Parenting Solved

The Public Evisceration of Dr. Bob Sears - A Sign of Change?

After having the chance to fully review Dr. Paul Offit’s carefully crafted analysis of The Vaccine Book, I can’t help but think that the American Academy of Pediatrics may be on to something. 

More than just exposure of how Sears has misrepresented vaccine science, Offit’s beautifully written piece represents an AAP endorsed, frontline offensive on a very popular, very visible medical family on the front pages of its journal, Pediatrics.  As an organization prone to neutrality, this represents a fundamental change in the way of handling the growing assault on vaccines.  I might suggest that a piece like Dr. Offit’s may never have seen the pages of an AAP publication as recently as five years ago.  This is progress.

While careful, thorough dissection of the antivax propaganda is a critical first step to public education, reiteration of Offit’s message in the social media will ultimately determine its destiny.  The hearts and minds of frightened parents are won on Google, Twitter, and the blogosphere.  As of the time of this post, a Google blog search for mention of this important article shows rare mention.  Myself and other pediatrician bloggers who passionately advocate for children and their needs were never notified.  This is a problem.

The American Academy of Pediatrics needs a clearly defined social media strategy that takes full advantage of opportunities such as this.  Dr. Paul Offit is a champion for parents, children and the AAP and his hard work needs translation onto social media platforms.  But as for now The Problem with Dr. Bob’s Vaccine Schedule will remain quietly in the shadows.

Offit Takes on the Sears Vaccine Schedule

It looks as though Dr. Paul Offit is finally going to the head of the beast by taking on Dr. Robert Sears' "alternate" vaccine schedule as detailed in "The Vaccine Book."  In a harshly worded review of the Sears book, Offit apparently makes the argument that the alternative vaccine schedule for infants and toddlers is flawed, misguided, and puts children at significant risk of preventable diseases.  Wow, and I thought the fireworks weren't until New Years Eve.

WebMD got to the key players in a well-done piece you can find here.  The most entertaining part of the article is watching Dr. Bob try to have it both ways as a pediatrician interested in increasing immunization rates while simultaneously pandering to the base that buys his books.  Talk about a dilemma.

I have been digging for the original article but I suspect that it’s embargoed and due for public consumption with the release of the January issue of Pediatrics.  More when I get my hands on it.

January 5, 2009: For more check out Offit vs. Sears - Anti-Vaccine Media Bias

Food Allergy Deaths May Be Overstated

This is fascinating.  It seems for years we’ve been overstating the incidence of death from food allergy at 150-200 per year.  But Meredith Broussard at The Huffington Post showcases evidence that the number may reach no higher than 11 deaths per year.  This is according to the most recently available statistics from the Centers for Disease Control.  Apparently the 150-200 deaths per year stat is derived from a 1999 study of an isolated county in Minnesota.  The figure has been taken as gospel and has been cited as recently as this month in the New York Times and the British Medical Journal.

While I’m always one to advocate for children who do suffer with serious anaphylactic reactions, I’ve had some reservation about the degree of allergic hysteria that rears its head in public places.  This statistic doesn’t change the fact that such children need to be taken seriously, but it might be a key first step towards easing the social tension of the allergic child.

Should Kids Eat Snow?

I remember as a kid in the 60’s and 70’s my grandfather would berate us for eating snow.  “You’re gonna pick up all that radioactivity from the atmosphere you know,” he’d shout into the back yard.  His concern was the fallout from nuclear testing, a concern of his generation.

I stumbled across a post at Julie’s Health Club that got me thinking about my grandfather, and my own kids.  So is snow safe for kids?  Helen Suh Macintosh, a professor of environmental health at Harvard, put together a nice summary of the snow issue last year.  She notes:

“It turns out that snow is a fairly efficient pollution collector when it is in the air. Snow is formed by water vapor that moves in clouds in cold air. As the water vapor moves in the cold air, it can stick to a tiny piece of dust and then have other water molecules attach to it, forming a crystal. Once formed, the crystal can continue to grow and can stay in the air for hours before it falls to the ground. It is during this time that the snow crystal can collect or “scavenge” pollutants that are present in the air.”  This, of course, is a bigger issue in urban areas than in rural areas. 

Macintosh goes on to suggest that white snow is probably a safe bet in small quantities.  And for the incredulous child, the impurity of snow can be demonstrated by melting some in a glass and simply looking at it.  After all, seeing is believing.

Should You Breastfeed on Facebook?

