little kids drinking alcohol

As much as parents may not like to think about it, the truth is that many kids and teens try alcohol during their high school and college years, long before it's legal for them to drink it. Research has shown that nearly 80% of high school kids have tried alcohol.

Although experimentation with alcohol can be common among kids, it's not safe or legal. So it's important to start discussing alcohol use and abuse with your kids at an early age and keep talking about it as they grow up.

The Effects of Alcohol Abuse

Alcohol interferes with a person's perception of reality and ability to make good decisions. This can be particularly hazardous for kids and teens who have less problem-solving and decision-making experience.

Short-term effects of drinking include:

• distorted vision, hearing, and coordination
• altered perceptions and emotions
• impaired judgment, which can lead to accidents, drowning, and other risky behaviors like unsafe sex and drug use
• bad breath
• hangovers

Long-term effects include:

• cirrhosis and cancer of the liver
• loss of appetite
• serious vitamin deficiencies
• stomach ailments
• heart and central nervous system damage
• memory loss
• an increased risk of impotence
• high risk for overdosing

Long before your kids are presented with a chance to drink alcohol, you can increase the chances that they'll just say "no."

Childhood is a time of learning and discovery, so it's important to encourage kids to ask questions, even ones that might be hard to answer. Open, honest, age-appropriate communication now sets the stage for your kids to come to you later with other difficult topics or problems.

Talking to Kids About Alcohol

Preschoolers

Although 3- and 4-year-olds aren't ready to learn the facts about alcohol or other drugs, they start to develop the decision-making and problem-solving skills they will need later on. You can help them develop those skills in some simple ways.

For instance, let toddlers choose their own clothing and don't worry if the choices don't match. This lets them know you think they're capable of making good decisions. Assign simple tasks and let kids know what a big help they are.

And set a good example of the behavior that you want your kids to demonstrate. This is especially true in the preschool years when kids tend to imitate adults' actions as a way of learning. So, by being active, eating healthy, and drinking responsibly, parents teach their kids important lessons early on.

Ages 4 to 7

Kids this age still think and learn mostly by experience and don't have a good understanding of things that will happen in the future. So keep discussions about alcohol in the present tense and relate them to things that kids know and understand. For example, watching TV with your child can provide a chance to talk about advertising messages. Ask about the ads you see and encourage kids to ask questions too.

Kids are interested in how their bodies work, so this is a good time to talk about maintaining good health and avoiding substances that might harm the body. Talk about how alcohol hurts a person's ability to see, hear, and walk without tripping; it alters the way people feel; and it makes it hard to judge things like whether the water is too deep or if there's a car coming too close. And it gives people bad breath and a headache!

Ages 8 to 11

The later elementary school years are a crucial time in which you can influence your child's decisions about alcohol use. Kids at this age tend to love to learn facts, especially strange ones, and are eager to learn how things work and what sources of information are available to them.

So it's a good time to openly discuss facts about alcohol: its long- and short-term effects and consequences, its physical effects, and why it's especially dangerous for growing bodies.

Kids also can be heavily influenced by friends now. Their interests may be determined by what their peers think. So teach your child to say "no" to peer pressure, and discuss the importance of thinking and acting as an individual.

Casual discussions about alcohol and friends can take place at the dinner table as part of your normal conversation: "I've been reading about young kids using alcohol. Do you ever hear about kids using alcohol or other drugs in your school?"

Ages 12 to 17

By the teen years, your kids should know the facts about alcohol and your attitudes and beliefs about substance abuse. So use this time to reinforce what you've already taught them and focus on keeping the lines of communication open.

Teens are more likely to engage in risky behaviors, and their increasing need for independence may make them want to defy their parents' wishes or instructions. But if you make your teen feel accepted and respected as an individual, you increase the chances that your child will try to be open with you.

Kids want to be liked and accepted by their peers, and they need a certain degree of privacy and trust. Avoid excessive preaching and threats, and instead, emphasize your love and concern. Even when they're annoyed by parental interest and questions, teens still recognize that it comes with the territory.

Teaching Kids to Say "No"

Teach kids a variety of approaches to deal with offers of alcohol:

• Encourage them to ask questions. If a drink of any kind is offered, they should ask, "What is it?" and "Where did you get it?"
• Teach them to say "no, thanks" when the drink offered is an alcoholic one.
• Remind them to leave any uncomfortable situation. Make sure they have money for transportation or a phone number where you or another responsible adult can be reached.
• Teach kids never to accept a ride from someone who has been drinking. Some parents find that offering to pick up their kids from an uncomfortable situation — no questions asked — helps encourage kids to be honest and call when they need help.

Risk Factors

Times of transition, such as the onset of puberty or a parents' divorce, can lead kids to alcohol use. So teach your kids that even when life is upsetting or stressful, drinking alcohol as an escape can make a bad situation much worse.

Kids who have problems with self-control or low self-esteem are more likely to abuse alcohol. They may not believe that they can handle their problems and frustrations without using something to make them feel better.

Kids without a sense of connectedness with their families or who feel different in some way (appearance, economic circumstances, etc.) may also be at risk. Those who find it hard to believe in themselves desperately need the love and support of parents or other family members.

In fact, not wanting to harm the relationships between themselves and the adults who care about them is the most common reason that young people give for not using alcohol and other drugs.

General Tips

Fortunately, parents can do much to protect their kids from using and abusing alcohol:

• Be a good role model. Consider how your use of alcohol or medications may influence your kids. Consider offering only nonalcoholic beverages at parties and other social events to show your kids that you don't need to drink to have fun.
• Educate yourself about alcohol so you can be a better teacher. Read and collect information that you can share with kids and other parents.
• Try to be conscious of how you can help build your child's self-esteem. For example, kids are more likely to feel good about themselves if you emphasize their strengths and positively reinforce healthy behaviors.
• Teach kids to manage stress in healthy ways, such as by seeking help from a trusted adult or engaging in a favorite activity.

