Their brand-name support is really the point, after all, because there are plenty of galactagogues (breast milk supply enhancers) already out there, either name brand herbal supplements or no-brand recipes that mothers have used for centuries. Fenugreek, for example—one of the ingredients listed in Milky!—is an herb used medicinally for centuries for various ailments and for boosting milk supply. While using herbal drinks (or food) to boost one’s milk supply is not unchartered territory by any stretch of the imagination, Milky! does have a certain convenience for on-the-go moms—just drink two bottles a day, they say, no tea brewing necessary.

But here’s the thing to remember: a galactagogue should not be the first remedy for solving your breastfeeding problems. If you’re really suffering from milk production issues (a commonly cited problem among breastfeeding mothers), you need to get to the root of the problem. Perhaps your baby has latch issues or nipple confusion, or maybe you need to address breastfeeding, pumping frequency, or other things that could be causing low milk supply. We suggest reading the World Health Organization’s “Infant Feeding: The Physiological Basis” to get a thorough understanding of how breastfeeding—and milk supply and demand—works.

The average mom doesn’t actually need a galactagogue to increase supply, and some lactation consultants feel mothers may experience a placebo effect when taking supplements.

According to researchers of the 2010 study “Safety and Efficacy of Galactagogues: Substances that Induce, Maintain and Increase Breast Milk Production,” published in the Journal of Pharmacy & Pharmaceutical Science, “The use of galactagogues should be restricted to patients with a no treatable cause of reduced breast milk production…[or] limited to those situations in which reduced milk production from treatable causes has been excluded, and to ‘surrogate’ and adoptive mothers [who want to breastfeed].”

Those researchers do not recommend herbal supplements as first choice treatments due to a lack of rigorous evaluation and standardization; rather, they “consider the use of Domperidone the galactagogue of choice because of its proven efficacy, lack of side effects in infants and rare side effects in mothers.” Domperidone is a drug designed to address gastrointestinal disorders; it interferes with dopamine (which decreases the pituitary gland’s production of prolactin), so it indirectly increases the pituitary gland’s production of prolactin, which stimulates the milk-producing cells in the breast to produce milk. The American Academy of Pediatrics considers domperidone compatible with breastfeeding, but it is not easily obtained in the U.S. because of objections from the Food & Drug Administration (FDA). (Some doctors, lactation consultants, and others vocal in the online breastfeeding community are still proponents of using domperidone as a galactagogue, and view the FDA’s stance as nothing more than a political statement.)

Even so, natural herbal and food supplements remain very popular, and why not? They may help (and won’t likely hurt) your breast milk supply, and there’s no prescription required. Mothers who credit their breastfeeding success to an herbal supplement are plentiful, and a few studies seem to support their claims.

One study published in The Journal of Alternative and Complementary Medicine found that “maternal galactagogue herbal tea supplementation seems to be useful for enhancing breast milk production and facilitating infant birth weight regain in early postnatal days.” Another, in the Asia Pacific Journal of Clinical Nutrition, found that Torbangun leaves, a Bataknese traditional food, boosted milk supply even more than fenugreek. A study published in Oriental Pharmacy and Experimental Medicine says that seeds from the Gossypium herbaceum L. plant (a species of cotton) is “efficacious, safe, and cost effective” in boosting supply. A study in the Ecology of Food and Nutrition looked at the perceived (not actual) effectiveness and safety of the tradition of Korean women consuming pig’s feet to boost breast milk supply, and found that the majority of these women report success.

But can you really trust the research? Scientists in epidemiology and biostatistics at the University of Illinois conducted a systematic review of studies to evaluate the effectiveness of herbal galactagogues. Their findings, published recently in the Journal of Human Lactation, report fundamental flaws in the trials—“small sample size, insufficient randomization methods, poorly defined eligibility criteria, use of poly-herbal interventions, and variable breastfeeding practices among enrolled subjects”—calling into question their validity.

“Given the insufficiency of evidence from these trials, no recommendation is made for the use of herbs as galactagogues,” the study authors write. “Well-designed and well-conducted clinical trials that address the above limitations are necessary to generate a body of evidence as a basis for recommendations regarding herbal galactagogues. Despite their prevalent use among lactating women, our review finds that herbal galactagogues have limited reported safety and efficacy data.”

Before that study, earlier research was also critical of studies on galactagogues lacking in evidence-based standards. However, the lack of a well-designed study on breast milk–boosting herbs may matter little to a mother desperate to breastfeed.

