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The birth and development of your child's green-eyed monster

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).

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A guide to address your top worries

copyright Jessica Snyder Sachs & Parenting magazine

When Katie Shutters's 13-month-old daughter, Averie, was born, she followed the recommended vaccine schedule for two months. Then she did some research and decided to hold off on additional shots until Averie turned 9 months old. "I liked the idea of my breast milk giving her the immunities she needs and allowing her body to work for her instead of some medicine," says the stay-at-home mom from Indianapolis. "She isn't in daycare, and we don't travel overseas. I had concerns about injecting her for no reason."

Eventually Shutters found a doctor who would immunize according to her schedule: "We broke up the MMR [which protects against measles, mumps, and rubella] into three separate shots spread out over a year, and we're skipping the chicken pox shot," she says. "Instead, I'd love to find a kid who has chicken pox so we could expose Averie naturally."

If Shutters's approach to vaccination sounds familiar, that's because it is. In fact, most moms don't have to look far beyond their circle of friends to find a family with serious concerns. It's not difficult to understand why. For one, it can be torture to watch your child get jabbed repeatedly with a needle. Combine that discomfort with a steady stream of negative publicity -- celebrity diatribes, alarmist news and Internet reports, ripped-from-the-headline TV shows -- and the wariness seems warranted.

Yet underneath all the debate and good intentions (after all, everyone hopes to be doing the best for their child no matter how or whether they immunize), there are some solid facts about the benefits of shots that cannot be ignored. "We live thirty years longer now than we did a century ago, thanks to purified water -- and vaccines," says Paul Offit, M.D., chief of infectious diseases at the Children's Hospital of Philadelphia. But as soon as compliance wanes, the protection we have against many devastating, and sometimes fatal, diseases wanes right along with it. This year's measles outbreak -- the biggest in nearly a decade -- may be the first warning shot, says Dr. Offit. Nearly all of the 131 people affected so far, many of them children, were purposely not vaccinated against the disease, according to a new report from the Centers for Disease Control and Prevention (CDC), in Atlanta. "We have to take this seriously," says Anne Schuchat, M.D., director of the CDC National Center for Immunization and Respiratory Diseases. "I do not want to see the day where thousands of kids get this disease and die when we have the tools to prevent it."

So what's a worried mom to do? [READ MORE IN THE NOVEMBER ISSUE OF PARENTING MAGAZINE]


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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.)

Thanks to his mom's encouragement, at 3 years old, Zachary Miller has become a vigorously active preschooler who loves racing around the backyard with his brothers, Matthew, 7, and Jake, 21 months. At 36 inches and 37 pounds, he's still on the stocky side. But he's developed the kind of habits that favor a lifetime of healthy physical activity. "He's very coordinated, riding his big brother's old training-wheel bike, kicking balls, climbing, and jumping," says his mom. "It's a regular circus around here.

Writer Jessica Snyder Sachs is the author of Good Germs, Bad Germs: Health and Survival in a Bacterial World and Corpse: Nature, Forensics and the Struggle to Pinpoint Time of Death.

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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

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).

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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)

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When you're tense, your kids feel it too. How to ease the pressure for everyone.

By Jessica Snyder Sachs, as first appeared in Parenting magazine

Like most moms, I wonder how my stress affects my child. On weekday mornings, though, I have an exquisite barometer at my fingertips: my daughter's hand as we walk down the sidewalk to her school. I'm amazed at how powerfully those small fingers can squeeze mine on the days I'm feeling the most harried and rushed.

She knows when I'm tense.

To psychologists, it goes by the name of "stress contagion"  -- the tendency of one person's tension to spread to those nearby. It's a phenomenon that's particularly evident in families. And children are most susceptible to its effects.

"Kids instinctively look to their parents to gauge whether all is right with the world," says Mark Sossin, Ph.D., an associate professor of psychology at Pace University in New York City. And they have an uncanny ability to know when all is not right, even when we try to hide it.

