At odds with vaccinations is a class of chemicals known as perfluorinated compounds (PFCs). PFCs are widely used in products and packaging to repel water, grease, and stains. Non-stick cookware, carpets, clothes, rain gear, fast-food wrappers, and pet food bags are just a few of the many products that are coated with PFCs. You might know them as Teflon, Scotchgard, Stainmaster, and Gore-Tex.

Experts have long been concerned about health risks posed by PFCs mostly because they persist in water systems and food chains for years, and because they are known to have elimination half-lives in humans of at least four years or more.

Previous research shows that the immune systems of mice are highly sensitive to such chemicals. And this week, a new study finds disturbing results in children.

Research
A research team led by Dr. Philippe Grandjean of Harvard University conducted a population-based study to investigate the antibody response to childhood immunizations. As Grandjean and colleagues explain, antibody responses to diphtheria and tetanus vaccinations are a measure of immune system function in children.

The study began with a group of 656 consecutive births in the Faroe Islands from 1999–2001. To examine the long-term antibody responses to the immunizations, the children were followed to the age of 7. Approximately 71 percent of participants (464 children) completed the study.

Researchers collected data on:

• prenatal exposure to PFCs, from blood collected from the mother during the 32nd week of pregnancy
• postnatal PFC exposure, from blood collected from the child at age 5
• concentrations of tetanus and diphtheria antibodies

Results
The researchers found that children with twice as much PFCs in their blood had half the antibody response to the tetanus and diphtheria vaccines. In addition, they found a lower antibody response in children who had received combination booster vaccines containing pertussis, polio, or both, compared to those who received diphtheria and tetanus shots only.

In short, prenatal and postnatal chemical exposures were associated with antibody levels below a protective level. That’s concerning, Grandjean explains, because “routine childhood immunizations are a mainstay of modern disease prevention. The negative impact on childhood vaccinations from PFCs should be viewed as a potential threat to public health.”

“You can only lose a certain amount (of antibody response) and then you won’t have enough antibody left to fend off the disease were you infected later on.”

In a recent interview with National Public Radio (NPR), Dr. Alan Ducatman from West Virginia University, which has been part of a large study of C8, a common PFC, says, “These chemicals aren’t as frightening as some found in the environment, but they are clearly problematic.” Ducatman added that the C8 study also found some evidence of an effect on the immune system.

Consumers in the U.S. have reason to be concerned about PFCs, says Ducatman. Even though exposure to some [PFCs] is falling, there are places where levels are rising.

One of those places is China, says Grandjean. And that’s a problem for countries that buy products from China. “We may just be importing products with the same compounds,” says Grandjean.

Recommendations
This study raises the need for parents to make every effort to keep PFCs out of the environment, our homes, and our children’s bodies.

• Choose safe cookware and kitchen utensils. Cast iron, enamel coated cast iron, or stainless steel cookware are suggested options. Choose stainless steel utensils. If you want to hang on to one non-stick skillet, make sure the skillet is in good condition (no scratches or chips). You can limit the release of fumes by not pre-heating the skillet and avoiding high heat when cooking. (The National Resources Defence Council (NDRC) offers a shopper’s guide to pots and pans.)
• Forgo fast food. Concerns over PFCs are one more health-related reason to avoid fast food!
• Use real plates instead of paper plates. PFCs are commonly used in paper products and food packaging to make them grease resistant.
• Choose safe toys. Even trusted brands are made in countries where there are no restrictions on the use of PFCs.
• Choose products free of PFCs (without PTFE or perfluoro). You’ll also want to avoid microwave popcorn, stain-treated carpets or upholstery, and some personal care products. (Environmental Working Group offers a one-page fact sheet of helpful tips.
• Talk with your child’s physician. If you’re concerned about the findings of this study or the effects of environmental contaminants on the effectiveness of your child’s vaccinations, talk with your child’s health care provider. You may want to consider single booster shots rather than combination vaccines if possible.
• Stay aware of policy changes. The U.S. Environmental Protection Agency has promised to eliminate the use of certain PFCs by 2015, but these chemicals and their health effects persist—for many years.

Now that assertion is being challenged by a team of researchers from the University of California at San Diego. According to Dr. Haruna Feldman and colleagues, there is “no safe threshold for alcohol consumption by pregnant women.” Rather, women who are pregnant and those who may become pregnant should abstain from alcohol altogether.

Research
Dr. Feldman and researchers pulled data from a statewide confidential individualized risk assessment program available to pregnant women in California. They examined nearly 1,000 mother-baby dyads who used the service from 1978 to 2005. They studied how prenatal alcohol consumption correlates to characteristic alcohol-related facial features and growth deficiencies.