I have personally known numerous women who had success with breastfeeding only after taking herbal or food supplements, in particular fenugreek, teas, specially formulated cookies, oatmeal, and beer (or the last two together in a low-alcohol stout).

I was lucky; someone grabbed me. I was brought to my mom, and I was hysterical. “I was drowning!” I said, over and over. She, on the other hand, was calm. “You were fine,” she told me, “and the water isn’t deep there.” It didn’t make sense to me. How could I have been so certain that I was drowning, and my mom was so sure I was fine?

As an adult, I’ve come to realize that such incidents are not uncommon. Drowning is typically a silent occurrence, without the shouting and splashing TV shows might cause us to expect. Is it any wonder that it is the second most prevalent cause of death among children 1–19 years old? (Read on for the signs of trouble.)

As a parent, I ask myself every year: What can I do to protect my kids from accidents so that they can enjoy the water safely? Whether you’re headed to the pool, the pond, or the beach this summer, here are 12 need-to-know tips:

1. “Touch supervision” matters. Never leave your child alone around water. For any infant or toddler, as well as any child who is not a skilled swimmer, use “touch supervision.” Remain within an arm’s length of your child, so you can check in often and respond quickly to any signs of trouble. Talk to your children about the “buddy system” for pools and open water. If your child is quiet, check on them right away; children playing in the water safely make noise!

2. If a child is missing, check the pool first. A recent study of popular inflatable pools pinpoints the risk of drowning for all children under the age of 5. But even a “kiddie” or “wading” pool can be dangerous to a toddler. Since they are top-heavy, they may be unable to get out of water if they fall in.

3. If you own a pool, create “barriers.” First, erect a smooth fence around all sides of your pool—even for large, inflatable, above-ground pools—and make sure there’s no place a child could crawl under or gain a foothold and climb over. Your fence gate should open outward away from the pool and be self-latching at a height taller than a child. The American Academy of Pediatrics (AAP) encourages homeowners to isolate any pool from the house, fencing it all the way around. If your house is one side of “fence,” consider installing a door alarm, and block off any pet doors, since small children can crawl through them.

4. Consider other safety devices. Pool covers add a layer of protection, and surface wave or underwater alarms can alert pool owners when a child enters the water unsupervised. In case you need to rescue a child in trouble, keep a fiberglass shepherd’s hook and a life preserver poolside. Also, keep a portable telephone near the pool in the event you need to dial 911.

5. Make sure someone is always watching the children. Don’t assume someone else is doing this; make it an assigned task.

6. Be alert for entrapment risks. Do not use a pool with missing or broken drain covers, which may create suction and trap a swimmer underwater, leading to serious injury or even death. Entrapments tend to occur due to suction of improper drains, or entanglement of a swimmer’s clothing, jewelry, or hair in the drain. If this occurs, turn off the pump and slip one or more fingers between the body and the drain to break the suction before rolling the swimmer away. Realize that, contrary to what might be expected, children’s public wading pools and toddler pools pose a high risk of entrapment; check the drains before you allow your child in the water.

7. Skip the “floaties.” So-called “water wings” may be cute, but they don’t help children stay afloat. Look instead for life vests that have been approved by the U.S. Coast Guard. For toddlers, some “flotation swimwear” does meet this standard. Make sure your child uses an appropriate flotation device that fits at all times when on a boat or near a body of water. Wear a life jacket as well, for your own safety and to serve as a role model.  For more about selecting a personal flotation device, see the Coast Guard website.

8. Choose beaches and pools with lifeguards. Swim only in designated areas, and enforce a “no diving” rule. Make sure your child doesn’t dive in any area unless it has been checked for depth and safety by an adult. Counsel them to avoid roughhousing by the water.

9. Consider swim lessons for your child. For children 1 to 4, successfully completing swim lessons may reduce the risk of drowning, so the AAP suggests parents consider lessons, in light of the child’s frequency of exposure to water and emotional development. Don’t assume lessons make them water safe. Also, note that the AAP does not support swim lessons for children under 1 year of age.

10. Take a CPR class. The Red Cross teaches courses in CPR and first aid, as well as lifeguarding and more, at locations across the U.S. If that’s not an option, ask your child’s pediatrician for resources in your area. Children can lose consciousness quickly in any water crisis, and CPR may be necessary. As the parents of Olympic swimmer Cullen Jones, who experienced a near-drowning at the age of 5 can attest, a quick response is important.