"Parents who, with all the best intentions, try to protect their children from their financial, marital, or work stresses nonetheless convey their anxieties nonverbally, in a powerful way," he says. Their kids see it in the furrowed brow and tensed shoulders, hear it in the too-loud tone of voice, and sense it in the distracted or irritable responses to their appeals for attention.

If it's occasional, that's fine. No one ever said that to be a good mom you have to be in a good mood all the time. It's all right for your child to see you sad, worried, even angry. But chronic tension at home can have a lasting impact. In one recent study of 326 families in Seattle, mothers who were anxious or depressed were twice as likely as other moms to take their children to the pediatrician with stomachaches  -- often when nothing was wrong. "If you establish a very stressful environment, you are increasing the chance that your child will develop an anxious disposition," says pediatric psychologist Jonathan Pochyly, Ph.D., of Chicago's Children's Memorial Hospital.

Knowing how your tension can affect your child might be the best incentive for addressing your own needs for rest, for relaxation, for rejuvenation. Here, common stress scenarios, and how some families have found a better way:

The Rushed Parent

"We used to have such a cramming mentality," says Laurie Kirkegaard of Atlanta. "We'd squeeze as much as we could into the week  -- and then still have lots to do during the weekends."

Both she and her husband, Jim, are self-employed consultants who work at home, and they'd find themselves continually juggling the needs of their clients with those of 5-year-old Ethan and Allie, age 3.  The backlog of household chores kept growing, and chronic late-night bedtimes left everyone ragged the next day.

For the Kirkegaards, the signal to change came from Ethan, who began to have discipline problems at school  -- everyday stuff like acting rowdy and not paying attention to the teacher. His mom and dad started to wonder whether their overbusy lives were part of the problem. So they sought out Atlanta-based parenting counselor Bob Lancer, author of Parenting With Love: Without Anger or Stress. He agreed that their supercharged pace was a concern.

"If you're living life in a rush," says Lancer, "you start blaming your child for not behaving, when what's really going on is that the constant overload incites his acts of rebellion, making normal behavior challenges more difficult to deal with."

stress remedy To move toward their new goals, the Kirkegaards became more selective in the clients they accepted ("lower-maintenance types," says Laurie), and that allowed more time for the family.

They established a firmer weekday routine for each child, cutting back on scheduled activities to one per child each week. Ethan, for example, dropped karate but kept his "ball camp" class. They started to have more regular weekday mealtimes. And on the weekends, which were much freer, they made a conscious effort to focus on their kids. They identified and eliminated several small daily stressors, too, like the habit of getting into intense work-related discussions around the kids. They closed the doors to the home offices when they were working so the kids couldn't just wander in.

Even cleaning up helped: Boxing extra toys and papers reduced the kind of household clutter that irritated Laurie, and also made it a lot easier to find shoes and jackets when the family was in a hurry to get out the door in the morning.

Would similar solutions work for your family? Each one is different  -- some can handle more busyness and activities than others  -- so in the end it's a personal decision. If your family feels stressed, it is, say experts  -- and reassessing your priorities may lead to more satisfaction and family peace. As a first step, try thinning your schedule until there's more time to move through each of your daily tasks without rushing  -- and some downtime for rejuvenation.

The Child-Frazzled Mom

"Our life is so loud right now!" says Amy Lester of Amarillo, Texas. Her son, Jake, is 6; her daughter, Darby, is 3. "When I've got both of them pulling at me  -- Jake wanting to help with everything, Darby crying  -- the chaos can really wear me out."

Playdates are the worst. "I like that my kids' friends come here to play, but sometimes I notice that my patience isn't keeping up." She knows she's near the edge when she hears the volume and pitch of her own voice rising, or she finds herself snapping over such "trivial" matters as a spilled drink. "Normally, these things would never bother me," she says.

Sommer Martorano of Boynton Beach, Florida, often finds herself frayed as she spends the day chasing after her turbocharged son, Nicolas, 2, undoing his random acts of toddlerhood. "I'll try to straighten up, and, as I turn around, I'll see him taking out everything I just put away."

stress remedy Parents need time-outs too. Even the smallest reprieve can give you a chance to catch your emotional breath. Lester plays "spider solitaire" on the computer to escape  -- and recharge  -- in the midst of chaos. "Although the computer's in the kitchen, I tune out while my husband takes charge of the kids for fifteen minutes. That silly little game works wonders."