Mom Kelli Roman found herself at the center of a brewing breast milk controversy when pictures of her nursing her baby were pulled from Facebook.  Apparently the images fell into the category of inappropriate.  An impromptu Facebook group (Hey Facebook, Breastfeeding is Not Obscene) has formed to officially protest the action.  Interestingly the group page has a Polaroid of a baby nursing but one has to assume that the Big Brothers at Facebook deemed this one tastefully draped. 

While I can see Facebook's position in keeping the ‘face’ in Facebook, I have to say I side with the nursing mother here.  People of reasonable judgment can look at an image and determine if it’s a representation of a loving bond between mother and child or just an old-fashioned cheesecake shot.  Am I wrong?

Milk: Flavored or Plain in Children?

It’s an recurring debate in parenting circles: to flavor or not to flavor a child's milk.  Those against think we’re creating the next generation of sugar-addicted chocoholics.  Those in favor of flavor think the former are a bunch of nutritionally uptight helicopter parents.

While I would never refer to any of my loving parents as nutritionally uptight helicopter types, I have to side with those who flavor.  Sorry.  So why shouldn’t we be concerned about powdered flavoring in milk?

The big argument: sugar.  Adding flavoring, of course, increases sugar consumption in milk-guzzling kids.  And a half-pint of chocolate milk provides 75 calories more than it’s plain white counterpart.  But a study published in the Journal of the American Dietetic Association found that flavored milk consumption in school-aged children was associated with less soda intake.  And from this study it appears that the sugar intake from flavored milk offsets that from soda – so as far as sugar is concerned, children don’t appear to consume more of it when drinking flavored milk.  Data from the Nutrition Health and Nutrition Examination Survey (NHANES) also found that flavored milks contributed only 2 percent of total added sugar in children's diets, compared to 50 percent or more added by soft drinks and fruit drinks.  Another study published this year also in the Journal of the American Dietetic Association found no increase in body mass index among children who drink flavored milk.  

Admittedly flavored milk adds some sugar but not to a fault.  So while I’m onboard with minimizing sugar, chocolate milk may not be the battle to pick.

If they have chocolate will they ever go back?  Tainted taste buds are a frequent preoccupation of parents.  But if they’re not keen on plain milk to begin with, you’ve got nothing to lose.  And for the picky eater, milk may be a key means of getting calcium and protein into your child.

Milk, flavored or not, delivers calcium.  An 8-ounce serving of milk provides 300 mg of calcium, about one-third to one-fourth of the daily calcium requirement for children.  And when it comes to calcium and kids we need to take it where we can get it.  The older children get the more likely they are to replace milk with soda and sports drinks – a move associated with decreased intake of riboflavin, folate, vitamins A and C, calcium and phosphorus.

Who needs milk, anway?  Finally, let me throw a big wrench in things by adding that milk in children may be highly overrated.  While we’ve all been raised to believe that we must not leave the table until we've finished our milk, this may actually be more of a cultural/parental habit.  In fact, there are no individual foods that we can’t live without.  While I love milk as a vehicle for protein and calcium, these nutrients can be found other places.  And although I exploit the fantastic qualities of milk regularly in my patients with poor diets, many kids can go without.  Call me a heretic and bring on the American Dairy Council!

Do Babies Need DHA in Their Baby Food?

It’s always been in breast milk, then it appeared in infant formula and now you can find it in baby food.  It’s DHA (docosahexaenoic acid).  So what is DHA and do you need to be feeding your baby DHA-supplemented baby food?

What is DHA? DHA is a special fatty acid critical to brain and eye development in babies and young children.  Babies get a bunch of it during the last trimester of gestation and then become dependent upon getting DHA in their diets.  DHA is found in breast milk (as it turns out, levels in breast milk depend upon your diet) and it first was added to infant formula here in the U.S. in 2002.

What does it do?  Studies have shown that DHA, when added to a baby’s diet at certain levels, can improve brain development and vision.  While this was initially felt to be true only in preemies, recent studies have supported a neurodevelopmental role for DHA in term babies.  And if that is isn’t interesting enough, try this on for size: A new study released this summer (abstract findings presented at the World Congress of Pediatric Gastroenterology, Hepatology and Nutrition) found a tight connection between DHA exposure in infancy and resistance from upper respiratory infections later in childhood.  Wow.  While its suspected that the effects reported in this study may be seen with the levels of DHA found in Mead Johnson’s Enfamil Lipil or Nestle Good Start, the study was conducted among children fed Enfamil Lipil.