Researchers collected specific data about alcohol use through a series of interviews with mothers who contacted the risk assessment program. In addition, medical records were reviewed, and babies were examined by specially trained staff.

As part of their effort to plug gaps in knowledge about how alcohol dose and timing affects risk at each point in pregnancy, they paid particular attention to the first trimester—the time when women may not know they are pregnant given that roughly 50 percent of all U.S. pregnancies are unplanned. They examined the first six weeks and the second six weeks of the first trimester, plus the first trimester as a whole, the second trimester, and the third trimester.

The women who enrolled in the study were on average 31 years of age and 13 weeks pregnant. The women consumed on average .06 drinks per day in the first trimester, with consumption ranging from 0.00 to 12.14 per day. For both the second and third trimesters, average daily intake was 0.00, with a range of 0.00 to 4.00 drinks per day. The researchers split the sample into two groups according to alcohol consumption; group one consumed 1 or more drinks per day in the first trimester and group two consumed less than 1 drink per day.

Results
Babies of mothers who reported drinking an average of one or more drinks per day during the first trimester were found to exhibit all of the physical traits of FASD being evaluated in this study, including microencephaly (small head), thin upper lip, smooth philtrum (area between the lip and the nose), and reduced birth length and weight. However, these characteristics were not limited to babies of mothers who consumed higher amounts; they were also found in babies of mothers who consumed small amounts of alcohol.

Many of the significant findings were among babies who were exposed to alcohol during the second half of the first trimester, from weeks 6–12 of pregnancy. Researchers speculate that this result may be because the study includes only live births, and doesn’t account for losses due to miscarriage during the vulnerable first six weeks. Alternatively, it could be that the placenta is not fully functional during the early weeks of pregnancy and therefore limits the amount of alcohol transferred to the baby during this time.

Perhaps most important to women making decisions about consuming alcohol while pregnant, the researchers noted a significant and strong dose-response effect. That is, the risk of FASD characteristics increased as the average number of drinks consumed daily increased. It also increased as the number of drinks consumed during a single occasion increased. Each alcoholic drink consumed and each event during which alcohol was consumed increased the baby’s odds of exhibiting FASD facial traits, as well as smaller birth length and weight.

Recommendations
As noted, this study focused exclusively on physical characteristics of babies who were exposed to alcohol in utero. However, since experts believe “far more children with prenatal exposure to alcohol are affected neurobehaviorally than those who exhibit structural features” of fetal alcohol disorders, this study ought to give women who are pregnant or likely to become so plenty of reason to pause.

“There is no safe threshold for alcohol exposure,” the authors conclude. Women of childbearing age who are pregnant or who could become pregnant are encouraged to abstain from alcohol completely.

The bottom line? When a pregnant woman drinks, so does her baby. And, as this study suggests, the repercussions may be much more serious than people think.

Rodale begins with the customary compliment, “…breastfeeding is better for Baby and Mother,” and follows with the inevitable, but, which in this case is however. Which effectively makes everything before the but (however) irrelevant. Or as my Dad would indelicately say, “It makes everything before the but, bullshit.”

“…breastfeeding is better for Baby and Mother… However, having done it three times, I think it’s time to tell the truth about it so moms know what they are getting into,” says Rodale.

She then goes on to list 11 “unvarnished, unfiltered truths about breastfeeding.” While I agree with many of the items on Rodale’s list—and applaud her efforts to give mothers realistic expectations—several of her truths (#s 1, 2, 3, 4, and 11) are short on facts.

#1 “Your milk will not “come in” for two to four days after the baby is born.”
Fact: Mothers begin to produce milk around the 20th week of pregnancy. The fact that small amounts of milk are produced in the first days after birth reflects the physiologic needs of newborns as they adapt to life outside the uterus. No one consumes a five-course meal after running a marathon. Athletes choose small, frequent meals instead. The same is true of newborns. Small, frequent feedings will ensure that newborns get the nutrients they need in the first days after birth, and reduce the risk of babies getting formula supplements. Rodale cautions mothers not to “let the baby over-suck.” What she fails to recognize is that nipple damage occurs when babies are poorly latched, regardless of how often they breastfeed. Mothers are urged to keep their babies close at hand, and to respond to every request to breastfeed. This is your chance to practice while there is expert help available.

