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With serious food allergies on the rise, it's hard to know if your child is at risk. Here's how to keep her safe, even when you're not around.

Copyright Jessica Snyder Sachs, as first published in Parenting

Ann Wood's* son Daniel almost died when he was 2 - from a snack. At first, Wood hadn't been worried when she'd called home from work and her babysitter mentioned that Daniel had just thrown up after eating an almond butter sandwich. "These things happen," she'd reassured her babysitter. "Just keep an eye on him." When Wood called back 15 minutes later, though, Daniel had developed diarrhea. When she called a third time, as she rushed home to their New Jersey suburb, he was struggling for breath. "Call 911 right now!" she instructed.

As Daniel emerged from an ambulance at the hospital, his face was covered with large red welts. The paramedics had found him in anaphylactic shock, which meant that his throat was swelling shut and his blood pressure was plummeting toward zero. They brought him back with injections of the stimulant pinephrine and an inflammation-squelching steroid. The next day, Wood and her husband learned that Daniel's reaction was from a life-threatening food allergy to peanuts, a trace amount of which had likely cross-contaminated the almond butter.

Now in second grade, Daniel isn't the only one of his friends with food allergies. Five kids in his grade carry EpiPens, the prefilled syringes that contain enough epinephrine to reverse a severe allergic reaction. And his grade is hardly unique. In the U.S., about 1 in 12 children under 3 have food allergies, and around 150 die each year because of them. Outside the U.S., the problem is no less serious; the incidence of food allergies in kids around the world has at least doubled over the last decade.

"The increase seems to be part of a general rise in allergies of all kinds," says Scott Sicherer, M.D., a pediatric allergist at New York's Mount Sinai School of Medicine and author of Understanding and Managing Your Child's Food Allergies.

While it's not clear what's behind this disturbing trend, many experts think it may have to do with the so-called Hygiene Hypothesis: that modern life - with its lack of exposure to the "germiness" of infiltered water, dirt, and animals - can leave people's immune systems prone to overreact to harmless substances. The result: Even something as innocent-seeming as a peanut can cause the body's defenses to go into overdrive. As overactive immune cells release histamine and other inflammatory chemicals, they produce symptoms such as hives, itching, diarrhea, and in severe cases, life-threatening anaphylaxis.

While regular exposure to relatively harmless bacteria might help make us less allergy-prone, no medical expert would advocate going back to the days of rampant cholera and intestinal parasites. So where does that leave us? Fortunately, there are steps you can take to reduce your child's risk of developing food allergies, and ways to handle them if they arise.

 
A Family Affair

The first thing you'll want to figure out is your family's allergy history. "The more people in your family who have allergies, the greater the risk your child will have one," says Dr. Sicherer.

Kathleen Murray-Lyons, of Townsend, Delaware, has allergies and asthma, so her pediatrician suggested special measures to decrease her 1-year-old son James's chances of food allergies. He recommended she delay introducing James to certain foods that are common allergens, such as nuts and eggs, and offer even low-allergenic foods, like carrots and rice, only gradually and one at a time. (See What to Introduce When). "So far, so good," says Murray-Lyons.

Another tactic doctors recommend: Wait to introduce any solids to your baby until after 6 months (as opposed to 4 months), since studies have found that this significantly decreases the risk of your child developing food allergies. As for what you should eat if you're breastfeeding, studies are mixed as to whether it's helpful to eliminate allergenic foods from your diet. Talk to your doctor about your particular case.

How to Recognize and Respond

Figuring out that your child has a food allergy can be half the battle. Leslie Norman-Harris of Woolwich Township, New Jersey, recalls the night her daughter, Camryn, 4, ate a mouthful of rice with shrimp.

"When she told us her mouth felt itchy, my husband and I looked at
each other and said, 'Uh-oh.'" Fortunately the symptoms subsided, but they knew not to give Camryn any more shrimp.

Other symptoms (which almost always appear a few minutes after eating the offending food):

Nausea

Vomiting

Diarrhea

Itching (throat, mouth, eyes, skin, and/or ears)

Lip swelling

Rash (hives or a flare-up of eczema)

Throat tightness (trouble swallowing or breathing)

Tongue swelling that obstructs the mouth

Chest pain

Dizziness

Sudden paleness or blueness, unconsciousness, and/or a faint pulse

 
For a mild allergic reaction, such as stomach upset or a rash, watch your child carefully in case she gets worse, and call your doctor. To relieve discomfort, you can give her a weight-appropriate dose of an antihistamine such as Benadryl or its generic equivalent (diphenhydramine).

If your child has a severe allergic reaction (like throat tightness, lip swelling, or unconsciousness), call 911. She may need an injection of epinephrine. Later, talk with your doctor about whether you should keep epinephrine on hand.

Testing and Treatment

If you think your child has a food allergy, see your doctor, who may recommend a pediatric allergist. He'll likely perform one of two tests: the classic skin-prick, which entails scratching a small amount of the allergen into the skin and watching for a reaction, or a blood test that screens for allergy-related antibodies.

But know that allergy tests are far from perfect, says Hugh Sampson, M.D., director of the Jaffee Food Allergy Institute at Mount Sinai School of Medicine. It's possible to have an allergy that doesn't show up on a test, or for a test to show that your child is mildly allergic to a certain food even though he can eat it without a problem. Bottom line: Diagnostic tests are best used to help confirm a suspected allergy, rather than to go fishing for possible ones.

Another alternative for determining food allergies is simply to talk about your child's symptoms with your doctor. Dr. Sampson, for example, says he looks for common patterns. Does the child always develop symptoms within minutes of having a particular food? Is it a food known to provoke allergies? If the answers are yes, then you may be dealing with a food allergy.

