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The lack of adequate, restful sleep can affect your child’s mood, behavior, health, memory, and growth. If there is anything standing in the way of a good night’s sleep it’s important to address the issue and solve the problem. Following is a list of typical sleep disrupters and possible solutions.

Nightmares
Children spend more time dreaming than adults do, so they have more dreams—both good and bad. After a nightmare saying “It was just a dream” doesn’t explain what they experienced—after all, most kids believe that the tooth fairy and Big Bird are real, too. After a nightmare, offer comfort just as you would for a tangible fear. If your child wakes with a nightmare:

• Stay with your child until she feels relaxed and ready to go to sleep, or if she’s reluctant to have you leave, stay with her until she is actually sleeping.
• Be calm and convey that what’s happening is normal and that all is well.
• Reassure your child that he’s safe and that it’s OK to go back to sleep.

Night Terrors
During a night terror your child will wake suddenly and may scream or cry. Her eyes will be open, but she won’t be seeing. She may hyperventilate, thrash around or talk incoherently. She may be sweating and flushed. She may seem scared, but your child is not really frightened, not awake, and not dreaming. She’s asleep, and in a zone between sleep cycles. A child having a night terror is unaware of what’s happening, and won’t remember the episode in the morning.

During a night terror you may try to hold your child, but often this will result in his pushing you away or fighting you off. The best response is a gentle pat, along with comforting words or Shhh Shhh sounds. If your child gets out of bed, lead him back. If he’s sitting up, guide him to lie back down. Keep an eye on him until he settles back to sleep.

Nighttime Fears
It’s normal for a child to imagine monsters that generate a fear of the dark. Even if you explain, and even if you assure him that he’s safe, he may still be scared. You can reduce his fears when you:

• Teach your child the difference between real and fantasy through discussion and book-reading.
• Find ways to help your child confront and overcome his fears. If dark shadows create suspicious shapes, provide a flashlight to keep at his bedside.
• Leave soothing lullabies playing, or white noise sounds running to fill the quiet.
• Give your child one, two, or a zoo of stuffed animals to sleep with.
• Put a small pet, like a turtle or fish, in your child’s room for company.
• Take a stargazing walk, build a campfire, or have a candlelight dinner to make the dark more friendly.

Preventing Sleep Disrupters
Some things have been found to reduce the number or severity of sleep-disturbing episodes. They are all based on good sleep practices and worth a try:

• Follow a calm, peaceful routine the hour before bedtime.
• Maintain the same bed time seven days a week.
• Avoid books and movies that frighten your child.
• Have your child take a daily nap.
• Provide your child with a light snack an hour before bedtime, avoiding spicy food, sugar, or caffeine.
• Have your child use the potty just before she gets in to bed.

Is there a time to call a professional?
Always call a professional if you have concerns about your child’s sleep.

By Elizabeth Pantley; text excerpted with permission by McGraw-Hill Publishing from The No-Cry Sleep Solution for Toddlers & Preschoolers (McGraw-Hill 2005).

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Never underestimate the power of Dora the Explorer, Scooby Doo, and Shrek. The results of a recent study, published in the July 2010 issue of Pediatrics, found that cartoon characters affect kids’ food preferences.

Researchers at Yale University asked 40 children (all 4 to 6 years old) to taste three pairs of identical foods in either a clear package or one with a picture of a cartoon character. The children were then asked whether the two foods tasted the same or one tasted better than the other, and which of the two foods they would most like as a snack.

For each of the three food pairs presented—gummy fruit snacks, graham crackers, and carrots—72 to 87 percent of the children chose the food with a cartoon character on the package. For example, 72 percent of the children chose the carrots with the character, 85 percent chose the  gummy fruit snacks with the character, and 87 percent chose graham crackers with the character. After tasting each pair of foods—50 to 55 percent of the children thought the food with a character on the package tasted best, and 25 to 37 percent thought the two foods tasted the same. Among children who thought the food without a character on the package tasted best—only 7 percent thought the graham crackers tasted best, 15 percent thought the gummy fruits snacks tasted best, and 25 percent thought the carrots tasted best.

Before you add your voice to those calling for restrictions or a total ban on the use of cartoon characters on food packages, consider the following:

• Only 40 children took part in the study—a small sample by any standard.