Recognizing the Signs

Despite your efforts, your child may still use — and abuse — alcohol. How can you tell? Here are some common warning signs:

• the odor of alcohol
• sudden change in mood or attitude
• change in attendance or performance at school
• loss of interest in school, sports, or other activities
• discipline problems at school
• withdrawal from family and friends
• secrecy
• association with a new group of friends and reluctance to introduce them to you
• alcohol disappearing from your home
• depression and developmental difficulties

It's important not to jump to conclusions based on only one or two signs. Adolescence is a time of change — physically, socially, emotionally, and intellectually. This can lead to erratic behavior and mood swings as kids try to cope with all of these changes.

If your child is using alcohol, there will usually be a cluster of these signs, like changes in friends, behavior, dress, attitude, mood, and grades. If you see a number of changes, look for all explanations by talking to your kids, but don't overlook substance abuse as a possibility.

Other tips to try:

• Keep tabs on where your kids go.
• Know the parents of your child's friends.
• Always make sure you have a phone number where you can reach your child.
• Have kids check in regularly when they're away from home.
• When spending an extended length of time away from you, your child should check in periodically with a phone call, e-mail, or visit home.

For teens, especially those old enough to drive, consider negotiating and signing a behavioral contract. This contract should spell out the way you expect your child to behave and state the consequences if your teen drives under the influence. Follow through and take the keys away, if necessary.

Make part of the deal with your teen that you and the rest of your family also agree never to drink and drive. Also encourage responsible behaviors, such as planning for a designated driver or calling an adult for help rather than driving under the influence.

It's important to keep communication open and expectations reasonable. Tying responsible actions to freedoms such as a later curfew or a driver's license can be a powerful motivator. Teach your kids that freedom only comes with responsibility — a lesson that should last a lifetime.

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15 Great Breakfast ideas For your Baby

Experts agree that breakfast is probably the most important meal of the day... and, as your baby begins to rely more on solid foods and less on milk to meet his needs (generally towards the end of his first year), then breakfast is the perfect opportunity to fill him up with some really nutritious foods! I've always found that my children have eaten breakfast much more readily than other meals - maybe because they have gone for a longer period without eating than at other times of the day!

It's a good idea - if possible - for the whole family to eat breakfast together. This establishes a healthy eating pattern for your baby to follow. And, of course, babies are much happier to eat with everyone else, than alone!

The ideal baby breakfast will be nutritious and balanced and some of the suggestions on our list of breakfast ideas for baby include more than one food type - wholewheat toast with yogurt, for example, which provides fibre, vitamins, minerals and calcium all in one meal!

And don't be afraid to look beyond traditional breakfast ideas for baby...

This list includes a few items which may not be considered "typical" breakfast foods - but if they're healthy and your baby likes them, then why not give them a try? What we consider to be "breakfast food" depends largely on our culture and upbringing - and, when it comes to food, we all know that stepping outide your cultural "boundaries" can be fun!

Breakfast ideas for baby - Tips for delicious oatmeal/porridge

 

Parents sometimes ask us if it's OK to give their babies instant oatmeal (or porridge, depending where in the world you're visiting us from). The only difference between plain, instant oatmeal and regular oatmeal is that the oats are sliced more thinly to help them cook more quickly. Flavoured oatmeal, on the other hand, tends to contain quite a lot of sugar and you should avoid giving it to your baby.

• Make your baby's oatmeal with milk instead of water. Ideally, use breastmilk or formula - but small amounts of cow's milk can be used in cooking for your baby after 6 months of age (see introducing dairy foods for more information and discover why it is important to use whole milk in your baby's foods.)
• Do not use sugar to sweeten your baby's cereal - instead, try applesauce, or your baby's favourite fruit puree. For older babies, happy coping with lumps, then try chopped fruit. The fruit you use in your baby's breakfast can be fresh, or canned/tinned (in natural juice, not syrup). Alternatively, try adding dried fruit like apricots, raisins or sultanas (for younger babies, try soaking sultanas first, then mashing them with a fork).
• If your baby doesn't enjoy oatmeal with fruit, then you could add a little molasses or maple syrup, but DO NOT SWEETEN ANY FOOD WITH HONEY IF YOUR BABY IS UNDER ONE YEAR OF AGE. Honey can sometimes contain botulism spores, which can be fatal for a young baby.

15 Breakfast ideas for baby

• Sliced fresh fruit with a natural yogurt dip
• Scrambled eggs with wholewheat toast (if your baby is under 1 year of age, serve scrambled egg yolk ONLY due to the risk of egg allergy associated with egg whites). Try adding diced avocado for a really nutritious treat!
• An alternative whole grain breakfast, with fresh fruit
• Wholewheat toast fingers with a natural yogurt dip (you can add pureed fruit to the yogurt for variety)
• Cottage cheese with fresh fruit slices
• Lightly toasted bagel pieces, topped with cream cheese
• French toast squares (after 1 year of age) - or try our egg free French toast recipes
• Cheerios soaked in applesauce, or your baby's favourite fruit puree
• Wholewheat toast with cream cheese
• Grilled cheese/cheese on toast
• Pitta bread with houmous (also known as humus or hummus - click here for more information about houmous and other foods containing sesame, or visit our tahini-free houmous recipe)
• Breakfast burritos with scrambled egg (yolks only before 1 year of age.
• Blueberries
• English muffins topped with cream cheese and fruit puree

NOTE: The ideas suggested here may not be suitable for all ages, as some may require your baby to be at the "self-feeding" stage. Remember - if any of these foods are new to your baby, then introduce them separately, following the four day rule. This will help you prevent and identify potential food allergies and digestive problems. ALWAYS discuss the introduction of any new foods with your child's doctor.

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Vitamin D Infant Overdose

FDA Warning: Infant Overdose Risk With Liquid Vitamin D

Many parents may be giving their baby too much liquid vitamin D.

The Scoop

Pediatricians recommend vitamin D supplementation for infants who are fully or partially breastfed. But are parents unknowingly giving their babies too much? In an alert issued by June 15, 2010, the Food and Drug Administration (FDA) warned parents and caregivers that some liquid vitamin D supplement products on the market come with droppers that could allow parents and caregivers to accidentally give harmful amounts of the vitamin to an infant. Some droppers may be poorly marked or hold a greater amount of liquid vitamin D than an infant should receive.