Once you know your child is allergic to a food, the best thing to do is avoid it entirely. (Allergy shots, while often effective for respiratory allergies, aren't usually used to treat food allergies because there's a greater risk of a dangerous reaction.) If your child does accidentally eat the wrong thing, the best line of defense is to follow your doctor's emergency plan, which will likely include relieving symptoms with an antihistamine or an emergency shot of epinephrine, depending on how severe the symptoms are.

Several promising treatments are now being studied. Most involve "immunizing" a person against the food allergen by injecting a modified version of it together with a substance that tells the immune system to "back off," or treat it as harmless. If these treatments pan out, they may become available as soon as 2010.

Avoiding Allergens

Steering clear of allergenic foods can be one of the toughest jobs a mom can take on. Fortunately, as of January 2006, the Food and Drug Administration requires all food labels to state if ingredients include any protein derived from one of the eight major allergenic foods. But you still need to be vigilant about reading the fine print on labels, which can contain surprises.

"Who would ever have thought that baby-food meats would have dairy in them?" says Jennie Oko of Westmont, Illinois, who has became an ingredient detective ever since her son Matthew, 3, was diagnosed with a dairy allergy as a baby.

Next: Make Your Child Food Smart

Not only do you need to be careful about keeping problem foods out of your house, you also need to teach your child to steer clear of them in other settings. "You don't want to scare him," Dr. Sicherer cautions. Just calmly explain, "Mommy and Daddy don't want you to feel sick, so it's important that you take food only from us and Grandma."

Dr. Sicherer even suggests role-playing together - for instance, by pretending to be a visitor offering him a cookie. If he starts to accept it, say something like "Uh-oh. Remember what we talked about - visitor doesn't know about your allergies."

You'll also need to get used to explaining your child's dietary restrictions when you eat out. A recent survey found that restaurant workers generally don't realize that something as small as a cross-contaminated serving spoon or frying pan could trigger a severe reaction.

"I Want What They're Having!"

For young children, not being allowed to eat what other kids do can be upsetting. When Sabrina Sciarrotta was 18 months, "she was so eager to have everything her big sister, Julia, had," recalls her mom, Monica, of Brea, California. "But while Julia was fine with dairy, Sabrina got headaches and broke out in rashes." To avoid a conflict, Sciarrotta now doles out Julia's yogurt and milk only when Sabrina is napping.

There will inevitably be times, though - at birthday parties, for instance - when your child can't ignore her limitations. Get in the

habit of sending your child to such events with "safe" food alternatives. At school, be sure to explain her food allergy to her teachers and the nurse. If your child has a severe allergy, see if her school will even send notes home to her classmates' parents, explaining that certain foods shouldn't be sent in for sharing.

Outgrowing Food Allergies

The good news is that many children's food allergies go away by age 5. In fact, milk, egg, wheat, and soy allergies disappear nearly 85 percent of the time. So if your child has sworn off, say, soy for several years, ask the doctor if it's a good idea to reintroduce it to him again. She may suggest repeat allergy tests under medical supervision.

While you're still dealing with food allergies, however, remember that "life should not be viewed as a mine field," says Dr. Sicherer. Wood agrees: "We try to protect Daniel while letting him live a normal life."

Allergy - or intolerance?

Many people use the terms "food allergy" and "food intolerance" interchangeably, but they're very different things. An allergic reaction involves a misguided immune response to an otherwise harmless substance. The result is runaway inflammation, which produces the rashes, itchiness, and swelling typical of allergies.

An intolerance results when a child (or adult) lacks one or more digestive enzymes needed to break down a food ingredient. Gas, bloating, and an achy stomach are the hallmark symptoms. (Lactose, or milk sugar, is by far the most common offender.) An intolerance can cause serious stomach pain but, fortunately, isn't life threatening.

* Name has been changed for privacy, at the request of the family.

Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World (Hill & Wang/FSG).

 

 

 

It's hard not to get anxious about the superbugs in the news, from drug-resistant staph to the new strain of avian flu  -- especially when young children are so vulnerable to infections. But how can parents keep from getting paranoid?

Copyright Jessica Snyder Sachs, as first published in Parenting magazine

While experts don't have all the information, they do have some clear and practical advice  -- some of it surprising. Here are their answers to parents' top questions about germs:

Q:  I've read about children who've died from drug-resistant supergerms. How can I protect my family?

ANSWER: The drug-resistant germs you've heard about are methicillin-resistant Staphylococcus aureus (MRSA) and Clostridium difficile (often referred to as C. diff). We do encounter these bacteria on a regular basis, but the good news: Only rarely do they cause major harm.

MRSA generally produces hard-to-treat skin infections. Less often, it can cause severe pneumonia, typically on the heels of a chest cold or the flu, says John Bradley, M.D., director of infectious diseases at the Children's Hospital and Health Center in San Diego. Infection with the other bacterium, C. diff, is usually triggered by antibiotics and generally causes intestinal problems, such as diarrhea. But in rare cases C. diff can cause dangerous intestinal inflammation.

To protect against MRSA: Wash cuts and scratches thoroughly with soap and water, and keep them covered with a bandage until they've healed. Check the bandage every day or so, and don't ignore redness, swelling, or pus, as these can signal an infection. If the wound gets worse after a day, see a doctor and ask her about the possibility of MRSA. The same advice goes for a chest infection that takes a sudden turn for the worse.

For C. diff, the best prevention is to avoid taking antibiotics needlessly. Remember, they work only against bacterial infections, not viruses like colds and flu. When you or your child must take antibiotics, talk with your doctor about choosing the least gut-disruptive drug available and consider taking probiotics (beneficial bacteria that may help protect against drug-resistant germs). Sources of this good bacteria include Saccharomyces yeasts (in supplements), as well as yogurt and supplements containing lactobacillus. You can take probiotics after a course of antibiotics, or you can take probiotics regularly. Ask your doctor what's best for you.}]

Q:  My kids love snacking on fresh fruit and veggies on the way home from the market. Is this safe?