• Fifty percent of those who were invited to participate (parents and their children) declined, increasing the risk for bias in this small, self-selected sample.

• There were nearly twice as many boys as girls.

• There were 2-4 times as many whites compared to other ethnic groups (black, Hispanic, Asian).

• One-half of the children watched television 1 or more hours a day and movies at home or in the theater at least once a week.

• The participants were not blinded—each knew the purpose of the study and which package had a character on it—making it possible for the investigators to influence the children’s choices, either intentionally or unintentionally.

Cartoon characters as spokescharacters
In 2006, Kroger partnered with The Walt Disney Company to promote healthy eating among children. Most of the nearly 100 products in the premium food program contained zero grams of trans fat and included healthy foods such as yogurt.  The products were eventually phased out and replaced with Kroger Brand products, suggesting a lack of sustained sales.

Nickelodeon launched a similar program in 2007 designed to get kids to eat healthy foods by putting SpongeBob SquarePants on packages of vegetables (carrots, spinach). The program generated lots of interest at first—but two years later, the majority of products sporting a Nickelodeon character are foods with little nutritional value.

The Walt Disney Company’s decision in 2008 to end its 10-year contract with McDonald’s was applauded by many, as was Sesame Street’s promotion of anytime and sometime foods. While some have embraced industry efforts to promote healthy eating, others have urged caution—arguing that profits will ultimately trump health.

It remains to be seen whether restricting the use of cartoon characters to healthy foods, or banning their use altogether, will improve kid’s diets. In order to pass meaningful legislation, more data is needed.

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Disguised as a means for insuring that finicky toddlers would get essential vitamins and nutrients, Enfagrow was pulled from the market on June 9, 2010 in a surprise announcement by its maker, Mead Johnson. Originally launched in July 2009 sporting a vanilla flavor, it was the release of a chocolate flavored version in February 2010 that proved to be not only unhealthy but unwise. With 19 grams of sugar in each 6-ounce serving, critics of Enfagrow chocolate weren’t hard to find. And with childhood obesity having reached epidemic proportions, many argued that the last thing most children needed was a super-sweet, high-calorie food.

The name alone, Enfagrow Premium chocolate toddler formula, was enough to incite detractors. What toddler needs a formula? Why should parents pay a premium for an expensive supplement that takes the place of much-needed fruits, vegetables, whole grains, and dairy products?

Unlike its chocolate counterpart, Enfagrow plain and vanilla will remain on the market because of, according to Mead Johnson, “numerous positive comments from grateful parents who have told us that they consider these products an important option for helping to meet their child’s overall nutritional needs, especially those who are picky or erratic eaters.”

But for parents rightly concerned about the added sugar, it’s important to know that according to the label on the container, Enfagrow vanilla has 18 grams of sugar per serving—only one less than the chocolate version. If that’s not enough sugar to reinforce your toddler’s preference for all things sweet, Mead Johnson provides recipes online for banana muffins, pancakes, and strawberry or banana smoothies with 28, 18, 16, and 21 grams of sugar per serving, respectively.

Putting sugar aside, this controversy begs the question, when (at what age?) and how (in the womb? through breast milk?) do children acquire taste preferences. And do those preferences affect their risk for becoming overweight later in life?

Preferences develop in utero
A 2001 study found that babies (when fed foods with certain flavors) responded differently to the flavors of foods eaten by their mothers during pregnancy, suggesting that a child’s taste preference can be influenced even before she is born.

Research conducted in a 2004 study found that in utero exposure to different flavors may affect food preferences after birth. This study involved four groups of formula-fed babies. One group was fed a traditional cow’s milk based formula; a second group was given an unpleasant tasting predigested formula; the remaining groups were fed a combination of the cow’s milk based formula for three months and the predigested formula for four months. After seven months the babies were videotaped on three separate days while feeding on the different formulas. Results showed that the longer the exposure to a specific flavor, the greater the acceptance of the flavor. This supports the theory that exposure to different flavors—whether via amniotic fluid, breast milk, or formula—may affect individual food and flavor preferences.

The extent to which flavor preferences are genetically predetermined was the topic of a 2005 study. A total of 143 pairs of mothers and their babies were screened for the presence of a taste receptor gene associated with bitter and sweet tastes. The results showed that the presence of the gene was associated with taste preferences in children, but the same was not true for adults, which suggests that cultural and environmental factors can override genetically determined preferences.