"It is important that infants not get more than the recommended daily amount of vitamin D," says Dr. Linda M. Katz, interim chief medical officer in FDA's Center for Food Safety and Applied Nutrition. Currently, the American Academy of Pediatrics recommends fully or partially breastfed babies receive a daily supplement of 400 IU of vitamin D.

As the FDA explained in its warning, vitamin D promotes calcium absorption in the gut and plays a key role in the development of strong bones. Vitamin D supplements are recommended for some infants—especially those that are breastfed—because deficiency of this vitamin can lead to bone problems such as thinning, soft, and misshaped bones, as is seen with the condition known as rickets.

However, too much vitamin D can cause nausea and vomiting, loss of appetite, excessive thirst, frequent urination, constipation, abdominal pain, muscle weakness, muscle and joint aches, confusion, and fatigue, as well as more serious consequences like kidney damage.

For Baby

To make sure Baby is getting the right amount of vitamin D, the FDA recommends parents take the following steps:

Keep the vitamin D supplement product with its original package so that you and other caregivers can follow the instructions. Follow these instructions carefully so that you use the dropper correctly and give the right dose.

Use only the dropper that comes with the product—it is manufactured specifically for that product. Do not use a dropper from another product.

Ensure the dropper is marked so that the units of measure are clear and easy to understand. Also make sure that the units of measure correspond to those mentioned in the instructions.

If you cannot clearly determine the dose of vitamin D delivered by the dropper, talk to a healthcare professional before giving the supplement to the infant.
Additionally, if your infant is being fully or partially fed with infant formula, check with your pediatrician before giving the child vitamin D supplements. Depending on the amount of vitamin D already in the formula (and Baby's intake), vitamin D supplementation may not be needed.

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Infant Reflux

All babies spit up, some more than others. 

They have immature digestive systems 
and sometimes the muscle at the top of
the stomach isn’t yet strong enough to 
stop the stomach contents coming back 
into the gullet or even the mouth (reflux). 

When reflux begins to get painful and frequent, you may be dealing with gastro-esophageal reflux disease (GERD).








When Luke was two weeks old, he was already showing the typical symptoms of gastro-esophageal reflux disease with constant vomiting. “It was incredibly stressful,” says his mom, Naomi. “It wasn’t just the milk in his stomach coming back up, it was also the acid, which made him scream. He would arch his whole body back in an attempt to lessen the pain.” Refusal to feed is common in babies with severe GERD. “He’d cry because he was hungry, but when he tried to feed it hurt him too much. I began to dread breastfeeding.”

HAPPY SPITTERS AND SCRAWNY SCREAMERS
If a baby is otherwise well, happy and gaining weight, most parents and health practitioners consider the reflux a laundry problem rather than a medical issue. But if a baby is showing symptoms of GERD, it’s time to seek help. “We’d go through six changes of clothes on a good day. It was frustrating, but we could cope. However, Luke’s breathing was affected by his reflux. He’d scream constantly. He developed a chronic cough, and we were constantly worrying if he was getting enough milk.” After referral to a pediatrician, a barium swallow test showed Luke had severe reflux with esophageal scarring.

It’s important to see your doctor if your baby isn’t gaining weight, there is blood in the vomit, or there is persistent coughing or chest infections due to stomach fluids getting sucked into the lungs. Usually, no tests will be necessary to diagnose GERD, although a 24-hour ph-Probe study is considered one of the more definitive tests. (A thin flexible probe is inserted to sit just above the stomach to test the amount of acid.)

Once a diagnosis of GERD has been made, there are various medications that can be used to treat it. Antacids are usually tried first and work well with mild cases. Drugs that neutralize acid such as Zantac have been used effectively for more than 20 years, and a newer development is the use of drugs like Prevacid that actually stop acid production. Motility drugs can sometimes be prescribed to help the stomach empty quicker. “Luke was put on Zantac,” says Naomi. “It took a couple of weeks to see the difference and we often had to adjust the dose as it was very weight-specific, but it made such a change to all our lives. Seeing him learn to love food was just the best.”

The great news is that ultimately it’s something 98 percent of babies grow out of, and surgery is necessary only in
the most extreme cases. “Luke was on medication until he turned two, but he’s finally over it and symptom free. We called it the reflux roller coaster.”

WHAT YOU CAN DO TO HELP:

• Minimize spit-ups by keeping your baby as upright as possible, particularly after eating.
• Keep the head-end of the crib propped up at a thirty-degree angle to reduce reflux episodes.
• Breastfeed. Breast milk is digested more easily, so empties out of the stomach quicker.
  Plus, breastfed babies take in less air when feeding.
• Give small, regular feeds.
• Once babies are on solids, gravity does a great job of keeping the food in the stomach.
• Remember that most babies outgrow reflux.

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Preventing Accidental Poisoning

Most people regard their home as a safe haven, a calming oasis in an often stormy world. But home can be a dangerous place when it comes to accidental poisoning, especially accidental poisoning of children. One tablet of some medicines can wreak havoc in or kill a child.

Childhood poisonings caused by accidental overdoses of iron-containing supplements are the biggest concern of poison control experts, consumer protection groups, and health-care providers. Iron-containing supplements are the leading cause of pediatric poisoning deaths for children under 6 in the United States. 

According to the American Association of Poison Control Centers, from 1986 to 1994, 38 children between the ages of 9 months and 3 years died from accidentally swallowing iron-containing products. The number of pills consumed by these children varied from as few as five to as many as 98.

In the Jan. 15, 1997, Federal Register, FDA published final regulations that will make it harder for small children to gain access to high-potency iron products (30 milligrams of iron or more per tablet). FDA has also taken steps to ensure that health-care providers and consumers are alerted to the dangers associated with accidental overdoses of iron-containing products, including pediatric multivitamin supplements that contain iron. Although iron poisoning is the biggest concern when it comes to childhood poisoning, there is also concern about other drugs.

"Over-the-counter diet pills have the potential to be lethal to children, as do OTC stimulants used to keep you awake and decongestant tablets," says George C. Rodgers, M.D., Ph.D., medical director of the Kentucky Regional Poisoning Center. Tofranil [imipramine], an antidepressant drug also used for childhood bedwetting, and Catapres [clonidine], a high blood pressure medicine, can be very hazardous because it takes very little to produce life-threatening problems in children. One tablet may do it.