A: It's probably okay  -- and it's great that your kids are eager to snack on produce  -- but in very rare instances contaminated fruits and vegetables can lead to serious, even life-threatening food-borne illness. (Bad spinach, anyone?) The most common culprits include sprouts, lettuce, unpasteurized juice, melons, and tomatoes. But with the exception of sprouts (which can't be cleaned well and should never be served raw to children), a thorough rinsing under tap water decreases the risk for most fruits and vegetables  -- no soap or special sprays needed. So even though your kids may like to munch on grapes or apples on the way home from the grocery store, it's better to rinse off the produce before digging in.

Using public restrooms; the 5-second rule

Q  What can I do to make sure my kids don't pick up disease-causing germs in public rest rooms?

A: Let's start with the toilet: Unless the seat is wet or dirty (yuck), it probably harbors few germs. So you don't need to worry about layering it with tissue paper. What's more important is to turn your face away when you flush, says University of Arizona microbiologist Charles Gerba, Ph.D. (a.k.a. Dr. Germ, for his unprecedented studies of which germs lurk where). This is because the droplets that fly when you flush can be full of bacteria and viruses. ("That's another reason to put the lid down at home," says Gerba, whose research shows that in a typical home bathroom, toilet spray contaminates just about everything.)

Of course, be sure your kids wash their hands with soap and water when they're done. And during cold and flu season, it's a good idea to use a paper towel on the doorknob as they leave, since one-third of public-bathroom visitors don't wash their hands.}]

Q:  What about the "five-second rule"  -- that it's okay to pick up and eat a dropped cookie, say, if you get it off the floor quickly. Is there any harm in it?

A: That depends on where you drop the cookie. "Compared to your kitchen sink, a bare floor is quite safe," says Gerba, who practically shudders at all the germs he's catalogued in drain traps, dishcloths, and sponges. "So long as you clean the floor now and again, I wouldn't worry."

As for food that drops outside, Gerba suggests erring on the side of caution. "Toss it," he says, whether it's been on the ground for five seconds or five minutes. You don't know what got deposited on that spot before you arrived. Beach sand, for instance, is notorious for being contaminated with bird droppings, which can spread intestinal bugs. "Knowing what I know, I never eat off a bare picnic table," says Gerba. "Birds use it as their rest room while they're cleaning up the crumbs the last picnicker left behind."

Eating rare meat; avoiding avian flu

Q:  My husband likes to cook our burgers medium-rare and our eggs "sunny and runny," but what about the bacteria in these raw foods? Am I being a germophobe?

A: No. Much of the meat and eggs on our supermarket shelves is contaminated with disease-causing bacteria, and these bugs are more drug resistant than ever. Most of the time, the infections people get are run-of-the-mill food poisoning, but in a small fraction of cases, gastrointestinal infections can become a life-threatening problem. Infected babies and toddlers are among those at highest risk of death and serious complications.

To kill these germs, public-health experts recommend that you hard-cook eggs and use an instant-read thermometer to make sure burgers and egg dishes reach an internal temperature of at least 160 degrees Fahrenheit. Also, don't let raw meat or eggs contaminate other food in your kitchen; wash any plate, cutting board, counter, or silverware that's come in contact with the raw food before it touches any other food. For people who really want their eggs sunny-side up and runny, a growing number of supermarkets now carry pasteurized-in-the-shell eggs (such as Davidson's Safest Choice).

Q:  I heard that avian flu could arrive any time with migrating birds. Is it safe to let my child feed ducks at the park or seagulls at the beach?

A: Even if the dangerous avian-influenza virus (technically referred to as highly pathogenic H5N1) turns up in North American birds, the chance of transmission from birds to humans is low. In Asia, the people who have gotten this flu were almost exclusively those who regularly handle chickens and ducks. The greater risk, then, is that this virus will mutate, or change, so that it can be transmitted easily from one person to another. Thankfully, that hasn't happened yet.

Still, you and your child shouldn't get too close to wild birds, says Paul Slota, branch chief of the U.S.G.S. National Wildlife Health Center. Feeding wild birds encourages their crowding  -- which is bad for the birds as well as for people (bird droppings can spread germs).

If your child does touch a wild bird or its droppings, be sure to wash her hands with soap and water before letting her touch her face, eat, or drink. If you're not near a sink, a dollop of alcohol hand gel will do the trick.

Antibacterial soaps; puppy kisses

Q:  The supermarket is filled with soaps and household cleaning products labeled "antibacterial." Are they better than regular cleaning products?

A: No. Antibacterial soaps and cleaning products aren't any more effective in preventing the spread of disease-causing germs. (Alcohol-based hand gels, on the other hand, have been shown to cut down on the spread of infections.) What's more, the chemicals in antibacterial products work like antibiotics  -- by interfering with bacterial growth  -- and you've no doubt heard there's concern (not yet proven) that these chemicals may promote the rise of drug-resistant bacteria. "If they don't provide any benefit, why take the risk?" says Tufts University microbiologist Stuart Levy, M.D. When you want to disinfect surfaces, he and other experts recommend cleaning products that contain bleach or alcohol.

Q:  Our new puppy loves to give playful kisses. Is it okay to let him lick our child's face?

A: "The odds are in your favor that the occasional face lick is okay," says Gerba. "Just ask yourself, what was the last thing your dog licked?" Dogs can pick up intestinal parasites from infected canine buddies or if they drink from streams and lakes frequented by wildlife  -- and these infections show up in stool. So if your dog has just licked himself down there, that may not be the best time for a kiss. But if your dog doesn't show signs of illness, you should generally feel safe letting him give your child friendly licks from time to time.

Parenting contributing editor Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World (Hill&Wang/FSG).

Winter is the season of the cough, the wheeze, the whoop, the bark, and the rattle, sniffle, and honk.