What role does breastfeeding play?
When two groups of 4- to 8-month-old infants (44 percent of whom were breastfed) were given either green beans alone, or green beans followed by peaches, the food was more likely to be accepted if the breastfeeding mother ate the food regularly. On the contrary, when the formula feeding mothers ate more green beans, there was no difference in their infants’ acceptance of the vegetable. However, repeated exposure to a food did result in greater acceptance in both the breastfed and bottle-fed children. These findings highlight the need for parents to continue to offer babies healthy foods, even though the foods may not be well received at first. Healthy foods include:

• fruits and vegetables;
• fat-free or low-fat milk and milk products;
• lean meats, poultry, and fish;
• beans and nuts;
• eggs; and
• whole grain cereals and rice.

Be sure to include nutrient-dense foods as well, such as:

• avocados;
• broccoli;
• brown rice and other grains;
• cheese;
• eggs;
• fish;
• kidney beans;
• pasta;
• peanut butter;
• potatoes;
• poultry;
• squash;
• sweet potatoes;
• tofu; and
• yogurt.

There is no need to restrict foods beyond six months, even in children with a family history of food allergies. Parents are advised to introduce new foods one at a time (ideally in the early part of the day, just in case a child has an allergic reaction), and to wait 3-5 days in between.

Food preferences and obesity
It’s clear from the data that foods eaten by mothers during pregnancy and while breastfeeding can impact babies’ food preferences. Study results also underscore the fact that the preferences may not persist once a baby is weaned unless the foods continue to be offered. What is less clear is how food preferences affect the risk for obesity and to what extent parents, siblings, and peers acting as role models can modify those effects.

There’s a limit to what First Lady Michelle Obama can accomplish with her Let’s Move campaign. Parents are the key to preventing obesity in kids. Eating a healthy diet during pregnancy and while breastfeeding may be beneficial in the short-term, but it’s the foods that parents and caregivers offer day in and day out that kids wind up preferring.

Tips for keeping kids healthy and fit:

• Set a good example by eating healthy foods yourself.
• Be patient but persistent. Commit to offering your child a new food at least 10 times.
• Make fresh fruits and vegetables readily available (cleaned, peeled, cut). Children are more likely to eat healthy foods when they can see them.
• Avoid sweetened drinks including sweetened fruit juices, which play a major role in shaping kids’ tastes for sweets.
• Buy fewer high-calorie, low-nutrient foods. But allow kids to have “junk food” occasionally. Denying access to a particular food may actually increase rather than decrease a food preference.
• Teach your children about “sometime” foods and “anytime” foods. Avoid labeling foods as “good” or ”bad.”
• Don’t use food as a reward. Find another way to reward good behavior.
• Insist on healthy foods in school cafeterias and vending machines.
• Discourage eating meals or snacks while watching TV. Children (and adults) are less likely to pay attention to feelings of fullness and more likely to overeat.
• Limit the amount of time your child spends watching TV, playing video games, and using a computer.
• Exercise together regularly. Walk, bike, swim, dance, or garden—anything that keeps you active!

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New parents have countless concerns: Is my baby too hot or too cold? Is she sick or just fussy? Do I need to wake her at night to breastfeed? While concerns may vary from parent to parent, one concern is universal—how will I know my baby is getting enough (or too much) to eat? Learning to recognize your baby’s feeding cues and to respond in an appropriate way is an important part of parenting. All babies (at some point) will transition to eating solid foods and drinking from a cup, and when that occurs, the same feeding cues will apply.

Early signs of hunger and fullness
Breast milk provides all the nutrients your baby needs for the first six months. With a stomach the size of their fist and a growth rate that is unparalleled, it’s easy to see why babies need to eat 8, 10, or 12 times a day. Watching your baby for early signs of hunger—such as sucking on fingers or fists, making sucking sounds, wiggling or squirming, and rooting (searching for the breast)—and responding to your baby’s cues, will ensure that your baby gets all the nutrients he needs to grow. Just like feeding cues that say, “I’m hungry,” your baby will also give you cues to tell you when he is full, such as releasing the breast or refusing the bottle, turning his head, or holding up his hands as if to say, “Stop.” As a parent, you simply need to watch carefully, and respond accordingly.

