It's Official: AAP Recommends Keeping Toddlers Rear-Facing Until At Least Two

Shortly after Violet's first birthday, I posted about why that occasion wouldn't be coinciding with at least one milestone it's often associated with: turning the car seat around so the child can ride facing forward like everyone else in the car. There's no disputing that in the event of an accident, kids are safer in rear-facing car seats long past the one year point when most people turn them forward. So Violet's birthday came and went, and she stayed rear-facing.

The available evidence and experts - including the American Academy of Pediatricians - have long confirmed that rear-facing is the safest way for kids to ride (within the height and weight limits of the car seat). But this month's issue of the AAP News finally included a direct recommendation to keep toddlers rear-facing until two. Hopefully lawmakers won't take long to catch up. As for Violet, she'll likely sail through her second birthday long before she reaches the 35 pound rear-facing weight limit of her Britax seat.

Speaking of Violet . . . what post could be complete without a photo?

One More Reason Why I Don’t Rely on the FDA: Melamine in US Infant Formula

I don’t consider myself a conspiracy theorist, but I admit I don’t trust a lot of the information our government offers on matters of health and safety. Of course I’m not suggesting the FDA and the CDC are out to get us, but the evidence of industry’s significant influence over such agencies is disconcerting, to say the least. I’ll save my favorite example - the story of the conflicts of interest discovered in FDA and CDC vaccine advisory committees for its own post on another day; suffice it to say, my inquiry into the risks and benefits of anything I'm considering for my daughter NEVER ends with "according to the FDA . . ."

So when I heard yesterday that the FDA says the amount of the toxic chemical melamine detected in U.S. baby formula is safe, I wasn’t entirely convinced. Last summer, more than 50,000 Chinese babies were sickened after drinking formula contaminated with melamine. Shortly thereafter, the FDA stated that it wasn’t able to establish ANY level of melamine and melamine-related compounds in infant formula that did not raise public health concerns. The agency also assured the American public that there was no known threat of contamination of formula manufactured by companies approved to sell formula in the U.S. That was the last anyone heard from the FDA on the subject until the Associated Press filed a Freedom of Information Act request requiring the FDA to disclose that it had found trace amounts of melamine in formula and nutritional supplements sold in the U.S. Consumer groups have questioned whether the information would ever have been released absent the FOIA request.

The FDA’s reticence on the issue hardly inspires confidence. Many Americans rely on government agencies like the FDA to protect them from harmful products, assuming that if it’s on the shelf it’s been approved by the FDA and so must be safe. Instead, the FDA seems to be sitting on information that may affect the most vulnerable among us. And the agency’s concurrent statement that the amounts detected in the U.S. formula were “trace amounts” which it considered to be “perfectly fine” for infants? Quite a departure from the agency’s original position that it could not identify any amount of melamine as safe for infant consumption. Color me skeptical.

Now that the word is out, the FDA appears to have been more forthcoming on the subject. Earlier this week, it revealed that melamine and byproduct cyanuric acid have now been detected in more containers of infant formula - twice as many as were reported in November. (Results of FDA testing for melamine in formula can be viewed here. Additionally, formula manufacturer Abbott Laboratories (makers of Similac) has also said that it detected trace levels of melamine in its formula. Whether the trace amounts of melamine discovered in any of these samples of formula would be harmful to a baby and how is uncertain, but I’m certainly not taking the FDA’s declaration that it is as the last word.

Melamine isn’t something I’d want to mess around with. A chemical commonly used in plastics and adhesives, it has been found in food products, usually added to increase nitrogen content which makes the protein content appear higher. For example, in the Chinese formula that made such news last summer, water was added to raw milk to increase volume, and melamine added to mask the lower protein content of the end product formula. Melamine can also get into food products through packaging or from a cleaning solution used on some food processing equipment. While no studies have been conducted on human subjects, animal tests demonstrate adverse health effects such as bladder stones and kidney stones which can lead to kidney failure and even death. Melamine has also been shown to have a carcinogenic effect on animals.

The levels of melamine in the Chinese formula that harmed so many children there were higher than those in the U.S. formula tested by the FDA (which the FDA believes was contaminated in the manufacturing process, rather than added intentionally), but it’s not clear to me how the FDA arrived at the conclusion that the levels in U.S. formula are safe for consumption by little bitty babies, especially with respect to long term effects. Hopefully more information will become available now that melamine is on the public’s radar. As to how reliable that information might be . . . I’ll be considering the source.

Who Says Kids Don't Like Curry?