11. Know the signs of drowning. As Dr. Francesco Pia notes in an article written for the U.S. Coast Guard, the drowning person may be able to call out and wave, but his actions are all automatic: straining to catch the next breath before going under, pressing arms against the water’s surface, and remaining upright in the water. Visible signs of drowning for adults and children include: head low in the water, mouth at water level; head tilted back with mouth open; glassy eyes that are unable to focus; closed eyes; hair over the forehead or eyes; vertical alignment without using legs; hyperventilating or gasping; appearing to be climbing an invisible ladder; seeming to swim one way without making progress; trying to roll over onto their back. (Note: A precursor to drowning, “aquatic distress” can involve shouting and waving. This will progress to drowning if the person is unaided.)

12. Know the signs of “dry drowning.” Dry drowning is a delayed reaction to a small amount of water in the lungs. It occurs after immersion in water—usually between 1 and 24 hours later. Without treatment, the condition can lead to respiratory distress, cardiac arrest, and eventually brain death. Signs to watch for include persistent cough, shortness of breath, chest pain, fatigue, or lethargy. If you think your child may have aspirated some water, particularly after a near-drowning incident, take your child to an emergency room right away.

I know firsthand that vigilance is key when it comes to children and water safety—not only as a child, but also as a parent. When my baby got hungry during an outing a couple of years ago, I left a friend in the water with my older two children and settled onto the beach to breastfeed him and watch their play. It was a beautiful day with blue skies, gentle waves, light breezes—and a lifeguard running top-speed across the sand at the same moment I leapt up and cried out to my friend. In the instant she had given all of her attention to my oldest child, his sister had gone under.

All turned out well for us—the lifeguard was alert and responsive—but it could have ended badly. It’s a startling reminder: Don’t forget “safety” in favor of “fun in the sun.”

more on water safety
Recall: Swimwear Set With Inflatable Inner Tube
When Can My Child Take Swim Lessons
Sail Into Summer Safely

Spurred by widespread efforts to increase breastfeeding rates—from banning hospital gift bags with infant formula samples to implementing breastfeeding support programs in pediatric offices—researchers surmised that giving “early limited formula” during the first days after birth to newborns who lose 5 percent or more of their birth weight, might enable more mothers to breastfeed exclusively and for longer periods of time. The concept seems counterintuitive—giving babies formula so that they will continue to breastfeed—but the results are worth noting.

Research
Forty full-term babies participated in the study. All of the babies were 24–48 hours old and had lost at least 5 percent of their birth weight. Although 7 percent is a more widely accepted standard study authors, Valerie Flaherman, MD, MPH, and colleagues, found through previous research that infants who lost 5 percent or more of their birth weight in the first 36 hours were at greater risk of losing 10 percent of their birth weight—a level that is considered dangerous.

The babies were randomly assigned to one of two groups. Those in group one (the early limited formula group) were routinely given 2 teaspoons (10 ml) of formula by syringe after each breastfeeding until their mothers’ milk “came in,” while those in the second group continued to breastfeed exclusively, and were taught “soothing techniques” to ensure that equal amounts of time were spent with each of the mothers. All the babies were examined at 1 week of age, and then again at 1, 2, and 3 months to assess formula use and whether they were exclusively or partially breastfeeding.

Results
Only 10 percent of the babies given small amounts of formula were still getting formula one week after birth, compared to nearly 50 percent of the babies who were exclusively breastfed. At 3 months of age, nearly 80 percent of the babies in group one were breastfeeding exclusively, compared to 42 percent of the babies in group two.

The results sound encouraging. But before you stock up on infant formula and feeding syringes, consider the study’s shortcomings:

• Only 40 babies participated in the study overall and the subgroups were even smaller—20 and 19 babies (one baby failed to complete the study). While this is a good start, it’s a far cry from the number needed to draw definitive conclusions.
• Only 62 percent of the mothers participating in the study intended to breastfeed exclusively—an inherent bias, given that exclusive breastfeeding is the outcome measure and maternal intent is a strong predictor of short-term breastfeeding outcomes.
• The sample was limited to full-term babies who rarely require formula supplements. In fact, high rates of in-hospital supplementation are deemed a barrier to exclusive breastfeeding.
• Babies who lost as little as 5 percent of their birth weight were included in the study. This decision was based on a prior study by the author showing that a 4.5 percent or greater weight loss in the first 24 hours was more likely to result in a 10 percent or greater weight loss during the hospital stay. This result is not reflected in consensus guidelines, however, where a weight loss of greater than 7 percent is listed as a reason for further evaluation.
• Babies were fed “small, carefully measured volumes of formula, so an infant would not be satiated and demand for breastfeeding would be maintained.” Yet the volumes were equal to the amount of early milk (colostrum) a baby typically gets at a feeding during the first day or two after birth—hardly a stimulus for continued breastfeeding.