Starting solids
Most babies will show an interest in solid foods around 6 months of age. You will know that your baby is ready for solid foods if she can:

• Sit up with little or no support;
• Hold her head up; and
• Pick up foods and put them in her mouth.

In addition to being developmentally ready, your baby needs to show an interest in foods other than breast milk or formula. Does he watch you eat? Does he try to snatch food from your plate? Does he react positively (opening his mouth wide) or negatively (clenching his jaw and turning his head) to a spoonful of food touching his lips? Regardless of your baby’s age, if you see signs telling you he’s not interested in solid foods, simply wait a few days, or even a week, and try again. Mealtime is a learning experience for you and your baby—one that is meant to be fun.

According to Ari Brown, M.D., a pediatrician in Austin, Texas, and co-author of Expecting 411, Baby 411, and Toddler 411, these early feedings are less about quantity taken and more about getting acquainted with new foods. “For kids under a year of age, breast milk or formula is still the mainstay of nutrition even after you introduce solid foods, so don’t worry if you haven’t gotten to all four food groups at each meal,” says Brown. “Just try to offer a variety of foods.”

How much is enough?
Babies come in all shapes and sizes, and those differences carry over to how much and how often they eat. According to Brown, 6-month-olds typically eat about two ounces of solids a day; 7-month-olds eat four ounces twice a day; and 8- to 9-month-olds, four to six ounces three times a day. While some parents have the urge to measure out these amounts, Dr. Brown says this is seldom necessary. “If a baby is not gaining weight appropriately, then it might be worthwhile, but otherwise it is a waste of time.”

Another time-waster is any attempt to carve out a mealtime schedule. Some babies prefer three meals with two snacks in between, while others prefer smaller meals scattered throughout the day. If you have a picky eater, mealtimes can be stressful—a positive attitude and a calm manner will benefit everyone. “Kids will eat if they’re hungry and have no other choices,” says Charles I. Shubin, M.D., medical director of the Children’s Health Center at the University of Maryland Medical Center. “I promise they won’t starve, but they will test the limits much further than what most adults can tolerate.”

“Most children are able to self-regulate calories until they reach the age of 5—eating when they are hungry and refusing to eat when they are full,” says Heather Russell, R.D., a pediatric registered dietitian at St. Joseph’s Children’s Hospital in Paterson, New Jersey. “This is normal and not something parents should worry about unless their child fails to gain weight or grow appropriately.”

Knowing your baby is eating enough
Regular checkups are the best way to ensure that your baby is getting enough to eat. “When you take your baby for checkups, the pediatrician will record your child’s height and weight on a growth chart to determine if the child is growing appropriately,” says Russell. “If the child’s height and weight are within normal limits, then you can be sure your baby is getting enough to eat.”

Keep in mind that as your baby becomes more mobile and starts crawling and walking, he will gain weight more slowly. For the first six months, your baby will likely gain one to two pounds a month. After that, weight gain generally slows to around one pound a month.

Knowing your baby is eating too much
One sign that your baby may be getting too much to eat is excessive weight gain. Parents should never force a child to eat. If your baby turns her head away from the spoon, try another food instead. And if she flat-out refuses this second attempt, it is likely she is trying to tell you that she is not hungry. Babies who are not hungry will:

• Turn their head away from the food;
• Push the spoon away from their mouth; or
• Lean back in their chair.

If you see these signs, take a break, and try again later.

Remember this: Your baby will let you know when she has had enough to eat. Generally, you don’t need to be concerned if, in some instances, more food ends up on the floor than in your baby’s mouth. “Anytime you think your kid isn’t getting enough to eat, just notice his energy level!” says Shubin. “We wish we had that much energy!”

If you have any concerns about your child’s weight and/or eating habits (undereating, overeating, picky eating), don’t hesitate to contact your child’s health care provider.

From the minute my oldest child was born, I have found myself singing. There have been the traditional nursery songs, the cherished lullabies, the dusted-off golden oldies, and the educational ditties. In a class of their own are the improvisations, made up on the spot to encourage a child searching for a lost item, coax him upstairs at bedtime, get him to lie still during a diaper change, or tease him into his winter gear.

