• The gastrointestinal (GI) tract of a normal fetus is sterile.
• The type of delivery has an effect on the development of the intestinal microbiota.

* Vaginally born infants are colonized with their mother’s bacteria.

* Cesarean born infants’ initial exposure is more likely to environmental microbes from the air, other infants, and the nursing staff which serves as vectors for transfer.

• Babies at highest risk of colonization by undesirable microbes or when transfer from maternal sources cannot occur are cesarean-delivered babies, preterm infants, full term infants requiring intensive care, or infants separated from their mother.
• Breastfed and formula-fed infants have different gut flora.

* Breastfed babies have a lower gut pH (acidic environment) of approximately 5.1-5.4 throughout the first six weeks that is dominated by bifidobacteria with reduced pathogenic (disease-causing) microbes such as E coli, bacteroides, clostridia, and streptococci o babies fed formula have a high gut pH of approximately 5.9-7.3 with a

variety of putrefactive bacterial species.

* In infants fed breast milk and formula supplements the mean pH is approximately 5.7-6.0 during the first four weeks, falling to 5.45 by the sixth week.

* When formula supplements are given to breastfed babies during the first seven days of life, the production of a strongly acidic environment is delayed and its full potential may never be reached.

* Breastfed infants who receive supplements develop gut flora and behavior like formula-fed infants.

• The neonatal GI tract undergoes rapid growth and maturational change following birth.

* Infants have a functionally immature and immuno-naive gut at birth.

* Tight junctions of the GI mucosa take many weeks to mature and close the gut to whole proteins and pathogens.

* Open junctions and immaturity play a role in the acquisition of NEC, diarrheal disease, and allergy.

* sIgA from colostrum and breast milk coats the gut, passively providing immunity during the time of reduced neonatal gut immune function.

* Mothers’ sIgA is antigen specific. The antibodies are targeted against pathogens in the baby’s immediate surroundings.

* The mother synthesizes antibodies when she ingests, inhales, or otherwise comes in contact with a disease-causing microbe.

* These antibodies ignore useful bacteria normally found in the gut and ward off disease without causing inflammation.

• Infant formula should not be given to a breastfed baby before gut closure occurs.

* Once dietary supplementation begins, the bacterial profile of breastfed infants resembles that of formula-fed infants in which bifidobacteria are no longer dominant and the development of obligate anaerobic bacterial populations occurs. (Mackie, Sghir, Gaskins, 1999)

* Relatively small amounts of formula supplementation of breastfed infants (one supplement per 24 hours) will result in shifts from a breastfed to a formula-fed gut flora pattern. (Bullen, Tearle, Stewart, 1977)

* The introduction of solid food to the breastfed infant causes a major perturbation in the gut ecosystem, with a rapid rise in the number of enterobacteria and enterococci, followed by a progressive colonization by bacteroides, clostridia, and anaerobic streptococci. (Stark & Lee, 1982)

* With the introduction of supplementary formula, the gut flora in a breastfed baby becomes almost indistinguishable from normal adult flora within 24 hours. (Gerstley, Howell, Nagel, 1932)

* If breast milk were again given exclusively, it would take 2-4 weeks for the intestinal environment to return again to a state favoring the grampositive flora. (Brown & Bosworth, 1922; Gerstley, Howell, Nagel, 1932)

• In susceptible families, breastfed babies can be sensitized to cow’s milk protein by the giving of just one bottle, (inadvertent supplementation, unnecessary supplementation, or planned supplements), in the newborn nursery during the first

  three days of life. (Host, Husby, Osterballe, 1988; Host, 1991)

* Infants at high risk of developing atopic disease has been calculated at 37% if one parent has atopic disease, 62-85% if both parents are affected and dependant on whether the parents have similar or dissimilar clinical disease, and those infants showing elevated levels of IgE in cord blood irrespective of family history. (Chandra, 2000)

* In breastfed infants at risk, hypoallergenic formulas can be used to supplement breastfeeding; solid foods should not be introduced until 6 months of age, dairy products delayed until 1 year of age, and the mother should consider eliminating peanuts, tree nuts, cow’s milk, eggs, and fish from her diet. (AAP, 2000)

• In susceptible families, early exposure to cow’s milk proteins can increase the risk of the infant or child developing insulin dependent diabetes mellitus. (IDDM) (Mayer et al, 1988; Karjalainen, et al, 1992)

* The avoidance of cow’s milk protein for the first several months of life may reduce the later development of IDDM or delay its onset in susceptible individuals. (AAP, 1994)

* Sensitization and development of immune memory to cow’s milk protein is the initial step in the etiology of IDDM. (Kostraba, et al, 1993)

• Sensitization can occur with very early exposure to cow’s milk before gut cellular tight junction closure.
• Sensitization can occur with exposure to cow’s milk during an infection-caused gastrointestinal alteration when the mucosal barrier is compromised allowing antigens to cross and initiate immune reactions.
• Sensitization can occur if the presence of cow’s milk protein in the gut damages the mucosal barrier, inflames the gut, destroys binding components of cellular junctions, or other early insult with cow’s milk protein leads to sensitization. (Savilahti, et al, 1993)

References

American Academy of Pediatrics, Work Group on Cow’s Milk Protein and Diabetes Mellitus. Infant feeding practices and their possible relationship to the etiology of diabetes mellitus.  Pediatrics 1994; 94:752-754

American Academy of Pediatrics, Committee on Nutrition. Hypoallergenic infant formulas. Pediatrics 2000; 106:346-349

Brown EW, Bosworth AW. Studies of infant feeding VI. A bacteriological study of the feces and the food of normal babies receiving breast milk. Am J Dis Child 1922; 23:243

Bullen CL, Tearle PV, Stewart MG. The effect of humanized milks and supplemented breast feeding on the faecal flora of infants. J Med Microbiol 1977; 10:403-413

Chandra RK. Food allergy and nutrition in early life: implications for later health. Proc Nutr Soc 2000; 59:273-277

Gerstley JR, Howell KM, Nagel BR. Some factors influencing the fecal flora of infants. Am J Dis Child 1932; 43:555

Host A, Husby S, Osterballe O. A prospective study of cow’s milk allergy in exclusively breastfed infants. Acta Paediatr Scand 1988; 77:663-670

Host A. Importance of the first meal on the development of cow’s milk allergy and intolerance. Allergy Proc 1991; 10:227-232

Karjalainen J, Martin JM, Knip M, et al. A bovine albumin peptide as a possible trigger of

insulin-dependent diabetes mellitus. N Engl J Med 1992; 327:302-307

Kostraba JN, Cruickshanks KJ, Lawler-Heavner J, et al. Early exposure to cow’s milk and solid foods in infancy, genetic predisposition, and risk of IDDM. Diabetes 1993; 42:288-295

Mackie RI, Sghir A, Gaskins HR. Developmental microbial ecology of the neonatal

gastrointestinal tract. Am J Clin Nutr 1999; 69(Suppl):1035S-1045S

Mayer EJ, Hamman RF, Gay EC, et al. Reduced risk of IDDM among breastfed children. The Colorado IDDM Registry. Diabetes 1988; 37:1625-1632

Savilahti E, Tuomilehto J, Saukkonen TT, et al. Increased levels of cow’s milk and blactoglobulin antibodies in young children with newly diagnosed IDDM. Diabetes Care 1993; 16:984-989

Stark PL, Lee A. The microbial ecology of the large bowel of breastfed and formula-fed infants during the first year of life. J Med Microbiol 1982; 15:189-203

Occasionally they may need extra oxygen by tube, nasal prongs or even need a respirator. Intravenous calories can nourish and sustain the most vulnerable preemies and a gradual transition from tube feeding to breast or bottle will let the stomach and intestines mature without risking harm.

Even babies born a week or two early can have “respiratory distress syndrome of prematurity”–or RDS as it’s called–but this is much more likely under 34-35 weeks gestation (5-6 weeks early.) If premature delivery is anticipated and can’t be stopped, an obstetrician will give the mother-to-be an injection of steroids to speed up lung maturation. This relatively simple and apparently harmless medication has saved countless babies’ lives and kept others from prolonged hospitalizations. Your doctor may not have a lot of time to explain this fully to you when it’s needed on an emergency basis but please know that it works and is safe.

Below I answer frequently-asked questions about the impact of prematurity on infant survival, development, vaccination decisions, and family dynamics.

Q: My sister-in-law delivered 5 weeks early. She smokes, and I’ve heard that smoking can trigger early labor. Is that true? What are my chances of having a premature baby?

A: Yes, smoking and poor (or absent) prenatal care increase the risk of prematurity. Low maternal weight, poor nutrition, drug abuse, maternal age under eighteen years or over forty may lead to prematurity. An attentive doctor in partnership with a healthy aware mom-to-be should recognize many of the risk factors and then the signs of pre-term labor. Premature labor can often be stopped with decreased activity, bed rest and medication. Please make sure you discuss these signs and symptoms with your doctor in early pregnancy visits.

Anatomical problems such as an incompetent cervix, fibroid tumors and unusual uterine shape may predispose a woman to early labor and delivery, too.

Q. “My friend’s baby has been diagnosed with cerebral palsy. He was born 8 weeks early, was in the hospital for over six weeks and had quite a few complications during that hospitalization. Is cerebral palsy associated with prematurity?”

A. Babies with neurological abnormalities or physical anomalies may be born early. We’re not quite sure why.

We’re also not sure if “cerebral palsy” (a broad diagnosis which encompasses motor and intellectual problems of infancy, childhood and beyond) is the cause of the premature birth. The other possibility is that babies who go through hard deliveries and then require extra oxygen, develop infections and have rocky hospital course suffer some injury to the nervous system and develop the neurological problems which we call cerebral palsy.

