Baby 411 Blog

Attention toddlers: HIB booster shot is back!

The Centers for Disease Control announced today that medical providers can now resume giving the much needed HIB booster shot to toddlers.

HIB stands for Haemophilus Influenzae B. It's a bacterial infection that can cause meningitis and serious throat swelling (epiglottitis) among other things. There has been a nationwide shortage of this vaccine for quite a while now, and as a result, the limited supply was being given only to infants who had no protection against the disease. Toddlers who had already gotten their primary vaccination series have had to wait on their booster dose.

Here are the official recommendations:

• Infants should receive their primary Hib series at ages 2, 4 and 6 months, and a Hib booster dose on time at 12 through 15 months of age.
• Older children for whom a Hib booster dose was deferred should receive the Hib booster at the next routinely scheduled visit or medical encounter.
• Mass recall of children for their catch-up Hib booster dose is not recommended at this time because physicians may encounter supply problems during such a massive recall.

"Updated Recommendations for Use of Haemophilus influenzae Type b (Hib) Vaccine: Reinstatement of the Booster Dose at Ages 12-15 Months," MMWR, June 26.

I highlighted the bullet point above so that every toddler in my practice doesn's show up at my office tomorrow morning asking for a HIB shot!  I know with my own practice, it will take a little time to get additional HIB vaccine in our office from our supplier. That will probably be the case for your doctor's office as well.

So, what does that mean for you?
If you have a child who is 12-15 months old, he will get his HIB booster just like he would have normally.

If you have a child who is between the ages of 18-36 months, ask your doctor if your child is due to get his HIB booster next time you are in for an office visit. Medical providers will be trying to catch all these kids when they come in for sick or well child visits, but you can help us remember!

Measles outbreak strikes East Coast

Did you see the Private Practice episode last week where the child returned from Switzerland with measles and then exposed an entire waiting room of young children and pregnant women? Sometimes art imitates life, and then life imitates art....

Several states are reporting measles outbreaks across the country this week, but particularly on the East Coast.

The following states are reporting confirmed cases of measles:
Iowa
Pennsylvania
Washington DC
Maryland
Virginia

Measles is a virus that cause a fever, cough, pink eye, and then a pretty characteristic rash of multiple raised red dots all over the body. The most serious complications are pneumonia, brain inflammation, and death. It's not a disease I'd wish on my worst enemy.

One tricky part of this infection is that people are contagious with it for a day or two before they feel sick and the classic rash may not show up until 3—5 days into the illness. So, measles infected people may walk around, unknowingly exposing others. The virus is spread in the air, through infected cough droplets, and can survive in the environment for a couple of hours after the infected person is gone.

Because of this exposure risk, county and state health departments are notifying residents of potential exposures with infected people here:
 www.fairfaxcounty.gov/hd/comdis/measles.htm and
www/dhmh.state.md.us/publ-rel/html/2009/joint042009.htm

The incubation period (time from exposure until illness) is about 1-2 weeks. So, if you think you were exposed, you have a couple of weeks to sweat it out. And, you may need to get a shot—see below for details.

As many of our readers already know, measles vaccine is usually given to children beginning at 1 year of age and a booster dose is given before starting kindergarten. The vaccine is extremely good at protecting against measles. In outbreak situations, it is recommended to give measles vaccine within 72 hours of exposure. In epidemics, measles vaccine can be given to babies as young as six months of age. We will keep you posted if any new recommendations come from the Centers for Disease Control.

NOTE: If you think you or your child has measles, do not just show up in your doctor's waiting room or local emergency room. Call someone first so precautions can be made to keep exposures to a minimum.

Peanut butter alert!

There's a Salmonella outbreak (one form of bacterial food poisoning) going on in the U.S. (474 cases thus far and 6 deaths) that appears to be linked to peanut butter manufactured by the Peanut Corporation of America.Their products end up in more than just the jar that's sitting in your pantry--it may include cookies, candies, and ice cream that use peanut butter as an ingredient. So, as a precautionary measure, check out the link to the Food and Drug Administration for their recommendations until more is known about the exact source of the outbreak.