It is easy to imagine Alison Blenkinsop’s musical imagination similarly taking hold as she prepared to teach a new mother about breastfeeding, to explain to expectant parents the role of midwives and doulas, and to discuss the pure goodness of breast milk. Not many women would choose to sing—or songwrite—about these topics, but Blenkinsop (a former midwife, now a lactation consultant) puts her musical skills to the task, with verve and humor that are sure to have her audience laughing from page to page.

Although the word “breastfeeding” is nowhere to be found in the book’s title, Fit to Bust: A Comic Treasure Chest, each page is a celebration of the wholesomeness of breastfeeding and mother’s love. Original lyrics about infant feeding are set to the tunes of well-known songs, with accompanying details about Blenkinsop’s inspiration for the piece, the occasion for which it was first performed, reflections on her experiences in foreign countries, stories about breastfeeding dyads, and more.

As a whole, Fit to Bust (2008) celebrates breastfeeding mothers; at the same time, it acknowledges that breastfeeding is not always easy and encourages parents who may face challenges such as tongue-tie, nipple pain, lack of support, and persistent formula advertising. New parents and expectant parents will find it to be a quick read that provides a wealth of practical information in a fun, easy-to-digest manner. Photographs, cartoons, song lyrics, and humorous anecdotes provide many passages readers will be eager to share.

While parents may enjoy most of this book, there are sections that seem to be included expressly for an audience of midwives, doulas, parent educators, and lactation consultants. For example, Blenkinsop’s discussion of how to make and use a knitted breast model to explain concepts to breastfeeding mothers simply is not relevant for a general parent audience. Also, a series of brief poems that ran monthly in a lactation consultant newsletter seems an odd fit to the book. In fact, parents may choose to skip Chapter 14, “Breastfeeding Supporters and Specialists,” altogether. But that would be a shame since Blenkinsop’s helpful “Thrush and Mastitis” (set to the tune of “Morning Has Broken”) is contained in that section.

Blenkinsop is British, so many of her reflections and statistics are about breastfeeding in the U.K., but the themes and concerns she addresses are universal. This book serves as a valuable, funny reminder to relax and enjoy this important, loving aspect of the parent-child bond. Proceeds benefit the non-profit Baby Milk Action in its effort to limit the damage of artificial infant feeding.

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It’s unanimous. The U.S. Consumer Product Safety Commission (CPSC) voted 5-0 in support of new standards to address the dangers posed by cribs—including risks associated with drop sides, mattresses, and slats. The standards are designed to eliminate gaps that allow a baby to fall out of the crib or become entrapped and suffocate.

The CPSC action comes on the heels of an announcement by Pottery Barn Kids that it is recalling more than 80,000 drop-side cribs due to concerns over entrapment, suffocation, falling.

Pending final approval by the federal commission sometime next year, the new standards would ban the sale of drop side cribs, require better mattress support, sturdier hardware, and better quality wood for crib construction.

According to CPSC Chairman Inez Tenenbaum, there were 36 crib-related deaths between November 2007 and April 2010. Defective hardware, gaps caused by poor mattress support, and use of inexpensive wood that allows crib slats to easily break are the biggest risk factors in drop-side cribs—factors addressed by the new standards.

The standards will have a rippling effect on manufacturers and retailers, with a spike in demand offset by an inability to sell the cribs already in stock that don’t meet the new standards. Hotels, motels, and child care facilities around the country will be forced to purchase new cribs that, for many, could prove unaffordable given the current economic environment.

“My biggest fear is that day care centers, in particular, will be stuck with no other option but to place babies in play yards or on floor mats—even temporarily—since the purchase of so many new cribs will be quite expensive,” said CPSC Commissioner Anne Northup.

Resellers will also feel the pinch. With people unable to donate cribs that fail to meet the new standards, the supply of used cribs will disappear for some time.

A final vote is expected in December 2010, with the new rules taking effect in the summer of 2011. A public comment period will begin shortly, after which the agency will assess the comments and decide if changes are needed.

In the meantime, the CPSC is asking consumers (parents and caregivers alike) to stop using recalled cribs, inspect the hardware to ensure that it is properly installed and not faulty, and check the mattress for gaps. Given the proven dangers, a play yard or a floor mat may be your best choice until a crib that meets the new safety standards is available and affordable.