This is a medical and a medicolegal issue and an extremely difficult discussion with your doctor. The prognosis for recovery is tremendously varied and I have seen many babies who looked pretty bad at the beginning make great recoveries as the months and years go by. I have become certain that optimism is almost always warranted.

Here’s the hardest part: Very few people have spent much time in a Newborn Intensive Care Unit. Here is what you will see: The premature infant will have at least one and sometimes as many as three IV lines. One or two may originate from the belly button where the umbilical blood vessels provide the best access for fluids and medicine. Extra oxygen may be delivered with a hood, mask, nasal prongs or through an endotracheal tube from a respirator. A preemie can look much more fragile and much sicker than he actually is and the first reaction may be panic and fear. Make certain that everything, absolutely everything, is explained to you during those first hours and that re-explanations and updates are given frequently.

Babies born prematurely or with any problems or instability are a completely different issue and you’ll be happy you’ve chosen an OB you trust, a pediatrician attentive to your baby and a hospital which can handle the problems or prematurity.

But, most babies are born at or near term (37-41 weeks) and need no extra attention from the nursery and don’t need to be separated from their moms and dads. Talk to your doctors and the nursery about this before you go into labor. It’s a much tougher discussion at 6 or 7 centimeters dilation.

Vitamin K is a slightly controversial topic. I believe it should be given orally rather than by injection, but most doctors and other expert disagree and have good reasons for their position. Discuss this with your doctor and read a little about the topic.

Previously silver nitrate and now erythromycin or tetracycline is used in newborns’ eyes to prevent the transmission of gonorrhea and chlamydia. Research published in mainstream journals has repeatedly stated that choosing no eye care at all is a reasonable option. Again, most experts disagree, but the research is clear and I recommend no eye care at all for babies who have responsible parents, good prenatal care and pediatric follow up. I have a more extensive article on this subject here: Neonatal Eye Care

Rooming in and not sending your baby to the nursery at all is accepted practice in many if not most hospitals. Again, almost all of this advice is applicable to healthy full term babies only.

Leave the hospital as early as you can but secure good follow-up for the first few days of life. Either a three day doctor visit or, preferably, a home visit from a lactation consultant to make sure that breastfeeding goes well in the first days and weeks. Get the help you need.

Meningitis is also one of the best headline-grabbing diseases. The new (January 2001) recommendation by the American Academy of Pediatrics to vaccinate all college students living in dorms with meningococcal vaccine will cause many parents to bring their soon-to-be graduates to the doctor because the disease rate is “almost five times greater in dorm students than in the general population.” Meningococcus is one of many organisms which can cause meningitis.

If one reads the original research data, the actual numbers might seems a little less impressive: The meningococcal meningitis rate in the general population is 1/100,000 and in the dorms it is 4.6/100,000. Yes, that is nearly five times greater but a few important facts may be omitted from the newspaper stories. If we give all 500,000 shots we could prevent about 15 to 30 cases of meningitis each year according to official estimates. The number of deaths prevented would be one per year according to the lowest estimate and three/year according to the highest estimate. Actuaries at insurance companies have therefore calculated a cost of nearly two million dollars/year/case of meningitis prevented and about $10,000,000 spent to prevent each death. One third of meningococcal meningitis is caused by Group B type and this type is not covered by the vaccine.

Assuming that this vaccination is covered by insurance companies the cost to each individual family is not a large concern. A much bigger concern might be the possible adverse effects on the vaccine recipients. Most studies have shown a high rate of minor problems such as swelling at the injection site and very infrequent kidney problems have followed the vaccine with no proven causal relationship. An interesting note not included in most stories about this vaccine: Because the disease is so rare, there have been never been clinical trials showing that it actually works. The antibodies are measurable in the blood stream and efficacy is assumed and probable but has never been proven.

Interestingly, ped ID and immunologists who should know how delicate the immune system is and how little we really know about it, are the doctors promoting this vaccine the hardest.

If your child will be living in a dormitory, conventional medical wisdom and official medical recommendations favor giving this vaccine. My minority point of view is to avoid it.

I have had firsthand experience and dozens of episodes reported to me of school officials attempting to convince parents that there something wrong with their signing the waiver. Parents have been coerced and threatened over and over again, particularly about the hepatitis B vaccination being absolutely required for entry to kindergarten, sixth or seventh grade. This is not true and represents a serious violation of the letter and the spirit of the laws of the state. This vaccine, along with any and all others, can be waived and refused. School entry may not be denied by either public nor private schools.

I recommend vaccines, gave most of them to my daughter and to the children of my friends, and still support the absolute right of parents to make decisions regarding vaccinations.

Hepatitis B is a terrible disease which causes liver damage and can lead to liver cancer. The vaccine is very effective but preliminary controversial research has suggested that the vaccine itself may increase the incidence of autoimmune diseases such as lupus, multiple sclerosis, diabetes and rheumatoid arthritis. To repeat, this research does not have the support of mainstream experts nor the backing of even a large minority of American doctors. The data were convincing enough, however, for the temporary suspension of administration of this vaccine in France. The disease is transmitted through high risk behavior: IV drug use or promiscuous unprotected sexual contact. Vaccination does not protect against any other sexually transmitted disease such as AIDS, hepatitis C or gonorrhea.

Additionally, the mercury used to preserve the vaccine has drawn the attention of the American Academy of Pediatrics who have recommended, as of August 1999, removal of the preservative and temporary discontinuation of the vaccine for babies under six months of age.

Do not be bullied into believing that your child must have these vaccines for school entry. Likewise, do not be stampeded away from the immunizations by research which is quite incomplete. This is a personal/medical choice without a wrong answer.

My only problem involves the schools, both public and private who are not displaying good judgment as they threaten parents with either non-admission or expulsion. They do, however have the right to exclude non-vaccinated children from school in the event of an outbreak of a contagious illness like whooping cough or measles. Outbreaks of these illnesses are few and far between but possible.

I will be happy to accept phone calls from your school nurse.

Q. “I have been told that my child may not start kindergarten until he has had all the vaccines on a list given to me by the school system. Why is this?”

A. Many illnesses can be prevented by immunization and the best way to do this is to control school entry. Public health and school officials feel very strongly about “universal immunization.” This means getting every single child vaccinated against every single preventable disease. These diseases are much more “communicable” (catching) in larger groups, like a school room for instance.

Q. “Why would anybody object to this?”

A. Good question. Some children have had bad reactions to vaccines involving very high fevers, seizures, “collapse syndrome” and other problems. Some of these reactions strictly prohibit giving another dose of that same vaccine. From a purely medical point of view, most of these reactions do not mean another dose should not be given, but the parents or doctor may be uncomfortable enough to stop that particular vaccination series. TV shows sensationalized the very rare severe reactions to the old DPT shot. They showed children who had been damaged or even fatally injured by the vaccine without giving any balance to the issue. The only benefit this may have had was to speed up the development and usage of the new, safer and more effective DPaT vaccine which does a much better job of preventing whooping cough without the side effects commonly seen with the old shot.

Q. “All right, but if a child has not had any bad reactions to vaccines–or has not even had any shots yet, why would someone object to beginning the vaccines to protect their children against these illnesses?”

A. Another excellent question. Some people think that the shots might cause harm to the immune system. Some have religious or philosophical objections to the vaccines. Others point to the studies which show that certain immune system problems may be caused by the vaccines and that the risk might even outweigh the benefits of the vaccines. Honest opponents of vaccines must admit two very important facts:

1) Vaccines work very well and have eliminated or nearly eliminated some illnesses which used to injure or kill many, many people. These diseases include small pox (gone!) polio (nearly gone) measles (100 cases in the USA last year down from a peak of nearly one million cases in the worst year) and Hemophilus Influenza B, which used to be the number one cause of bacterial meningitis under age two years and which is now virtually unheard of in the pediatric population in America. Pertussis (whooping cough) cases are way down and the new vaccine is the reason.

2) There is no conclusive research which has shown damage from vaccines. There is some good research, some incomplete research, some ongoing research but there are no “anti-vaccine” studies which have drawn the support of the majority of mainstream experts in the field.

Q. “What is your opinion?”

A. The medical community have never been completely honest with parents about the risks and benefits of vaccines. Parents should not only have much more information, but much more input into the decisions about vaccines. These decisions might include when and if certain shots are given.

Parents might decide that their child is not at any risk for contracting hepatitis B and decide that the benefits from that shot don’t outweigh the possible risks. I think this is a parent’s privilege.

All 50 states allow for a medical exemption from the shots, most allow a religious or philosophical exemption and at least a dozen allow a “personal choice” refusal. There are many web sites which will give you the information you need to make an informed choice and for a full explanation of the convention AMA/American Academy of Pediatrics point of view, discuss this issue at length with your pediatrician.

Q. “The vaccination against Hepatitis B seems to be the biggest ‘sticking point’ in getting my children into school. How do you get hepatitis B?”

A. The disease is transmitted through high risk behavior: IV drug use or promiscuous unprotected sexual contact. Vaccination does not protect against any other sexually transmitted disease such as AIDS, hepatitis C or gonorrhea. There may be a very small number of cases of Hep B transmitted through “unknown” means. I have never found this data convincing but many doctors believe it.

Q. “Why does the issue of school vaccinations concern you so much?”

A. I have had first hand experience and dozens of episodes reported to me, of school officials attempting to convince parents that there is something wrong with their signing the waiver. Parents have been coerced and threatened over and over again particularly about the hepatitis B vaccination being absolutely required for entry to kindergarten, sixth or seventh grade. This is not true and represents a serious violation of the letter and the spirit of the laws of most states. This vaccine, along with any and all others, can be waived and refused. School entry may not be denied by either public nor private schools.