Recommendations
Keith Yamamoto, PhD, executive vice dean of the UCSF School of Medicine in a recent article defined research as something that “dare[s] scientists to dig deeper, ask tougher questions, and invent novel ideas and approaches that defy the status quo.”

Flaherman and her colleagues need to be applauded for digging deeper to find a novel approach for increasing exclusive breastfeeding rates. Babies, in order to breastfeed effectively, must be able to latch-on, suckle, swallow, and breathe—all of which require energy in the form of calories. And while it’s easy to demonize formula supplements as the bane of breastfeeding advocates, few would argue that short-term use of supplements might enable some babies to eventually breastfeed exclusively and for longer periods of time.

Critics are right to be concerned that giving formula supplements to breastfeeding babies can be a slippery slope. What these researchers are suggesting, however, is that a small amount of formula (assuming human milk is not available) when used for a very brief period of time can provide the energy some babies need to breastfeed effectively.

Where the researchers fall short is in their pursuit of a novel idea. There’s nothing new about the in-hospital use of formula supplements. In fact, overuse of formula is what prompted the Joint Commission in 2009 to add exclusive breast-milk feeding to its list of perinatal care measures. Rather than devising a strategy to preserve exclusive breast-milk feeding, Flaherman turned to formula supplements (albeit small amounts)—suggesting once again that it is the default solution to every breastfeeding problem.

Most experts would agree that infant formula has a place in the care of some mothers and babies. But instead of showing mothers how to administer infant formula with a syringe, let’s teach them how to hand express their milk and feed it to their babies with a teaspoon until both mom and baby are confident in their ability to breastfeed. Now that’s a novel approach!

1. “Broad spectrum” is a “must”! According to the Environmental Working Group (EWG), only about 25 percent of sunscreens on the market offer good protection against both UVA and UVB rays. Look for the “broad spectrum” label to ensure the sunscreen you choose is just that.

2. “30″ is the new “15″. While 15 SPF is the minimum rating that the Food and Drug Administration (FDA) allows for claims of protection against skin cancer, the Children’s Melanoma Prevention Foundation recommends a 30 SPF standard. (See this fact sheet for more about why. Hint: Even children can get melanoma—the most serious type of skin cancer.)

3. “50″ is the goal. SPF might mean “Sun Protection Factor,” but it is only a measure of protection against UVB rays, which cause sunburn. The number gives no indication of the product’s protection against UVA rays, which causes other kinds of skin damage, including skin aging and possibly cancer. People tend to extend their time in full sun when they feel protected by “high number” SPF, but this only leaves them vulnerable to the damage caused by UVA rays.

4. There is no “waterproof”—or “sweatproof”—suncsreen. In fact, these terms are no longer allowed to be used by sunscreen manufacturers—although some still do. Remember that all sunscreens do wash off over time, with exposure to water or sweat. Also, be leery of “water-resistant” claims. While this phrase is only to be used if tests confirm 40–80 minutes of protection, you need to know that if your child is sweating or swimming, sunscreen will need to be reapplied more often.

5. Spray sunscreens are trouble. The FDA has expressed concern about the risks of inhaling these products, which remain popular because they are often easier to apply to wiggly children. Resist the temptation to “spray” your child. While the inhalation risk is unclear, it is still too easy to miss a spot and cause a localized sunburn or to apply too little sunscreen to the exposed skin. Similarly, skip any powder applications, which due to the inhalation risk, will no longer be allowed by the FDA in 2014.

6. There’s one vitamin you don’t want: A. Vitamins are healthy, right? Well, not in this context. A form of vitamin A often called “retinyl palmitate” or “retinol,” an antioxidant that seems to slow skin aging, has been implicated in the development of skin tumors and lesions when applied to the skin and exposed to sunlight. Still, it’s a common additive in many sunscreens.

7. You need more than you think. The skin experts at the American Academy of Dermatology (AAD) recommend using “enough sunscreen to generously coat all skin that will not be covered by clothing.” Keep in mind that most people only apply about one-half or even one-quarter of the recommended amount of sunscreen. (Note that sunscreen is not generally recommended for babies under 6 months of age, who should be kept out of direct sunlight. When necessary, use a small amount of sunscreen in the 15 SPF to 50 SPF range only on particular, exposed areas such as the face, neck, and back of the hands.