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If the words “health care reform” make your eyes glaze over, check out the American Academy of Pediatrics’ (AAP) one-page fact sheets intended to explain the Health Care Reform Law, the Patient Protection and Affordable Care Act, and the Health Care and Education Reconciliation Act of 2010, and how they align with the academy’s core principles:

1. Every child must have quality health insurance.

2. Quality health insurance should be a right, regardless of income, for every child, pregnant women, their families, and ultimately all individuals.

3. All health insurance plans should have a comprehensive age-appropriate benefits package directed to the special needs of the pediatric population as recommended by the AAP.

4. Every child should receive care in a medical home with a primary care pediatrician, and have access to pediatric medical subspecialists, pediatric surgical specialists, pediatric mental and dental professionals, and hospitals with appropriate pediatric expertise.

5. All health plans should have payment rates that assure that children receive all recommended and needed services.

Did you know that the reform act will expand health insurance to cover almost 32 million more children and parents? Did you know it will ban pre-existing condition exclusions for kids, and allow young adults to stay covered by their parents’ insurance until age 26?

Families of children who are uninsured (10 percent of all American children) or on Medicaid (30 percent of American children) will find the fact sheets particularly helpful.  Thanks to the AAP, staying up-to-date on health care reform has never been easier. Click here to access the fact sheets and related news and editorials.

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The economy may be lagging, but organic food sales are booming. In 2009, sales of organic food and beverages were up an estimated 5.1 percent over 2008—a grand total of $24.8 billion in sales; organic fruits and vegetables alone increased 11.4 percent compared to 2008. Sales of organic baby food have trended upward as well, with a whopping 21.6 percent increase between 2006 and 2007. It is estimated that by 2012, organic baby food will be a $2.26 billion business.

Parents who give their babies organic foods typically do so because they believe they have higher levels of vitamins and minerals, and lower levels of pesticides and other potentially harmful chemicals. However, many parents question whether organic baby food is really worth the price.

Organic vs. non-organic
“Results actually do show that organic produce tends to be higher in certain nutrients,” says Amy Marlow, RD, MPH, a nutrition advisor at HappyBaby, and co-author of HappyBaby: The Organic Guide to Baby’s First 24 Months. “I will concede, however, that when it comes to some vitamins and minerals, there has not been a consistent finding that organic is more nutritious than conventional.”

Marlow cites a 2008 review suggesting that, over the long haul, organic foods tend to win out. “The researchers looked at 97 studies and compared 236 matched pairs of organic versus conventional crops,” says Marlow. “They found that in 61 percent of the pairs (145), the organic sample was more nutrient-rich, mostly in antioxidants.” What Marlow doesn’t point out is that the review was conducted by the Organic Center, an organization supported by businesses and individuals with a vested interest in organic food production and distribution. That’s not to say that the review is without merit, only that, like all scientific data, the risk of bias must be considered.

A similar analysis was performed in 2009 by a group of British researchers with funding from the Food Standards Agency, Britain’s version of the U.S. Department of Agriculture (USDA). The researchers compared the nutrient content of conventionally produced crops (non-organic) with those produced organically. Out of 52,471 articles they identified 162 studies—of those, only 55 were of satisfactory (not good but adequate) quality. Eleven nutrients were examined. With the exception of nitrogen and phosphorus—non-organic crops had a higher nitrogen content and organic crops had a higher phosphorus content—the nutrient levels in organic and non-organic foods were the same. The researchers did not measure levels of pesticides, herbicides, or fungicides. Nor did they attempt to look at taste and freshness. Given the lack of good quality data, the authors concluded that more research is needed before the nutrients in organic and non-organic foods can truly be compared. The Lancet, in an editorial response to criticisms of the British study advised its readers to buy organic food—not because it’s more nutritious, but “… do so because it might be fresher and taste better, contains far less chemical residues, and is kinder to farmed animals.”

Organic food and chemicals
For many moms and dads, there is no doubt in their minds that organic foods have lower levels of potentially harmful chemicals compared to conventional foods. But once again, the research is inconsistent.

One survey conducted in New Zealand found that organic products are more likely to contain pesticide residues than products grown conventionally. But that the average pesticide residue level is more likely to be higher in the conventionally grown products.

In contrast, an analysis by the USDA of USDA and other data documenting pesticide residues on fresh vegetables and fruits found that organic produce carries significantly fewer pesticide residues than conventional produce.