Copyright Jessica Snyder Sachs, as first published in PARENTING magazine

We spend so much more time indoors, where it's easier for respiratory infections to spread from person to person. Children, with more immature immune systems, get colds and the flu more often than grown-ups. And they have their very own diseases, like croup.

That's why millions of moms (and dads) will be awake tonight, trying to figure out how to relieve their kids' coughing and congestion and fretting over whether to call the doctor or even make a midnight run to the emergency room.

Most of the time, all our kids need is a little symptom relief and comforting -- even when they sound terrible. Sometimes, a parent's wisdom lies in not giving her child medication. But some symptoms do warrant immediate medical attention, while others linger long enough to make you wonder if they signal asthma.

Art by Courtney

What you need to know:

The very common cold
Babies and kids get six to eight colds a year, but sometimes they sound sicker than they are. "What parents usually hear are the random snorts and sniffles of air passing through mucus and secretions in the nose and throat," says pediatric pulmonologist Peter Scott, M.D., of Children's Healthcare of Atlanta. There's no need to worry as long as your child seems reasonably comfortable and active, continues to eat and drink, and starts to get better after a few days. In the meantime:

Try saline drops to loosen nasal congestion. They're especially helpful for babies too young to blow their noses. Use three or four times a day.

To relieve a nighttime cough, elevate your child's head with a wedge beneath the mattress.

Offer liquids to lubricate an irritated, cough-prone throat. For babies, nurse or bottle-feed more frequently. For children, give water or diluted juice (semi-frozen if you want, for its pain-soothing chill). "But there's no need to push fluids -- normal intake is fine," says Dr. Scott.

Go easy on cold preparations. Never give babies under 6 months decongestants or cough suppressants, says Dr. Scott. Some decongestants can act as stimulants and keep an older child (and you) awake if taken within four hours of bedtime. Some moms find that over-the-counter cough suppressants help their kids, although studies haven't shown them to be effective. If coughing interferes with your child's sleep for four or five nights, talk to your doctor, who may prescribe a stronger prescription cough suppressant.

See the doctor if your baby is under 3 months and has a fever over 100.5 degrees. And call if a child of any age has symptoms -- cough, congestion, mild sore throat -- that linger for longer than a week.

 

RSV: a risk for infants

Respiratory syncytial virus (RSV) is either a minor nuisance or an emergency. Most kids get it by age 1, but parents usually think it's just a cold. But around 2 percent of the time, the virus causes bronchiolitis, an inflammation of the small tubes of the lungs. Even this condition is not usually life-threatening, but it can be in some babies under 6 months, and in preemies up to 1 year.

Maribelle Lewis, a medical technologist in Palisades Park, New Jersey, suspected RSV when her 3-month-old daughter, Aiyannah, developed a persistent wheezy cough but no fever. "Her extreme lethargy tipped me off," says Lewis.

Aiyannah's pediatrician gave her an inhaler with medication to open her airways. But over the next two days, Aiyannah stopped nursing and became even more listless. When Lewis took her baby back, the pediatrician sent her to the hospital, where Aiyannah received intravenous fluids and intensive respiratory therapy (inhaled steroids). Today Aiyannah is a healthy, happy 3-year-old.

Some babies with severe RSV do spike a high fever, but others never get hot at all. Always call your pediatrician if your child's wheezing or coughing makes it difficult to breathe, or if there's a loss of appetite and unusual lethargy.

Flu fears

Anxiety over avian flu may be dominating the news, but even the old-fashioned kind can prove severe, with symptoms that often begin like a cold but become more debilitating and long-lasting.

It often hits more abruptly, with a sudden high fever, dry cough, and a headache. There can also be muscle aches, sore throat, and a runny nose. Kids -- but rarely adults -- sometimes also have stomach problems, like diarrhea or belly pain.

For most babies (6 months and up) and children, treat flu-related cough and congestion much like those of a cold (with acetaminophen or ibuprofen, but never aspirin). Just expect more lethargy and feverishness. One exception: If you suspect flu in an infant under 2 months, go to the doctor right away; from 3 to 6 months, call.

And for a child of any age, watch out for that sore throat. If it's severe, there's a fever over 101, and it lasts more than a day, see the doctor to rule out strep. Also bring your kid in if his ear hurts (flu can cause ear infections), if a fever doesn't go away in three or four days, or if a cough persists more than a week. But it's fine to call earlier.

Sinusitis and pneumonia

Sinusitis
Around 10 percent of the time, a child's cold or flu will progress to sinus inflammation, or sinusitis, which may include a wet, or phlegmy, cough, bad breath, and thick yellow or green mucus. Sinusitis may also bring headache and fever.

The underlying cause is a bacterial infection, so it always warrants a trip to the doctor, who will likely prescribe antibiotics to clear it. Once you're back home, you can help your child breathe better by letting her inhale steam over a hot (but no longer boiling) pot or cup of water.

Pneumonia
"We were a bit too sanguine," admits Marina Budhos, a mom in Maplewood, New Jersey. Last February, her son Sasha, 4, had been coughing for nearly two weeks, though he never had a fever. Then, in the middle of one night, he woke up crying inconsolably. His breathing was labored, and he looked exhausted. "We brought him in the next morning, and the nurse took one look at him and said, 'He's a mess.'"

Sasha had pneumonia, which occurs when a respiratory virus settles into the chest and causes an inflammation of the lung's air sacs. Sometimes the cause is bacterial, typically as a secondary infection after a cold or flu.