Here’s the problem.  When it comes to brain and eye development, no one knows exactly how much DHA a baby needs.  Several organizations have taken a stab at minimums but they’re nothing better than a stab.  And these stabs are based on minimum levels proven to make a difference.  The American Dietetic Association, for example, has suggested that infant formula contain at least 0.2% of its fatty acid content as DHA.  The American Academy of Pediatrics has been conspicuously silent on DHA since its introduction into infant formula.

So back to our question.  Do children need DHA in their baby food?  No one knows the answer to this question.  While we may accept the mounting data showing that certain levels in infant formula when taken at standard baby volumes are associated with improved brain development and vision, there’s no evidence that the addition of more DHA in baby food offers any advantage.

But as with most elements of our baby’s diet, the body takes what it needs and what remains feeds the Diaper Genie.  And so it may be with DHA.  But at least we all feel good believing we’ve tried to make a difference.

More later as the DHA story evolves.

When Can a Child Eat Sushi?

It seems more and more children are appearing in sushi establishments.  But is sushi safe for children?  And when can you feel good about offering your little bundle of joy a raw wedge of tuna?  Great question because the Internet is teeming with vague, unsubstantiated information on sushi safety.  And perhaps for good reason: there’s no committee-established consensus on the issue.  

When making decisions about fish and your child, just look at it like any other food but with a couple of very important caveats.  Consider three fish factors:  Allergy, safety of preparation, and environmental contamination.  Lets take one at a time

Allergy – Concerns over fish allergy should vary depending upon your family’s allergy history.  If there is no history of food allergy, it’s fair game to offer your child fish once on table food.  Offer cooked fish before venturing into sushi.  If there is a family history of fish allergy, introduction should be withheld until after three years of age and with the approval of your pediatrician or allergist.

Cool side note: a study that published in the Archives of Disease in Childhood found that babies who start fish before they’re 9 months old have a lower risk of getting eczema and allergy-related skin disease

Safety of preparation – Uncooked food is different from cooked food in that infectious contamination always has to be considered.  When uncooked food sits, bacteria can grow and pose risks intestinal infection and food poisoning.  Assuming that sushi is fresh, properly handled and prepared correctly, contamination risk should be minimal.  Look for high volume, reputable establishments.  When it comes to fish, high turnover is a good thing.  Oh, and when serving fish to a young child inspect carefully for bones.

Contamination – Arguably the most concerning risk to young children when it comes to fish is mercury exposure.  Like most toxins, remember that it’s difficult to avoid mercury entirely – all we can do is make every effort to minimize exposure.  The FDA recommends that you avoid giving young children shark, swordfish, king mackerel and tilefish because of high mercury levels.  Good ‘low mercury’ fish to offer your child (once on table food) include shrimp, canned light tuna (albacore is higher in mercury), salmon, tilapia, farmed trout and catfish.

So be it for fashion or taste, sushi represents healthy alternative for the evolving palate.  Just watch your P's & Q's and keep in mind the three fish factors.

Birthday Party Payola

My son turned 10 recently.  And this year we negotiated for a party payoff.  Instead of forking over 250 dollars for laser tag, bad pizza, responsibility of eight kids, and a headache we bartered to instead offer a crisp $100 note to be used at his discretion.  The payoff was accepted and everybody was happy.  

Shoulda thought of this last year.

Sexualization of Childhood Doesn't Pay

If you’ve got a daughter and you’re concerned about our sexed-up, materialistic pop culture, this has been the week for you. 

Childhood boutique Libby Lu landed in the weeds and, according to its website, will shutter its stores at the end of January.  Libby Lu was founded in 2000 by Mary Drolet, acquired by Saks and ultimately expanded to 98 stores.  For the unitiated, Libby Lu offers future divas a boutique experience that (via On Parenting) “hooks girls as young as 3 on glittery tube tops, tight pants, boas, nail polish, lip gloss, tiaras and runway modeling.”  Apparently parents aren’t big on this.  Good riddance.

The Bratz crew was shown to the door when, after a long legal battle, a federal judge decided that the Bratz belong to Mattel.  And Mattel, of course, wants no part of 'em.  For those new to the game, Bratz is the hyper-sexualized doll series that's training the next generation of American women to dress and behave as 50-dollar streetwalkers.  Chilling.  As a father it’s reassuring to know that my daughter’s future playdates won’t be able to influence my spawn with these lecherous little trolls.

Enough said.