#2 “Be careful what you wish for because when your milk finally does “come in,” it will come in with a vengeance, and it will hurt like hell for two to three days and your boobs will feel like giant rocks and you may even want to cry.”
Fact: Milk production will increase dramatically around day 2–4. Milk removal is key to preventing engorgement (rock-like boobs). Responding to your baby’s every request to breastfeed will ensure that your baby breastfeeds at least 8 times in each 24 hours, and that your breasts remain soft, albeit full. Cool compresses (bags of frozen peas covered with a wet cloth) will reduce the swelling so that your baby can latch on well. While the supportive bra recommended by Rodale may be helpful, the bra should be removed for several feedings during the day and at night, so that milk can be removed from all parts of the breast.

#3 “You will start to leak. And you will leak for months, or maybe even years…”
Fact: Leaking is cause for celebration. Yes, I’ve got milk! Now the only challenge is getting the milk out of your breast and into your baby. Once your baby settles into a routine (around 6–12 weeks) and your breasts know how much milk to make and when to make it, leaking will become less of an issue. Leaking rarely lasts more than 3–6 months. Breast pads can be used to protect your clothing. Some pads are meant to be used only once, while others can be washed and used over and over. Remember to change pads frequently, and avoid pads with waterproof liners that trap moisture against the skin.

#4 “Your nipples will probably hurt. A LOT. For a good two to three weeks.”
Fact: During the first week or two of breastfeeding, you may feel pain at the start of a feeding, when your baby first latches on to your breast. If your baby is positioned well, the pain should stop after a few seconds. If the pain persists, slide your finger into your baby’s mouth, release the latch, remove your baby from the breast, and try again. If your baby is positioned poorly and continues to breastfeed, you can damage your nipples. Don’t ignore breast or nipple pain.

#11 “Finally, one day your boobs will return to normal size, and even though the shape might have changed and they might sag a bit more, they will still be beautiful and loved by all the people in your life who loved your breasts to begin with.”
Fact: Breasts may change shape, but before you assign breastfeeding as the culprit, know that breast changes occur in women who bottle-feed as well. Why? It’s a result of weight gain and weight loss—something every pregnant woman, and many never pregnant women, experience.

As for the remaining six items on Rodale’s list, my favorites are #10 “Breastfeeding is free” in which she dispels the myth that breastfeeding moms need to follow a special diet, and reminds readers that even in a toxic world, a mother’s own milk is still a better choice “than whatever mystery is in formula.” And #6 “Once the pain goes away, it is totally easier,”—although I would downplay the pain and emphasize the convenience. But I particularly like Rodale’s use of the word “easier,” because the fact is breastfeeding isn’t always easy. Like any new skill, it often requires patience, persistence, and practice. But it does get easier. Plus, as Rodale aptly states, in the end, “It’s worth it!”

An advisory panel of the CDC called on the agency to abandon the term “blood lead level of concern.” Even low levels of the heavy metal are problematic, as indicated on the first page of the panel’s report, Low Level Exposure Harms Children.

Recognizing the health and developmental risks of even low levels of lead, the panel urged the CDC to halve the blood lead level (BLL) of “lead poisoning” from 10 micrograms per deciliter of blood to 5 micrograms per deciliter, arguing that not only are children with so-called “low levels” at risk for IQ deficits, attention-related behaviors, and lower academic achievement, but research shows lead negatively affects cardiovascular, immunological, and endocrine function as well.

Background
The CDC has been charged with eliminating childhood lead poisoning in the U.S. for nearly 25 years. The key elements of the agency’s current strategy, with the Department of Housing and Urban Development and Environmental Protection Agency, include identification and control of lead paint hazards; identification and care for children with elevated BLLs; surveillance of elevated BLLs in children to monitor progress; and research to further improve childhood lead poisoning prevention.

The Advisory Committee on Childhood Lead Poisoning Prevention (ACCLPP) was convened by the CDC to “advise and guide the CDC regarding new scientific knowledge and technical advances and their practical implications for childhood lead poisoning prevention efforts.”

Implications
It seems a sure thing that the CDC will adopt the ACCLPP-recommended standard just as they have adopted all of the panel’s recommendations in the past.

Furthermore, this report follows naturally on the heels of its Guidelines for the Identification and Management of Lead Exposure in Pregnant and Lactating Women, released almost one year ago. Like the ACCLPP’s recent release, that document set the level at which health care providers should act at 5 micrograms (except for workplace exposure, for which up to 10 micrograms per deciliter was considered acceptable).

Under the CDC’s existing 10-micrograms standard, it is estimated that 250,000 U.S. children suffer from lead poisoning. The proposed change to 5 micrograms could almost double that figure, recognizing lead-exposure risks for 450,000 children nationwide.