Unfortunately, figuring out whether a child's congestion is in the lungs is maddeningly difficult, even for doctors. "That's why we spend so much time with our stethoscopes on your child's chest," says Joshua Needleman, M.D., a pediatric pulmonologist at Children's Hospital at Montefiore, in New York City. Three red flags:

Coughing that lasts two weeks or more

Coughing plus fast breathing and a high, persistent fever

Coughing that returns a few days after a cold appears to go away

Pneumonia can come on quickly, with fever, shaking, and chest pain, or slowly, with fatigue, weakness, and headache. See your pediatrician, who'll examine your child and most likely have her chest x-rayed. If he sends you home, treat symptoms with rest, fluids, and children's pain relievers (but not cough suppressants, which may interfere with your child's ability to clear congestion out of the lungs). But don't be surprised if the doctor hospitalizes your child to make sure she's getting enough oxygen and to bring the infection under control.

Croup

Croup, an infection of the larynx (the voice box) is a rite of early childhood for millions of families. When Jennifer Lopez's son Noah, 3, woke up barking one night, she turned on the hot shower and sat with him upright on her lap in the steamy bathroom. "He was coughing so deep in his chest, we could just feel his pain," says the Gainesville, Florida, mom. When Noah's breathing became more labored -- his nostrils flaring and his belly and chest heaving -- his parents called the pediatrician, who sent them to the emergency room. There, Noah got an injection of steroids -- a standard treatment that's safe in kids as young as 3 months -- and was given an inhaler with medication to help open his airways. He went home three hours later.

"The family did everything right," says pediatrician Ari Brown, M.D., author of Baby 411. They elevated their child's head and headed for a steamy bathroom. (The opposite -- going out into the cool night air -- can also ease croup for many children.) Even more important, the Lopezes sought immediate medical care when they saw signs that Noah was struggling for breath.

Another sign of extreme airway narrowing is when croup's classic bark turns into a high-pitched squeal, called "stridor." If a steamy bathroom or a whiff of chilly air doesn't make the squeal disappear in 20 minutes, head to the emergency room, says Dr. Brown.

 

Whooping cough

Sandy Knight thought she knew what to expect when her 3-month-old son Luke got his third cold: "It always started the same, with a runny nose. Then toward the end, he'd get a nighttime cough."

But this cough sounded different. Instead of a little "cough-cough," Luke would hack on and on and then pause, as if gagging. "My husband and I would sit there on edge, just waiting for Luke to take a breath." Somewhat sheepishly, Knight, of Austin, Texas, took Luke to his pediatrician the next morning. "I'm probably being a silly mom," she began. Far from it, given what Knight described -- prolonged coughing followed by a gag or gasp. The doctor swabbed Luke's nose and throat for analysis. The diagnosis: pertussis, a.k.a. whooping cough, a serious bacterial infection that can lead to pneumonia, seizures, even death. Luke and both of his parents got a five-day course of antibiotics, and everyone was fine.

This highly contagious disease has been making a disturbing comeback across North America. It's the only vaccine-preventable disease that's on the increase, with more than 18,000 reported cases in 2004, up from around 10,000 in 2003. Babies are especially vulnerable until they get the third of four diphtheria-tetanus-pertussis (DtP) vaccinations, usually at 6 months. Those under 3 months are at special risk of pertussis-related apnea, in which they stop breathing altogether and need emergency help.

Pertussis starts like a common cold, with a runny nose, sneezing, and cough, with or without fever. After a week or two, the cough tends to worsen, with severe and prolonged coughing jags punctuated by gags and gasps and, occasionally, vomiting. In spite of its name, babies under 1 rarely "whoop." Nor do adults (kids do). Any suspected case of pertussis warrants a trip to the doctor, as antibiotics may be needed.

The best prevention: Stay on schedule with baby shots and remain vigilant for signs of pertussis until full protection kicks in around 6 months. Though your baby's first DtP shot may produce a spike in temperature, studies have shown it does not cause lasting harm -- and certainly nothing to compare with the disease's dangerous symptoms.

By the time your child becomes a teenager, though, his immunity will start to wane. That's why the Centers for Disease Control and Prevention now recommends that all kids at age 11 or 12 get the new Food and Drug Administration- approved Tdap vaccine (Boostrix), which adds pertussis to the tetanus-diphtheria booster -- and that adults get it every ten years (sooner if you're around an infant). This should help curb the spread of whooping cough to young children.

Coughs and congestion may always be a part of early childhood. They'll become less frequent as our kids strengthen their immunity through regular vaccinations and, inevitably, a touch of actual sickness. In the meantime, your watchful vigilance protects them from serious dangers, and your TLC eases these rites of passage.

When to call 911
Pneumonia, croup, whooping cough (pertussis), RSV, and asthma can each make a baby or child struggle to breathe. This is an emergency. Call 911 if your child:

pauses more than 10 seconds between breaths

breathes very rapidly for more than a minute

turns gray or blue

Or if:

his nostrils are flaring

the muscles between or below the ribs (or the chin) are moving inward, a phenomenon called retraction

PARENTING contributing editor Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World (Hill&Wang/FSG)

 

My Baby Made Me Do It: The surprising reasons why we coo, make faces, sway, and more ...

Copyright Jessica Snyder Sachs (as originally appeared in Parenting magazine)