Baby gas drops recalled

Two lots of the popular infant gas drops, Mylicon, were recalled by the manufacturer due to potential contamination with metal fragments. There are no details on the true health hazard--and there are no reported problems thus far. But, no one really wants their gassy baby to be eating metal. Here's the actual press release from the FDA:

FOR IMMEDIATE RELEASE -- Fort Washington, PA (November 7, 2008) – Johnson & Johnson • Merck Consumer Pharmaceuticals Company (JJMCP) is voluntarily recalling approximately 12,000 units of Infants' MYLICON® GAS RELIEF DYE FREE drops (simethicone-antigas) non-staining sold in 1 oz. plastic bottles that were distributed after October 5, 2008 nationwide. The company is taking this action in consultation with the U.S. Food and Drug Administration (FDA). Although the potential for serious medical events is low, the company is implementing this recall to the consumer level as a precaution after determining that some bottles could include metal fragments that were generated during the manufacturing process. If any medical events were to occur, most are expected to be temporary and resolve without medical treatment. Parents who have given the product to their infant and are concerned should contact their health care provider immediately.

The two lots of Infants' MYLICON® GAS RELIEF DYE FREE drops non-staining 1 oz. bottles included in the recall are:

Product Code #	Lot #	Exp	Product
71683791111-1	SMF007	09/10	Infants' Mylicon® Gas Relief Dye Free Non-Staining Drops 1 oz.
71683791111-1	SMF008	09/10	Infants' Mylicon® Gas Relief Dye Free Non-Staining Drops 1 oz.

Consumers can find the lot numbers on the bottom of the box containing the product and also on the lower left side of the sticker on the product bottle.

Consumers who purchased Infants' MYLICON® GAS RELIEF DYE FREE drops non-staining included in this recall should immediately stop using the product and contact the company at 1-800-222-9435 (Monday – Friday, 8:00 a.m. – 8:00 p.m. EST) or via the internet at www.mylicon.com for instructions regarding how to dispose of the product and request a replacement or refund.

Infants' MYLICON® drops are sold over-the counter, in retail stores and pharmacies, as an anti-gas medicine to relieve the discomfort of infant gas frequently caused by air swallowing or by certain formulas or foods.

The recall does not affect any Original Infants' MYLICON® GAS RELIEF products (1/2 oz. or 1 oz. size) or Infants' MYLICON® GAS RELIEF DYE FREE drops non-staining (1/2 oz. size).

The manufacturer has instructed retailers and wholesalers to return their inventories.
 
Adverse reactions or quality problems experienced with the use of this product may be reported to the FDA's MedWatch Adverse Event Reporting program either online, by regular mail or by fax.

Online:  www.fda.gov/medwatch/report.htm
Regular Mail: Use postage-paid FDA form 3500 available at:
www.fda.gov/MedWatch/getforms.htm.
Mail to MedWatch 5600 Fishers Lane, Rockville, MD 20852-9787
Fax: 1-800-FDA-0178 

New Vitamin D recommendations? Confused? Here's the 411.

Greetings from Boston! The weather is beautiful and the leaves are changing colors. It's also the site of the American Academy of Pediatrics annual convention this year. The AAP's major policy statement released at the convention is that all kids need more Vitamin D in their diets. The previous recommendation, which dates back to 2003, says that kids need 200 IU of Vitamin D. The updated statement doubles that daily requirement to 400 IU.

Why? Vitamin D is needed for bone strength. In young growing kids, vitamin D deficiency can lead to rickets (softening of the bones in children that leads to fractures and deformities). In adults, deficiency can lead to osteoporosis. There's also emerging data that shows Vitamin D can help prevent certain types of cancers, autoimmune disorders like Multiple Sclerosis, and diabetes.

In the good old days before sunscreen, UVB rays would help our bodies make Vitamin D naturally by setting off a chemical change through our skin. Now that we all (or most of us) wear sunblock, we need to get more Vitamin D from our diets. Unfortunately, that's not an easy task.

Vitamin D is found in large quantities in fatty fish (like cod liver oil) which most kids and adults don't probably eat that often. Milk is fortified with Vitamin D--about 100 IU per cup. Some yogurts also are fortified, but the amount of Vitamin D is significantly less--like 40 IU per serving.