"Antidepressant drugs have a high degree of toxicity," he continues. "They are cardiac and central nervous system toxins, and it doesn't take much of them to do harm, particularly in children. They are prescribed fairly ubiquitously. One of the things we look at when we get kids' poisonings is who had the medicine, and why."

Rodgers also urges extra caution when antidepressant drugs are prescribed for teenage patients who may have behavioral or emotional problems.

"Antidepressant drugs are commonly given to adolescents with behavioral problems, and often a month or two-month supply is prescribed. Teens should not be given more than a week's supply to begin with, and parents need to monitor their usage," he says.

The marketing of pediatric vitamins is also a cause of concern for Rodgers. "Because they're marketed to look like candy or cartoon characters, it looks like candy and doesn't seem like medicine," he explains.

In addition, children frequently mimic the behavior of their parents. Children who watch their parents take pills may want to do it, too--with potentially fatal results.

Poison-proofing your home is the key to preventing childhood poisonings. In the case of iron-containing pills or any medicine:

Poison-Proofing Your Home

• Always close the container as soon as you've finished using it. Properly secure the child-resistant packaging, and put it away immediately in a place where children can't reach it.
• Keep pills in their original container.
• Keep iron-containing tablets, and all medicines, out of reach--and out of sight--of children.
• Never keep medicines on a countertop or bedside table.
• Follow medicine label directions carefully to avoid accidental overdoses or misdoses that could result in accidental poisoning.

For other substances, buy the least hazardous products that will serve your purposes. When buying art supplies, for example, look for products that are safe for children. For hazardous products such as gasoline, kerosene, and paint thinners that are often kept on hand indefinitely, buy only as much as you need and safely get rid of what you don't use. Never transfer these substances to other containers. People often use cups, soft-drink bottles, or milk cartons to store leftover paint thinner or turpentine. This is a bad idea because children associate cups and bottles with food and drink.

The kitchen and bathroom are the most likely unsafe areas. (Medicines should never be stored in the bathroom for another reason: a bathroom's warm, moist environment tends to cause changes or disintegration of the product in these rooms.) Any cabinet containing a potentially poisonous item should be locked.

"Bathrooms with medicines, kitchens with cleaning products, even cigarette butts left out, can be toxic to kids," Rodgers explains. "And remember that child-resistant caps are child-resistant, not childproof. The legal definition is that it takes greater than five minutes for 80 percent of 5-year-olds to get into it: that means 20 percent can get in in less time! Kids are inventive, and can often figure it out. And leftover liquor in glasses on the counter after parties? Don't do it!"

Alcohol can cause drunkenness as well as serious poisoning leading to seizures, coma, and even death in young children. Children are more sensitive to the toxic effects of alcohol than are adults, and it doesn't take much alcohol to produce such effects. Alcohol-laced products, such as some mouthwashes, aftershaves or colognes, can cause the same problems.

Garages and utility rooms should also be checked for potential poison hazards. Antifreeze, windshield washing fluid, and other products should be stored out of children's reach in a locked cabinet. Childproof safety latches can be purchased at your local hardware store.

In the living room or family room, know your plants' names and their poison potential. Although most houseplants are not poisonous, some are. To be on the safe side, keep houseplants out of the reach of young children. Although much has been made of problems with poinsettias (blamed for a death as early as 1919), recent studies indicate it is not as highly toxic as was once believed. Although ingesting it may cause some stomach irritation and burning in the mouth, it's unlikely to be fatal.

"Plants are mostly a problem for children, since it's a natural response for children to taste things. Few adults eat houseplants," Rodgers points out. "Plants have a high capacity for making you sick, but they are usually low-risk for producing life-threatening symptoms." After poison-proofing your home, prepare for emergencies. Post the numbers of your regional poison control center (which can be found on the inside cover of the Yellow Pages or in the white pages of your phone directory) and your doctor by the phone. Keep syrup of ipecac on hand--safely locked away, of course. Never administer any antidote without first checking with your doctor or poison control center.

Lead Poisoning

Although lead levels in food and drink are the lowest in history, concern remains about lead leaching into food from ceramic ware. Improperly fired or formulated glazes on ceramic ware can allow lead to leach into food or drink.

Long recognized as a toxic substance, adverse health effects can result from exposure to lead over months or years. After a California family suffered acute lead poisoning in 1969 from drinking orange juice stored in a pitcher bought in Mexico, FDA established "action levels" for lead in ceramic ware used to serve food. Over the years, these original action levels have been revised as research has shown that exposure to even small amounts of lead can be hazardous. The last revision for ceramic foodware was in 1991. On Jan. 12, 1994, FDA published a regulation for decorative ceramic ware not intended for food use, requiring a permanently affixed label on high-lead-leaching products.

"Most lead toxicity comes from multiple exposure and is a slow accumulation over time," says Robert Mueller, a nurse and poison information specialist at the Virginia Poison Center, headquartered at The Medical College of Virginia Hospitals in Richmond. "Refusing to eat, vomiting, convulsions, and malaise can all be symptoms of lead poisoning." Because lead poisoning occurs over time, such symptoms may not show up right away. A blood test is the surest way to determine that your child has not been exposed to significant amounts of lead.

"In general, if a consumer purchases ceramic ware in the U.S. marketplace today, it meets the new action levels," says Julia Hewgley, public affairs specialist with FDA's Center for Food Safety and Applied Nutrition. "But if you travel abroad and buy ceramic ware, be aware that each country has its own safety regulations. Safety can be terribly variable depending on the type of quality control and whether the piece is made by a hobbyist." To guard against poisonings, Hewgley advises that ceramic ware not be used to store foods. Acidic foods--such as orange, tomato and other fruit juices, tomato sauces, vinegar, and wine--stored in improperly glazed containers are potentially the most dangerous. Frequently used products, like cups or pitchers, are also potentially dangerous, especially when used to hold hot, acidic foods.