Long before my friends and I had kids of our own, we swore we'd never sing those frightful lullabies we'd hear mothers croon. You know, the ones about babies falling from treetops and papas buying them everything from mockingbirds to diamond rings. ("How materialistic can you get?") Being rather late to motherhood, I also had ample opportunity to snigger when my college-educated buddies devolved into baby-talking simpletons within hours of becoming parents.
Of course, I got my comeuppance. Not only did I start cooing to my "suuuu-weeet baaay-beee" the moment I lifted her into my arms, I soon found myself singing every lullaby I'd ever berated, as well as one in German that mysteriously resurfaced from my own early childhood.
Then came the day we cracked open Eva's first jar of baby food. My husband pointed out that I gaped like an oxygen-starved guppy every time I offered her a spoonful. "Try it, buster. You'll see," I replied. Extend spoon, drop jaw: It's physically impossible to do one without the other.
Mercifully for those of us still clinging to some shred of dignity, researchers have begun to uncover what's behind much of our parental madness. And understanding why we do these things can help us maximize their positive impact. Likewise, it can be helpful to recognize when our well-meaning impulses become counterproductive.
Making faces
Of course, you don't have to turn on the volume to recognize a videotape of someone interacting with an infant. We open our mouths and contort our faces into wide-eyed expressions of surprise and delight, all within a few inches of a baby's face. Try this in-your-face mugging with anyone over 18 months and they'll think you're crazy, if not dangerous. Yet infants eat it up.
"Early on, babies have pretty crummy vision," says Colombo. "They start out very nearsighted." So getting up close and exaggerating your expressions can help an infant make out your features against the blur of the world.
Many researchers believe that cartoonish expressions help elicit what they call the mimicry response. "In our studies, we find we have to really exaggerate our facial expressions when we want babies to mimic something like opening their mouths or sticking out their tongues," says developmental psychologist Sybil Hart, Ph.D., of Texas Tech University, in Lubbock. This mimicry, in turn, may help babies learn to form sounds.
"A lot of the time that babies spend looking at our faces, they're actually focusing on our mouths and copying our expressions," she says. Which also explains why gaping like a fish encourages an infant to "open wide" for the next spoonful.
Perhaps the best studied — though not altogether understood — parental behavior is the way we speak to infants. "Parentese" spans virtually every culture and language. Its most conspicuous traits: elevated pitch (as much as an octave higher than normal), drawn-out vowels, and a general slowing of speech to at least half the rate of normal conversation. It's a speech pattern that tends to grate on older kids and adults who aren't parents. So why do infants love it so?
For starters, babies, especially newborns, don't hear well at low frequencies. "Babies are much better at picking out higher-pitched sounds from surrounding noise than lower pitches," says John Colombo, Ph.D., a developmental psychologist at the University of Kansas.
Even when infants can hear adult conversation clearly, they still show a preference for baby talk, says neuroscientist Patricia Kuhl, Ph.D., of the University of Washington. Nineteen years ago, Kuhl set up a now-classic experiment in which she allowed infants to control whether they listened to parentese or adult-style conversation. The babies consistently preferred baby talk. Moreover, experts believe this would hold true even if the baby talker spoke a language not heard in the infant's home.
Kuhl concluded that the universal exaggeration of vowels and slowing down of speech help babies learn the phonetic elements of speech, perhaps even the particular intonations of what will become their native tongue.
Researchers at the Temple University Infant Lab, in Ambler, Pennsylvania, have noted that parents (at least, English-speaking ones) imbue their parentese with a singsong quality that emphasizes the ends of sentences, and this may further help babies parse speech into its crucial elements, says Kathy Hirsh-Pasek, Ph.D., coauthor of How Babies Talk. "Anyone who's learned a foreign language knows that the greatest challenge is simply to separate out the words, phrases, and sentences. That's exactly what baby talk does."
Still, experts agree that teaching children how to use words is unlikely to be the whole story. Given that people regularly lapse into baby talk with pets and romantic partners, something about baby talk conveys warmth and caring. "Long before babies can pick out individual words, they pick up on affect," explains Hirsh-Pasek. "You can say something not at all nice to a baby in a friendly tone and that baby will smile and gurgle. Say something nice in an angry tone, and the baby will cry."
This isn't to say that parents who somehow resist the urge to baby talk will produce language-disabled children, says American University linguist Naomi Baron, Ph.D., author of Growing Up With Language: How Children Learn to Talk. "Refusing to talk in a high voice is harmless enough," she says. "What's crucial is that parents and caregivers talk and listen to babies as much as possible, because that's how infants learn how we communicate."
Attentive parents and caregivers often mimic their babies as much as, if not more than, the other way around. Some may snicker at the sight of a big, burly man "goo-gooing" and "wuu-ahhing" with an infant on his lap, but child-development experts couldn't be more pleased.
"It's a characteristic of a responsive parent to realize that a baby has the skills to drive interactions and then allow that infant to take the lead," says Colombo. "When a baby makes a sound and that sound comes back to her, it provides her with a sense of control over her environment." Similarly, following the lead of a baby's actions — smiling when she smiles, touching an object she touches, pointing where she points — lets her know that she has the power both to communicate and make things happen.
Rocking out
Even more universal than oogling and goo-gooing is the instinct to sway while holding a fussy or sleepy baby. It appears that, in part, gentle motion activates a baby's vestibular system — the innate sense that lets us know where we are in space.
Although most people picture rocking a baby as something done side to side (the way a child rocks a doll), at least one study shows that an up-and-down motion proves more effective, especially with newborns. "We find that the best way to console a crying newborn is to hold him upright on your shoulder, then bend and straighten your knees so he moves in a vertical direction," says Colombo.
Attentive parents and caregivers often mimic their babies as much as, if not more than, the other way around. Some may snicker at the sight of a big, burly man "goo-gooing" and "wuu-ahhing" with an infant on his lap, but child-development experts couldn't be more pleased.
"It's a characteristic of a responsive parent to realize that a baby has the skills to drive interactions and then allow that infant to take the lead," says Colombo. "When a baby makes a sound and that sound comes back to her, it provides her with a sense of control over her environment." Similarly, following the lead of a baby's actions — smiling when she smiles, touching an object she touches, pointing where she points — lets her know that she has the power both to communicate and make things happen.
Rocking out
Even more universal than oogling and goo-gooing is the instinct to sway while holding a fussy or sleepy baby. It appears that, in part, gentle motion activates a baby's vestibular system — the innate sense that lets us know where we are in space.
Although most people picture rocking a baby as something done side to side (the way a child rocks a doll), at least one study shows that an up-and-down motion proves more effective, especially with newborns. "We find that the best way to console a crying newborn is to hold him upright on your shoulder, then bend and straighten your knees so he moves in a vertical direction," says Colombo
Singing lullabies
It feels only natural to murmur a soft lullaby as we walk and sway with our babies. Something about an infant in arms elicits song in even the most musically challenged. "There's been a lot of research on music and babies," says Hart. "We know they love it, are soothed and comforted by it, and that they generally prefer a simple melody to something overwhelming like a full orchestra or hard rock."
There's also something about trying to calm an infant that brings back what calmed you when you were small. Perhaps singing mimics the rhythmic sounds of a beating heart and whooshing blood heard in utero. "All we know for sure is that babies need a rich sensory diet — a wide array of input to all their senses," says Roni Cohen Leiderman, Ph.D., associate dean at Nova Southeastern University, in Fort Lauderdale, Florida.
Ready to fight
Far deeper than any amusingly quirky behavior lies the fierce protectiveness that our children evoke in us. I can vividly recall the night I stood in a neonatal intensive care unit, blocking a six-foot-tall pediatric resident who'd been ordered to learn how to insert an intravenous line using my newborn's tiny veins. The image that comes to mind is that of a lioness standing over her cub. The ferocity of my protectiveness took me by surprise. The same instinct positions us between our children and any real or perceived danger (traffic, strangers, relatives with colds), and motivates us to spend hours covering electric outlets with plastic doohickeys and safety latching every drawer in the house.
In this realm more than any other, something about a baby induces truly primal behavior. Certain aspects of a baby's appearance — large eyes, large head relative to the rest of the body, button nose, receding chin — trigger both an instant attraction and a sense of protectiveness. It's an instinct that both advertisers and wildlife crusaders exploit to catch our attention and melt our hearts.
It's also what might lead an adult to risk her own safety for that of a baby or small child. On a less dramatic scale, it ensures that parents get up for 3 a.m. feedings despite their mind-numbing need for sleep. Evolutionary biologists point out that an otherwise helpless human baby depends on such self-sacrificing behavior for survival. To we parents who are doing it, though, self-sacrifice is hardly the issue: For us, tending to our babies in the wee hours, babbling to them, singing, and swaying are all expressions of the most important parental instinct: love.

