Parenting Solved

Dr. V, Are You a Militant Breast-Feeding Advocate?

One of my colleagues recently joked that I was a “militant breast-feeding advocate.” I told her that this wasn’t necessarily true but it did get me thinking.

I’m not militant about much. You would think I am if you’ve read Colic Solved. Sure I’m passionate about the recognition of acid reflux in babies but I would never put the interests of a baby behind this passion. And while I advocate breastfeeding, I do so because it represents the best nutritional substrate for babies. I don’t toe the line with breast-feeding advocacy groups peddling sociopolitical agendas – my allegiance is to children, not a cause.

I guess you could say that I’m militant about advocating for children and parents. I try to make tricky things less complicated in a way that helps empower parents. It’s what got me going with Parenting Solved.

More than militant, I guess, I’m just plain passionate.

Measles Rising - Is the Anti-vaccine Movement to Blame?

Measles is on the rise. The Centers for Disease Control reports 64 measles cases between January and April 2008, the highest number in recent years. Declining immunization rates and immigration are felt to be responsible and this has created the setting for a major outbreak.

Britain is experiencing its worst outbreak in 20 years. London's Daily Mail blames the Andrew Wakefield and his debunked vaccine claims which resulted in an 80% plummet in MMR vaccinations.

While the autism-vaccine connection has been disproven repeatedly, the prophets of the anti-vaccine movement are too caught up in their own opinions to understand that measles actually kills children. Consider this: Before introduction of measles vaccination in 1963, approximately 3 to 4 million suffered with measles annually in the United States; approximately 400 – 500 died, 48,000 were hospitalized, and 1,000 developed chronic disability from measles encephalitis.

Those who fail to immunize selfishly put your children at risk. Responsible parents everywhere should be outraged.

Image courtesy of the CDC.

Local WIC Program Goes BPA-free

Maryland’s Howard County Health Department has taken the step of providing only bisphenol A-free products to its WIC (Woman’s, Infants and Children) Program. WIC provides supplies and supplemental foods to low-income pregnant women, new mothers, infants and children under the age of 5. According to Maryland Med, Dr. Peter Beilensen, Howard County’s top health official “hopes to turn BPA into another trans fat: legal but largely shunned by the public.”

As far as I can tell this is one of the first WIC programs in the country to take a firm stand on BPA. But here’s the $64,000 question: Will the Howard County Department of Health restrict infant formulas packaged in BPA lined containers? And if you’re going to be BPA-free, how free do you need to be?

While I respect Dr. Beilensen’s stand on the issue, his department’s broad statement on BPA is as likely to fuel public hysteria as it is to positively influence the indigent children of Howard County. And while I agree with their policy as it pertains to bottles, their commitment to go BPA-free will need to address the issue of when, where and how much is too much (aka, the packaging issue) as well as the real risk of non-oral exposure. And he will inevitably need to explain to the citizens of Howard County that there are more questions to be answered before public health policy can be chiseled in stone.

Free Range Kids and America's Worst Mother

Here's a new way to look at things. Lenora Skenazy, a columnist from the New York Sun, has initiated a movement against protectionism in parenthood. She calls it the Free Range Kids movement and it’s gathering some real momentum from the looks of thing. The free range philosophy supports the belief that we should spend less time coddling and more time letting go. Labeled “America’s Worst Mom” by some, I think she may be on to something. Check it out on her blog.

My favorite quote: “Children, like chickens, deserve a life outside the cage. The overprotected life is stunting and stifling, not to mention boring for all concerned.”

Via 43f

Does Your Baby Need a BPA-Free High Chair?

The evolution of the bisphenol A witch hunt is interesting. What started in bottles has evolved to toys, formula containers, and most recently high chairs. Sites and blogs are building reputations by being the ‘first to the press’ breaking resin disclosures on the latest products. While providing a valuable service in many cases, it runs the risk of creating unnecessary stress for parents desperate to do the best for their children. And the question of toxic high chairs represents a great example. To understand whether a high chair puts a child at unnecessary risk, we have to understand how BPA gets into children.

Eating High Chairs
All peer-reviewed research on this issue currently supports the idea that bisphenol A’s primary route of entry is through ingestion. Bottles, teething toys, cups and food containers containing BPA would appear at this time to represent exposures that should be avoided when possible. Contact exposure does not appear to warrant practical concern unless you are putting your high chair into liquid suspension and applying it to your child’s skin for prolonged periods of time. Even then, transdermal migration is quite low. This fact is supported by studies cited in the November 2007 NTP-CERHR Expert Panel Report.

Consequently, concern over high chairs, automobile interior molding, decorative elements in your home, Halloween costumes, seats on carnival rides, grocery store displays, etc. shouldn’t be a primary source of your attention as a parent unless your child persistently sucks, chews, and eats these items.