I recommend vaccines, gave most of them to my daughter and to the children of my friends and still support the absolute right of parents to make decisions regarding vaccinations.

Do not be bullied into believing that your child must have these vaccines for school entry. Likewise, do not be stampeded away from the immunizations by research which is quite incomplete. This is a personal/medical choice without a wrong answer.

Q. “But, modern medicine has come along to the point where could treat Hepatitis B and cure it if we get it, right?”

A. Sadly, no. There is no known cure for Hepatitis B and treatments are only partially effective at slowing the progression of the disease.

Hepatitis B is a terrible disease which causes liver damage and can lead to liver cancer. The vaccine is very effective but preliminary controversial research has suggested that the vaccine itself may increase the incidence of autoimmune diseases such as lupus, multiple sclerosis, diabetes and rheumatoid arthritis. To repeat, this research does not have the support of mainstream experts nor the backing of even a large minority of American doctors. The data were convincing enough, however, for the temporary suspension of administration of this vaccine in France. Again, the disease is transmitted through high risk behavior: IV drug use or promiscuous unprotected sexual contact and the vaccine should give no one false confidence about these behaviors: Vaccination will not protect against any other sexually transmitted disease.

Additionally, the mercury used to preserve the vaccine has drawn the attention of the American Academy of Pediatrics who have recommended, as of August 1999, removal of the preservative and temporary discontinuation of the vaccine for babies under six months of age.

Q. “With all this conflicting information, how can I make an informed choice?”

A. You might want to err on the side of caution, as people like to say. The vast majority of doctors and experts recommend this vaccine very strongly; The vast majority of children entering school are receiving the vaccine. I do not feel that getting the shots poses a high risk to children and, by the same token, I don’t feel that refusing them sets up a high risk situation for an otherwise healthy child.

This is another medical issue without an absolutely correct answer but there is no wrong answer either.

There is a wide variety of color and consistency of bowel movements.  In my glamorous job as a pediatrician, I discuss this hot topic every day.

A change of pattern can throw the most confident mom for a loop and can even confuse an experienced pediatrician.  Babies have blood in their stool fairly often and it virtually never is the sign of serious illness, but I pay a lot of attention to this because it alarms parents and requires that a reason be found.

We shouldn’t be any more surprised to see a variety of bowel movements in our babies than we would in anyone of any other age.  In breastfed babies, the mom’s diet can affect the color or consistency of a baby’s stools, particularly if the baby is showing an allergic reaction to a certain food or food group.

Sticky, tar-like and green or black
This is meconium. The first stools of a newborn will be this consistency and color. It is what is present inside the bowels of a newborn upon birth and will clear itself out within the first couple of days and represents the “byproducts” of building an entire human being for nine months.

Greenish or Yellow/Brown, grainy or seedy
This is the transition between meconium and a regular breastfed stool and begins as mom’s milk is coming in on the second, third or fourth day of life.  There may be three stools each day, ten, or even twenty.  Occasionally, even a baby in the first week of life will skip a day and have no bowel movements at all.  Call your doctor to discuss this even though it is normal.  This does not require a dietary change or supplementation of a breastfed baby.

Light yellow to bright green, loose/runny, curdy, lumpy, seedy, creamy, mustard-like
These are normal breastfed stools.  The consistency, frequency and color vary from day to day.  My wife described the smell as “curried yogurt”.  Opinions on this odor description differ widely.

Frequent Watery Stool often “Greener” than usual
How can you spot diarrhea in a baby who has loose frequent stools every day?  This type of poop is “diarrhea” in a breastfed baby.  It can be due to a virus, a bowel infection, stress, anxiety or a food intolerance.

Hard, pellet – like, presence of blood or mucous
This is constipation in a breastfed baby and is so very rare that I cannot recall ever seeing it in a baby who is receiving breastmilk as a sole source of nutrition, as are most babies in the first six months.  It could be related to a food allergy.  Formula fed babies get constipated much more often and may even have harder bigger stools like older kids and adults.  Getting these stools softer is a balancing act of great proportions.

Black stools often accompanied by constipation
This is the result of iron supplementation. Iron fortified infant foods and infant vitamins can cause constipation. A healthy breastfed baby does not need iron supplementation. The iron in breastmilk is much more bioavailable than any other form.

Red streaked stools
This usually comes from bleeding in the lower intestine or rectum.  Most often it is caused by rectal fissures which are tiny “cuts” around the circumference of the anus.  This can be a reaction to dairy in mom’s diet.  Elimination of all dairy is the first line of defense in this situation.  I have seen countless babies who had blood in their poop which resolved when mom stopped all dairy products and returned with even a small amount of milk or cheese.  Other dietary changes may be needed for breastfeeding moms.  Formula fed babies lose blood from the lower intestine when they drink cow milk formula and some have the same losses on soy formula.  Occasionally, this “micro-hemorrhaging” can become visible as blood streaking on the surface of the stool.  Persistent or increasing blood in the stool or blood mixed with mucus (described as “currant jelly” stool in the texts) requires an immediate call to your doctor.

Green, frothy stools
This can be a result of a hindmilk/foremilk imbalance. A true imbalance is rare. It is often seen accompanying a forceful letdown. Lactation consultants will help moms find a nursing pattern which works to combat this problem.  If letdown it too forceful in the early weeks, the solution can be to allow milk to leak into a cloth diaper during letdown, then latch baby back on.  Feeding two to three times off the same side may also show improvement. Caution should be used with same side feeding as it can decrease supply.

Green, mucousy stool
This can be a result of a virus. Often the only sign we see of a virus is in the green stool. This is evidence of malabsorption in the intestines. Watch for how many days and with what consistency it is occurring. With a virus, it will run its course over a few days and begin to improve.

Another cause of malabsorption in the intestines can be teething. The profuse saliva of a teething baby can cause irritation in the intestines interfering with proper absorption.  When babies teethe, we can see lots of drooling.  Large quantities of saliva is swallowed which can irritate the intestines causing runny, acidic stools. This can also cause a rash in the diaper area.

There is something important to point out regarding frequency of stooling in an exclusively breastfed baby.  Many parents are concerned when after the early weeks where they may have been seeing a little bowel movement in almost every diaper, they suddenly begin to see days go by without any.  This is perfectly normal.  There is a great range of frequency of bowel movements with exclusively breastfed infants, ranging from a couple of times a day to several days.  There are completely healthy nursing babies that have a bowel movement once a week, once every ten days, or even a few that go a bit longer. If your baby is healthy, developing well, nursing well and the consistency of the bowel movement when it does make its appearance is soft or loose, then do not be concerned.  It is not constipation if it arrives in soft form.  Constipation would arrive in pellets and hard formed pieces.

In summary, stools in breastfeeding babies are predictably green, brown, yellow or orange.  It is runny and has curds almost every time.  It changes color with viruses, may have a small amount of blood (call your doc) and may come once a day and even taper off to once a week or more after a few weeks of age.  Formula feeding babies may show a little trickier set of changes involving constipation and diarrhea.  This is just one small reason to strongly recommend and support breastfeeding your baby.

Dentists wondered why, in the early 1900′s, in pockets of the Southwest USA, many residents’ teeth were permanently stained yellow, brown or black, some just had white blotches, some were crumbling. They called it “Colorado Brown Stain.” The culprit – high levels of tasteless, odorless fluoride in drinking water, from 2 – 13 parts per million (ppm), which also irrigated crops the locals ate.

These ugly, sometimes deformed, teeth were unusually cavity-free. Since fluoride stained teeth, dentists assumed fluoride also prevented decay. “Colorado Brown Stain” became known by the more scientific term, dental fluorosis. Unfortunately, dentists overlooked what’s obvious today, even to a layperson. They failed to factor in the calcium, magnesium and other teeth strengthening minerals also in the water supply.

During an era when doubting government was anti-American, when public health heroes of the day were idealists who believed they were saviors of their people, fluoridation began in the late 1940′s. One part per million fluoride added to “fluoride deficient” water supplies, reduced decay by 70% without unwanted fluorosis public health officials promised. Holding the paternalist values of their time, they believed mothers couldn’t be trusted to give their children their daily fluoride dose in pill form so they prescribed it into the drinking water. Children up to nine years old would benefit, they told us. Fluoride incorporated into their developing teeth to erupt with a shield against decay as long as they consumed 1 milligram fluoride daily via approximately one quart of 1 ppm fluoridated water.

Children, who didn’t live in fluoridated communities, were (and still are) prescribed fluoride supplements – a drug marketed before safety testing was required by the Food and Drug Administration.

At its inception, fluoridation, or these supplements, was virtually children’s only fluoride source. Now over 62% of US water supplies are fluoridated and so are the foods and beverages grown, bottled and manufactured with that water. There’s a glut of fluoridated dental products on the market, both over-the-counter and by prescription. Fluoridated pesticide residues remain on foods, medicines contain fluoride, and air is polluted by fluoride from industry.

Instead of bringing tooth decay rates down to that enjoyed by early Southwesterners who ate produce from their own gardens, children’s dental fluorosis rates have steeply increased. Yet, tooth decay is still a major problem for malnourished or poorly nourished Americans.

New research proves old-time dentists’ premise was wrong. Fluoride’s possible benefits, if any, are topical. So there’s no good reason to swallow fluoride or put it into the water supply.

The old dogma is beginning to unravel. British researchers report in the British Medical Journal that fluoridation studies are flawed. A Canadian Government report found fluoridation does more harm than good. A US National Institutes of Health Panel found most tooth decay studies, including hundreds on fluoride, scientifically invalid. Even UNICEF, the organization that protects children, reports, “more and more scientists are now seriously questioning the benefits of fluoride, even in small amounts.”

