Qn of the Month: Is Childhood Lead Poisoning Still an Issue in the US?

A: Yes, unfortunately. Long used in human history for its usefulness in a multitude of products, the unpleasant side effects of lead such as sterility and mental confusion have also been known in ancient times. In the United States, lead mining and smelting began soon after the first colonial settlement. Since the advent of the use of tetraethyl lead in automobiles to improve engine performance and reduce engine knock in the early 1920s, leaded gasoline remained important in America until the 1970s when the Environmental Protection Agency (EPA) began efforts to reduce the lead content in gasoline fuel. Enough evidence had finally been collected on the adverse effects of lead on the health such as permanent nerve damage, anemia or mental retardation in children. Further steps were taken at the Federal level. In the late 1990s, the Lead Contamination Control Act of 1988 authorized the Centers for Disease Control and Prevention (CDC) to start program efforts to eliminate childhood lead poisoning in the United States. This created the CDC Childhood Lead Poisoning Prevention Program, which is still ongoing today. Finally, in January 1996, EPA called for a total phase out of leaded fuel.

In recent years, almost 60 childhood lead poisoning prevention programs have been funded to develop, implement, and evaluate lead poisoning prevention activities. The CDC Childhood Lead Poisoning Prevention Program also led to the development of the Childhood Blood Lead Surveillance System through which states can report data to CDC. So has childhood lead poisoning been eradicated? Not quite.

Today, lead is still an issue, especially in certain parts of the country. This is most clearly seen in the recent Flint, Michigan crisis with lead contamination in the drinking water. However, there are other areas in the United States, such as in Houston Alabama, where more than half the children show elevated blood lead levels. Another issue is that although the Centers for Disease Control collects data on child lead poisoning rates, only about half the counties in the United States reported it in 2014. So unfortunately the data may not be very helpful, depending on where you live, as the data may not be reported or much information collected.

Alarmingly, many states have not submitted any data to CDC. These include Alaska, Arkansas, Hawaii, Idaho, Montana, Nebraska, North Dakota, South Carolina, South Dakota, Utah, and Wyoming. For more information see source 4 (http://www.vox.com/2016/1/21/10811004/lead-poisoning-cities-us). States should definitely be made to report lead poisoning rates in children as a requirement. To find out more about the impact of lead on public health in the United States, see these upcoming presentations: American Public Health Association Webinars.

(Sources:

  1. CDC’s Childhood Lead Poisoning Prevention Program. Centers for Disease Control and Prevention. http://www.cdc.gov/nceh/lead/about/program.htm. Updated February 9, 2015. Accessed January 31, 2016.
  2. Lewis, J. United States Environmental Protection Agency. Lead Poisoning: A Historical Perspective. EPA Journal. May 1985. http://www.epa.gov/aboutepa/lead-poisoning-historical-perspective. Access January 31, 2016.
  3. EPA Takes Final Step in Phaseout of Leaded Gasoline. United States Environmental Protection Agency. EPA press release. January 29, 1996. http://www.epa.gov/aboutepa/epa-takes-final-step-phaseout-leaded-gasoline. Accessed January 31, 2016.
  4. Frostenson S. Vox.com. America’s lead poisoning problem isn’t just in Flint. It’s everywhere. http://www.vox.com/2016/1/21/10811004/lead-poisoning-cities-us . Updated January 21, 2016. Accessed January 31, 2016.
  5. Nelson L. Vox.com. Flint, Michigan, tried to save money on water. Now its children have lead poisoning. http://www.vox.com/2015/12/15/10237054/flint-lead-poisoning. Accessed January 31, 2016.)

Constipation Matters (Part 1): Prevention Tips for Babies

baby-diaper-toes-cloth-cropped

(Shutterstock)

If you ask me, I think babies have a tougher time dealing with constipation than toddlers. For one, they can’t really tell you what’s wrong apart from wailing, while a toddler at least (for the most part) can communicate a bit better about what’s going on. And I think parents have an easier time dealing with constipation in a toddler than in a baby. It’s much easier to get a toddler to drink more fluid or to be more active. But it’s tougher to get a baby that can’t even crawl or sit up yet to move more. Note though that babies often strain, get red in the face and cry when trying to pass a stool, but this does not necessarily mean the baby is having constipation.