While some lead poisoning cases in children can be pinned to toys, most are due to paint in their environments. As explained elsewhere on baby gooroo, lead-based paint was often used in houses built prior to 1978. If the paint is in good condition, there’s usually no problem. But if the surface is breaking down, or if the paint is disturbed by renovation, then the risk of exposure is high. In addition, windows and doors can pose a problem, as friction can release lead-based paint dust into the room. This can mix with household dust and stick to surfaces. Since babies and toddlers don’t wash their hands as often as older children and often put their hands in their mouths, they are at a high risk for illness and poisoning from paint found right in their homes.

In response, the ACCLPP recommends that the CDC develop a nationwide campaign to ensure “that no children in the U.S. live or spend significant time in homes, buildings, or other environments with lead-exposure hazards.”

Other recommendations of the ACCLPP include:

• Clinicians should serve as leading information source about lead. They should educate patients about environmental lead assessment prior to screening.
• CDC should facilitate data-sharing between stakeholders, identify funding for lead hazard remediation, provide families with information, and develop/enforce lead-safe housing standards for rental and owner-occupied housing.
• CDC should also emphasize the importance of environmental assessments, which should be conducted in all units of a multi-unit dwelling if a problem is found to exist in a one unit.
• CDC should encourage additional research on health care interventions, as well as data development and use.

It’s not a sure thing that the ACCLPP’s recommendations will be adopted—but this report calls for fresh attention to an important, manageable health risk too many American children face.

If you want to voice your support for the lead exposure updates, you can contact the CDC or the ACCLPP directly.

Sounds simple enough. But a recent New York Times article suggests that good intentions may have unintended consequences. Since the no aspirin policy was implemented, cases of Reye’s syndrome have decreased but asthma rates have risen.

Dr. Arthur Varner was the first to suggest a possible link between acetaminophen and asthma in an article published in 1998 in The Annals of Allergy and Asthma Immunology. Since then, numerous studies have shown similar results, including a large analysis of data on more than 200,000 children that found an increased risk of asthma among children who had taken acetaminophen.

Most recently, Dr. John T. McBride, a pediatrician at Akron Children’s Hospital in Ohio, in an article published in the December 2011 issue of Pediatrics suggests that there is enough evidence for doctors to recommend not giving acetaminophen (using ibuprofen instead) to children with asthma or those at risk for developing the disease.

However, Dr. Mahyar Etminan, a pharmocoepidemiologist at the University of British Columbia and lead author of a meta-analysis on acetaminophen use and asthma published in 2009 urges caution. Despite evidence showing an increase in the risk of asthma and wheezing in children and adults exposed to acetaminophen, it’s unclear whether acetaminophen is responsible for the increase or whether the viral infection that prompted the use of acetaminophen is the cause. Parents of study children were asked to remember how much acetaminophen they gave their child and how often. Because parents of children with asthma are more attune to events leading up to an attack, they may be more likely to recall giving their child acetaminophen.

Until more data is available (several trials are currently underway), parents are urged to talk with their child’s health care provider about treatment options for fever. Given that both acetaminophen and ibuprofen have been linked to asthma and aspirin to Reye’s syndrome, perhaps using anti-fever medications sparingly is the best course of action for parents.

Click here to read more about treating fevers.

Parents must make sure their kids eat enough but not too much, and ensure the foods their children eat satisfy the recommended daily allowances displayed on the new national standard, MyPlate. But kids typically eat what they want, when they want, with little regard for accepted norms, be it three square meals a day, the clean plate club, or arugula salad with candied pecans and shaved parmesan cheese. The omnivore child who will eat anything and everything is a rarity.

For some children, the picky periods are short-lived, while others survive for months or years on one or two go-to foods. Where does the picky eating tendency come from? Will all kids eventually eat a variety of healthy foods?

Nature versus nurture
In 2007, scientists found that an expectant mother’s diet during pregnancy and while breastfeeding can affect her baby’s taste preferences. Flavors in a mother’s diet pass to her unborn baby via the amniotic fluid and later through breast milk, in essence creating preferences for certain types of food.

That same year, researchers examined 5,390 sets of twins and discovered a genetic link between eating habits and taste preferences, suggesting that parents may have little control over taste preferences. Researchers concluded that 78 percent of a child’s aversion to new foods is genetically determined, while only 22 percent is affected by the environment.

Still, that 22 percent is what prompts parents to beg and plead, hide vegetables in cookies, cakes, or macaroni and cheese, and ultimately resort to bartering or threats (“No TV for a week!”) in an effort to get their children to eat healthy foods (or any food for that matter).