The first time a friend offered Violet a veggie “puff,” I was puzzled. ”They’re healthy,” she explained. “They’re made from vegetables.” Why not, I wondered, just give her the actual vegetables instead?

Western culture has an unfortunate tendency toward dumbing-down food for kids. Whether it’s for the sake of convenience, or the mistaken assumption that kids won’t like cauliflower, it’s more common to see a toddler munching on gummy fruit snacks than a fresh nectarine. Hoping to encourage an affinity for healthy, whole foods is one reason my husband and I opted to follow an approach I’d read about referred to as “baby-led weaning” (BLW) to introduce Violet to solid food. Instead of offering her the standard rice cereal and purees, we presented her with the real thing from the beginning and let her lead the way. Read more about Violet’s first encounter with solid food (we started with bananas) here.

BLW allows the baby to become acquainted with real food in its true form, exploring tastes and textures at her own pace. Texture is such a pivotal part of the epicurean experience, but purees eliminate that element entirely; learning to love pureed peas may not translate into an affection for the small round version that bursts in the mouth. BLW also gives the baby the chance to choose for herself among what is offered (i,e., polishing off her yam before moving on to the Quinoa with Latin Flavors and black beans or kiwi, above) and to be in control of how much she wants to consume - which helps her learn to follow her body’s signals in determining when to stop eating, rather than relying on the person wielding the spoon to decide for her.

From bananas, Violet ventured to other soft foods like avocado, squash and very ripe pears, and she didn’t stop there. By the time she was a year old, she had developed a pretty sophisticated palate, enjoying all the same dishes we do: from steel cut oats with cinnamon and raisins to Vegetarian Paella, Baked Ziti with Vegetables and Mushrooms, and grilled wild Alaskan Salmon with rosemary roasted potatoes and steamed broccoli. In a time crunch, we fall back on her favorite spinach, feta and heirloom tomato omelet.

We can’t take all the credit, of course – Violet’s willingness to sample anything we serve is in large part a product of her personality. But we certainly hope that exposing our daughter to healthy, unprocessed fare at an early age has contributed to her developing a taste for a variety of whole foods, prepared in different ways with different flavors . . . and that her preference for such delicacies will persist, even in the face of the less nutritionally desirable options she’ll no doubt encounter (and occasionally indulge in, as we all do) someday.

Reposted from API Speaks, September 14 2008.

Stuff We Like: Tiny Diner Portable Placemat

We don't eat out often, but when we do, we want Violet to be able to eat with us. That's tough at this age, when food on a plate might as well be sitting on a frisbee waiting to find itself in flight. And of course the thought of putting what she'll be eating directly on the restaurant table is - put politely - stomach-churning. The solution? The Tiny Diner Portable Placemat.

The Tiny Diner placemat is compact (it rolls up to take up less space in the diaper bag), durable, and most importantly, made of safe materials: no lead, PVC, or phthalates. The suction cups on the bottom help affix it to the table, and the spill catcher is effective at keeping at least some of the food that doesn't make it to her mouth off the floor. We pack it alongside her meal whenever we head elsewhere to eat, and when she's done, roll it up, bring it home and wash it so it's ready to go again.

Here she is, putting it to good use tonight as she enjoys her dinner of brown rice, black beans, tomatoes and avocado (with a side of melon) at a brewery alongside the river:

Don't Turn Around: Keep Kids' Car Seats Rear-Facing Longer

Although Violet is one year old, we don't have any plans to turn her car seat to face forward any time soon. Most parents are aware of the minimum standard: wait to turn the car seat from rear to forward facing until your child is one year old AND weighs at least twenty pounds. But experts - including the American Academy of Pediatricians (AAP) - agree that keeping kids rear-facing longer keeps them safer in the event of an accident.

How long? Kids are safest riding rear-facing as long as they continue to meet the height and weight limits of their specific car seat. For most convertible car seats, that means until the top of the child's head reaches the top of the shell, and up to 30 or 35 pounds. Many kids won't reach those limits until well past two, or even three.

In a frontal collision, injuries to a child in a car seat are generally limited to the head and neck. In a forward-facing seat, a child's body will be held back by the harness, while the head is thrown forward, subjecting the neck to massive stress, and possibly stretching or even breaking the spinal cord. In a rear-facing car seat, on the other hand, the head, neck and spine stay fully aligned, allowing the child to "ride down" the crash while the back of the seat absorbs most of the impact.

Though a rear-facing seat won't provide as much protection in a rear end collision, rear end collisions only account for about 4% of severe crashes - 72% of severe crashes are frontal collisions, and 24% side impacts. Frontal collisions are not only much more common, but much more severe than rear end crashes.