So here is what the recommendations boil down to:

1. Newborns who are exclusively breastfed need a Vitamin D supplement, 400 IU per day. There are infant drops that are Vitamin D only, and others that contain Vitamins A, D, and C. Multivitamins or those with iron are not necessary unless directed by your doctor.

2. Newborns who are formula fed and eat at least 32 oz of formula per day do NOT need a Vitamin D supplement. However, babies aren't consuming that kind of volume until they are at least one month of age--sometimes up to four months of age. So, until that volume is reached, formula fed babies need a supplement too. And babies who get some breast milk and some formula need a vitamin D supplement until they are consuming at least 32 oz of formula per day.

3. All kids over age one need 400 IU of Vitamin D per day. If they get it in their diets, they do not need a supplement. This gets a little tricky, so follow along: The AAP  recommendation is for 1 to 2 year olds to drink 16 oz of whole milk a day (which also contains 200 IU of Vitamin D). To get the 400 IU Vitamin D requirement in, that would mean 32 oz of whole milk a day--NOT a good idea. So, if your child doesn't drink cod liver oil, he'll probably need to get the remaining 200 IU of Vitamin D from a vitamin supplement. 

4. For kids ages 2-3: The recommendation for milk changes to skim or 1% milk, but the volume remains 16 oz/day as the recommendation. Again, that only gives your child half of the daily Vitamin D he needs. But, if your child wants to drink more skim milk, that's fine.

5. For kids over age 3: Because this age group's daily calcium needs go up, we already recommend 3-4 servings of dairy a day. And yes, not every kid gets that. But, if he did, he would also fulfill his daily Vitamin D requirements. If that's not happening, yes, the recommendation would be to give a vitamin supplement.

Hopefully this helps clarify what you have been hearing on the news (I had to clarify it myself when I heard it!)

Chinese formula recall

The Food and Drug Administration issued an advisory today warning people to avoid using infant formula made in China. You won't find this formula at traditional grocery stores or at megamarts because it is illegal to sell it in the U.S. However, you might find a can or two at ethnic grocery stores. The concern? It may be contaminated with melamine, a product found in plastic. Melamine ingestion can cause kidney stones and other kidney problems.

Infant cough and cold med recall

The major manufacturers of infant cough and cold preparations have voluntarily recalled 14 products from the market today, saying that there is too much risk of misuse or overdose of these products. They should be applauded for being proactive on this one.

This comes shortly before the Food and Drug Administration is scheduled to release a report next week about their investigation on these over the counter preparations.

The FDA was alerted to potential for overdose by the City of Baltimore Health Commissioner, who identified four children under three years of age whose cause of death was accidental overdose of cough and cold products.

As we all know, these products say "consult a physician" instead of offering a dosing guideline. Parents may then try to guess-timate what is the correct dose. To add to the confusion, some products are used to treat multiple symptoms and thus, contain two or even three different medications. If a parent then gives another medication, like a decongestant, the child may be accidentally be getting double doses of one product.

I, like most of my pediatrician colleagues, have never recommended these cough and cold remedies anyway. They have marginal benefit in relieving symptoms of the common cold or flu and don't make the disease go away any faster. And, clearly the risk outweighs the benefit.

I still recommend using saline nose drops (you can';t overdose on those!), a humidifier, and lots of TLC from Mom and Dad.

Toy Recalls: Get the lead out!

Yes, first it was a toxic Thomas and dangerous Dora, now its bad Batman.

As you may have heard, there was another major toy recall for toys manufactured in China. Today’s alert instructs families to throw away some 9 million Mattel toys due to loose magnets and lead paint:

http://www.cpsc.gov/ (click on Recent Recalls)

Given recent events, we thought we’d get you up to speed on lead and our suggestions for how keep your kids safe.

Q. What is the problem with lead anyway?

A. Lead is a metallic element which is a known neurologic toxin. When it became apparent that lead could cause significant harmful effects in humans, even at low levels of exposure, it was removed from gasoline and paints in the 1970’s.

Blood levels of 10 micrograms/dl or more are considered toxic and may have adverse health effects. Kids under six years of age are most sensitive because the lead can impact the developing brain.

Most children do not have any symptoms when they are diagnosed with mildly elevated blood lead levels. However, potential effects include developmental delays, loss of developmental milestones (especially in language skills), and learning difficulties. More serious health consequences are also possible, especially with higher toxicity levels and chronic exposure.