More recently, a study published in the December 2011 issue of Appetite, examined 104 U.K. mothers with children ages 3–6 years and recorded mealtime behaviors including fussiness, slowness in eating, under-eating in response to emotional state, and how quickly children said they felt full.

Results showed that mothers with fussy children applied more pressure on their children to eat, which in the end resulted in the children eating less not more. Gentle encouragement won the day, with undue pressure a distant second.

Study author, Claire Farrow, a senior psychology lecturer at Loughborough University in Leicestershire, England, told MyHealthNewsDaily, “These findings support other research which has shown that if parents or caregivers override their children’s signals of hunger and fullness—as in pressuring the child to eat when not hungry—then often children struggle to regulate their appetite appropriately in the future.”

In short, know your child’s feeding behavior, hunger habits, eating tendencies, and meal timings, and use them to your advantage. It’s okay to allow kids to not eat when they say they’re not hungry and to create their own eating habits and schedules. On the other hand, giving your child junk food, just so that they will eat something, is rarely justified.

“The more you force your child to eat, the less likely your child will be to eat,” says Ellyn Satter, author of two popular books on parent-child feeding relationships and the focus of an NPR report that basically says “back off.”

There is no silver bullet; no simple solution. Every child is different, but there are some things every parent can do and plenty of places to learn more.

The USDA suggests the following:

• Introduce new foods slowly over time.

• Offer one new food at a time.

• Keep foods simple and separate.

• Offer new foods first at mealtime and in small portions.

• Always eat what you offer your child.

The American Heart Association has more tips related to snacks, mealtimes, and sweets:

• Establish set times for meals and snacks and stick to it. Kids like routines.

• Keep healthy, finger foods available. Toddlers are often eager to feed themselves.

• Serve sweets in moderation, but don’t eliminate them altogether. Children who get a piece of candy or a small scoop of ice cream now and then are less likely to overeat when sweets are offered.

The Mayo Clinic focuses on the shared experience of eating between a parent and child and urges parents to take a longer view. Most kids may get plenty of nutrients over the course of a week even though two days are devoted to chicken nuggets and one day is a food strike. Some tips:

• Children are more likely to eat foods they have chosen and prepared. At the grocery store, encourage your child to select fruits, vegetables, and other healthy foods. Toddlers can rinse and stir while you are cutting and chopping.

• Make mealtime fun by cutting foods into various shapes and serving brightly colored foods.

• Encourage exploration. Tasting, touching, and talking about the color, shape, texture, and smell of new foods can make them more appealing to younger children.

Ultimately, if your child refuses to eat, don’t force him to. (And don’t bribe him either.) Respect his appetite. When he comes looking for food, be prepared to dish up some healthy options.

An old idiom claims that you can lead a horse to water, but you can’t make it drink. But what if that horse is thirsty? You better believe he’ll drink, eventually; it just might not be exactly when you want him to drink. Kids are pretty much the same. With a variety of methods to choose from, feeding children is largely trial and error. Like breastfeeding, healthy eating habits develop over time, and often require patience, practice, and persistence. But their importance can’t be overstated.

Unfortunately, the USDA’s provisions are under fire by Congress.

Although it has been 15 years since school lunch standards were updated, buying school lunch is as popular as ever. The USDA estimates that the proposed changes would reach approximately 32 million children every school day. Given that school lunch can provide half of the daily calories for many children and that nearly 32 percent of children ages 6 to 19 years are overweight or obese, the school lunchroom seems like an obvious opportunity for change.

The proposed changes to the school meal program regulations were based on research by the Institute of Medicine (IOM), found in its 252-page report, School Meals: Building Blocks for Healthy Children, the Dietary Guidelines for Americans, and Dietary Reference Intakes.

The changes aim to bring the Nutrition Standards and Meal Requirements into line with what’s been learned about nutrition science in the years since the requirements were last updated. They also strive to increase the availability of key food groups in the school meal program, including fruits and vegetables, whole grains, and fat-free or low-fat milk, and to set limits on saturated fat and sodium.

Fifteen years ago, a cost-cutting measure by the USDA threatened to allow condiments such as ketchup and pickle relish to be classified as vegetables under the school meals program. That was overturned, but recent action by Congress has allowed pizza sauce and French fries to maintain their vegetable status in lunchrooms across the country.