Kids can continue to ride rear-facing safely even when their legs are long enough that their feet are touching the vehicle seat. It may look uncomfortable to an adult, but kids are flexible and often prefer to sit with their legs folded. More importantly, there are no documented cases of hip or leg injuries in rear-facing children. And even if a child were to suffer an injury to a hip or leg, such injury would certainly be less devastating than the head or neck injury the child would likely have suffered if she had been forward facing during the collision.

In the United States, motor vehicles collisions are the number one cause of death for children under the age of 14. Keeping the car seat rear-facing as long as possible significantly reduces the risk of injury and death to children involved in collisions.

Looks like Violet is going to be enjoying the view out the back window a while longer.

Technorati Tags: carseat, rear-facing

Stuff We Like: Sophie the Giraffe

As we amassed baby gear in the months before (and after) Violet was born, we relied heavily upon the recommendations of other parents with similar priorities in making our selections. We still do, though we're moving beyond baby gear as Violet approaches toddlerhood. And now that we have a little bit of experience ourselves, we're looking forward to turning others on to things that have become favorites in the East End, starting with Sophie the Giraffe.

Made by Vulli for over 40 years, this teething toy has earned her status as a classic. Sophie was without question Violet's first favorite toy. Soft and pliable, Violet could manipulate Sophie's long legs and neck easily early on and - as intended - her head and hooves found themselves in Violet's mouth often. Most importantly, all that chomping was completely safe: Sophie is handmade in France with natural rubber and non-toxic paint. She's become my go-to baby gift, so if you're expecting, well . . . you'll know what to expect.

Working Toward Becoming BPA-Free: This Stuff's Not Just in Your Water Bottle

Of course becoming parents changed our lives. Who knew it would also change our water bottles? But our increasing awareness of risks associated with exposure to BPA (inspired, of course, by Violet) led us to do exactly that. Our Nalgene bottles have been replaced by shiny new Siggs (non-leaching aluminum water bottles), and that was just the beginning.

Bisphenol A (BPA) is an industrial chemical used to make polycarbonate plastic resins (all number 7 plastics are polycarbonate and contain BPA), epoxy resins, and other products. Numerous studies have shown BPA to cause serious health effects, including cancer, diabetes, infertility, and behavior disorders, even at low doses. Mainstream media has covered the growing concerns over BPA and other toxins (like PVC and pthalates) in plastic - particularly plastic water bottles and baby bottles - extensively as of late. What isn't discussed as often are the other common items contaminated by BPA: for example, baby formula, canned food, and dental sealants.

According to Center for Disease Control (CDC) data, people are routinely exposed to unsafe levels of BPA from such sources. Not surprisingly, babies and children are the most vulnerable; their bodies' immature detoxification systems allow increased exposure to BPA which, according to the National Toxicology Program (NTP) brief on BPA could impact developing reproductive systems, hastening puberty and even leading to breast/prostate cancer, and affect behavior in children. It's scary stuff, and probably can't be avoided entirely, but there are alternatives to many of the major offenders.

Baby bottles. Most plastic baby bottles contain BPA, which is of particular concern because heating items containing BPA has been shown to increase the rate at which it leaches from the plastic by 55 times. Canada has actually banned baby bottles containing BPA from the market there. We have always used glass Evenflo bottles for Violet, but I understand there are BPA-free plastic bottles out there, too.

Sippy cups/water bottles. Most plastic sippy cups also contain BPA. Though Violet is still figuring out the sippy cups thing, her choices are BPA-free: a Safe Sippy and a Thinkbaby trainer cup. Other good options we intend to explore for her: Kleen Kanteen and a Sigg kid's bottle. Both Kleen Kanteen and Sigg make BPA-free water bottles for big people too (stainless steel and aluminum, respectively).

Food storage containers. Toxins in plastic food storage containers may leach into the food inside. This, too, is more likely if the container is heated, but even ordinary use and washing is sufficient to break down the plastic and allow leaching to occur. We avoid all number 7 plastics for our food storage, and all of Violet's food is kept and heated in glass. We're working toward replacing the rest of our Tupperware and Rubbermaid containers with glass storage pieces like Pyrex as well.

Canned food. Though the public eye has been focused recently on our exposure to BPA from plastic, BPA is also found in the lining of metal cans, where it leaches into the food or drink inside; independent studies have shown that exposure to BPA from such sources is significant. The EWG tested 97 canned foods and found that of all the foods tested, chicken soup, infant formula and ravioli had the most concerning levels of BPA: “Just one to three servings of foods with these concentrations could expose a woman or child to BPA at levels that caused serious adverse effects in animal tests.”