8. Sunscreen doesn’t work right away. Ideally, apply your sunscreen about 20–30 minutes before heading outdoors, so it can be absorbed before you are in the sun.

9. “Reapply as needed” really means “reapply often.” If you’re in the water, or engaging in any activity that’s causing you to sweat, make sure to reapply your sunscreen every hour. If what you’re doing is more idle, aim for every two hours.

10. Combination products may sicken you. Use sunscreens for sun, and bug sprays for bugs; steer away from those products that claim to be two-in-ones. You need to reapply sunscreen frequently, and this would expose you to higher levels of pesticide than are recommended. Also, wait at least 15 minutes between applying sunscreen and insect repellant, so that less of the spray is absorbed. (For more about choosing a bug spray, see this fact sheet from the American Academy of Pediatrics.)

If this all seems like a lot to remember, take heart. EWG has an app that can help.

Remember that sunscreen should be only one part of your summer health strategy. First, you should limit your time in direct sunlight during peak hours. Expert opinions vary about whether “peak hours” are 12 p.m. to 2 p.m., 10 a.m. to 2 p.m., or even 10 a.m. to 4 p.m. Since it is unlikely you will spend every summer day indoors, you will need to use your judgment and consider the particulars of your environment. Will you be in the shade? Partial shade? Full sunlight? Act accordingly. And remember that cloudy days don’t mean you can’t get sunburned. If it’s light outside, the sun is reaching your skin—clouds or no clouds.

Also, cover up what you can. Wear sunglasses, to help prevent the sun’s rays from damaging your eyes. UV radiation has been linked to cataracts, macular degeneration, and corneal sunburn. Doctors also warn about skin cancer in the tissue surrounding the eye. Look for lenses that block “99- or 100 percent of UVB and UVA rays,” provide “UV 400 protection,” and meet “ANSI Z80.3 standards.” Use a lip balm with at least a 30 SPF to protect your lips. Sunhats should have a brim about three inches wide. Wear light clothing, including lightweight pants and breathable long-sleeve shirts if you’re worried about being overexposed to sunlight.

For more about summer safety, read this.

Research
A research team led by Dr. Bill Hessenmar recruited pregnant women receiving care at a Swedish hospital for inclusion in the study; their babies were added to the “AllergyFlora” birth cohort between 1 and 3 days after birth. Those babies born earlier than 38 weeks or who spent time in the neonatal intensive care unit were excluded from the study. The researchers focused primarily on families with at least one allergic parent, to ensure a high proportion of participants with a history of allergy.

Researchers relied heavily on parent self-report data. Mothers were interviewed about their pregnancy, delivery, family structure, and housing conditions at enrollment. They were then asked to keep diaries about food introduction, weaning, illnesses and medications, and other significant events. This information was collected for the first year. A detailed phone interview was conducted at six months; parents were asked questions such as “Does the child use a pacifier?” and “Is it cleaned by boiling, rinsing in tap water, or by the parents sucking on it?” (More than one method could be specified.)

A pediatric allergist examined the children at 18 months and 36 months. He also reviewed their medical charts and interviewed their parents. Children who joined the study from 2001 through 2003 also provided saliva samples for analysis. (This testing was not part of the study from 1998 to 2001.)

In total, 206 pregnant women were recruited for the study. Of these, 187 met study criteria, 184 remained in the study at 18 months, and 174 at 36 months. Eighty percent had at least one parent with allergies. Pacifier use was popular among study participants; nearly three-quarters of babies in the study used a pacifier in the first six months of life. Fifty-four percent of parents said they boiled their baby’s pacifier to clean it, 84 percent said they rinsed it in tap water, and 48 percent cited sucking the pacifier to clean it.

Results
Dr. Hessenmar and colleagues found that parental cleaning of the pacifier by sucking was “strongly associated with the risk of allergy development.” They concluded that:

• Eczema and asthma were reduced in children whose parents cleaned their pacifier by sucking it.
• Rates of respiratory infection were virtually the same during the first six months for infants whose parents sucked the pacifier and those who did not.

The research team suggests that the children are at a reduced risk of allergy and asthma due to the transfer of oral bacteria from the parents’ mature immune system to their babies’ developing one. Acknowledging that babies are exposed to parents’ bacteria during (vaginal) childbirth as well, the researchers suggest the effect may be cumulative. Just 20 percent of children who were born vaginally and whose parents sucked the pacifier had eczema, while 54 percent of those who were not exposed in either way (cesarean delivery and no parental pacifier sucking) developed the skin condition. Thirty-one percent of children for whom parents reported one type of exposure (vaginal delivery or parental pacifier sucking) had eczema.