Jessica Snyder Sachs is the author of GOOD GERMS, BAD GERMS: Health & Survival in a Bacterial World (Hill & Wang/FSG October 2007).

The Truth About Sugar
Does it really make kids hyper? Or fat? How sweets affect your child, and the smartest ways to set limits

By Jessica Snyder Sachs
(originally published in Parenting)

DeeDee Brown of Richmond, Virginia, was looking for anything that might explain her daughter's meltdowns. "Normally, Chloe's calm and happy," says Brown. "But there were times when she'd fall apart — screaming and yelling and so angry that nothing I said or did could console her." Just the terrible twos? Overtiredness? Playing with certain friends? Brown ruled out the possibilities one by one till she made the connection.

"Once a week, we'd go to the bank, where Chloe would get a lollipop. An hour later, she'd be a complete emotional mess." Brown noticed the same pattern after cookie binges and birthday parties. "I should have known," she says in hindsight. "I get cranky after eating sugar. I just didn't think about my child having the same issue."

Lick the Sugar Habit. The New Sugar Busters! Little Sugar Addicts. Good Carbs, Bad Carbs. A slew of new books would have us blame sugar for everything from behavioral problems to skyrocketing rates of childhood obesity and diabetes. Yet babies come into the world with a sweet tooth (nature's way of drawing them to breast milk). So you may rightly wonder, how could an occasional lollipop or cupcake be so detrimental?

Is sugar really poison — or a harmless part of childhood?

For all the hype on both sides of the controversy, the truth may surprise you. Pediatricians and nutritionists agree: In modest amounts, sugar can have a healthful place in a child's diet (or an adult's). But many kids get too much, too often. Worse, sugar-rich foods tend to be full of empty calories and often displace the nutritious foods children need. A recent landmark study of more than 3,000 infants and toddlers found that close to half of 7- to 8-month-olds are already consuming sugar-sweetened snacks, sodas, and fruit drinks, a percentage that increases dramatically with age.

What's The Harm?
Findings like these concern health experts, especially because eating high-sugar foods early on makes kids crave them more later. Fortunately, "parents can do a lot to train their young child's taste buds so she doesn't end up wanting sweetness so much," says Gail Frank, a nutritional epidemiologist at California State University, in Long Beach.

Just as children differ in body type, activity level, and temperament, there's no set measuring spoon for the right amount of sugar in their diet. At the same time, how sugar plays into various health considerations can help guide you toward the right balance for your child:

Cavities Sugar alone doesn't cause them, but it does fuel the growth of bacteria that do. So while fluoridated water and regular toothbrushing help prevent cavities, a steady stream of sugar in the mouth increases their likelihood. That's why dentists advise against putting babies to sleep with a bottle of milk (it contains milk sugar) or fruit juice, or letting them sip the stuff throughout the day.

Behavioral problems Numerous studies have confirmed that sugar does not cause hyperactivity. In fact, a few drops of sugar water (a half teaspoon in an ounce of water) can soothe a fussing baby. When sugar enters the bloodstream and reaches the brain, it temporarily increases calming neurochemicals, such as serotonin.

That's not to say you're just imagining those post-birthday-cake meltdowns. The problem is what happens when blood-sugar levels rise too high. The body responds by producing a large amount of insulin, a hormone that sweeps sugar out of the blood and into body cells. Blood-sugar levels may then drop so quickly, your child may feel shaky or sluggish. Not surprisingly, low blood-sugar levels can trigger a craving for more sweets, which creates a vicious cycle of sugar highs and lows.