Though fresh, whole foods are always our first choice, we do rely on certain canned food staples like beans and tomatoes. Where other forms of items like these (for example, dried beans) aren't available or practical, we've switched to Eden Organic for almost all of our canned goods - they package their foods in a BPA-free can.

Dental sealant. Yes, that mysterious substance most of us have somewhere in our mouths contains BPA. And it's leaching out into our heads. What to do about that is less clear, as there don’t appear to be any safer options available for treating cavities. In a recent discussion with my dentist on the subject, I managed to talk my way out of a filling and into a crown. I guess that’s one way to avoid additional exposure to BPA, but I’m not sure I’d recommend it.

On Eating Organic

While we started thinking about what kind of food we wanted Violet to eat early on, intending for her to be exclusively breastfed for at least six months bought us some time to study up on nutrition before we had to make any decisions about what to put on her plate. (Multiple health care organizations, such as the World Health Organization, UNICEF, the American Academy of Pediatricians and the American Academy of Family Physicians recommend delaying introduction of solid food, including cereal, until at least six months.)

I found myself fascinated as I explored for the first time the vast expanse of information available on diet/nutrition. I plowed through several books on the subject: The Omnivore's Dilemma, by Michael Pollan; Eat to Live, by Joel Fuhrman; From Here to Longevity, by Mitra Ray; and The China Study, by T. Colin Campbell; and of course continued my research online through various websites and forums. It will remain an ongoing process, I'm sure, but we have reached at least one initial conclusion: organic is important. And for Violet, it's very important.

We all know that most of the produce we buy has been doused with pesticide. The movement toward organic food (produced without pesticides, fertilizers made with synthetic ingredients or sewage sludge, bioengineering, or irradiation) has been growing, but many people still aren't sure whether eating organic is really necessary, or just another marketing gimmick. Commercial growers and pesticide manufacturers imply that consumption of pesticide residue in produce is "safe" because "there is no conclusive evidence of harm to humans." However, as explained by the Environmental Working Group (EWG), the lack of evidence regarding harmful effects long-term, low dose exposure to pesticide is not a result of studies proving pesticides safe - it simply hasn't been studied at all.

Government regulations on pesticide use are instead based on testing of high doses of pesticides in adult animals. But even if those regulations provide sufficient protection to adults (and I wouldn't count on it - remember, government regulations permitted the use of DDT once, too) they do not address the unique effects of pesticide consumption in infants and children. A study conducted by the National Research Council, Pesticides In the Diets of Infants and Children, confirmed that the toxicity of pesticides is different in infants and children than in adults, and found that "little work ha[d] been done . . . to "investigate the effects of pesticide exposure on neurotoxic, immunotoxic, or endocrine responses in infants and children."

There is no dispute that the infants and children are the most vulnerable to the toxic effects of pesticides. Children's developing organ systems, including the brain, nervous system, and endocrine system, can be damaged by exposure to toxins in amounts that would be tolerated by an adult. While we may not know exactly how harmful the pesticides used in growing our food might be, pesticides are toxic by nature - it doesn't seem like much of a stretch to conclude that their effects, however mild, can't be good for a growing little body.

An organic diet has been proven to decrease - immediately and dramatically - overall pesticide exposure in children. One study showed this to be particularly true for organophosphorus (OP) pesticides, a group of pesticides known to cause neurologic effects in humans, the residue of which has been detected in many fruits and vegetables. We may not be able to prevent Violet from being exposed to pesticides and other chemicals, but we can make every effort to limit that exposure where we can - and her dinner seemed like a good place to start.

Admittedly, organic produce - all organic foods - are more expensive than their conventional counterparts. But what's more important than providing our baby girl with the best, and safest, food we can find? In addition to being free from pesticides, organic produce has been shown to have higher nutritional content. There are better places in the budget to cut back than her health.

So far, Violet's menu of solid foods has been limited to fruits and veggies. We hope to keep her eating whole foods as much as possible, for as long as possible. (Within reason of course. We're not expecting her to go off to college never having experienced such culinary delights as the McDonald's french fry, or Ben and Jerry's. We're not cruel!)

The jury's still out on the extent to which meat, dairy and other animal products will be a part of her diet, but where they do show up we'll absolutely insist on organic. Organic meat, dairy, and eggs are even more important than organic produce, for a whole host of reasons, not the least of which is the added dangers associated with the antibiotics, hormones, and other drugs found in non-organic animal products. But that's another post for another day.