Is tomato paste a vegetable?
Under the guise of tight budgets, Congress has prevented the USDA from adopting its newer, more rigorous nutritional standards. Saying that schools shouldn’t be telling children what to eat—and ignoring the fact that schools will still be doing that, just with fewer healthy options—members of the House Appropriations Committee determined that the USDA’s new rules would “provide greater flexibility for local school districts to improve the nutritional quality of meals.”

Many school districts chafed at the cost of meeting the new requirements, and Congress also felt pressure from the food industry, including ConAgra, Coca-Cola, Del Monte Foods, and makers of French fries and frozen pizza, like Schwan. These companies spent more than $5.6 million lobbying against the USDA’s proposed changes.

Not everyone is thrilled with Congress’ decision. Margo G. Wooten, director of nutrition policy at the Center for Science in the Public Interest, a nonprofit research group, notes that child nutrition and childhood obesity are “national health concerns,” arguing that Congress “should be supporting USDA and school efforts to serve healthier school meals, not undermining them.”

According to the USDA, the proposed changes would have cost about 14 cents more per meal. That would have raised the annual budget for the school nutrition program from about $70 billion per year to about $71.4 billion per year. However, by bringing more fruits and vegetables into the school lunch program, and making standbys like pizza healthier with whole grain crusts and lower levels of sodium, the revised lunch program would have exerted an important influence on America’s schoolchildren.

Not only could school lunch changes have improved children’s health, but it would have provided a vivid, daily example of good nutrition. It’s hard to understand the importance of “2 ½ cups of veggies a day” in the classroom when the veggies in the cafeteria are tablespoons of sodium-laden pizza sauce under the cover of cheese.

Lack of iron is currently the world’s most common nutrient deficiency, according to the U.S. National Institutes of Health. The U.S. Centers for Disease Control and Prevention (CDC) reports the condition can range from depleted iron stores that do not result in health issues to iron deficiency with anemia, which affects the functioning of several organ systems. In infants, iron deficiency can also delay gross motor skills as well as cognition. (You can learn more about iron deficiency on baby gooroo here.)

Although the prevalence of iron deficiency has decreased in the U.S. since cereals and infant formulas have become fortified with iron, more than 9 percent of Americans remain iron deficient, the CDC adds.

Among children, iron deficiency most often occurs between the ages of 6 months and 3 years—a time when children grow very quickly and may not be able to keep up with their bodies’ demands for iron through diet alone.

Some infants and children are at greater risk for this deficiency than others, the CDC notes, including:

• Premature or very small infants. (Infants’ essential iron stores are accumulated in the womb during pregnancy. The infants of breastfeeding mothers who are iron deficient as well as premature infants are likely to deplete their iron stores by 3 to 4 months of age.)

• Breastfed babies who are not given iron-fortified cereals or another iron-rich food starting around 6 months of age.

• Formula-fed babies who do not get iron-fortified formulas.

• Babies given cow’s milk before age 12 months, as well as children between 1 and 5 years of age who get more than 24 ounces of cow, goat, or soy milk daily. (Excessive milk intake can decrease a child’s appetite for other iron-rich foods, such as meat or iron-fortified cereal.)

• Children with chronic infections, restricted diets, or other health issues.

Since adequate stores of iron are essential to infants’ central nervous system development, infants are often treated with iron supplements to avoid long-term developmental problems. The AAP recommends iron supplements for most infants—but these recommendations are not without controversy.

How much is too much?
New research has renewed controversy over universal iron supplements, stating that too much iron can have adverse effects on brain development.

A Chilean study published online in Archives of Pediatrics & Adolescent Medicine found that infants with high hemoglobin levels who received iron-fortified formula from 6 to 12 months of age had worse developmental outcomes over the course of a decade than babies who were fed low-iron formula.

None of the 835 children who participated in the study were considered to be iron-deficient when the study began. After 10 years, 473 children were reassessed. The researchers found the 244 kids who received iron supplements in their formula scored 1.4–4.6 points lower on every developmental test (particularly those assessing spatial memory and visual-motor integration) than kids who didn’t receive iron supplements.

They added that children who had the highest hemoglobin levels (more than 12.8 g/dL) at age 6 months and received iron-fortified formula had the most negative effects from the supplementation, scoring 10.7–19.3 points lower on the tests than those with low hemoglobin levels (less than 10.5 g/dL). In contrast, those with low hemoglobin levels scored 2.6–4.5 points higher.

On the flip side, the study authors point out, previous research has shown that at 5 and 10 years old, children who were iron deficient and anemic in the first year of life also have poorer developmental outcomes. They added that iron has shown positive effects on some aspects of iron deficient children’s behavior and function, including “exploration, psychomotor development, and visual perceptual skills.”