"Stop using any item if the glaze shows a dusty or chalky gray residue after washing. Limit your use of antique or collectible housewares for food and beverages," she says. "Buy one of the quick lead tests available at hardware stores and do a screening on inherited pieces."

Iron Poisoning

Iron-containing products remain the biggest problem by far when it comes to childhood poisoning. Between June 1992 and January 1993, five toddlers died after eating iron supplement tablets, according to the national Centers for Disease Control and Prevention's Morbidity and Mortality Weekly Report of Feb. 19, 1993. The incidents occurred in a variety of ways: Children ate tablets from uncapped or loosely capped bottles, swallowed tablets found spilled on the floor, and, in one case, a 2-year-old fed an 11-month-old sibling tablets from a box found on the floor.

Iron is always included in prenatal vitamins prescribed for pregnant women, and is often included in multivitamin formulas and children's supplements. Usually available without prescription, iron supplements can be found in grocery stores, drugstores, and health food stores in a wide variety of potencies, ranging from 18 milligrams (mg) to 150 mg per pill. For a small child, as little as 600 mg of iron can be fatal.

Because iron supplements are typically brightly colored, some people are concerned they may look like candy, and, therefore, are particularly attractive to children. In 1993, the Nonprescription Drug Manufacturers Association (NDMA), which manufactures about 95 percent of nonprescription OTC medicines available to Americans today, adopted formulation provisions for iron products containing 30 mg or more of elemental iron per solid dosage form. These provisions also stipulated that such products would not be made with sweet coatings. That same year, NDMA manufacturers also independently agreed to develop new voluntary warning labels for these products. The voluntary labels read: "Warning: Close tightly and keep out of reach of children. Contains iron, which can be harmful or fatal to children in large doses. In case of accidental overdose, seek professional assistance or contact a poison control center immediately."

FDA's new rules, effective July 15, 1997, require unit-dose packaging for iron-containing products with 30 milligrams or more of iron per dosage unit. Because of the time and effort needed to open unit-dose products, FDA believes unit-dose packaging will discourage a youngster, or at least limit the number of tablets a child would swallow, reducing the potential for serious illness or death. This requirement is in addition to existing U.S. Consumer Product Safety Commission regulations, which require child-resistant packaging for most iron-containing products.

The new rules also now require that labels for all iron-containing products taken in solid oral dosage forms contain the following: "Warning: Accidental overdose of iron-containing products is a leading cause of fatal poisoning in children under 6. Keep this product out of reach of children. In case of accidental overdose, call a doctor or poison control center immediately."

Iron is an essential nutrient sometimes lacking in people's diets, which is why iron is often recommended for people with conditions such as iron-deficiency anemia. Taken as indicated, iron is safe. But when tablets are taken beyond the proper dose in a short period, especially by toddlers or infants, serious injury or death may result.

Children poisoned with iron face immediate and long-term problems. Within minutes or hours of swallowing iron tablets, nausea, vomiting, diarrhea, and gastrointestinal bleeding can occur. These problems can progress to shock, coma, seizures, and death. Even if a child appears to have no symptoms after accidentally swallowing iron, or appears to be recovering, medical evaluation should still be sought since successful treatment is difficult once iron is absorbed from the small intestine into the bloodstream. And children who survive iron poisoning can experience other problems, such as gastrointestinal obstruction and liver damage, up to four weeks after the ingested poisoning.

FDA regulates iron-containing products as either drugs or foods, depending on the product formulation and on intended use, as defined by labeling and other information sources.

Some iron-containing products have been regulated as prescription drugs because they included pharmacologic doses of folic acid and usually were prescribed to meet high nutritional requirements during pregnancy.

Signs of Poisoning

How can you tell if your child has ingested something poisonous? "Most poisons, with the exception of lead, work fairly quickly. A key is when the child was otherwise well and in a space of hours develops unusual symptoms: They can't follow you with their eyes, they're sleepy before it's their nap time, their eyes go around in circles. Any unusual or new symptoms should make you think of poisoning as a possibility," Rodgers advises. "Poisonings typically affect the stomach and central nervous system. If a child suddenly throws up, that can be more difficult to diagnose."

Other signs of poison ingestion can be burns around the lips or mouth, stains of the substance around the child's mouth, or the smell of a child's breath. Suspect a possible poisoning if you find an opened or spilled bottle of pills.

If you suspect poisoning, remain calm. For medicines, call the nearest poison control center or your physician. For household chemical ingestion, follow first-aid instructions on the label, and then call the poison control center or your doctor. When you call, tell them your child's age, height and weight, existing health conditions, as much as you know about the substance involved, the exposure route (swallowed? inhaled? splashed in the eyes?), and if your child has vomited. If you know what substance the child has ingested, take the remaining solution or bottle with you to the phone when you call. Follow the instructions of the poison control center precisely.

Progress Against Poisonings

The nation's first poison control center opened in Chicago in 1953, after a study of accidental deaths in childhood reported a large number were due to poisoning. Since that time, a combination of public education, the use of child-resistant caps, help through poison control centers, and increased sophistication in medical care have lowered overall death rates.

Often, calling a poison center simply reassures parents that the product ingested is not poisonous. In other cases, following phone instructions prevents an emergency room trip.

Children are not the only victims of accidental poisonings: Older people in particular are at risk because they generally take more medicines, may have problems reading labels correctly, or may take a friend's or spouse's medicine.

In June 1995, the U.S. Consumer Product Safety Commission voted unanimously to require that child-resistant caps be made so adults--especially senior citizens--will have a less frustrating time getting them off. Because many adults who had trouble with child-resistant caps left them off, or transferred their contents to less secure packaging that endangers children, officials say the new caps will be safer for children. "Childhood poisoning will always be a focus, because children are so vulnerable, especially children under age 5," says Ken Giles, public affairs spokesman for the Consumer Product Safety Commission. "The first two or three years of a child's life are the highest-risk time for all kinds of injuries, so there is a special need to educate new parents. It's essential we keep raising these safety messages that medicines and chemicals can be poisonous."