How Free Do You Need to Be?
So how BPA-free do we need to be? Do we need to dump our high chairs and castigate a manufacturer who happens to use BPA in the grommet fitting of an exersaucer? Do we need to sell our cars, fire our daycare and move out of our homes? Probably not. We do, however, need to recognize that BPA is one of many compounds of concern in our personal environment. And this concern needs to be approached with an understanding of the real risks. When BPA meets its likely fate, there will be suiters in the wings ready to take its place.

While there may be those who suggest that the BPA in a high chair represents unreasonable risk, I’m currently not one of them. As a pediatrician, I try to balance the voices of those special interest groups representing the plastic industry with those special interests profiting from BPA madness. That would make me the lone man out. But based on the words of frightened parents desperate for truly objective information, I’m definitely not alone.

Retail Clinics Officially Circle the Drain

Here’s some shocking news: “Retail Clinics Likely to Slow Their Growth” according to today’s Wall Street Journal. Retail clinic operators from Wal-Mart to CVS are shuttering many of their clinics due to slow growth. Apparently the private equity firms and venture capitalists that backed this half-baked concept “failed to appreciate how complicated and expensive the clinics are to operate.” This is especially true when the patients never actually show up.

As I predicted in 2006 the retail model of health care delivery is appropriately doomed. If nothing else we’ve learned that for even their simplest health needs, providing for children is actually different than peddling corn nuts and disposable razors.

Say "No" to Lactose-Free Formula

Let’s put an end to lactose-free formula. Babies just don’t need it

Here are the facts: babies go through a very transient period where their production of lactase (the bowel enzyme necessary for digestion of lactose) is subpar. Beyond this very early and temporary period, babies tolerate lactose just fine. There are a handful of babies in recorded medical history who have been born without lactase. And unless you’ve birthed one of these half-dozen babies, your baby shouldn’t need a lactose-free formula. One exception: viruses may injure the lining of the small bowel to the point where lactase can be temporarily lost. While some pediatricians will recommend going lactose-free during this time period, there’s little evidence that it actually improves a baby’s course of diarrhea. And soy formulas for generations have covered the waterfront just fine – they’re lactose-free.

And while there will always be those who claim that lactose-free formula “saved their baby’s life”, there will also be those who suggest that switching from Similac to Enfamil had the same impact. Infant formula urban legends are complicated and what some parents report is truly hard to reconcile. I can say this as a father and a pediatrician.

As someone who makes a living caring for babies with fragile tummies, I can attest to the fact that presence of lactose-free formula on grocery store shelves serves to confuse parents. And in some cases this confusion fuels the game of formula roulette. While I won’t go so far as to call the marketing of lactose-free formula irresponsible, I will suggest that it should go the way of low-iron formula. It represents a market-driven product that doesn’t serve the needs of its customer, the baby. Further, its empty promise of soothing “colic” serves only to bamboozle desperate parents who think that it might make a difference.

Let’s put an end to lactose-free formula. Babies just don’t need it.

How Do Bedroom Televisions Impact Children?

I knew there was a reason why our kids don’t have TVs in their rooms.

A study from the University of Minnesota published in the journal Pediatrics last month compared the characteristics of teens with televisions in their rooms to those without. Here’s what they found: “Adolescents with a bedroom television reported more television viewing time, less physical activity, poorer dietary habits, fewer family meals, and poorer school performance.”

Wow. The link is here but I think my cited conclusion is all you need to know.

Where are the Doctors on Bisphenol A?

I love to learn where parents get their information. If you are in my office and you quote a statistic, I’ll ask where you got your information. Not in a confrontational way but in a curious way.

And when it comes to BPA, here’s what’s interesting: It seems everything parents know about plastic safety is from the Internet. Doctors, it seems, are less apt to confront the edgy material that parents buzz about. It’s Google, not Dr. Spock, that’s empowering this generation of parents. The handouts and instruction sheets on ear infections and constipation that have been disseminated in pediatrician offices for generations are still everywhere. They’re the yellowed remnants of a time when doctors smoked more cigarettes, made more money and controlled information. What you knew was what your doctor told you.

But for better or worse, when it comes to the latest information on BPA, it seems parents are very much on their own. For now. I suspect that the final version of the NTP Brief on Bisphenol A which is due this summer will force the issue further. And if the NIH doesn’t shape professional opinion, the market will.

The Internet is something of an information free market – and ultimately the wisdom of the mob has to be respected. For now, those of us are who are coming up to speed on the issue are finding few professional resources to help us. We too are on our own and we’re depending on the same resources now available to inquiring parents like yourself.

If Dr. Spock could see us now.