Although the researchers admit the link between iron deficiency, iron deficiency anemia, and developmental problems remains controversial, they concluded iron supplementation could have negative effects on brain development and universal guidelines on iron supplements for infants may need to be reevaluated.

In an editorial accompanying the study, Dr. Parul Christian, Department of International Nutrition, Center for Human Nutrition, The Johns Hopkins Bloomberg School of Public Health pointed out several limitations, which could have an impact on the findings, including:

1. Maternal smoking has also been associated with poor developmental outcomes. The study lacked information on maternal smoking after 10 years as well as the smoking habits of other people living in the child’s home.

2. The NIH reports that hemoglobin levels can also be lowered or elevated due to a number of causes, including:

(low levels)

• Bleeding
• Destruction of red blood cells
• Leukemia
• Malnutrition
• Overhydration

(high levels)

• Chronic mild hypoxia (low blood oxygen levels)
• Congenital heart disease
• Dehydration
• Erythrocytosis (too many red blood cells)
• Pulmonary fibrosis (scarring or thickening of the lungs)
• Polycythemia vera (a bone marrow disease that causes a surge in the number of red blood cells)

3. The study included a relatively small number of children with very high hemoglobin levels.

4. The study used only hemoglobin levels as the iron measure for all infants. (A child does not have to be anemic to have an iron deficiency, according to the AAP. The group reports that animal studies have shown that when iron levels are low, iron is conserved for the blood at the expense of the brain. As a result, iron deficiency won’t always be detected with a simple hemoglobin test.)

How to tell if your child requires supplementation?
There are ways parents can protect their children’s health and avoid giving them more iron than they need.

A report from the AAP states there is no solid evidence demonstrating a connection between iron deficiency and lowered IQ. The group adds however, there is enough evidence to recommend universal screening.

The only way to identify all children with iron deficiency would be to draw blood for analysis—an undertaking that would be too invasive and costly, according to the AAP. To address this controversial issue, an AAP report concluded that all children should have a finger prick at 12 months of age to test their hemoglobin level.

Pediatricians should also assess other risk factors for iron deficiency to determine if more comprehensive testing is needed, the AAP cautions.

The CDC also recommends parents take the following steps:

• If possible, breastfeed babies for at least 12 months. Between 4 and 6 months of age, introduce plain, iron-fortified infant cereal or other iron rich foods. The AAP also says iron supplements should be given to breastfed infants beginning at 4 months of age and continued under the direction of their pediatrician.

• When your baby is about 6 months of age, include a feeding per day of iron-rich foods (meats included) as well as foods high in vitamin C to boost iron absorption.

• Non-breastfeeding mothers should give their children iron-fortified formula.

• Give your child ages 1–5 years a diet with iron-rich foods such as iron-fortified breads, cereals, and lean meats.

How much iron is enough?
The APP recommends that babies between 6 and 12 months of age should get 11 mg of iron each day. Toddlers up to the age of 3 years should consume 7 mg of iron daily.

The CDC provides several examples of some iron-rich foods, including:

The best sources of iron are red meat, iron-fortified cereals, and vegetables containing iron and vitamin C.

Until there is more data confirming the benefits and risks of iron supplements, parents are urged to talk with their child’s health care provider.

Designed to reduce the risk of sudden infant death syndrome (SIDS), the Milwaukee Department of Health campaign has reignited the national debate about co-sleeping and about the effectiveness of provocative ads.

City officials defend ad
“Is it shocking? Is it provocative?” asked Bevan Baker, the city’s commissioner of health, according to the Milwaukee Journal Sentinel. “Yes. But what is even more shocking and provocative is that 30 developed and underdeveloped countries have better infant death rates than Milwaukee.”

The campaign posters, released on November 9, feature an image of a baby (one black, one white) lying in a bed next to a butcher knife. “YOUR BABY SLEEPING WITH YOU CAN BE JUST AS DANGEROUS,” the caption cautions. The posters also include a phone number for parents to call to receive a free Pack ‘N Play if they can’t afford to buy a crib.

“I’ll take some heat,” Mayor Tom Barrett told ABC News. “Some zipcodes in Milwaukee have [infant mortality] rates higher than third world countries. That’s unacceptable.”

“If the ads make some people uncomfortable, I guarantee it’s a lot less uncomfortable than having another baby die from co-sleeping,” a cause of death that is “so preventable,” he added.

NBC commentator Dr. Nancy Snyderman disagrees. “This campaign is over-the-top. The message is absolutely important. This is not the right way to do it.”