For toddler-chasing Martorano, a solitary jog or a drive after dinner while her husband, Louis, plays with Nicolas is often the answer. When she's in the car, she says, "I just go to the pharmacy down the street. Maybe I'll buy a lipstick or something else that's small but just for me. Then when I drive home, I'll be singing along with the music on the radio, and I'm ready to take on another day!"

Looking forward to an adult playdate helps too. Knowing that she and her husband have a babysitter on Saturday nights helps keep Martorano calm in the midst of bedlam. "I tell myself, 'Saturday, we'll be sitting down in a restaurant!'"

To know that you need a break, though, the first step is simply recognizing when you're tense, says Robert Friedman, a psychotherapist in Queens, New York, who specializes in stress management. "Work on developing a body awareness of the places where stress affects you," he says. "Do you get indigestion or a stomachache, or a backache or a headache? Whatever your personal symptom, let it be your signal to take measures to short-circuit the stress response." Whatever works for you  -- deep breathing, tightening muscles and then releasing them, imagining that you're in a beautiful vacation spot  -- now's the time to use it.

The Preoccupied Parent

When Helen Mitchell of Marietta, Georgia, picked up her son, Tyler, 9, from school, her mind was often still swimming with the day's undone tasks. "When I was most preoccupied, that's when Tyler started asking the weirdest questions," she says. "Like 'Mom, what color is the sky?'" My first reaction was to get angry. I mean, he knows full well what color the sky is!"

But nonsensical questions may just be a way for a child to reach out to a mom who seems harried. So can being cranky, loud, or demanding. "Now I know it's just his way of trying to get my mind off whatever's bothering me  -- he sees it on my face," she says.

stress remedy When Mitchell realized, gradually, that being so preoccupied wasn't good for her son  -- that he really needed her full attention  -- she started to make a habit of "settling myself down" before picking him up. She'll take an hour to lift weights or do yoga at her gym, or at least listen to some relaxing light jazz or uplifting gospel as she waits in the carpool line. "By the time I ask him about his day, I'm really listening," she says.

Chelle Daly of Chandler, Arizona, has a different trick to let go of mental distractions so she can focus on daughter Audrey, 3, and 20-month-old son Kelden. "I pretend someone I admire is nearby," she says, "and I want that person to feel proud of me." In the process, she forgets about whatever was bothering her and more fully enjoys her children.

Even something as simple as taking a deep breath can help you release whatever is worrying you, says Friedman. He recommends leaving notes to yourself in crucial places  -- the car dashboard, the kitchen counter, the baby-changing table  -- that say simple things like "Breathe" or "Be here now," to remind yourself to focus on the moment and not on everything else you need to do. As you exhale, he adds, visualize the tension leaving with your breath.

The Anxious Parent

I'll own up to this one. While momhood forced me to slow down (a bit), it opened my mind to a whole new cosmos of fears. As a new mom, I fretted over developmental delays in our otherwise healthy daughter. Now that Eva's in school, I worry about whether she's making friends, being encouraged, feeling good about herself. Of course, I try not to express my concerns, in so many words, to her.

"You don't have to," says Friedman. "While some parents consciously put stress on their children  -- for example, by demanding that they do well all the time  -- others do so without being conscious of it at all." So maybe it shouldn't be a surprise that when I'm standing in the doorway, anxiously watching Eva, now 13, walk to a friend's house alone, I see her jump at the sound of a car motor. The result, says Friedman, can be a cycle in which the concerns of parent and child feed off one another.

stress remedy It helps to keep in mind that anxiety doesn't solve problems. But to break the worrying habit, many of us need repeated reminders to let go. First, pay close attention to your body's signals: Is your jaw clenched, are your shoulders up to your ears, is your breath short and shallow? If so, take a moment to breathe deeply and relax so you can begin to shift mental gears.