Protect Yourself Against Tampering

With FDA's new proposed regulations regarding packaging of high-dose, iron-containing pills in mind, it's important to remember that no packaging or warnings can protect without your involvement. Nonprescription OTC drugs sold in the United States are among the most safely packaged consumer products in the world, but "child-resistant" and "tamper-resistant" do not mean "childproof" and "tamperproof." FDA adopted "tamper-resistant" packaging requirements after seven people in the Chicago area died from taking cyanide-laced Extra-Strength Tylenol capsules in 1982. 

Although the product met all FDA requirements at the time, it wasn't designed so tampering would leave visible evidence. FDA swiftly enacted new regulations requiring most OTC drug products to be packaged in "tamper-resistant" packaging, defined as "packaging having an indicator or barrier to entry that could reasonably be expected to provide visible evidence that tampering had occurred," and required OTC product labeling to alert consumers to tamper-resistant packaging. In 1989, FDA regulations were amended to require two-piece hard gelatin capsules to be packaged using at least two tamper-resistant features unless sealed with a tamper-resistant technology.

"Consumer vigilance is part of the equation," says Lana Ragazinsky, consumer safety officer with FDA's Center for Drug Evaluation and Research, division of drug quality evaluation, office of compliance. "The consumer is being led into a false sense of security because they see 'tamper-resistant'... 'tamper evident' means you, the consumer, need to look for evidence of tampering." FDA has proposed changing the term "tamper-resistant" to "tamper-evident" to underscore the fact that no package design is tamperproof. The most important tool to detect tampering is you! Here are a few tips to help protect against tampering:

• Read the label. OTC medicines with tamper-evident packages tell you what seals and features to look for.
• Inspect the outer packaging before you buy.
• Inspect the medicine when you open the package, and look again before you take it. If it looks suspicious: be suspicious.
• Look for capsules or tablets different in any way from others in the package.
• Don't use any medicine from a package with cuts, tears, slices, or other imperfections.
• Never take medicine in the dark. Read the label and look at the medicine every time you take a dose.

 Antidotes

If you suspect childhood poisoning, call the nearest poison control center or your physician first, and follow their instructions precisely.

To induce vomiting in case of accidental poisoning, experts recommend keeping on hand syrup of ipecac--safely stored away from children, of course! Syrup of ipecac induces vomiting, thus ridding the body of the swallowed poison. It usually works within a half-hour of ingestion.

Some medical experts also recommend that parents keep activated charcoal on hand as well: You may have to ask your druggist for it, because it may not be on store shelves. Although some poison control experts recommend having activated charcoal on hand, there is a difference of opinion on its use by consumers. The U.S. Consumer Product Safety Commission, for example, does not recommend that consumers use activated charcoal because it is less palatable to young children.

Activated charcoal (or charcoal treated with substances that increase its absorption abilities) absorbs poison, preventing it from spreading throughout the body. One advantage of activated charcoal is that it can be effective for a considerable time after the poison is swallowed. But activated charcoal should never be used at the same time you administer syrup of ipecac: The charcoal will absorb the ipecac.

For children ages 1 to 12, give one tablespoon of syrup of ipecac followed by one or two glasses of water. Children ages 12 and over should get two tablespoons, followed by one or two glasses of water.

Activated charcoal is usually found in drugstores in liquid form in 30-gram doses. For children under 5, give one gram per every two pounds of body weight. Older children and adults may require much higher doses. Both antidotes should only be used on conscious poison victims; an unconscious victim should always be treated by professionals.

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Bottle Feeding

Baby drinking bottle

There are lots of great reasons for bottle feeding. Perhaps you cannot breastfeed because of your health and comfort, or that of your baby. Perhaps you work and are away from your baby most of the day. Maybe you need to be able to monitor your baby's intake more closely, or perhaps you gave breastfeeding a shot and it just didn't work. In any case, there are a few things you should know about bottles and nipples before entrusting them with your baby's food.

Nipples come in a wide variety of models, but the nipple you choose, no matter what its features, should deliver breastmilk or formula in a steady drip. And whichever nipple you decide you like, you should buy it in bulk. You will need to be able to replace worn, thinning, and discolored nipples immediately because they can become choking hazards.

Bottles, too, come in a dizzying array, and you should not commit to a particular model until you have tested it. Many people prefer glass bottles, but if you prefer to use a plastic one, make sure that it is made from polypropylene. Also make sure you buy at least eight bottles, and that you pick up the four-ounce size for your newborn, and switch to the eight-ouncers later. Newborns' tummies can only hold one or two teaspoons of milk or formula, and they will soon be devouring one to two ounces, but you're still a while away from needing room for eight!

Before using new bottles, nipples, or rings, no matter their shape, size, or features, sterilize them by submerging them in boiling water for at least five minutes and sterilize them more than once if you are using well water. Let them drip dry on a clean towel. Once you have disinfected them this way once, you can routinely clean them in hot soapy water or a dishwasher.

It is equally important to make sure that the milk you are giving your baby is safe. If your baby is finished eating and there is still a little formula or breastmilk left over, it's best to throw it out. Every time your baby has finished a bottle, you need to clean it thoroughly. If you're using formula, make sure to follow the directions on the package when preparing it, and boil the water for one to two minutes before using it, even if the water you used was bottled rather than tap. When you're pumping milk for your baby, date the bottle or plastic liner you express into, refrigerate it, and make sure to use the milk within three or four days. Kept at room temperature, milk is usable for only 12 to 24 hours, but if you freeze the milk, at zero degrees, it can keep for as long as three to six months, though it does lose some of its antibodies.

When you are thawing frozen milk, or heating refrigerated milk, make sure to use your stovetop rather than your microwave. Microwaves heat unevenly. On your stovetop, heat water to below the boiling point with the bottle immersed, or use a bottle warmer. There is no reason to warm milk or formula before a feeding, but some babies prefer it warm because it reminds them of breastmilk direct from you. To ensure an accurate test and to redistribute the cream layer, shake the bottle before testing the temperature giving it to your baby.

Until your baby is on a schedule, you should offer to feed him or her every two to three hours, or whenever he seems hungry. To prevent him from taking in too much air, hold the bottle at a 45-degree angle and make sure that the nipple and neck of the bottle are always full. And never force your baby to suck down any more than he seems to want; when he spits out the nipple, he's done.