Readers should interpret this study with caution. The study population is small; the population of the various subgroups is even smaller. For example, only 14 percent of children in the study were born via c-section, a grand total of 18 children. Of those, only five had parents who sucked the pacifier to clean it. It is difficult to draw strong comparisons from such small numbers.

This study also does not address the role of breastfeeding in the development of infant gut microbes—and subsequent allergy and asthma prevention. Although 98 percent of Swedish babies are “ever breastfed” and more than half are reportedly exclusively breastfed until at least 4 months of age, just over one-third of participants in this study group reached that mark.

The fact that the study relies on self-reported data from parents is another weakness. We know little about the frequency of the pacifier sucking or the duration. We know little about how long the children continued to use their pacifiers, as well. The parental pacifier cleaning by sucking is reported until six months, but one might venture to guess that the behavior continued thereafter; would that make a difference?

Recommendations
Parents should not take this study to mean that their baby “must have” a pacifier. Although the American Academy of Pediatrics (AAP) recommends pacifiers at naptime and bedtime to reduce the risk of sudden infant death syndrome (SIDS), this study doesn’t mean that parents’ sucking on the pacifier will ensure a healthy development of the infant’s immune system. Also, it doesn’t mean that if their child refuses a pacifier they should force the issue, or that they must rush out to procure one before their child is born.

In fact, pacifier use has been linked to recurrent ear infections and a small study of bacteria on pacifiers suggests that pacifiers may carry bacteria—and, in some cases, fungi. Yuck!

So, you may still want to skip the binky with your baby. But if you opt to use it, you’ll be glad to know that when the pacifier falls on the ground—and, rest assured, there will be many times when that happens!—you don’t need to head for the nearest restroom. Just plop it in your own mouth for an ad-hoc inoculation and give it right back to your sweetie pie. Now that’s love!

For additional tips on using a pacifier safely, read this and this.

Research
In a study newly published in Current Biology, an international team of researchers from Japan and Italy sought to understand more about infants’ responses to their mothers carrying them. There has been a lot of research on the importance of skin-to-skin contact for infants, as well as on a chronic crying (a.k.a. “colic”). Research on transient infant crying and holding or carrying has been more limited, and it has relied largely on information provided by parents through written diaries. In this study, researchers took a less-biased approach, using audio-video monitors to view infant-mother interactions, behaviors, and vocalizations. They also used electrocardiograms to track the infants’ physiological responses. These measures were monitored when the infant was lying in the crib, when he was held by the mother, and when he was carried by the mother while she was in continuous motion (walking).

Twelve healthy infants and their mothers participated in the study. (As a pilot study, this research looks only at a small number of participants; additional research with more participants could be conducted to enhance our understanding of the calming effect.) All infants who participated were between 1 and 6 months of age. The order of the conditions—lying in the crib, being held, being carried—was randomized.

Results
Researchers found that the act of crying “strongly increases physical activity and significantly alters the respiratory pattern.” (This will be no surprise to parents and other infant-caregivers who cannot help but notice the flailing arms and labored breathing that accompany infants’ crying!)

More importantly, they noted several differences in infant response:

• Being carried by the mother produced the greatest reduction in infant movement and crying. In addition, the infants’ heart rates decreased. Infants were more relaxed during carrying than any other study condition.
• Lying in the crib led to increases in infant movement and crying, as well as faster heart rate.
• Being held by the mother led to moderate response. That is, infants who were held had less movement and crying than their “cribbed” peers, but more than their “carried” peers.
• Mothers “carrying” their babies “walked” with them. Mothers “holding” their babies sat with them. The calming effect was greater for “carrying”—which was essentially “holding plus standing and walking”—than with just “holding.” While the mothers’ presence and physical contact calmed the baby some, the greatest effect was found with “carrying,” which here was essentially “holding plus walking.” It is unknown whether other types of movement such as rocking in a glider or swaying or whether a different seated posture (such as partial recline) would have the same effect.

The study researchers ran similar tests on mouse subjects, hypothesizing that the pups would exhibit behavioral and physiological responses in response to maternal carrying similar to those of human babies. Although mother mice carry their young in a manner very different from the way that human mothers do, the results were strikingly similar on all measures. The results of this animal study reinforced the biological imperative of a carrying-calming response in mammal young.

