the meal's over," says Christine Wood, M.D., the author of How to Get Kids to Eat Great and Love It!

Getting active: Infancy is a critical time for new brain-muscle connections, but all you need to provide are soft, safe toys and an unrestricted space, such as a five- by seven-foot rug, where your baby can safely roll over, push and pull up, sit, crawl, and play movement games like patty-cake with you. (But don't force his body into extreme positions, such as feet over head.) "I put Samantha, who's nine months old, where she can watch her older siblings playing," says Anna Toma, of Monmouth Junction, New Jersey. "I can tell by the way her eyes light up and her arms go up in the air that she's going to be right in there running around with them as soon as she can."

Toddlers: 1 to 3 years

Eating well: Toddlerhood is a time when many parents, without realizing it, set the stage for mindless consumption of empty calories. Even 100 percent juice should be limited to four to six ounces a day for kids ages 1 to 6, according to the AAP; fruit "drinks" and sugary sodas don't belong on toddler menus. The best beverages are low-fat milk -- and water.

Try not to start hard-to-quit habits, like snacking on fast food, eating in front of the TV, or pacifying a full but restless (or crying) toddler with convenience snacks when you're in the checkout line or car, or just too busy to play. Instead, find a self-directed activity, book, or other noncaloric distraction.

On the other hand, toddlers need to eat between meals -- when they're hungry -- and should be offered healthful snacks, such as soft, bite-size pieces of fruits and vegetables, string cheese, or a tube of low-fat yogurt. (Avoid choking hazards such as whole grapes, nuts, and hard chunks of fruits and vegetables.)

Getting active: Once your child is walking, let him act on his natural desire to keep moving. Whenever you can, slow down so he can walk and climb the stairs, and make sure his days include outside play. "When my daughters were two, four, and six, we all loved to go out in the yard, pretend we were the Powerpuff Girls, and chase each other around," says Hannah Storm, coanchor of The Early Show on CBS and author of Go Girl! Raising Healthy, Confident and Successful Girls Through Sports. (Now that they're a few years older, they all play soccer and T-ball in the yard.)

When it's raining, explore ways to be active indoors -- dancing or wrestling on the rug, or climbing on sturdy furniture. Kids under 2 should watch very little TV; those 2 and up, no more than an hour or two a day. And when it's time to shop for daycare or a preschool program, look for a daily schedule that includes both structured games like Duck, Duck, Goose and unstructured run-around time. Experts recommend that toddlers get at least 30 minutes of structured activity and one to several hours of unstructured activity daily.

Preschoolers: 3 to 5 years

Eating well: Practice portion control. Serve your child one tablespoon per year of age. A typical meal for a 3-year-old might be three tablespoons each of pasta (try whole-wheat), peas, chicken, and fruit. (If your child doesn't want it all, that's fine.)

What about the child who wants only carbs (the infamous "white diet") while leaving everything else on his plate? Saying "veggies first before seconds of pasta" is tempting, but using food as a reward can backfire -- kids tend to like the reward food even more and the have-to-eat food even less. One solution: Make just enough for one or two toddler-size servings.

Whatever you do, keep offering a variety of healthful choices at every meal. "Tastes mature," says early-childhood educator Harriet Worobey, director of Rutgers University's Nutritional Sciences Preschool, in New Brunswick, New Jersey, which combines early-childhood education with research on childhood nutrition and family development. "Don't stop serving broccoli just because your child rejects it once."

Getting active: Frisbee, hopscotch, bike riding, kickball, dancing -- the joy of movement takes dozens of wonderful forms in the preschool years. (Watching a screen isn't one of them.) By age 3, kids need an hour of structured and one to several hours of unstructured play -- and shouldn't be sedentary for more than an hour at a time. You don't need to do much to get kids moving at this age: If the weather's nice, just open the door and go outside, or take a nature hike with a plastic bucket, which your child can fill with found "treasures."

Schoolkids: 5 and up

Eating well: Find fun ways to teach your child about nutrition. Here's what Joy Bauer, a registered dietitian in private practice in New York City, does with her kids: She helps each make a list of the favorite treats that, in quantity, would not be good for their "teeth or insides." She then allows one or two a day, any time they choose. And she keeps the portions within reason by stocking up on small versions, such as "fun-size" candy bars.

Bauer also suggests having kids use sticker charts to log each time they eat fruit, veggies, or other healthful foods. If you've already let sugar and other empty calories swamp your child's diet, gradually start to dial it back. Bauer recommends cutting sugary cereals, fifty-fifty, with healthful look-alikes.

Getting active: Your child can now share more fully in family outings such as hiking, biking, and skating. The early grade-school years, of course, are also a great time to sample a variety of sports and dance, from team sports like soccer and softball to individual ones like karate and gymnastics, hip-hop and ballet. By this age, kids should get about an hour of moderate to vigorous activity a day, with rest breaks. It doesn't have to be all at once, either -- 10 or 15 minutes at a time is fine. Now's the time to find creative ways to rein in the mounting temptations of electronic entertainment: TV, DVDs, video games, and Internet sites. "Since my boys were six and nine, they've known that they need to spend a half hour moving for every half hour on the computer or Xbox," says LynnAnn Covell, an exercise physiologist at Green Mountain at Fox Run, a nondiet weight-loss resort in Ludlow, Vermont.