Q. How can my child be exposed to lead in the environment?

A. The most significant exposure risk is in children who live in homes built before 1978. Lead paint dust can be ingested by young children, especially when they spend time crawling on the floor and putting their hands in their mouths. Lead water pipes can also be a source of exposure.

Lead continues to be used in products (paint, pottery glaze, cooking products, pigment in cosmetics, crayons, paints, medications) throughout the world, particularly in developing countries. And, when these products are imported into the U.S, we may be exposed to them.

Q. What should I do if my child has toys that are recalled?

A. Odds are, your child has not had a significant lead exposure even if you have more than one of the toys lying around your playroom. It’s a little more concerning if your child was using one of these toys as a teething toy or really enjoys exploring toys with his mouth.

It’s probably wise to bring up your concerns with your child’s doctor, and get a blood lead level drawn depending on your child’s possible risk of exposure. If your child’s blood lead level is less than 10 micrograms/dL, toss out the recalled toys and call it a day.

Plastic Baby Bottles: Are they safe?

Breaking news: Experts cite “concern” over polycarbonate baby bottles

Are certain plastic baby bottles dangerous? Readers of our new 3rd edition (out in stores now) may remember our discussion of the safety of polycarbonate baby bottles—and how a federal panel studying the issue was about to weigh in on the issue.

Well, the results are in. Here’s the scoop:

An independent review panel assigned by the National Institute of Environmental Health Sciences and the National Toxicology Program weighed in on the toxic plastics debate last week. Their conclusion: they have “some concerns” about chemical used to make polycarbonate bottles, Bisphenol A (BPA), potentially causing neurologic and behavioral problems in fetuses, infants, and children.

What does that mean for your baby and those baby bottles and sippy cups sitting in your kitchen? Here are the most common questions parents are asking, and our answers based on what we know.


Q. What the heck is BPA? Why is it dangerous?

Clear plastic baby bottles (as well as some food containers and water bottles) are made of polycarbonate, which contains a chemical called Bisphenol A (BPA). It is the BPA that makes the hard, clear plastic bottles . . . well, hard and clear.

Here’s the rub: BPA’s chemical bond with polycarbonate breaks down over time—especially with repeated washings or heating of the bottle. As a result, BPA may leach out of the plastic bottle or sippy cup . . . and into the liquid (that is, breast milk or formula). BPA has been used since the 1950’s in a variety of products and we know that humans ingest (and eliminate) small amounts of this substance on a daily basis considering 95% of humans studied have it in their urine.

While most data BPA comes from animal research, studies show even low-level BPA MAY be linked to everything from early puberty to breast cancer, to attention and developmental problems. It’s hard to say that humans will have the same health consequences, but there is certainly enough concern that it deserves investigating the effects on humans.

The Environmental Protection Agency has set an “acceptable” or “safe” level of daily BPA exposure to be 50 micrograms per body kilogram per day. However, some scientists worry that humans may be exposed to up to ten times that daily dose.

We wrote a detailed article on BPA and plastic baby bottles in our newly revised 3rd edition of Baby 411. It is available online at our website:

http://www.windsorpeak.com/baby411/bpa.html

Q. Do we really know that these bottles are dangerous to humans?

No, we don’t. There have been no human studies on BPA—so far, researchers have only found problems in animal research.

There is a split opinion here among scientists. The same federal panel that said it had “some concern” about behavioral and developmental problems in babies also stated that links to other ailments like birth defects and adult ailments were “negligible.”

That contrasts to the group of 38 scientists who last week called the threat from BPA as “significant.”

But the fact the federal panel said there were some concerns for the health of babies tipped the balance for us.

As a parent, we realize it can be hard to decide what to do when the debate is so heated. As always, our mantra is “show us the science.” We believe enough science is now in to recommend a change in course.

Q. Isn’t it a bit alarmist to say stop using these bottles?

The truth is we won’t know for YEARS if there is a human health problem. And, it could be YEARS more before the government decides to take some regulatory action.

Our opinion: if concerns exist today (and that is backed up by reputable scientific research), then why not try to limit your baby’s exposure to this chemical?