What’s more unbelievable is that the chemicals most used to fluoridate drinking water are silicofluorides, contaminated waste product of industry, that were never safety tested on humans or animals. Meanwhile we are conducting a massive toxicological experiment. Our children are the test subjects

Silicofluorides are linked with children’s increased lead absorption. Studies link fluoride chemicals to bone fractures, lowered IQ, thyroid dysfunction, cancer, allergies and more.

And the American Dental Association is working on a new and improved cavity fighter, even better than fluoride – calcium and phosphate – the minerals they overlooked in the early 1900′s.

• Fluoride Action Network
• Fluoride: Protected Pollutant or Panacea?
• The Fluoride Stop
• Take Action
• Pennsylvania Environmental Network
• Fluoride Journal
• Preventive Dental Health Association
• Gary Null, PhD
• Citizens for Health
• Fluorosis Education Resources, David Kennedy, DDS
• Suite 101 – Fluoridation
• New York State Coalition Opposed to Fluoridation
• UNICEF, Water, Environment & Sanitation – Fluoride In Water: An Overview
• After 50 Years, Fluoride Supplements have Never been Approved by the FDA

Carol S. Kopf is a freelance health writer who has written for many publications, including Reuters Health, WebMD.com, Onhealth.com, and Newsday. She has a BS in Biology and a master’s in Science and Environmental Reporting. As President of the Levittown Safe Water Association, she spearheaded a campaign that ended 29 years of fluoridation in her town in 1983. Carol can be reached via email at caru@earthlink.net.

Those patches are fluorosis, a condition that shocks many parents because of the cause — too much fluoride. “It was even a bigger surprise to his pediatric dentist — he’s Gradon’s father,” said the Canadian broadcaster. (1)

“We don’t really know how much fluoride it takes to cause fluorosis; and it’s not something we really knew much about ten years ago,” said the Canadian dentist in 1998.

Dental fluorosis is growing in prevalence and severity in American children (2) and can range from mild, white spotted teeth to moderate and severe fluorosis — yellow, brown or black and sometimes pitted and crumbling teeth.

American children are over-fluoridated. It’s hard to believe that dentists themselves are undereducated about fluoride and its adverse effects, but they are.

Some dentists and pediatricians wrongly prescribe fluoride supplements to children who live in fluoridated communities. Further, the Center for Disease Control (CDC) teaches dentists that fluoride supplements and fluoride treatments by dentists are only advisable for those with a high risk for tooth decay (3), although doctors usually prescribe supplements based on water fluoridation status, age and fluoride treatments based on insurance carriers’ willingness to pay. The only scientifically-valid predictor of future cavities is present tooth decay.

Fluoride treatments may be a money-maker for dentists, but there’s no proof it benefits children at low risk for tooth decay. (4)

Fluoride’s alleged beneficial effects are topical, not systemic as once believed. Scientists discovered that fluoride supplements discolor teeth but don’t reduce tooth decay. (5)

That is why mainstream dental groups such as the Canadian Dental Association, the Western Australia Health Department’s Dental Service and the German Scientific Dental Association stopped recommending routine fluoride supplementation, unlike the American Dental Association who still recommends supplements, not based on patient need, scientific evidence or CDC guidelines, but on water fluoridation status and age.

And to add insult to injury, fluoride supplements have never been approved or safety tested by the FDA (U.S. Food and Drug Administration), having been “grandfathered” in, (already being sold) before the law to test drugs was passed (6).

In the early 1900’s, Americans drinking naturally calcium-fluoridated water supplies displayed cavity-free but discolored teeth. Fluoride, the tooth staining culprit, was assumed the cavity preventer, also. But researchers overlooked calcium, magnesium and other teeth-building components in the water supplies.

Those early studies are dismissed as flawed. (7) But, still not ready to give up on fluoride, dentists claim fluoride must work topically. However, no well-done studies exist comparing cavity rates between similar populations of fluoride users vs. non-users.

Neither a nutrient nor essential to health, fluoride is simply used as a drug to treat tooth decay. Unlike vitamin and mineral supplements discouraged in favor of a balanced diet, fluoride supplements are promoted by the medical establishment and mandated into water supplies, even though slightly more than recommended leads to adverse effects such as dental fluorosis. Three to four times “optimal” can actually cause tooth decay. (8)

In larger amounts, fluoride is lethal. But some dentists are painfully unaware of this, too.

In order to convince California legislators to vote for fluoridation, a dentist swallowed a whole vial of fluoride tablets in front of them and then said, “Hey, guess what? I’m still alive.” (9)

Swallowing too many fluoride pills killed children. (10) Another child died after swallowing instead of expectorating his dentist’s fluoride treatment. The dentist didn’t think it was toxic. (11) People have become sickened and died because water engineers or machinery malfunction injected excess fluoride into water supplies. (12)

Warnings on the back of fluoridated toothpaste tubes and boxes are there because ingestion of the whole tube’s contents can be lethal to a small child. (10)

Over 65% of America is fluoridated, and virtually all Americans consume too much fluoride in their foods, beverages and dental products. With dental fluorosis increasing, one would expect tooth decay would be obliterated.
Instead tooth decay rates climb. (13)

The only virtual sure thing that’s linked to extensive cavities is poverty, which is also linked to poor nutrition, high rates of infant mortality, higher cancer death rates, and most other health disorders. Unlike nutrients which have deficiency health consequences, fluoride deficiency has no health consequences.

Dentist Weston Price discovered in the 1920s and ‘30s that “primitive” populations around the world who followed their traditional nature-based diets enjoyed decay-free teeth, while those that turned to the “civilized” diet of processed, sugar-laden foods had many missing and decayed teeth. (14)

There are ways to help prevent tooth decay in children. The American Dental Association (ADA) states, “Pregnant women can help ensure their children get a good start on their oral health by focusing on staying healthy, including a proper diet, because teeth begin developing between the third and sixth month of pregnancy.” (15)

Breastmilk is the healthiest choice for a young child’s overall development. It also has anti-cariogenic properties and is an important factor in keeping teeth healthy. Breastmilk contains bacteria fighting cells and enzymes, which may help destroy the germs that cause tooth decay. (16) (17)

As children begin eating solid foods, continuing to provide a well balanced diet, rich in fresh fruits and vegetables, is beneficial to good dental health.

References:

(1) CBC News, December 1998, http://cbc.ca/cgi-bin/templates/view.cgi?category=Sci-Tech&story=/news/1998/12/29/fluoride981229

(2)”Prevalence and trends in enamel fluorosis in the United States from the 1930s to the 1980s.” by Beltran-Aguilar, et al, Journal of the American Dental Association, February 2002

(3) “Recommendations for Using Fluoride to Prevent and Control Dental Caries in the United States” August 27, 2001, CDC
http://www.cdc.gov/mmwr/preview/mmwrhtml/rr5014a1.htm

(4)”Preventive dentistry: practitioners’ recommendations for low-risk patients compared with scientific evidence and practice guidelines,” Am J Prev Med Feb 2000 , by Frame et al http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&
db=PubMed&list_uids=10698247&dopt=Abstract

(5) “The case for eliminating the use of the dietary fluoride supplements for young children,” J Public Health Dentistry 1999 Fall by BA Burt
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&
db=PubMed&list_uids=10682335&dopt=Abstract

(6) Letter from New Jersey Representative Kelly to FDAhttp://www.citizens.org/Food_water_safety/Fluoridation/Materials/
web_pages/letter%20_%20to_FDA.htm and confirmed by Crystal Wyand, spokesperson, FDA’s Center for Drug Evaluation and Research, e-mail correspondence.

(7) “More Rigorous Studies Needed to Advance Emerging Dental Caries Diagnostic and Management Strategies, Says NIH Consensus Panel,” NIH News Release, March 28, 2001http://consensus.nih.gov/news/releases/115_release.htm and British Medical Journal (B.M.J.), October 7, 2000,McDonagh, et al

(8) “Dentistry, Dental Practice and the Community,” by Burt and Eklund.

(9) Journal of the California Dental Association, January 1997, “The Fluoride Victory,” by Joanne Boyd

(10) “The Metabolism and Toxicity of Fluoride,” by Gary Whitford and
http://pmeiers.bei.t-online.de/burton.htm

(11) http://pmeiers.bei.t-online.de/kennerly.htm

(12) “Acute fluoride poisoning from a public water system,” New England Journal of Medicine, Jan 1994, Gessner et al,
http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd
=Retrieve&db=PubMed&list_uids=8259189&dopt=Abstract
and http://www.fluoridealert.org/leaks-spills.htm

(13) “Health Journal: As kids’ cavities rise, some dentists advocate using tooth sealants,”Wall Street Journal, Tara Parker-Pope, March 8, 2002http://www.sfgate.com/cgi-bin/article.cgi?file=/news/archive/
2002/03/08/financial1058EST0079.DTL

(14) “Nutrition and physical Degeneration,” by Weston A. Price D.D.S.

(15) http://www.ada.org/public/media/newsrel/0202/nr-01.html
ADA News Releases
February 2002
Good Oral Health Begins in the Womb

(16) Loesche WJ, “Nutrition and dental decay in infants.” Am J Clin Nutr 41; 423-435, 1985

(17) Lucas, A, Cole T, “Is Breast Feeding a Likely Cause of Dental Caries in young Children?” Journal of American Dental Assoc., 1979; 98:21-23

Fevers help to fight infections because white blood cells move faster and kill viruses and bacteria better at 102 degrees than they do at 98.6. Additionally, many germs have a limited range of viability and do not grow as well when the temperature is higher.