To prevent constipation in adults, the 3 ‘Fs’ are usually recommended: Fluids, Fiber and Frequent Exercise/Activity. Well, it’s the same for babies and toddlers as well.

Fluids
In general breastfed babies tend to get plenty of fluid (think of the more watery portion of the breast m
ilk at the beginning of a breastfeed session) and are seldom constipated. However be aware that depending on age, breastfed babies tend to have a wide variety of normal stooling patterns (from a few times a day to once a week!). While formula fed babies may be more regular (e.g., once a day or so), they may experience slightly thicker and firmer stools, so offer water in a bottle regularly in between formula bottle feeds.

Starting at 9-10 months of age, offer your baby a free flow sippy cup of water with meals and at frequent intervals throughout the day. This way, he/she will not only get used to the taste of water, but will also get used to drinking it often in the course of a day. This shouldn’t affect your breastfeeding, but if you’re worried, you can offer the water after a breastfeeding session instead of right before it.

Fiber
Once baby starts solids, you can begin to add some fiber into your baby’s diet. Some have said that baby rice cereal can be constipating, and this can be true if you offer your baby a lot of baby rice cereal daily since there’s hardly any fiber in it. So instead of only offering baby rice cereal, you can focus on offering more pureed fruits and vegetables like butternut squash, avocado, and mango as first foods to your little one. However, you may have to increase the fiber content in your baby’s diet gradually as some babies have digestive systems that need a little bit more time to get comfortable handling a higher fiber load.

Frequent Movement/Activity
This may be a bit more trickier for babies, especially if they are young and haven’t even learned to lift up their heads yet! But you can still employ ‘baby massage’ techniques to help relax baby’s body and possibly help move down gas and stool in the digestive tract. Taking baby’s legs and doing some ‘cycling/bicycling’ motions a few times a day could help too. But don’t worry, all too soon, baby will sitting and crawling, and then pulling up to a stand. Getting active is something that will come naturally and instinctively!

Qn of the Month: Help! Baby May Be Constipated…What Can I Do?

First, what is considered constipation? According to the American Academy of Pediatrics (AAP), a baby is more likely to be having constipation if he/she displays the following signs and symptoms: being excessively fussy; spitting up more; unusually hard stools or stools containing blood; a big difference in bowel habits or bowel patterns; straining for more than 10 minutes without success.

Before I talk about some strategies that may help, I want to mention two key points. First, while many babies may follow the ‘book’ in terms of stooling and wet diaper patterns, this may not always be the case for some babies. For breastfed babies, especially, there can be a wide range of normal, with baseline stooling patterns varying from a few times a day to some only going once a week. This is fine, as long as feeding is not affected, and the baby does not seem bothered. Second, prevention (fluids, fiber and frequent movement) is easier and still better than treatment. For more on that, see some upcoming posts dealing with this topic.

Now here are a few simple strategies that may help your little one:

  • Food: If your baby has started on solids, you can try mixing in a bit of home or commercially prepared prune puree or a tiny bit of diluted prune, pear or orange juice into your baby’s food
  • Fluids: For an older baby, you could offer fluids like water more frequently during the day (in between breast or formula feeds). For a younger baby, you could offer some water after a breastfeed, so as not to impact the breastfeeding, as well as add a bit more liquid (expressed breast milk, formula or water) into his/her solids. Just make sure that you don’t compromise the texture too much. It is still important to make the texture appropriate to your baby’s age and abilities, so that it won’t be a choking risk.
  • Movement: A bit of bicycling/cycling motion with the legs (with baby on his/her back and facing up) a few times a day can always help!
  • If medicine is really needed, the doctor may prescribe something like lactulose. Don’t worry, lactulose mainly works by just helping to draw water into the gut to help with softening and moving the stools along baby’s gastrointestinal tract.