When he's working with truly hard-core worriers, Friedman may prescribe negative reinforcement: Put a rubber band on your wrist and give it a gentle snap whenever you catch yourself fretting. (It works, but let me tell you from personal experience: A deep breath is a lot more enjoyable.)

I've also found it helps to admit to my daughter that my anxieties tend to be over the top. When we can both laugh at them, that's even better.

Whatever your family scenario, there's no avoiding the fact that every solution to hand-me-down stress comes back to your need, as a parent, to take care of yourself. That may mean prioritizing to make time for yourself, or working to let go of worries, or laughing at them.

We all want what's best for our children. We'll sacrifice if need be. But sometimes, the best way to get there is through our own happiness.

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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Why some germs may be good for your child's health

By Jessica Snyder Sachs, as first appeared in PARENTING magazine

Emma Donahue, 2, enjoys life on her family's farm. She loves to touch the menagerie of animals -- and pick up the feathers and other "treasures" they leave behind. "I'm not the type to get stressed out over dirt. That takes a lot of the fun out of being a kid," says her mom, Stacey, of Lithia, FL. "I just tell Emma not to put her hands in her mouth until we can wash up."

Emma's early exposure to old-fashioned muck, with its cornucopia of germs, may be just what the doctor ordered -- at least according to the "hygiene hypothesis" and a growing number of studies that support it. The crux of the theory: The modern war on germs may have gone too far, wiping out too many of the good guys along with the culprits that cause diseases. Exposure to certain bacteria in the first years of life is crucial for teaching the developing immune system to recognize friend from foe. Without this early training, the imbalance within the body's immune cells may predispose them to attack a host of harmless substances, such as cat dander and pollen -- or even other cells in the body.

That immune-system immaturity may be a major contributor to one of the most perplexing public-health problems our country faces: the increasing number of kids who are suffering from childhood allergies, asthma, and eczema. "The hypothesis is a leading theory to explain things like rising rates of these illnesses," says Richard Johnston, M.D., a member of the Institute of Medicine and a pediatric immunologist at the University of Colorado School of Medicine, in Denver. Many experts are also investigating possible links to adult autoimmune diseases, such as diabetes, multiple sclerosis, and lupus.

 
It's time to rethink our efforts to wipe out every microbe that comes near us. Some of those germs might actually be good for our kids.

"Part of the problem comes from our belief in the myth that we would want to live in a germ-free world," says Graham Rook, M.D., an immunologist at the Royal Free and University College Medical School, in London. "Lab animals raised in a genuinely sterile environment develop abnormal immune systems." Indeed, a typical adult human houses trillions of bacteria in his intestines. These normal gut "flora" aid digestion, produce such nutrients as vitamin K and certain B vitamins, and play a long-recognized but little-understood role in the operation of the immune system.

Even our skin is replete with harmless bacteria so deeply embedded you could never scrub or sanitize them away. Nor would you want to: These skin germs serve as a barrier against harmful stray bacteria that might otherwise take up residence there.

Of course, no one is claiming we shouldn't protect ourselves against illness. Or return to the days before water treatment, antibiotics, and vaccinations largely wiped out scourges like cholera, tuberculosis, and polio. "Rather, we're recognizing that in the process of sanitizing our modern environment, we've taken away something that the immune system needs to program its early development," says Dr. Rook.

Scientists aren't yet certain how the process works, but they believe specific microbes switch on cells that then suppress a reaction against allergens and beneficial bacteria. They point to numerous studies that show that allergies and asthma occur less frequently among children who:

· have older siblings (think walking germballs)
· spend time in daycare in the first year or two of life
· have early exposure to pets or farm animals
· live in rural parts of the country or in areas of the world that lack modern sanitation.

The good news: The organisms that babies and toddlers need to encounter in daily life to develop healthy immune systems aren't the kinds that make us sick. Instead, the common denominator among older siblings, daycare, animals, and rural environments appears to be the largely harmless bacteria found in dirt, mud, puddles, and ponds.