The problem is that most children do not eat, drink or sleep very well when they have high fevers. They are also not easy to assess medically at 102 either. To a parent or a doctor, a child with a high temp looks pretty bad even when the illness causing the fever is “just a cold.”

There are two reasons to bring down the temperature:

1. To make a child more comfortable so they have an easier time staying hydrated and getting a little more rest.
   
2. To be able to observe a child with a lower temperature and realize that it was a large fever and a small underlying illness making them look a lot worse than they really are.

In adults, the height of the fever often correlates well with the severity of the illness. In children, this is not always the case: a two-year-old can develop a 105 fever with a viral cold or could be sick with pneumonia but only have a 100.8 temp. Bringing the temp down on that first child will give you a fairly normal child for an hour or so but bringing the temp down for the kid with pneumonia or some other more significant illness won’t do anywhere near as much to make them feel a lot better.

I recommend long lukewarm tub baths as the best way to lower temperatures when you need to. Also, make sure to “unwrap” your baby or child to allow heat to radiate out from the body rather than being trapped underneath heavy clothing or blankets. This is much more important than many parents realize.

Most doctors also recommend Tylenol type drugs or Advil/Motrin type anti-inflammatory medicine. Some families also rely on a homeopathic medicine like belladonna. More natural approaches favor not bringing down the fever at all but just working for good hydration and comfort while allowing the immune system’s natural mechanisms (including fever) to work on the infection. This is not a bad course of action but a lot of parents I know are not very comfortable watching their child’s temp go up and stay up. If this is the way you feel, try lowering the temperature at least once to reassure yourself and your doctor that under this big fever is a small illness.

Aspirin must never be used in childhood or teenage years because of the statistical association with Reye’s syndrome, a potentially fatal liver disorder.

A word about febrile seizures: From about 18 months through age five years or slightly later, about 1 out of 50 children will have a convulsion with the fever. This is an innocent occurrence about 99.99% of the time but one of the most frightening things you’ll ever see. Remain as calm as you can, call your doctor right away, and do not put anything into your child’s mouth. Hold them upright and slightly tilted forward so that they have an easier time with secretion or vomit. The seizure will last 1-3 minutes (it will feel like an hour) and then your child will sleep or act very lethargic. Immediate medical evaluation is needed for at least the first of these seizures. Over half the kids go on to have a second convulsion with a fever but virtually none of them develop epilepsy or other complications. Call your doctor. Most families also call 911 and this is not a bad idea except that transporting your two-year-old by ambulance to the nearest hospital may put you in an ER inexperienced or over reactive to sick kids. Over reaction may be better than a laissez-faire approach by far, but it is not the best way.

To summarize: fever is natural, helps end the infection faster but may need lowering for the child’s comfort or the parents’ reassurance.

Most of these visits, with healthy, growing babies and children, are not needed at all. When I look in the ear with my otoscope, I am looking through the external canal to the ear drum which lies at the end of the canal and transmits sound vibration to the bones and fluid of the middle ear.

The bones of the middle ear are “lubricated” by a mucus-like fluid which then drains from the middle ear into the Eustachian Tube and into the throat. In adults and older kids, this is a nearly vertical drainage tube but in babies and younger kids, it’s nearly horizontal. As you might guess, horizontal drainage of middle ear fluid can be easily slowed or stopped if the mucus gets thicker or if the tube gets inflamed and narrowed.

This leads to a “stagnant puddle of water” in the middle ear which is prone to thickening and/or infection with viruses or bacteria. The fluid accumulates and, lacking the normal drainage through the Eustachian tube into the throat, causes pressure on the ear drum which hurts and shows visible inflammation when I look at it.

When viruses and/or bacteria manage to grow in the fluid, “acute otitis media” can be diagnosed. The traditional treatment with antibiotics has been shown to be quite ineffective and, as a matter of fact, not anymore effective than doing nothing at all during the first three to four days. Most experts now recommend pain control only during the first days of an ear infection, although I think thatsafe alternative care (homeopathy, ear drops, hot compresses, vitamin C, elderberry or echinacea) will improve the healing course.

Please understand that very small babies with fevers and obvious ear pain or children with special conditions and underlying problems deserve a visit to the doctor and your doc may want to use medicine right away even thought antibiotics don’t work as well as we have claimed for decades. The advice here is mainly for healthy full term babies and children whose main problem is fever and ear pain. For most illnesses like this, I tell parents that the best way to evaluate a sick child is from a few feet away when the fever’s down. Most kids will “bounce back” for a little while. They smile a little, play a little and are obviously not very sick.

Ear infections occasionally cause the ear drum to perforate which is in some ways analogous to a pimple popping: The infection may go away and the pain is gone. The ear drum heals and sometimes the fluid reaccumulates but often the infection is gone. The drainage and occasional blood from the ear looks frightening and your doctor may want to have a look. Don’t put drops in a draining ear without first talking to your doctor.

As an ear infection heals, the drum may not look 100 percent normal for weeks or months. The current recommendation is to tolerate the appearance of increased fluid behind the drum for 60 to 90 days.

Ear tubes have very little benefit in the long term and don’t even preserve hearing the way we pediatricians once believed. I have seen them seem to help a lot in the short term when the “ventilation” of the middle ear (a hole poked in the ear drum and kept open by a tiny tube for a year or so) led to a lot less pain, fewer doctor’s visits and less missed school and fun. However, tubes, for the most part, are not worth it.

Treat ear infections with pain control, “watchful waiting” and a call to the doctor when you are uncomfortable.

Croup is a viral infection that causes a swelling in the larynx (voice box), trachea (windpipe), and other airways leading to the lungs, making breathing noisy and difficult. The swelling is not visible in the tonsils and cannot be heard when a doctor listens to the lungs with a stethoscope, so you won’t know your child has it until he or she wakes up with the distinctive barking seal cough.

Most common in the fall and winter in children under four, the swelling is also accompanied by increased secretions in the air passageways that become dried out. The dried, thick secretions in turn block the respiratory tract and make breathing even more difficult. Children outgrow croup as the airway passages enlarge; it is unusual after age seven.

The best treatment for this swelling and narrowing of the respiratory tract is cool, moist air. The best way to get this “dose” is by driving towards or along the beach or another body of water with the windows rolled down. Dress warmly, including a hat, and take a late night ride for 20-40 minutes and your child will probably experience almost instant relief from the frightening sounding cough. As these dried, hard secretions are dissolved and the air can again pass freely into the lungs, the child’s discomfort will subside.

You may be thinking about your mother’s admonition that “You’ll catch your death of cold” if you go outside late at night, especially with your precious baby in your arms. Well, forget the idea that you’ll catch a cold from the brisk night air. That idea is a myth–you cannot catch pneumonia or any other illness from cold air. Colds, flu and pneumonia are spread by viruses which like to stay nice and warm… and in humans.

Another option is to steam up your bathroom to create a moist, soothing environment. Close all the doors and windows and run a warm shower to create steam, but avoid really hot water as it may scald the child. To avoid slipping while holding your child, do not stand in the shower. Remember too, that steam rises, so do not set the child on the floor, but hold him or her upright in your lap. Usually after ten minutes you’ll see improvement, but continue comforting the child.

You can also purchase a cool mist humidifier and place it in the child’s room for several nights. Position the humidifier as close to the bed as possible so the moist air can make its way to the child’s airway passages.

Croup is a “self-limited” viral illness, meaning you have to let it run its course. Unfortunately the second night is often worse than the first. There may be a few more scary nights of the barking cough, but continue with the car rides or steam treatments to relieve symptoms. The illness then changes into a long, mucousy cold which can last for another week or more. The fever rarely rises above 102 or 103 degrees and can be treated with anti-fever medications, long lukewarm baths, and light clothes to allow the body to cool itself.

Take your child to the emergency room if he or she:

• shows no improvement in breathing with either of these mist therapies after 30 minutes;
  
• cannot talk because of lack of breath;
  
• has difficulty swallowing, drools, and breathes with chin jutting out and mouth open, this could be a rare infection called epiglottitis;
  
• struggles when inhaling or appears to be in severe respiratory distress.

This is a controversial issue and the vast majority of doctors and experts recommend giving the treatment shortly after birth.  Nonetheless, there is research to suggest that this routine may not be necessary.

Obviously, this represents a minority point of view both in the hospital and in the pediatric community in general.

I have added my own emphasis to these articles.

Pediatrics 1993 Dec;92(6):755-60
Randomized trial of silver nitrate, erythromycin, and no eye prophylaxis for the prevention of conjunctivitis among newborns not at risk for gonococcal ophthalmitis. Eye Prophylaxis Study Group.
Bell TA, Grayston JT, Krohn MA, Kronmal RA
Department of Biostatistics, University of Washington, Seattle 98195.
OBJECTIVE. To compare the efficacy of commonly used forms of eye prophylaxis for newborns with no prophylaxis in the prevention of nongonococcal conjunctivitis. DESIGN. Randomized doubly masked clinical trial. SETTING. University of Washington Hospital and affiliated clinics, Seattle, between 1985 and 1990. SUBJECTS. The medical records of 8499 women were evaluated for possible participation; 2577 were eligible. Of the 758 enrolled, the infants of 630 were evaluable. INTERVENTION. Comparison of silver nitrate, erythromycin, and no eye prophylaxis given at birth for the prevention of conjunctivitis. MAIN OUTCOME MEASURES. Conjunctivitis during the first 60 days of life and nasolacrimal duct patency in the first 2 days of life. RESULTS. The frequency of impatent tear ducts at the 30- to 48-hour examination did not differ significantly by prophylaxis group. Among the 630 infants randomized and observed, 109 (17%) developed mild conjunctivitis. Sixty-nine (63%) of the cases appeared during the first 2 weeks of life. After 2 months of observation, infants allocated to silver nitrate eye prophylaxis at birth had a 39% lower rate of conjunctivitis (hazard ratio = 0.61, 95% confidence interval = 0.39 to 0.97), and those allocated to erythromycin had a 31% lower rate of conjunctivitis (hazard ratio = 0.69, 95% confidence interval = 0.44 to 1.07), than did those allocated to no prophylaxis. CONCLUSION. Silver nitrate eye prophylaxis caused no sustained deleterious effects and even provided some benefit to infants born to women without Neisseria gonorrhoeae. However, the effect was modest and against microorganisms of low virulence. The results suggest that parentalchoice of a prophylaxis agent including no prophylaxis is reasonable for women receiving prenatal care and who are screened for sexually transmitted diseases during pregnancy.