After every one to two ounces consumed burp your baby over your shoulder, over your lap, or while sitting and rocking. Don't rush the feedings. Watch your baby, respond to his cues, maintain eye contact, and cuddle away! Feedings are some of the most special mother-baby moments there are!

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Colic

There is little anyone can do to soothe and quiet a baby with colic, which makes it one of the most frustrating experiences for new parents. Experts estimate that as many as 25 percent of babies have colic, yet they are still puzzled at its causes.

Colic is defined as a period of prolonged crying or fussiness, with episodes usually occurring in the evening and lasting approximately 3 to 4 hours. It usually appears in the first three weeks of life and lasts for about 3 months.

Many people incorrectly apply the term "colicky" to any fussy baby; however, a baby with true colic presents specific symptoms, including:

• Intense, inconsolable crying - The crying is lusty and forceful, not weak or sickly. His face will probably be flushed and he will be difficult, if not impossible, to comfort and quiet.
• Predictable, recurring episodes of crying - Your baby cries around the same time every day, usually in the late afternoon or evening. The crying begins suddenly and for no apparent reason, and may last for just a few minutes or to several hours.
• Physical tension - Many babies with colic have bloated, tense abdomens, pull their legs up to their stomachs, clench their fists, and appear to be in pain during the crying episodes.

Experts still don't know for sure what causes colic, even after many years of research. However, the following are all possible culprits:

• Cow's milk allergies or intolerance
• An immature digestive system that causes unusually strong intestinal contractions
• Gastroesophageal reflux disease (GERD)
• Increased intestinal gas
• Hormonal changes
• Diet of mothers who breastfeed
• Maternal anxiety or postpartum depression
• Baby's temperament - some babies just take longer to adjust to the world outside the womb

No medication, prescribed or over-the-counter, has been shown to always relieve colic safely and effectively. In addition, what works for one colicky baby may not work for another; and what works today may not work tomorrow, so you may have to try many methods to find one that works for you. The following have shown to help some colicky babies:

• Slower, more frequent feedings - Eating too much, too fast may cause intestinal gas to build up in your baby, causing pain. Try feeding your baby half as much, twice as often.
• Burp more frequently - Stop several times during feedings to burp your baby.
• Rocking, swinging, dancing - Try to mimic the movements your baby experienced in the womb.
• A warm bath – Climb in the warm water with your baby and hold her close, rocking her in the water.
• Gas reducer - Place your baby on his tummy across your lap and rub his back, or try placing your baby on his back and pump his legs up and down as if he were riding a bicycle. Try laying him on his back and gently massaging his tummy.
• Warm tummy - Place a warm (but not hot) water bottle on your lap and lay your baby face down, so his tummy is on the water bottle.
• Music - Some babies respond well to music and it helps them calm down.

It can be extremely frustrating to care for a colicky baby; just remember, it is not your fault. One of the most difficult, yet important, things to remember is to keep yourself calm; try to relax and remember that your baby will eventually grow out of this phase. If you feel yourself becoming angry, stop and take a break. Call someone to watch your baby for a little while and go for a walk or take a relaxing hot bath. If you don't have anyone you can call and feel you are near the end of your rope, place your baby somewhere safe (such as the crib) and take a 10 minute break. Never shake or hit your baby.

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Constipation

Baby crying

Learning to recognize whether or not your baby is constipated is a common challenge for new parents. But for young children, especially breastfed babies, constipation is rare. Some babies have several bowel movements a day while others will go a few days between bowel movements. Knowing your baby's pattern of bowel movements can help to diagnose possible constipation.

Though stools vary in color, if your baby seems to be passing hard, painful stools, small pebble-like stools or if you notice a streak of blood in the stool, he or she is more than likely constipated. Don't be alarmed if there is a tinge of blood in the stool, this is caused from straining the rectum, causing a small tear (also called an anal fissure). You should however, always mention blood in your baby's stool to your pediatrician, just to rule out any other serious health problems.

So what causes such discomfort for our children? There are a number of factors that contribute to a child becoming constipated. The most common is a diet high in milk products and low in fiber. Your baby's stool is stored in the large intestines and colon. The intestines and colon break down waste and absorb water, making a bowel movement firm. Dehydration and dietary changes such as switching your baby to whole milk or solid food can make constipation more prevalent.

To relieve constipation in babies younger than four months of age, you could give fruit juice (such as apple, pear, white grape, or prune) diluted with water. The mixture should be one part juice to two parts water. Give a call to your pediatrician and ask what they recommend to relieve constipation. A warm bath can also be a very relaxing and soothing experience for a baby with abdominal cramping.

If your baby is eating solid food, adding foods higher in fiber like apricots, peas, raisins, beans, spinach, prunes or whole grain cereals can help to relieve constipation. Your doctor may also recommend changing to a soy baby formula if they feel regular formula is the problem. If changes in your baby's diet don't appear to bring relief for your baby, call your pediatrician. The doctor may advise using glycerin suppositories or a stool softener, but these should only be used with your pediatrician's approval.

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Baby food revolution: New rules for feeding

Baby food revolution: new rules for feeding your baby

Written for Canada

Approved by the BabyCenter Canada Medical Advisory Board

Last reviewed: October 2010

• Rethink what you've heard about food allergies
  
• Don't be afraid of spices and seasonings
  
• Don't be intimidated by homemade baby food
  
• Go with your gut on organics
  
• Expand your baby's tastes
  
• Find out which old solid feeding rules still apply
  

Sometime near six months of age, your baby's all-liquid diet becomes more outdated than a maternity tent dress. It's time for solid food – so how about a little curried chicken? Or a nice bowl of borscht?

Believe it or not, babies can handle all sorts of interesting food (pureed, of course) well before age one. New research and a fresh look at baby feeding are turning cultural norms and even expert guidelines on their heads, and many believe that the result will be better health for kids.

While the bland fare that has traditionally dominated the diet of North American babies – rice cereal, plain pasta, and the like – isn't bad for them, it may be depriving babies of important nutrients and creating generations of picky eaters. With their cautious palates, it's not surprising that preschoolers reject healthy "real food" in favour of uniform, sodium-loaded "kid food" – macaroni and cheese, breaded chicken fingers, and those ever-present fish crackers.