The hundreds of antibacterial products flooding the market each year -- in everything from hand gel and soap to toys and even sneakers -- may be making the problem worse. "If our past experience with overuse of antibiotics is any guide, these items could do more than eliminate good germs," says Tufts University microbiologist Stuart Levy, M.D., author of The Antibiotic Paradox. "They're likely to encourage bacterial resistance to these products -- and to antibiotics." Some of those newly resistant bacteria could cause illness.

 

Echoing Dr. Levy's concerns, the American Medical Association recently urged government regulators to speed their review of antimicrobial agents in consumer products to determine whether they actually pose a threat. (Manufacturers of these products defend them as beneficial, pointing out that they can kill or inhibit the growth of bacteria, including salmonella and E. coli, that cause intestinal illnesses, skin infections, and other unpleasant -- and in some cases fatal -- diseases.)

The alarm first sounded in 1998, when researchers at Tufts University discovered that triclosan, the active ingredient in most antibacterial cleansers, works more like an antibiotic drug than a disinfectant. Instead of obliterating bacteria and then evaporating (like bleach), triclosan blocks a specific enzyme that germs need to survive. The trouble is, microbes are infamous for developing ways around such narrow modes of attack. Triclosan also lingers on such surfaces as tubs and kitchen counters for days, even weeks, which gives bacteria plenty of time to develop resistance.

While critics counter that no one knows whether any of this poses a real problem, many microbiologists believe that it's not worth taking the risk, especially given that the only place triclosan and other similar products have been proven to reduce the spread of illness is in hospitals, where workers scrub their hands and douse surfaces for 5 to 20 minutes -- not the mere seconds most people spend on such activities.

So what should you do to give your child's immune system a head start, without going overboard? Experts -- even those who aren't sold on the hygiene hypothesis yet -- agree that taking the following easy steps is wise:

Widen your circle: If your child's not in daycare and doesn't have an older sibling, make sure she still has lots of contact with other kids -- and their germs. You might join a playgroup or sign her up for Mommy and Me classes once or twice a week. But don't purposely expose her to people who are sick -- those are not the type of bacteria she needs.

Don't relegate your pet to the backyard It's fine to have a gentle pet in the same room with your baby. (But not if your child's already developed an allergy to animals -- in that case, isolating the pet from bedrooms, or even finding it a new home, may be called for. Once an allergy develops, exposing a child to the allergen only makes things worse.)

Head outdoors: Because good bacteria are found in soil and natural bodies of water, families who enjoy gardening, camping, a day at the lake, or trips to the country shouldn't be shy about including their youngest one in the fun.
Stick with your tried-and-true cleaners The best antibacterials are the old-fashioned ones, says Dr. Levy. That includes bleach water (one cup chlorine bleach to one gallon water), cleansers (like Comet or Bon Ami), alcohol (either isopropyl or ethyl alcohol), or hydrogen peroxide. It's also smart to open windows to bring in fresh, clean air.

Recent warnings about the dangers of triclosan have spurred new antibacterial cleaners and lotions labeled "alcohol- and triclosan-free." But take care: These often use triclosan's close cousin, triclocarban, a compound that is thought to work in essentially the same way, so check the ingredients. If you must use these or other antimicrobial products, do so sparingly -- only when cleaning up after cutting raw meat or poultry, for example, or if someone living in the house has a medical condition that leaves him susceptible to infection.

Don't encourage germaphobia: Of course, parents mean well when they disinfect playground equipment or insist that kids stay away from yucky, dirty mud. But doing so may pass on some unnecessarily scary ideas about the world. Instead, try to give your child the freedom to explore his environment, then matter-of-factly tell him when it's time to wash up. If he starts refusing to touch things, washing excessively, or asking fearful questions about dirt and grime, look hard at the message you're sending. It may be that in the end, the best way to give our kids a healthy attitude about germs -- as well as a strong immune system -- is by trying not to protect them too much.

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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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: Recent research (in adults) suggests that artificial sweeteners--like true sugars--may elevate the risk of cardiovascular disease, perhaps because the body responds to sweet tastes by producing insulin and/or storing fat. In addition, saccharin, aspartame, and acesulfame potassium don't taste exactly like sugar. 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).