Recommendations
The researchers suggest that the infant’s physical and physiological responses to the act of walking are biological—automatic and instinctive. In an otherwise healthy child, walking should produce an immediate reduction (if not cessation) in crying and physical signs of stress. To calm your baby:

• Take the first step—literally. When you pick up your crying baby, move with him. Carrying does not address the underlying cause of the infant’s crying, but the researchers suggest that “a brief period of carrying could be an effective approach to soothe crying caused by transient irritations such as vaccinations or frightening noises.” Even for infants with colic, for whom crying is unlikely to stop without other strategies, walking may help as an initial step.
• Look for an underlying cause. Infants may cry for a host of reasons—they’re hungry, tired, dirty; they’re feeling too cold or too warm; they’re exposed to too much noise or other distractions (see our slideshow for help on figuring out why your baby might be crying). Caregivers should seek to identify and address the cause right away. Calming the infant by moving about may make this task easier. But walking only goes so far; the infant is likely to return to crying when the caregiver stops moving if the cause isn’t found.
• Wear your baby. Being “worn,” such as in a sling or a wrap, is associated with lessening babies cries (learn more about babywearing benefits here). The reasons why are inconclusive and researchers still don’t know whether it’s the physical closeness or the movement (as this study seems to suggest) that triggers a calming effect.
• Consider other calming strategies, as needed. Some babies do experience unexplained bouts of crying; an estimated 10–20 percent of infants have colic. If you are worried your baby might be colicky, read this for guidance on what you can do about it and this for additional strategies to help soothe your child.
• Reconsider whether “cry it out” methods are effective for your child. Several previous studies have called “cry it out” methods of sleep training into question; this study also raises concerns about such an approach, highlighting a link between the infant’s crying and calming in response to interaction with the mother.
• Understand the physiologic nature of crying. The researchers hope that their work leads to greater understanding of the nature of crying and reduces incidence of child abuse, which can stem from an overreaction to infant crying. Parents who understand their child’s cries as an automatic biological response may be more likely to respond calmly to it.

While the population of this study is small, the researcher’s leading recommendation is non-invasive and easy to do. If your baby is crying, pick him up! Walk around. This approach won’t eliminate crying altogether, but it might help to calm babies—and their parents—when it happens! And don’t worry, we promise you won’t spoil your child by doing so. It’s just not possible.

Most children and adults get their daily dose of fluoride from fluoridated toothpaste, mouthwash, and water. Fluoride occurs naturally in water, but the level can be very low (less than 0.2 mg/L) or very high (more than 2.0 mg/L), so communities adjust the local water supply by adding or removing fluoride.

Infant formula manufacturers intentionally keep fluoride levels in infant formula low to guard against formula-fed babies getting too much fluoride when their formula is mixed with fluoridated water. When powdered or concentrated liquid infant formula is consistently mixed with fluoridated water, exclusively formula-fed babies can get fluorosis. To prevent fluorosis, parents are cautioned to use low-fluoride or fluoride-free bottled water (labeled as de-ionized, purified, demineralized, or distilled) when mixing infant formula for some of their child’s feedings each day. Parents can also use ready-to-feed formula that doesn’t require mixing with water. But be aware that ready-to-feed formula is much more costly than powdered or concentrated liquid formula. The best way to prevent fluorosis is to monitor your child’s fluoride intake.

Tips for monitoring your child’s fluoride intake:

• Know your water’s fluoride level. If you live in a state that participates in the Centers for Disease Control and Prevention (CDC)’s My Water’s Fluoride program you can check your water system’s fluoride level online or contact your local water supplier. If your drinking water contains more than 2.0 mg/L, the CDC recommends that you get your drinking water from another source.
• Delay the use of fluoride toothpaste. Children ages 6 months to 2 years are at risk of swallowing toothpaste used for brushing and ingest too much fluoride. The American Academy of Pediatrics (AAP) recommends that parents wait until their child is 2 years old to use fluoride toothpaste and then to use only a “pea-sized” amount. Children ages 6 months to 2 years can use fluoride-free “beginner” toothpaste to practice their brushing and spitting skills.
• Avoid fluoride mouthwash. Fluoride mouthwash isn’t nearly as effective as fluoride toothpaste in fighting cavities, so it should not be used in children under the age of 6 years, and then only in children who are at high risk for tooth decay.
• Check with your child’s dentist before taking fluoride supplements. Fluoride supplements (liquids, tablets, and lozenges) can increase the risk of fluorosis and should be used only if prescribed by your child’s dentist.
• Get yearly check-ups. The AAP and the American Academy of Pediatric Dentistry recommend that every child see a dentist annually beginning around 1 year of age.