Pediatr Infect Dis J 1992 Dec;11(12):1026-30

Prophylaxis of ophthalmia neonatorum: comparison of silver nitrate, tetracycline, erythromycin and no prophylaxis.
Chen JY
Department of Pediatrics, Chung Shan Medical and Dental College Hospital, Taichung, Taiwan, Republic of China.
From November, 1989, to October, 1991, 4544 neonates were born at our hospital. Neonatal ocular prophylaxis immediately after birth was used with 1% tetracycline ophthalmic ointment in 1156 neonates, 0.5% erythromycin ophthalmic ointment in 1163 neonates and 1% silver nitrate drops in 1082 neonates. No prophylaxis for neonatal conjunctivitis was given to 1143 neonates. A total of 302 infants (6.7%) developed conjunctivitis during the first 4 weeks of life. Between December, 1991, and January, 1992, 425 neonates were born at our hospital and all were given 0.5% erythromycin ophthalmic ointment twice in the first 24 hours after birth for ocular prophylaxis. Thirty-one (7.3%) infants developed conjunctivitis during the neonatal period. The incidence rates of neonatal chlamydial conjunctivitis in the tetracycline, erythromycin, silver nitrate, no prophylaxis and erythromycin twice groups were 1.3, 1.5, 1.7, 1.6 and 1.4%, respectively. We conclude that neonatal ocular prophylaxis with erythromycin (one or two doses) or tetracycline or silver nitrate does not significantly reduce the incidence of neonatal chlamydial conjunctivitis compared with that in those given no prophylaxis.

5: Am J Epidemiol 1993 Sep 1;138(5):326-32   
The bacterial etiology of conjunctivitis in early infancy. Eye Prophylaxis Study Group.
Krohn MA, Hillier SL, Bell TA, Kronmal RA, Grayston JT
Department of Epidemiology, School of Public Health and Community Medicine, University of Washington, Seattle.
The authors conducted this study to determine the etiologic agents of conjunctivitis in early infancy. From 1985 to 1990, 630 infants enrolled in a randomized, controlled, double-masked study of eye prophylaxis were observed for 60 days after delivery for signs of conjunctivitis. The following isolates were categorized as pathogens: Haemophilus influenzae, Streptococcus pneumoniae, Neisseria cinerea, Klebsiella pneumoniae, and Chlamydia trachomatis. Using conditional logistic regression for analysis of 97 infant pairs, the authors identified isolates categorized as pathogens almost exclusively among cases (odds ratio (OR) = 18.0, 95% confidence interval (CI) 2.3-128). Among the microorganisms which have not usually been regarded as pathogens in the etiology of infant conjunctivitis, Streptococcus mitis was the only microorganism associated with an increased risk of conjunctivitis (OR = 5.3, 95% CI 1.8-15.0).The findings concerning the species of bacteria most often associated with conjunctivitis, as well as the finding that method of delivery is unimportant, suggest that bacteria were transmitted to the infants’ eyes after birth and not from the birth canal.

14: Pediatr Infect Dis J 1989 Aug;8(8):491-5
Failure of erythromycin ointment for postnatal ocular prophylaxis of chlamydial conjunctivitis.
Black-Payne C, Bocchini JA Jr, Cedotal C
Department of Pediatrics, Louisiana State University School of Medicine, Shreveport 71130.
Chlamydia trachomatis is the most common pathogen associated with conjunctivitis during early infancy in the United States. During a 13-month interval at our medical center 4834 infants were born, 311 of whom (6.4%) had conjunctival specimens tested for chlamydial antigen before the age of 12 weeks. In 44 (14% of all tested infants, 0.9% of live births) chlamydial antigen was present. Because the rate of asymptomatic maternal chlamydial endocervical colonization is estimated to be 26% at our institution (previous prospective study), we calculated a minimal failure rate for erythromycin ocular prophylaxis of from 7 to 19.5%. A subsequent case-control study revealed that mothers of infants with chlamydial conjunctivitis were more likely to be primiparous (P = 0.03) and experience longer duration of rupture of membranes before delivery (P = 0.046). We conclude that a substantial percentage of infants exposed to Chlamydia develop chlamydial conjunctivitis despite receiving erythromycin ocular prophylaxis.

In the first 24 to 72 hours after birth babies tend to lose about 3-10% of their birth weight and then regain that weight over the next 2 to 3 weeks. If a mother receives lots of IV fluids during labor, the baby could be born “heavier” because of the increased water. The somewhat higher weight could be measured if a baby were weighed right before it peed for the first time. The difference of this extra fluid retention might only be a few ounces, but some parents are told to be concerned when, at their baby’s two week checkup, the baby is a few ounces under birth weight.

Another common problem at early checkups is a baby that is not gaining what the practitioner considers to be “normal weight gain.” There is not general agreement on normal weight gain and the range in texts are from 4 to 8 ounces a week. Some babies are genetically destined to be a lot smaller or larger than others. As I mentioned in the first paragraph: Easy concept, isn’t it?

If you have been told that weight gain is not acceptable, look hard at this list of questions:

• Is your baby eager to nurse?
• Is your baby peeing and pooping well?
• Is your baby’s urine either clear or very pale yellow?
• Are your baby’s eyes bright and alert?
• Is your baby’s skin a healthy color and texture?
• Is your baby moving its arms and legs vigorously?
• Are baby’s nails growing?
• Is your baby meeting developmental milestones?
• Is your baby’s overall disposition happy and playful?
• Yes, your baby sleeps a lot, but when your baby is awake does he have periods of being very alert?

If you have answered yes to the above questions, you may want to progress on to two important questions which the “charts” seem to ignore.

• How tall is mom?
• How tall is dad?

If someone were to ask you what weight a 33 year old man should be, you would laugh. The range of possibilities varies according to height, bone structure, ethnicity and many other factors. Yet babies are expected to fit onto charts distributed throughout the country with no regard to genetics, feeding choice or almost anything else.

There can be nursing problems that can cause slow weight gain; an inadequate “latch-on” is probably the only common breastfeeding problem in the first weeks. This is an easily remedied problem with the right help. In the best of circumstances, breastfeeding should be assessed within the first day or two after birth by a skilled lactation expert. Good hospitals have these LC’s and IBCLC’s on staff and, if not, please line up a consultation within the first 12 hours of life. Your pediatrician can help you with this. If not, call La Leche League and ask them whom they recommend in your area. This is a crucial step in becoming a parent and must not be skipped.

If there are nursing problems, the first answer should never be supplementation but must be to find the best advice and help available. Find quality help in person if possible and online if needed. There is nothing better than having an experienced breastfeeding expert watch you and your baby and give you the help and encouragement and support you need and deserve.
Too many mothers and babies lose the breastfeeding experience and the lifesaving and illness preventing benefits because we doctors are trained to look harder at the scale than we are at the baby.

A few notable examples:

• Baby, birth weight: 9 lbs. 12 oz.
  Weight 36 hours after delivery: 9 lbs. 2 oz.

I have seen mothers encouraged to supplement because “they have no milk, the baby is hungry and losing weight.” The baby looks good and is nursing every 1 to 3 hours and mom’s nipples are not getting sore. There is no need to do anything but nurse often, switch breasts every 5 minutes or so and wait another day or two for the milk to come in. A thirsty baby nurses strongly and is in no danger. A baby given water or formula might not nurse so strongly and mom’s confidence (and milk supply) will suffer for it. This mom only needs the support of an expert who can be sure that she knows how to latch her baby on to the breast.

• Same baby, two week checkup: 9 lbs. 6 oz

Forgetting that this represents a 4 oz. weight gain from the 36 hour weight, some docs might recommend supplementation. Again, watch breastfeeding and if everything is going well, don’t worry. A dry, jaundiced baby with darker yellow urine is a different case and needs more help with nursing. This baby still should not get formula. Make sure mom is drinking enough water, nursing often without a set schedule (every 1 to 3 hours) and make very sure that she gets help latching her baby on, especially if she has sore nipples.

• Same baby, six month checkup: 15 lbs.

Lactation consultation had been successful in the early weeks thanks to mom having found a supportive, smart doctor and being determined to succeed at feeding her baby the best. This big baby (9 lbs. 12 oz. at birth, remember?) had weighed 13 pounds at her four month visit and now weighs 15 pounds. The doctor is paying attention and sees that Mom is 5′ 3″ and Dad is 5′ 9″ and slender. He looks at the charts second and the baby first and isn’t concerned about the baby dropping from a very high percentile at birth to a lower one and then to a lower one still.

I think I’ll conclude this scenario with this happy ending.

In summary, babies who are nursing, peeing clear urine and wetting diapers well in the first weeks of life are almost always all right. I cannot recall seeing a baby for whom slow weight gain in the first 2 to 6 weeks was the only sign of a problem.

Older babies, 2 to 12 months of age, grow at varying rates. Weight gain should not be used as a major criterion of good health. Developmental milestones and interaction with parents and others are more important. Do not be persuaded to supplement a baby who is doing well. Get help with breastfeeding and use other things besides weight to guide you.