If your child tends to have postsugar meltdowns, you can prevent them by tempering the amount he gets at any one time — controlling portion size, diluting fruit juices, choosing treats low in sugar — and by making sure he eats something heartier along with sweets. Protein (cheese, soy, beans, meat, nuts) and fiber (fruits, veggies, whole grains) help slow the rise and fall of blood-sugar levels.

Obesity Sugar alone doesn't make kids overweight. Children gain too many pounds when they take in more calories than they burn. Unfortunately, sugary drinks and treats typically supply calories above and beyond what kids need to satisfy their hunger.

Sugar calories also tend to go down too fast and easy. A 12-ounce can of soda contains ten teaspoons of sugar (160 calories), and many sweetened fruit drinks have as much or more. Regularly drinking even one sugary drink (soda, fruit punch, or sweetened iced tea) a day increases the risk of obesity. That's one reason the American Academy of Pediatrics (AAP) issued a policy statement in January urging schools to stop offering sweetened drinks in cafeterias and vending machines.

Fruit juices, which contain concentrated amounts of fruit sugar, can also be overdone, says pediatrician Barbara Frankowski, M.D. The AAP advises age-by-age limits:

• No fruit juice for babies under 6 months

• No more than 6 ounces a day for babies 6 months to 1 year

• No more than 6 ounces a day for kids 1 to 6

• No more than 12 ounces a day for kids over 6.

Diabetes Sugar by itself isn't to blame. But a high-sugar diet can increase a child's risk of developing Type 2 diabetes or the prediabetic condition known as insulin resistance syndrome. Both can result when the body becomes less sensitive to insulin, and both are associated with a variety of serious health problems in later life, including heart disease and even infertility.

According to endocrinologists, a high-sugar diet may raise the risk of diabetes and insulin resistance syndrome indirectly, by contributing to obesity (a strong risk factor), and directly, by overworking the pancreas, the organ that produces insulin.

A Place At The Table?
While some moms discover that even a small piece of cake can trigger a meltdown in their child, many kids can indulge in occasional sweets without a problem. "Desserts and candy can be once-in-a-while treats," says pediatric endocrinologist David Geller, M.D., of Cedars-Sinai Medical Center, in Los Angeles. "Once a week is a good goal. The body only cares what you do to it most of the time."

What's more, in small amounts, sugar can even encourage nutritious eating. "When I was little, I learned to love grapefruit if it had a little sugar on it," says registered dietitian Valerie Duffy, Ph.D., of the University of Connecticut.

Similarly, a recent study found that adding about a teaspoon of sugar to a serving of whole-grain breakfast cereal — such as oatmeal, wheat bran, or muesli — made a tremendous difference in whether kids liked it, but it had no significant effect on their blood-sugar levels.

"There's some truth to the saying 'A spoonful of sugar helps the medicine go down,'" says Duffy. So relax: Go ahead and let your kids enjoy sugar in moderation. You may even find ways to let that natural sweet tooth lead them down the road to a lifetime of healthful eating.

A Shopping Guide
Everyone recognizes the white stuff in the sugar bowl, but what about the corn syrup in sweetened fruit drinks or the natural sugars in fruit juices, honey, maple syrup, and raw sugar? Are they any better, or worse, for our kids? And what's the scoop on artificial sweeteners? "For the most part, there are no good versus bad sweeteners, just all those choices," says University of Connecticut nutritionist Valerie Duffy. Some produce a faster rise in blood-sugar levels, however, which can then trigger rebound low-blood-sugar levels — and thus emotional ups and downs — in some kids and grown-ups. A guide to the leading sweeteners available, and how to ferret out a few that are hidden in foods and drinks:

Sucrose

White, powdered, brown, or raw, it's all sucrose. On product ingredient lists, it's usually just called "sugar." Also look for its close relatives dextrose, glucose, and maltose. In large amounts (more than a couple teaspoons, or about 5 grams), all produce an immediate rise in blood-sugar levels.

Calories: 16 per teaspoon, 4 per gram.

Fructose

Also called fruit sugar, it occurs naturally in fruits and fruit juices. It produces a slightly slower increase in blood-sugar levels than sucrose, so it may be helpful for people who experience "sugar rebound." But fructose may be easy for the body to convert into fat. And we're consuming very large amounts of it as high-fructose corn syrup, especially in sodas.

Calories: 16 per teaspoon, 4 per gram.

Sugar alcohols

Often found in sugar-free gum and no-sugar-added pastries, sorbitol, mannitol, maltitol, and xylitol are also in fruits. Why they're a good choice: They don't produce a significant rise in blood sugar, they're lower in calories than more quickly absorbed sugars, and they don't cause cavities.

Calories: 9 to 12 per teaspoon, 1.5 to 3 per gram.

Artificial sweeteners

The Food and Drug Administration has deemed five artificial sweeteners safe for everyday consumption by kids as well as adults: aspartame (Equal), acesulfame potassium (Sunett, Sweet One), sucralose (Splenda), neotame, and saccharin. (Saccharin's safety has been called into question, but long-term studies show no cancer risk to humans.) Their advantages: They're calorie-free, they don't produce a rise in blood sugar, and they don't cause cavities. Their disadvantages: Saccharin, aspartame, and acesulfame potassium don't taste exactly like sugar. And aspartame can't be used in baking or cooking.

Calories: 0.

Honey and maple syrup

These contain sucrose, fructose, and water and produce a quick rise in blood-sugar levels. Honey isn't safe for babies under 1.

Calories: about 22 per teaspoon.

Stevia

This herbal extract hasn't been tested in humans, but animal studies suggest a link to reproductive problems and cancer. Nutritionists caution that stevia shouldn't be given to anyone until more is known about its safety.

Calories: 0.

Jessica Snyder Sachs is the author of GOOD GERMS, BAD GERMS: Health & Survival in a Bacterial World (Hill & Wang/FSG October 2007).