A recent study examined urine samples from 23 children ages 3-11 for pesticide residues. Samples were collected each morning for 15 consecutive days. During days 1-3 and 9-15 the children ate a normal diet; during days 4-8, organic foods were substituted for conventional foods. The results, published in Environmental Health Perspectives, showed that immediately after eating the organic foods, the children had significantly lower levels of pesticide residues in their urine; and that the levels remained low until conventionally grown foods were reintroduced.

“For me, this is the main health-related reason to buy organic foods,” says Marlow. “We know for a fact that young children who eat organic foods are exposed to fewer pesticides than children eating conventionally grown foods. We also know that exposure to synthetic pesticides has been linked to negative health outcomes. Further, babies and young children are more susceptible to the health effects of pesticide exposure because of their high percentage of body fat, because they are so rapidly growing, and because they eat more food per pound of body weight than adults.”

The bottom line on organics
Most parents tend to take a cautionary approach, which may explain why organic foods have become so popular with new moms and dads. If you’re on a tight budget, you might want to confine your organic purchases to those fruits and vegetables known to be highly contaminated. The Environmental Working Group publishes a list of the most- and least-contaminated fruits and vegetables each year—Dirty Dozen & Clean 15. This guide will help parents easily determine which fruits and vegetables are the most contaminated and replace them with their organic counterparts or with more of the conventionally grown Clean 15. Parents should also remember that diet is not the only method of pesticide exposure for children. A chemical-free environment both inside and outside a home is equally important.

Many parents may continue to purchase organic foods, motivated by the belief that every little bit helps. But still one wonders if the growing demand for organic food is a good thing or a prelude to “a future of less efficient, more expensive food?”

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Pass the peanuts may soon be passé if opponents of peanuts on airplanes have their way. The Department of Transportation (DOT) is considering banning peanuts on airplanes, and has given the public until August 6, 2010 to comment on the ban. But the DOT cautions that without scientific proof of severe allergic reactions to the tiny peanut particles that might be present on a plane, it cannot implement a ban.

Although peanut allergy is thought to be among the most serious food allergies, the overall prevalence of food allergies is unclear—so too are strategies for their diagnosis and management. The National Institute of Allergy and Infectious Disease (NIAID) is in the process of developing clinical practice guidelines to ensure better diagnosis and treatment of food allergies. To assist in that effort, researchers conducted a systematic review of the existing scientific evidence.

More than 12,000 articles were identified but only 72 met the criteria for inclusion—sufficient data and rigorous testing—revealing that most of the studies on food allergies were poorly done making the results suspect. While nearly 30 percent of the population report having a food allergy, only about 8 percent of children and 5 percent of adults actually do, according to Dr. Marc Riedl, one of the study’s authors. “Even the belief that breastfed babies have fewer allergies or that babies should avoid eggs in their first year of life lack strong evidence,” said Riedl.

Studies rife with limitations
The authors cited numerous study limitations—food allergy has no universally accepted definition; self-report was used as a means of diagnosis; no well-accepted criteria for diagnosing food allergies; limited data for the effectiveness of various treatments such as elimination diets, immunotherapy (shots), probiotics, and education; and limited data for the use of prevention strategies such as exclusive breastfeeding, delayed introduction of solid foods, use of hydrolyzed formulas, and use of probiotics.

Although U.S. studies found a statistically significant increase in food allergy over time (3.3 percent of children in 1997 compared to 3.9 percent in 2007), the authors of those studies acknowledged that the increase could be due to increased awareness rather than an increase in actual food allergies.

The authors concluded:

• Food allergies affect 1-2 percent but less than 10 percent of the population;
• It is unclear whether the prevalence of food allergies in increasing;
• No one diagnostic test has sufficient sensitivity to be recommended over other tests;
• No single test (either the skin-prick test or IgE antibody test) should be used as the basis for a diagnosis of food allergy;
• A food challenge test is a better way to confirm a diagnosis of food allergy;
• Elimination diets are the mainstay of allergy therapy. However, their effectiveness is unproven;
• Immunotherapy may result in desensitization, but long-term tolerance is yet to be determined; and
• Definitions of ‘high-risk’ and ‘hydrolyzed formula’ do not exist. Therefore the effectiveness of probiotics in conjunction with breastfeeding or hypoallergenic formula in preventing food allergy in high-risk infants is unclear.