In the older grade-school years, sports and dance can become highly competitive. "That's unfortunate, as it means that less athletically inclined kids tend to drop out," says pediatric exercise physiologist Randy Claytor, Ph.D., of Cincinnati Children's Hospital and Medical Center. If that happens to your kid, he suggests, try setting up social situations in which she can play sports with friends "just for fun." Walking or riding bikes to school together can also be an opportunity to chat and bond. (For tips on making it safer in your town, go to the CDC's Walk to School website.  And if you're looking for ways to make your child's school healthier,
check out Action for Healthy Kids.)

It's a drizzly morning on New York's Upper East Side, and Rockefeller University microbiologist David Thaler is sipping a double espresso amid the retro-hippie pillows and dangling paper stars of Java Girl, a favorite haunt of the neighborhood's brainiac Nobel laureates, aging poets and famous entertainers. Thaler somehow manages to embody all three-a long, graying ponytail curling down the middle of his back, wire-frame glasses askew over expansive brown eyes, and a schnozz to rival an Einstein, Ginsberg or Allen. Thaler is one of the leading cheerleaders for a new field of biotechnology aimed at engineering the bacteria inside us to deliver drugs, destroy tumors, actively fight infection, and even vaccinate against their disease-causing kin.

Our ancestors, Thaler explains, emerged from the Stone Age by genetically engineering plants and animals through selective breeding, transforming the wolves that preyed on their flocks into the domestic dogs that would guard them. "Except for wild-caught fish, virtually everything we eat today has been engineered," he says. "Meanwhile, we're walking through this ocean of bacteria and only looking at them as something that can make us sick, rather than something to cultivate." He believes that it's time to move humanity from being microbe exterminators to microbe farmers.

Thaler thinks we need what he calls a "second Neolithic revolution." Although his day job as a microbiologist at Rockefeller revolves around such abstract research as testing life's speed limit (current record for replication: eight minutes), he sees himself as an idea man, someone who might help advance an entirely different mind-set in medical microbiology: Instead of using antibiotics to kill harmful bacteria in our bodies and our environment, why not coax bacteria to do our bidding?

"The technology to harness these bacteria exists," Thaler says. Biotechnology firms already use bacteria like E. coli as tiny factories. Just slip the DNA instructions for, say, a new protein-based drug into E. coli and, in its endless quest to replicate itself, the bacterium will replicate the drug as well.

But it's one thing to employ genetically engineered bacteria to produce pharmaceuticals inside a sealed vat. It's quite another to deploy what some call "Frankenbugs" inside a patient. The same characteristics that make bacteria so amenable to genetic engineering-their malleability, their incredible replication speed, their genetic promiscuity-allow their newly acquired DNA to spread to other microbes, including potentially dangerous ones.

Such concerns have largely kept the first generation of engineered superbugs confined to biohazard-containment labs. But the few microbes that have made it into limited human trials-a cavity stopper, a tumor destroyer, a bowel soother-have been enticingly successful. And so the first standoff over body-ready bugs is taking place before the review boards of medical centers and government regulatory agencies, the people who will decide if the world is ready for engineered superbugs.

"I honestly think people are more comfortable with the idea of nano-robots scurrying through their bodies than they are of deploying bacteria," Thaler muses. "But when you think about it, you cultivate your lawn. You'd probably like to cultivate your internal landscape."

THE CAVITY KILLER

Jeffrey Hillman, an oral biologist for-merly of the University of Florida, is a poster child for the kind of biotherapeutic future that Thaler envisions. Hillman has spent a decade lobbying the FDA to let him test a transgenic tooth bug in volunteers. "Fortunately, we had no idea what was ahead," says Hillman of the gantlet of regulatory requirements he has had to tackle since 1996. That was the year Hillman founded Oragenics, a biotech firm dedicated to commercializing his patented cavity-preventing Streptococcus mutans, a genetically modified organism (GMO) that's the product of nearly 30 years of research.

Inside the mouth of most every person on the planet, colonies of S. mutans bacteria thrive on leftover sugars. The by-product of their digestion is the acid that eats away at tooth enamel and causes cavities. But there are many different strains of S. mutans, and some cause more trouble than others. In the summer of 1976, Hillman was trying to replace cavity-prone strains with those that secrete less enamel-eroding acid. Unfortunately, it seemed almost impossible to permanently eradicate a person's "native" S. mutans once his or her teeth became colonized in early childhood.

"We were trying all sorts of crazy things," Hillman recalls. "One time, we were painting volunteers' teeth with iodine. Then we tried fitting their teeth with trays filled with antibiotics." Yet no matter how thoroughly Hillman banished his volunteers' native S. mutans or how quickly he re-colonized their teeth with a benign strain, the switch-out never stuck. "Slowly but surely, a person's indigenous strain always came back," Hillman says.