In extreme situations, hyperbili can stain the brain and damage it or make babies sleepy, lethargic and prone to under eating and dehydration. Severe infections often have jaundice as their first sign. These are rare problems but it is dangerous to ignore the possibilities.

In the vast, vast majority of healthy full term babies, mild jaundice is normal and harmless. Breastfeeding babies get more jaundiced than formula fed babies and there are some researchers who think this represents an advantage because bilirubin is a “bacteriostatic” chemical. That is, it inhibits the growth of infectious bacteria.

Jaundice itself may not be a problem but increased jaundice may indicate poor breastfeeding. This is a problem and this is one of the reasons that the “knee jerk” reaction to jaundice is so dangerous. Instead of just attempting to change the baby’s color from slightly yellow (or quite yellow) we should be looking much harder at the reason for the increased bilirubin. Lactation consultation is usually much more valuable than bilirubin tests and bili lights.

PLEASE REMEMBER, this information is strictly applicable to healthy full term babies; preemies and sick kids must be cared for differently and this is beyond the scope of this brief discussion.

Jaundice may continue and even increase through the first week or two and if a baby is doing well, milk is in, nipples are not sore, jaundice is rarely a problem. If a baby continues to lose weight and jaundice is increasing, lactation help is needed and closer medical observation is crucial.

It is almost never correct to interrupt breastfeeding nor to supplement babies with mild to moderate jaundice. The disease entity called “Breast Milk Jaundice” is rare and possibly involves a chemical in breastmilk which inhibits the metabolism of bilirubin. This jaundice is longer and more yellow and almost always harmless. Some experts advocate breastfeeding interruption for a day to help make the diagnosis in a baby with jaundice beyond week two or three. Many experts do not recommend this and instead will wait if the baby’s clinical appearance is reassuring.

Jaundice is a normal condition of babies in the first week of life. Healthy full term babies who are nursing well, urinating and looking good do not need intervention. Supplementing with water makes this worse and supplementing with formula is not necessary and interferes with breastfeeding success and good health.

More information:

• Breastfeeding and Jaundice
• LLLI: Learning About Jaundice

Bilirubin has the ability to function as an antioxidant in the brain, scavenging free radicals and protecting the brain against oxidative damage.

“When women breastfeed, the babies have higher levels of bilirubin and are healthier. Babies with higher bilirubin levels are more disease-resistant,” said Dr. Sylvain Dore of Johns Hopkins School of Medicine, Baltimore, Maryland. “Bilirubin also protects against retinopathy in premature babies.”

Dr. Dore has done research on the neuroprotective effect of bilirubin in the hippocampus. His studies have indicated that low concentrations of bilirubin decreased oxygen-radical mediated injury, suggesting that bilirubin could act as an antioxidant.

Dore further experimented on cultured neurons showing that bilirubin protects against oxidative stress. The enzyme hemeoxygenase is responsible for making bilirubin. In these experiments researchers prevented bilirubin synthesis by eliminating the gene for hemeoxygenase and found, as a result, twice the level of stroke damage in mice.

There is also some belief amongst medical professionals that bilirubin is a bacteriostatic compound which acts to slow or eliminate bacterial growth and therefore give an advantage to babies with higher levels of jaundice. This theory would contribute to the fewer infections in breastfed babies, whose bili counts often descend at a slower rate.

These studies shed new light on the way in which bilirubin in a newborn should be viewed. There is no reason to overreact to bili counts ranging up to low 20′s as long as the mother is frequently nursing (every 60 – 90 minutes during the mother’s waking hours and no more than two stretches of four hours maximum at night), baby is wetting and the counts have begun to slow in ascension or have begun their descent.

Mother must be diligent at following a pattern of frequent nursing until jaundice is gone, even if it includes having to wake the baby, because jaundice tends to make a baby sleepy.

Breastfeeding moms get lots of advice about the food they should be eating while nursing their babies.  I try to discuss this with the mom- and dad-to-be when we meet during a prenatal appointment.  I often wish I could talk to more women before they become pregnant to discuss anti-allergy measures and other topics.

Please don’t misunderstand the incredible superiority of human milk for human babies.  Infants who receive formula have more intestinal problems by far than infants who drink breastmilk.  Uninformed medical practitioners have actually told mothers that their babies were “allergic to their breastmilk.”  Nothing could be further from the truth.

Babies can be allergic to protein fragments from mom’s diet which end up in the milk, but if they are sensitive to those proteins, they would be much more affected by an artificial baby milk made entirely of non-human protein.  Even so called “hypoallergenic” formulas are rarely any better.   They are made of proteins broken down into smaller fragments to provoke less of a reaction.  They are still allergenic and don’t solve the problem for many babies.

Common Symptoms of a Reaction to Dairy

• Green, runny stool
• Blood tinged stool
• Skin rashes
• Chronic nasal stuffiness
• Vomiting
• Diarrhea
• Excessive abdominal discomfort
• Cramping
• Coughing
• Mimic of GER (gastroesophageal reflux) symptoms
• Heartburn
• Spitting up
• Gassiness
• Constipation

Gassiness

Babies are gassy.  That is an immutable fact caused by the need to double or triple one’s weight in a year.  Try doing that yourself and see if you don’t spend a little time gassy.

I have seen the gassiest babies get better when moms removed dairy products from their diets.

Some babies seem to cry much more than others and their parents describe them as “writhing in pain.”  Changing the nursing pattern helps some newborns and older babies if overactive milk ejection reflex (OMER) or a hindmilk/foremilk imbalance is the cause, but many more babies are helped when mom changes the way she eats.  My list of allergens begins with cow’s milk and continues with eggs, peanuts, wheat and citrus.  The most important change a mom can make is to stop drinking milk and eating things made with milk.

Blood in Stools

Babies with blood in their stool often stop having blood when moms stop drinking milk and eating other dairy products.

Cow’s milk protein irritates the intestinal lining and virtually always causes what’s called “microhemorrhaging.”  Sometimes this bleeding is quite visible and helps alert parents to the need for mom to change her diet.  Blood in the stool can be frightening but is rarely dangerous.  It has a few other causes such as viral irritation, but the most common reason I have seen it is dairy allergy.

Eczema

Eczema lessens and often goes away completely when breastfeeding moms become dairy-free.

Skin rashes occur frequently in newborns and babies.  The most common, worrisome, persistent problem is an allergic rash called eczema.  Dermatologists and allergists describe eczema as not a “rash that itches, but an itch that rashes.”  That is the first thing that happens and the first thing the parents may notice: increased irritability and “face rubbing” by their baby.   They may also see a red rash which becomes more and more “angry” looking and eventually gets scaly and even bloody.  Superficial skin infections can follow and be difficult to treat.

Dairy elimination is crucial.  Long before you use cortisone cream, stop all dairy.  Stop peanuts and eggs, too.

Constipation

Babies who are constipated often improve when dairy is eliminated from mom’s diet.  Older children may also get relief from constipation with complete dairy elimination.  In older children, studies have shown that some bedwetting may also be cured by dairy elimination.  The allergic reaction to the offending protein in milk is exhibited in a variety of ways that affect the bowels and urinary tract.  If your child is suffering from problems in these areas, dietary restriction should most certainly be considered prior to doing further testing or using medications.

Changing a breastfeeding mom’s diet or changing the diet of an older child eating solid foods will often lessen medical problems dramatically.

Cold Symptoms

Babies who have constant runny noses often get better when moms stop all dairy.  Cow’s milk allergies may look just like “hay fever” at any age:  stuffiness, cough, runny nose that seems to persist for weeks and weeks.

Older kids with ear infections often stop having ear infections when dairy is removed from their diets.

This has been a key intervention in my practice.  I have cared for hundreds of kids who have taken ten or even twenty courses of antibiotics and even steroids.  They were able to cancel scheduled ear surgery because they got better when they stopped drinking milk and eating cheese.  The ear infections just plain stopped for many of the children and for others they decreased to manageable childhood illnesses rather than being a constant source of pain, school absences and incapacity.

Read more at: http://www.notmilk.com/mucus.html

GER (Reflux)

Before a baby gets evaluated for GER (gastroesophageal reflux), breastfeeding moms must eliminate all dairy from their diets.  To some, this seems like a drastic step.  It is far less drastic or invasive than the tests and medications for GER in babies.

When eliminating dairy and watching for a reduction of GER symptoms, patience is a key.  The offending protein can take a few weeks to be completely undetectable in breastmilk.  Many will see improvement within days, because the levels begin to decrease as a diet devoid of dairy is consumed.  It is not unusual to see little change until two or three weeks after eliminating dairy.

The almost miraculous improvement in hundreds of troubled babies in 22 years of practice might be the strongest evidence, albeit anecdotal evidence, that I bring to the table.  Does this work 100% of the time?  No, nothing works 100% of the time, but dairy elimination is the single-most important advice I give to dozens of people each and every week.

Casein and B-lactoglobulin

The two proteins that trigger the biggest allergic response are casein and b-lactoglobulin.  If your baby doesn’t get as much relief as you had hoped just from dairy elimination, read labels carefully.  Soy cheese and many other foods that we expect to be dairy protein-free are really not.  Even diaper creams may contain casein.

Read more at: http://www.drjaygordon.com/nutrition/dangerousfood/dairy

Increased exposure to allergens like dairy allergens can even lead to fatal reactions.  Fortunately, the “minor” symptoms almost always go on for a long time before major reactions in almost all babies, children and adults.