Data on food allergies is plentiful, but very little is high quality. Before decisions can be made about prevalence, treatment, and prevention, consensus needs to be reached as to the criteria for food allergy and evidence-based guidelines for making the diagnosis. If you have a family history of food allergy, talk with your doctor and your baby’s doctor before pursuing any strategies to prevent food allergies—the unproven benefits may not be worth the known risks.

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Some are obscure, others more common, but all can have devastating consequences if not diagnosed right away—which is why Newborn Screening (NBS) is so important. And why Kathleen Sebelius, Secretary of Health and Human Services, acting on a recommendation from the Secretary’s Advisory Committee on Heritable Disorders in Newborns and Children has announced the first-ever national standards for newborn screening—standards that proponents of newborn screening hope each state will adopt.

Currently, newborn screening standards differ from state to state with the number of conditions screened for and the type of testing procedures used varying widely. With the availability of national standards, newborn screening advocates are hoping that all states will adopt these standards, and that all babies will have equal access to screening for potentially life-threatening but treatable diseases.

The March of Dimes has long criticized state screening programs that favor cost savings over infant health. In 2004, the American College of Medical Genetics (ACMG), joined with the March of Dimes in acknowledging the need for national standards. And in a report to the Health Resources and Services Administration (HRSA), ACMG identified 29 core conditions for newborn screening and 25 secondary targets (a total of 54 diseases). Many states (a total of 36) have also added hearing testing to the list of conditions required by newborn screening programs. In 2009, all 50 states and the District of Columbia had laws requiring that every baby be screened for 21 or more of the 29 core conditions. Currently, only 24 states and the District of Columbia require screening for all 29 core conditions. And only New Jersey and Minnesota screen for all 54 conditions—at a cost per newborn of $71 and $101 respectively.

History of newborn screening
Newborn screening programs began in the early 1960s when scientist Robert Guthrie, PhD. developed a test for phenylketonuria (PKU). Individuals with PKU lack an enzyme needed to process the amino acid phenylalanine. This amino acid is essential for normal growth, but too much phenylalanine can damage brain tissue and cause mental retardation. By putting babies with PKU on a special diet immediately after birth, scientists found the babies were able to develop with zero occurrence of any brain damage.

Since the development of the PKU test—which underscored the importance of early detection and treatment—scientists have developed screening tests for other conditions. Decisions about which conditions to include in newborn screening programs are made by state boards of health, unless mandated by federal law, which currently requires that all newborns be screened for only three diseases—phenylketonuria (PKU), congenital hypothyroidism, and sickle cell disease.

Factors that influence screening decisions include:

• how often the condition occurs in the general population
• whether an effective screening test exists
• whether the disorder is treatable
• cost of screening
• cost of acquiring and implementing new technology
• cost of follow-up if results are abnormal

Conditions most commonly included in state newborn screening programs include:

• Phenylketonuria (PKU)
• Congenital hypothyroidism
• Sickle cell disease
• Galactosemia
• Congenital adrenal hyperplasia
• Biotinidase deficiency
• Maple syrup urine disease
• Homocystinuria

States currently spend over $120 million on newborn screening—charging on average $20-40 per newborn. Primary care and specialty physicians are responsible for notifying the family of abnormal results and reconfirming initial results through additional testing. Physicians are also responsible for identifying appropriate management and treatment options and ensuring follow-up.

Take home message
Learn about the newborn screening program in your state. Find out what tests are included. Discuss the pros and cons of screening for additional conditions including cost. Talk with your health care provider (doctor, midwife, or nurse) if you have a family history of a genetic disease, have given birth to a child with a genetic disease, or have reason to believe that your child may be at risk for a specific disease.

Newborn screening is usually done before your baby leaves the hospital (within 2-3 days after birth). It requires that a small sample of blood be taken from the heel of your baby’s foot. A positive test does not necessarily mean that your baby has a specific disease, but it does mean a second test is needed to confirm the results of the first test. Parents find it reassuring to know that most genetic diseases are rare. Should your child test positive for one of the conditions, it’s important to remember that most babies do well with early treatment.

For more information about newborn screening or to see how your state compares to others in terms of conditions screened for, check out the national screening map at the National Newborn Screening and Genetics Resource Center.