We suggest stop using polycarbonate baby bottles and sippy cups now. Since there are quite a few BPA-free bottles on the market (see below), we believe this is an easy call for parents.

Q. The Juvenile Products Manufacturer’s Association said plastic baby bottles are safe.

In a recent statement, the JPMA said the federal panels report on BPA “reaffirms the safety of plastic baby bottles.”

With all due respect to the fine folks at the JPMA, we’re not sure they were reading the same report we did. If they did, they would note this sentence: “The Expert Panel expressed some concern that Exposure to BPA causes neural and behavioral effects.”

Click here to read it:

http://cerhr.niehs.nih.gov/chemicals/bisphenol/draftBPA_MtgSumm080807.pdf

We realize you can argue that the panel didn’t call for the ban of products with BPA. But, that’s NOT what the panel was asked to do. It will now take years of debate among scientists, researchers and politicians as to the best course to take with BPA.

For the record, Avent told us they believe their bottles are safe and pose no health threat to babies.

Q. Which bottles should we NOT use? Which ones are BPA-free?

Polycarbonate baby bottles make up about 90% of the bottle market. The most common polycarbonate bottle is Avent’s Natural Feeding Bottle and Dr. Brown’s Natural flow. But other major baby product companies like Playtex and Gerber also make polycarbonate bottles.

See our website at baby411.com for pictures of bottles containing BPA:

http://www.windsorpeak.com/babybargains/BPAbottles.html

Here are the alternatives that are BPA-free:

• Use glass bottles. Obviously, there is a risk of injury to baby or mom if the bottle is dropped, so glass isn’t a perfect alternative.

• Use bottles made of opaque plastic. These bottles (made of polyethylene or polypropylene) do not contain BPA.

• Consider a BPA-free plastic bottle. Born Free makes a BPA-free clear plastic bottle (Newbornfree.com) sold at Whole Foods. But these cost about $10 each, twice the price of Avent bottles.

• Use a drop-in system. For example the Playtex Drop-in System is BPA free (that is, the bottle liners do not contain BPA). Avent’s Tempo liners are another example.

Pictures of BPA-free bottles are here:

http://www.windsorpeak.com/babybargains/BPAFREEbottles.html


Q. Is there a way to tell if a bottle has BPA?

A. Unfortunately, it isn’t easy. Here’s a general guide:

BAD:
• Bottles that have a #7 on their recycling label most likely are made of polycarbonate (and contain BPA).

GOOD:
• Bottles that have a #2, #4 , #5 are made of polyethylene or polypropylene—these do NOT have BPA.

We call on the government to require disclosure of which bottles have BPA, so consumers can make an informed choice.

Q. What about sippy cups?

A. Basically, the same advice applies: avoid those made of polycarbonate. Sippy cups made of opaque plastic are fine.

Q. What about breast-pump collection bottles?

A. Again, avoid polycarbonate bottles (Avent Isis is an example) and choose BPA-free options. For example, all of Medela’s bottles are made from BPA-free plastics.

Q. I just bought $50 worth of Avent bottles. Are you saying I should throw them out?

A. Yes. We realize this in an inconvenience—but if you think about it, buying replacement bottles would run only $50 to $100. When it comes to safety, we think this is a worthwhile investment.

What if you don’t want to give up your polycarbonate bottles? While we don’t recommend that option, to lower the amount of BPA that may leach out, avoid heating the bottles in a dishwasher, microwave, or sterilizer. And, toss out any baby bottles that are cracked. Again, we believe the safest course is to replace the bottles with BPA-free alternatives.

Cough and cold meds: BEWARE

The Centers for Disease Control is investigating the deaths of three babies under six months of age who died after taking cough and cold medication.

According to the CDC, “because of the risks for toxicity, absence of dosing recommendations, and limited published evidence of effectiveness of these medications in children aged <2 years, parents and other caregivers should not administer cough and cold medications to children in this age group with-out first consulting health-care provider and should follow the provider’s instructions precisely.”

Bottom line: Cough and cold remedies don’t work that well and in some cases, may be dangerous to young children. Don't guess-timate the right dose of a cough and cold product made for kids over six years of age. And, multi-symptom products or using a combo of over-the-counter and prescription products may inadvertently cause an overdose. For a majority of viral respiratory illnesses, the best remedy is time.