Lastly, I just want to mention that some bowel pattern changes are normal. For example, over time as my little one got older and began to eat more solids, her stooling also gradually changed. At first it was a few times a day, then there was a transition period with the introduction of solids, so that it eventually became once a day, or once every other day. As she started to eat more, of course the quantity was also a lot more (and as my husband would say, “More pungent!”). And let’s not forget that teething is another factor, often making stools looser/more frequent during those periods!

Qn of the Month: My Baby Doesn’t Want to Drink Water. Should I Worry?

Your baby may sometimes go through phases of whether she wants to drink water. If your baby is over 9 months old, has mastered how to take water from a free flow lidded cup, but just doesn’t seem to actually want to take much, then don’t worry.  He is obviously not thirsty! Know that your baby’s body is remarkable and will adjust to the amount of fluid intake. On days when there is less fluid in, baby just won’t urinate as much so diapers won’t be as wet, but this doesn’t mean baby is dehydrated. As long as there are some wet diapers in the midst of the drier ones, then that’s fine. Babies can often also compensate and make up their fluid needs in a day by taking in more breast milk during breastfeeding or more formula from a bottle. The most important thing is to keep regularly offering the water cup at different times of the day. If baby seems to be in a playful mood, biting or playing with the water spout, then just gently take the cup away from the baby and offer it again later. Trust that when baby is thirsty, he will drink!

My little one was doing really well at 8 months learning to drink and swallow water. Then at 9 ½ months she discovered how to suck water and but let it dribble out of her mouth, getting her shirt very wet! When she started to drink from the free flow sippy cup again, she seemed to need to relearn the process. She would tilt the cup too much and take gulps that were too big, ending up choking quite a few times. Since 11 months though, she is back to drinking better and can now even take sips from an open cup.

During all these ups and downs in her water intake, I didn’t worry as I noted that her intake of breast milk was actually better during this time, and though it was hot summer weather, she still had some good wet diapers (some were definitely not as wet), her bowel movements were still smooth and the stools were not too hard. I also counteracted her drop in water intake by offering more expressed breast milk in an open cup with meals so she could practice drinking more of that, as I had started to make her meals drier and thicker in texture.

If, however, you know baby is definitely not taking in enough fluids overall, then there are some steps you can take. Even if baby is no longer breastfeeding or drinking much formula from a bottle, you can still add in more expressed breast milk, formula or water to baby’s foods to help increase baby’s overall fluid intake, or offer other fluids like expressed breast milk in a free flow lidded or open cup instead. Expressed breast milk or formula provides more nutrients than water anyway. See also my post on ‘Water Please…Upping Baby’s Water Intake’ for more tips that may help!

Water Please…Upping Baby’s Water Intake

Do you have a baby that tastes water in the bottle, and then pushes the bottle away, refusing to drink? You might have already started giving your baby some water in early infancy. Or, you might have waited till baby was 10 months old, before beginning to offer water in a bottle. Either way, if you have a baby that’s 8 months or older and not taking water from a bottle well, try these steps which might help:

  1. Put water in a new snazzy free flow lidded cup (a bright colorful one is best) so it is something new like a toy. Designate this as the water cup. Help baby learn how to drink from it the first few times until she gets it. It’s alright if she wants to play with it more at first, as long as she doesn’t choke on the water.
  2. Offer it every day before and after meals and after breastfeeds (so that giving water won’t affect your breastfeeding milk supply as much) even if it is just a sip, so that baby will get used to it. It works well as a time filler when baby is on the high chair and you are getting baby’s food ready!
  3. Give LOTS OF ENCOURAGEMENT and praise when she holds the cup right, or takes a proper sip (instead of just playing with the bottle nipple). She/he will lap up the attention and praise!
  4. Model. When you give baby a drink, drink some water from a cup yourself (see through is best) so baby can see you are doing the same thing.

Giving your baby water is important. Besides helping with hiccups, offering some water can help when you start your baby on solids by keeping the bowel movements going smoothly and the stools from getting too firm. It’s especially important to give your baby water often if your baby is formula fed as formula is not as hydrating as breast milk. So don’t give up, keep offering that water!