Compelling campaigns
Provocative and shocking campaigns have a long history of success. Since 1942, the Ad Council has launched a series of campaigns with compelling images and memorable slogans. “Only YOU can prevent forest fires.” “Your brain on drugs.” “A mind is a terrible thing to waste.” However, the common thread that led to the success of these campaigns was consensus around the topic. Unlike co-sleeping, which is highly controversial.

Although the Milwaukee campaign may be well-intended, any attempt to distill the safe sleep message into a “never, ever” dictate is doomed to failure. Why? Because simplistic messages fail to recognize the complexity of co-sleeping and the extent to which it both threatens and protects.

Perhaps it’s time for the authorities and the experts to stop telling parents how to parent, and start giving them the knowledge, skill, and resources needed to parent safely and effectively.

New research shows that pervasive formula marketing targets those who would benefit most from breastfeeding—impoverished Philippine families with the highest infant mortality rates.

Research
Manila-based researchers from the World Health Organization (WHO), Action for Economic Reform, and PhilHealth aimed to find out whether aggressive marketing by the infant formula industry was responsible for the 6 percent increase in formula use between 2003 and 2008 in the Philippines.

Researchers conducted household surveys and focus groups in 16 barangays (communities) in 2006 and 2007 to learn about advertising exposure and formula feeding decisions. The barangays were randomly selected, but did not represent the nation. They were generally less educated, more rural, and had a lower socioeconomic status than the rest of the country.

“The authors believe these limitations do not diminish the results,” they write, “but suggest the marketing messages are reaching the most vulnerable sector of the Philippine population, which also has the highest infant mortality rates.”

Results
Even after the data were adjusted for education and economic indicators, the results were clear: if the mother saw advertising for formula, or if a doctor, mother, or relative recommended using formula, the children were more likely to get formula. Out of 5,219 households, 6.7 percent had children under the age of 24 months; out of those 345 children, 41.1 percent were fed with formula. The moms who used formula were 6.4 times more likely to stop breastfeeding before 12 months.

Recommendations
The study’s findings might sound like commonsense—that anyone in any part of the world would be more likely to formula feed if they were encouraged or persuaded to do so by advertising, family, and doctors. But the Philippines is an interesting setting to look at this issue, given its “aggressive industry practices and rising formula usage,” write the researchers.

That influence of such pervasive marketing practices was apparent in the parents’ responses to the researchers. Parents said that they remembered infant formula advertising claiming that formula had ingredients that “make babies healthy,” “make children smart,” and “protect against infections.” Only 17 percent recalled the message that “breast milk is best for babies.”

The advertising slogans made their mark: “The participants had high recall of the advertising messages which included: ‘Batang May Laban (child with strong resistance),’ ‘hindi sakitin (child without sickness),’ ‘nakakatibay ng buto (child with bones),’ ‘may nucleotides (with nucleotides),’ although no one could say what nucleotides were, and ‘for the gifted child.’”

Parents made no mention of medical indications (passing on certain diseases or medications through breast milk) as reasons given by advertisements or doctors to formula feed.

Parents said that they were approached directly by formula sales representatives, getting phone calls asking if they had already given birth and what kind of formula they planned to use. They were invited to go to formula-feeding seminars and received literature on formula feeding—sometimes with other small gifts—in the mail. Doctors also encouraged new moms to formula feed, giving prescriptions, telling mothers that their breast milk did not have enough nutrients, even selling the formula in at least one reported case.

In the end, the study found that 59.1 percent of mothers remembered infant formula advertising (and were twice as likely to use formula) and one-sixth reported doctor recommendations (and were four times as likely to use formula).

Unethical marketing of infant formula is nothing new—the WHO’s International Code of Marketing of Breast-Milk Substitutes has long been adapted and ignored. The Code forbids advertising or other forms of promotion of infant formula to the general public, but few countries follow that guideline. The Philippines did not achieve its formula-feeding rate all on its own; the U.S. spent over $100 million on formula advertising in the Philippines during only six months in 2006, according to the study. And Americans too experience questionable infant formula marketing practices (read more on this here).

The researchers make a bold suggestion for solving the problem: “total bans” on infant formula advertisements and other promotional efforts worldwide, and for doctors to follow the Hippocratic Oath and cease all promotions of “medically unnecessary and unsafe feeding practices.”

Given the infant formula industry’s global marketing practices, it’s unlikely that message will be well received in the Philippines or the U.S. However, China is currently considering banning all sales promotions and advertising of infant formula for children under the age of 6 months. Perhaps other countries will follow suit.