So how do you get your baby to branch out early? It's surprisingly easy. Here's the exciting new thinking on how and what to feed your baby.

Rethink what you've heard about food allergies

Experts used to recommend holding off of common allergic foods until at least age one (and sometimes three years of age), and parents everywhere made a long list of items off-limits, including eggs, tree nuts, peanuts, fish, and shellfish. But recent studies have led to revised.

Health Canada recommendations that most foods, with a few important exceptions (for example honey, egg whites, and milk) can be introduced to babies after they are at least six months old.

Health Canada still recommends introducing your baby to one food at a time so you can watch for allergic reactions. If your baby does react to a common allergen then you should hold off that food and consult with your baby's doctor about when to introduce other common allergens. If your family has a strong history of food allergies or asthma, it's a good idea to check with the doctor first. If your baby has eczema, it may be a sign of more allergic potential, so when you do introduce allergenic foods, be aware of what to do if a reaction does arise.

Of course, it still comes down to parental choice. If the thought of serving egg yolks to your young baby makes you nervous, you're not alone. Even some health professionals disagree with the new thinking.

"As a parent myself, I'd choose to hold off on allergenic foods for at least the first year," says US-based physician and dietitian Christine Gerbstadt. There are plenty of interesting non-allergenic foods out there, so no matter what you decide, you can still introduce your baby to a wealth of fabulous flavors.

Don't be afraid of spices and seasonings

While babies throughout the world are dining on complex, flavor-rich cuisine, many Canadian babes are gumming plain, tasteless mush. The reasons behind our love affair with blandness are open to debate. Health Canada suggests that bland foods may be easier on your baby by allowing her to experience one new sensation, like texture instead of taste, at a time.

But a culinary walk on the wild side won't hurt your baby in the slightest. So toss some rosemary in with that squash, liven up that chicken with a dash of cumin, and give those mashed potatoes a kick with a blend of paprika and parsley. You may be surprised by your baby's reaction.

Contrary to popular belief, you don't need to banish hot spices from the highchair tray either. Obviously, you'll want to steer clear of anything that would irritate your baby's skin or mouth or digestive system – no habaneros yet – but there's no harm in giving mildly or moderately spicy food a try. While you shouldn't overload on cayenne, there's no harm in giving your baby other spices like cinnamon.

And if Granny or another parent raises an eyebrow, you can tell them that babies in other parts of the world have thrived on spicy food for generations, and Canadian babies are joining them. "Spicy chickpea curry with lots of ginger was one of my son's favorite finger foods," says fiery food lover Jennifer Pinarski of Winnipeg, Canada.

Don't be intimidated by homemade baby food

"Homemade baby food" sounds almost as daunting as "homespun clothes" – but don't let that fool you. It's unexpectedly easy, and doesn't require a nutrition degree, gourmet cooking skills, or fancy equipment.

Making baby food can be as simple as mashing up a banana or avocado with a fork and adding a little seasoning; opening a can of chickpeas or beans and squashing them with garlic; or steaming veggies and spices and then pureeing them.

If you're not in the mood to prepare separate "baby" meals, no worries – your baby can eat the same food you eat, as long as you omit salt from the recipes and are eating healthy food yourself.

"We love baby-food grinders," say Aviva Pflock and Devra Renner, authors of Mommy Guilt. They recommend grinding up your own meal – provided you're eating something healthy, of course – until it's the right consistency for your baby. "Your baby will get used to the way you cook, and you won't have to search out baby-friendly recipes." Of course, a blender or food processor may be all you need.

On the flip side, jarred baby food exists for a reason. Maybe you don't like to cook, or your busy schedule keeps you out of the kitchen. "I have no problem with jarred baby food," says dietitian Eileen Behan, author of The Baby Food Bible. "The baby food companies do a very good job at keeping the contents free of contaminants, and they no longer have added salt, sugar, or hidden modified food starch."

Read the labels, though. Many dietitians say that the fewer ingredients in jarred food, the better. "Instead of buying a jar of noodle-and-chicken dinner, I would rather parents mix jarred chicken with noodles from the family table. That way, they know the child is getting a good portion of chicken and not all noodles," says Behan.

Go with your gut on organics

There are more questions than answers when it comes to organics. They are not necessarily healthier than conventional foods. But some parents feel that the pesticides and hormones in conventional foods might be harmful to a small baby and that's enough reason for them to go organic; for others not. In deciding whether to feed your baby only, some, or no organic food, you'll have to decide what works for your family and budget.

One thing we do know is that the organic factor matters more for certain foods than others. For example, asparagus, bananas, and avocados tend to have relatively low levels of pesticide residue, while conventional apples, lettuce, and strawberries have some of the highest levels. Some nutritionists also recommend buying organic milk (once your baby's ready – at age 1 or after) as well as organic eggs, meat and poultry when possible.

Whatever you decide, remember that good general nutrition trumps organics. Feed your baby a wide variety of nutritious food.

Expand your baby's tastes

While consistency in everything from bedtime to discipline is one of the hallmarks of parenting advice, a little inconsistency at mealtime can be a wonderful thing. Changing up the menu will broaden your baby's palate and, particularly when it comes to produce, help ensure good nutrition.

Often, this means heaving ourselves out of a well-worn food rut. Stuck on sweet potatoes? Shake things up with some steamed beets. Peas and carrots every night? Go for brussels sprouts. Rice cereal overload? Try quinoa.

Lianne Phillipson-Webb, author of Sprout Right - Nutrition from tummy to toddler offers some tips on how to expand your repetoire. "Developing a palate for great tastes and textures starts early. Cilantro, parsley, basil, oregano, lemon or lime juice, coriander, cumin, ginger, cinnamon, and cardamom all enhance the taste of the food you are making. It really carries through the typical 'picky toddler' years, so give it a try!"

Find out which old solid feeding rules still apply

Ideas about what to feed your baby may be changing, but many of the old rules about introducing solids and encouraging your baby to eat well still stand. Be sure to check out Baby food revolution: Old rules for feeding your baby that still apply.

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