Lactose Intolerance

The major “sugar” in cow’s milk is lactose and some people confuse lactose intolerance and cow’s milk protein allergy.  Lactose intolerance evolves gradually after about age 7 or 8 years and is particularly common in those of Asian, Native Alaskan and African decent. Gassiness and bloating after drinking milk, eating cheese or ice cream occur in many people.  Some choose to ignore it, others limit dairy and still others just use supplemental lactase (an enzyme) to lessen their symptoms.

Viral stomach flu can create temporary lactose intolerance.

We adults are clearly not meant to drink cow’s milk and the number of children adversely affected by dairy protein and dairy sugars is underestimated in mainstream nutrition books.

A very informative article in August 2000 issue of “Discover Magazine” features a discussion with T. Colin Campbell, an ex-dairy farmer now a Cornell University nutritional biochemist:

“The bottom line for Campbell is simple: ‘It’s unnatural to drink milk.’ Most adults in Asia and Africa, along with many in southern Europe and Latin America, have trouble digesting lactose, the main sugar in the milk of both humans and cows. Some suffer from bloating, cramps, or diarrhea if they try.  A 1978 population survey, compiled by geographer Frederick J. Simoons of the University of California at Davis, suggests that it was only because of a genetic aberration that milk became a food staple in northern Europe and North America. Nature normally programs the young for weaning before they reach adulthood by turning down production in early childhood of the enzyme that breaks down lactose. But a gene mutation inherited by people of northern European descent prevents the production of this enzyme from being turned down. As a result, the majority of Americans can drink milk all their lives.”

This excellent, short article also talks about osteoporosis as it relates to dairy consumption: Countries with the highest dairy intake have the highest incidence of osteoporosis.  This striking fact seems at odds with everything we think we “know” about calcium and nutrition. Osteoporosis is related more to calcium excretion due to salt and protein intake than to calcium deficiency in the diet.  The entire article and the attached graphics are well worth a look.

Read more at: http://www.discover.com/aug_00/featmilk.html

Other Medical Experts on Dairy

Hundreds of medical articles and many books have been written about the problems with milk products in humans.  The authors are physicians of great standing in the medical community.  The late Frank Oski MD was head of the Department of Pediatrics at Johns Hopkins University and the editor of the Yearbook of Pediatrics. The late Dr. Benjamin Spock was the most famous and most influential physician of the past 100 years and many other doctors have participated in trying to bring dairy’s shortcomings to the attention of doctors and patients alike.

Dr. John McDougall often cites milk’s problems alphabetically:

Allergies (dairy is the leading cause of allergies in adults and children) and continuing with a discussion of .  .  .

Anemia. Again milk products are the number one cause of this problem because they cause blood loss and also interfere with iron absorption.  Additionally, kids who drink lots of milk feel very full and often have no “room” for healthier iron-containing foods.  Dr. Oski wrote many articles about milk’s role in causing anemia in America’s children.

Arthritis is the third on Dr. McDougall’s list and he documents published studies from the British Medical Journal, the Journal of Arthritis and Rheumatology and other major medical journals.  The mechanism of action involves antibody/antigen particles which lead to inflamed joints.

Atherosclerosis, or heart and blood vessel disease, make the third “A” on the list.  Milk is the number one source of saturated fat in most diets.  A further problem involves the antibodies formed against milk attacking the delicate lining of arteries.

Blood loss, constipation, and diabetes follow in alphabetical order.  The medical evidence strongly points to early exposure to cow’s milk leading to an increase in Type 1 diabetes.  I have seen constipation clear up in a matter of days when parents remove dairy products from their child’s diet and the intestinal blood loss from drinking milk (or exposure to milk protein through breast milk) is an accepted medical fact.

Read more at: http://www.ffl.org/html/milk_facts.html

Talking to patients about dairy products is a lot easier than it used to be because the “problems with milk” are better known than just a few years ago.  Still, it’s hard to combat the $400,000,000 annual advertising budget available to the purveyors of dairy products.  Milk does not “do a body good” nor build strong bones.  It is a traditional food which has become a lazy staple of the American diet.

Children (and their parents) get healthier when they have fewer dairy products and are healthiest when they have none.

When I’m talking to older kids about making dairy a smaller part of their diets, I tell them that it’s kind of like an old Seinfeld joke:  “Hey, look at those large animals in the field!  Let’s go squeeze those things underneath them and then drink whatever comes out.  Then, let’s take whatever’s left over, put it aside for a year or so and .  .   . eat it!”  The kids respond with a hearty “eeeeew!”  Even adults get it sometimes.

I don’t believe that vaccines are “poisonous” or that the tremendous increase in the incidence of autism is directly and solely linked to the “MMR” or mercury in the shots. I do think that there are adverse impacts on a child’s immune system and central nervous system from some immunizations and the preservatives in the solutions, but I don’t agree that we have figured everything out. Nor do I agree with the vaccine opponents who continue to shout at us all about the shots “not even working” and harming everyone who gets them.

The Institute of Medicine reported last year and Dr. Neal Halsey stated (in the Journal of the American Medical Association in November of 1999) that there are enough questions about mercury’s toxicity to warrant eliminating this metal from shots “as soon as possible” to use the IOM’s words. Other constituents of vaccines have not received the same scrutiny but may also have at least minimal side effects that could be cumulative in a 10-pound baby receiving four separate inoculations on the same day.

While there is a huge amount of scientific research to support the fact that vaccines protect against illness, there is very little science supporting the way we give vaccines in America and many other countries. Many children receive the Hepatitis B vaccine within hours of birth and then six weeks later receive another Hep B shot along with a DPT, Hemophilus Influenza B (HIB) Polio vaccine and the newest recommended shot, the Prevnar vaccine. The timing of four or five shots with seven components and a multitude of preservatives and “inert” ingredients is very possibly the wrong thing to do. Two months later this same regimen is repeated and 3 or 4 shots are also given at the six-month visit. The one-year checkup is the time for the measles/mumps/rubella combination vaccine and the chickenpox shot.

Many countries begin vaccines later and slower and I strongly believe we should do the same things. The expedient and economically superior method, which we use now, doesn’t serve our babies well.

I would like to summarize my point of view by making it clear, once again, that very few responsible experts have reservations about the way we give vaccines. I do.

I also don’t like the financial ties that vaccine researchers have to the manufacturers because some of these same experts help make the official decisions about which shots will be approved and/or required.

The diseases against which we vaccinate used to be much more common (and still are in some other countries) but we are now down to an average of one case of diphtheria (the “D” of the DPT) per year in the U.S., a few thousand cases of Pertussis (“P”) and 30 or so cases of Tetanus each year.

We have not had a case of “wild” polio in America since 1979 and the entire Western Hemisphere has been free of the disease for some years.

HIB bacteria used to be the most common bacterial cause of meningitis in young children. Meningitis is a dangerous, potentially fatal infection of the lining of the brain and spinal cord. This vaccine is extremely effective and has eliminated over 95% of this illness. I personally have not seen a case if HIB meningitis in at least 7 or 8 years, maybe more. This shot was a godsend but some scientists and others now think that the vaccine may cause “autoimmune” problems — the immune system mistakenly attacks one’s own body — such as diabetes. This is very much a minority point of view but some data have been gathered which support this possibility.

The Prevnar vaccine was invented to protect higher-risk individuals from a particular group of dangerous bacteria. It was never intended to be, and is not very effect as, an “ear infection” shot. The diseases that it prevents are extremely rare.

The MMR vaccine merits an entire page of its own. Virtually no reputable American authority agrees with the research of Dr. Andrew Wakefield who tied the vaccine to intestinal infection that might lead to autism. But there is enough evidence that these “live-virus” vaccines may not be as safe as we thought to convince me that we need much more study before we can stop looking. The idea of separating these vaccines strikes me as having no advantage.

Chickenpox is a relatively benign disease in childhood and a potentially dangerous disease in adult years. Doctors may have forgotten that this is not a new vaccine but a shot invented in the 1970s to protect children on chemotherapy or high dose steroids for asthma and other illnesses. These very high-risk kids could get severe complications from varicella (chickenpox) but normal kids get immunity from the illness which might actually have been better than that acquired from the shot. My take on this shot is to try to get your child natural chickenpox for 4 or 5 years and then get the shot later if you’re not successful.

The Hepatitis A vaccine may become part of the California State law next year and very few pediatricians would have supported that some years ago. While Hep A might ruin an adult’s vacation (“food handlers’ hepatitis”) this viral illness passes virtually unnoticed in children. This is in marked contrast to the great danger and possible permanence of Hepatitis B and Hep C. The Hep B shot works very well but may have autoimmune complications (again, this belief is held by only a very small minority of physicians) and should be given after careful evaluation of the risks and benefits to the child. There is no Hepatitis C vaccine yet. Hepatitis B and C are diseases transmitted through high-risk behavior involving sex and intravenous drugs.

Smallpox and Anthrax vaccines are not available now and neither is as safe nor effective as it needs to be. These diseases have gotten far more “press” than they deserve at the present time.

Perhaps the most frequently asked questions involve coming in contact with ill people while our families travel and the possibility of immigrants or visitors from other countries bringing rare illnesses to the U.S. “Possible but highly unlikely,” is the short answer with a full discussion beyond the scope of this short article. A family planning a two-year sojourn to Africa or Asia or Eastern Europe needs a completely different discussion of vaccination. There are no diseases in Europe that will threaten an unvaccinated child any more than in the USA. Again, this is beyond the scope of this present discussion.

In my office, with families I know well, I believe that the main idea I convey is that we should vaccinate later and slower. One shot at a visit starting later in the first year and perhaps in the second year of life. I have many families in my practice who have chosen to give their children no vaccines.

My one request is that you thoroughly discuss with your physician all of the benefits and risks of vaccines with an absence of the usual scare tactics we doctors sometimes use.