A recent Harvard University review was cited as proof that “fluoride reduces children’s IQ,” when in fact most of the 27 studies included in the review were from China and weren’t applicable to U.S. kids.

“There are many rural areas of China that have naturally high levels of fluoride in the well water,” says Steve Novella of Science-Based Medicine. “The studies were largely looking at this exposure. Two studies actually looked at fluoride exposure from inhaling smoke from coal burning. The question is how these high levels of exposure compare to the fluoride levels in water. Generally the high fluoride groups were in the 2-10 mg/L range, while the low fluoride groups were in the 0.5-1.0 mg/L range (not including the coal burning studies, which had much higher fluoride levels),” explains Novella.

“The recommended water fluoride level in most countries is 0.5-1.0 mg/L (Australia, for example, uses 0.6-1.1 mg/L). The Environmental Protection Agency (EPA) set the safe upper limit at 4.0 mg/L with a secondary (voluntary) recommendation of 2.0 mg/L.,” says Novella. “Areas with high natural fluoride actually have some of the fluoride removed from the drinking water.”

For the most part, fluoridated water in the U.S. has the same level of fluoride as the control or low-fluoride groups in the China studies. The negative association with IQ was only found in villages where fluoride levels were above EPA limits.

Novella also cautions that most of the 27 studies were epidemiological and not experimental like the landmark Grand Rapids study at the heart of water fluoridation. Also, it’s possible that the high levels of fluoride exposure from natural or industrial sources (as opposed to deliberate fluoridation) are the result of exposure to other contaminants, such as arsenic.

A history of water fluoridation
Fluoridation dates back to the 1930s, when researchers discovered that children who drank naturally fluoridated water had fewer cavities. Since 1945, the U.S. has taken the lead in fluoridation, with two dozen countries following suit, including Great Britain where an estimated 10 percent of the population or 5.8 million people have fluoridated water, Australia which boasts rates of 80 percent or 17.6 million people, and Canada where 44 percent of the population or 14.3 million people have fluoridated water.

Overall, an estimated 395,565,000 million people in 25 countries have fluoridated water—17,910,000 get naturally fluoridated water, and 377,655,000 get water with added fluoride. Rather than fluoridating the water supply, some countries fluoridate their salt or milk, much like the U.S. adds iodine to salt, vitamin D to milk, and folic acid to breads and cereals.

Some U.S. cities and states, convinced that fluoridation poses unnecessary risks, continue to resist fluoridation. In a special election slated for May 21, 2013, Portland voters will decide whether or not to fluoridate the city’s water supply. Presently, Portland is one of only two major U.S. cities (Honolulu being the other) to refuse water fluoridation—not once, not twice, but three times. Portland voters rejected fluoridation in 1956 and 1962. And while a measure was passed in 1978, it was repealed just two years later.

Currently only 23 percent of Oregonians get artificially fluoridated water. Only Hawaii and New Jersey have lower rates. The Centers for Disease Control and Prevention (CDC) estimate that 74 percent of U.S. residents (or 204 million individuals) get fluoridated water—10 million get it naturally and the remaining 194 million get it when fluoride is added to the community water supply.

Scientists acknowledge that fluoridation is not risk-free. The National Research Council (NRC) in a 2006 report concluded that water that contains more than 4 mg/L or 4 ppm (the maximum contaminant level according to the EPA) may increase the risk of bone fractures and discolor teeth (fluorosis). In response to the NRC report, the U.S. Department of Health and Human Services (HHS) proposed that the maximum contaminant level be changed from the current range of 0.7 to 1.2 mg/L to 0.7 mg/L. Their recommendation is based on the fact that there are more sources of fluoride available today (toothpaste, mouthwash, water), making the risk of getting too much fluoride greater.

How much fluoride is enough?
It depends on the age of your child. From birth to 6 months, no fluoride supplements are needed. This is true for breastfed as well as formula-fed babies. Until a child has teeth there is no need for fluoride. Once teeth start erupting (usually between 6 and 12 months of age) and until your child has all her permanent teeth (around 8 years of age), the American Academy of Pediatrics (AAP) and the CDC recommend fluoride supplements, but only if the water supply (public, well, or bottled) contains less than 0.3 mg/L of fluoride. If you don’t know your water’s fluoride level, check with your local water supplier or health department, or have your water tested by an independent laboratory before giving your child additional fluoride. Knowing the level of fluoride in your drinking water will reduce the risk of fluorosis. Once teeth are fully developed, even though some are not yet erupted, around 7 or 8 years of age, dental fluorosis cannot occur.