Child Health Alert Newsletter February 97

Child Health ALERT

Volume 15 A Survey of Current Developments Affecting Child Health Care February 1997

Fruit Juices In The News: Can Too Much Fruit Juice Cause Growth Failure?

Over the last 30 to 40 years, infants and young children have increased the amount of fruit juices they drink. This is partly due to the variety of products available, the convenience of juices as a snack food, their relatively low price, and the view of many parents that fruit juice is a healthy drink. Public health campaigns encouraging more fruit in the diet may also have contributed to the increased consumption of fruit juice in recent years.

Now, researchers in upstate New York studied the dietary habits of 2-year old and 5-year old children and found that children who consumed 12 ounces or more of fruit juice per day are more likely to be shorter than normal or obese. Based o n this. they recommend that "parents and care takers should limit young children's consumption of fruit juice to less than 12 fluid ounces per day." (Dennison BA et al: Pediatrics, Jan 1997, pp. 15-22)

COMMENT: This report, and the advice it contained, received a lot of publicity, but the issue isn't as simple as some seem to think. By way of background, we should point out that over the past twenty years there have been a number of concerns raised about young children drinking too much fruit juice. First, pediatric and dental societies warned against using fruit juices in bottles of nursing babies, since the sugar in the juices can lead to dental cavities. More recently there have been reports that excessive use of fruit juice could lead to chronic diarrhea and abdominal CHILD HEALTH ALERT January, 1993). The most serious concern was raised three years ago (CHILD HEALTH ALERT March, 1994), when doctors showed that in some children, drinking too much fruit juice could be related to their failure to grow adequately.

The current report showed that shorter or heavier children tended to drink more fruit juice than other children, but the study design could not show that the juice consumption actually caused the children to be shorter or heavier. In fact, it could be argued that juice drinking is just a sign of a poor diet or other poor health behaviors (like not getting enough exercise), and that the child's overall diet or lack of exercise was the real cause of the growth problems. For similar reasons, this study can't show exactly what amount of fruit juice could be harmful.

Since this kind of study only tells us that short or heavy children tend to drink more fruit juice than children who are normal in height and weight, is there other evidence that too much juice can cause growth problems?

In the 1994 study we cited above, researchers found that a small group of children who failed to grow adequately also were drinking very large amounts of fruit juice (12 to 30 ounces per day), and at the same time their diet was low in protein, fat, and other nutrients. In addition, these children were not adequately absorbing the sugars from the juices, so it was possible that they also weren't adequately absorbing the small amounts of other nutrients they ate. When their diets were changed by reducing the amount of fruit juice they consumed and by improving their overall diets, the children gained significant amounts of weight.

The information we have to date does not show that every child drinking more than 12 ounces of fruit juice daily will have growth problems. Rather, children drinking large amounts of fruit juices may be at risk for these kinds of problems if they are "filling up" on fruit juices and not getting a balanced diet with enough protein, fats, and other nutrients, or not getting enough exercise. Put another way, if a child drinks very large amounts on a daily basis, parents and other care providers should see this pattern as a possible sign of other problems with diet or exercise, even if the child is growing normally. Just reducing a child's juice consumption to below 12 ounces a day is unlikely to benefit the child's nutrition unless other changes are made. These reports should reinforce common sense about doing things in moderation, and they also reinforce Grandma's warnings that "if you fill up on juice you'll have no room for dinner".

... And Apple Juice, Cider, And Illness

This fall, apple cider or apple juice was associated with three outbreaks of illness which in some instances were serious enough to require hospitalization and even caused the death of one child. As we reported previously (CHILD HEALTH ALERT, December, 1996), two outbreaks were blamed on a particularly toxic form of E. coli bacteria (called E. coli 0157:H7). One, in Connecticut, involved apple cider, and the other, in the western United States, involved apple juice and other fruit juice products that contained apple juice. In both outbreaks, the apple cider and juice had not been pasteurized.

The U.S. Centers for Disease Control and Prevention now add a third outbreak to the list, this one occurring in New York State and caused not by E. coli but by another organism called cryptosporldium. The children and adults who were affected had diarrhea and also were likely to have abdominal cramps, vomiting, and fever. The contamination was traced to apple cider produced at a particular mill that was located near a dairy farm (and dairy cattle are one source of crvptosporidium). The apple cider had not been pasteurized.

An editorial note from this federal health agency points out that unpasteurized apple cider and juice have been associated with outbreaks of infections due to E. coli 0157:H7, cryptosporidium, and salmonella. The organisms are carried in various animals, and contact with their manure is the likely way in which apples become contaminated.

While washing and brushing apples or using preservatives may help eliminate these organisms, there's no guarantee that some won't survive. Pasteurization and boiling are the most effective methods, and the government is considering whether apple cider and juices should be required to undergo these processes. This report concludes that "until alternative effective methods are developed, consumers can reduce their risk for (these) infections by drinking pasteurized or boiled apple cider and juice." (Morbidity & Mortality Weekly Report, January 10, 1997, pp. 4-8)

COMMENT: There may be confusion in readers' minds about the difference between apple cider and apple juice and whether one product poses more of a risk than the other. While cider is typically cloudy (containing small bits of apple and apple skin) and juice is typically clear, the important distinction is whether the products are pasteurized or not.

Apple cider that is fresh-pressed and sold at roadside stands is usually not pasteurized, nor is apple cider that is kept under refrigeration at supermarkets. Apple juice generally refers to commercially prepared products which are pasteurized and don't require refrigeration in the store. However, as the Odwalla juice outbreak on the West Coast demonstrated, products may be called "apple juice" but at the same time be unpasteurized and labeled as "natural".

So consumers concerned about avoiding the risks of giving potentially contaminated juices to their children (and children are at greater risk for some infections than adults) should avoid "fresh-pressed" and refrigerated apple cider and should look for apple juice products that have "pasteurized" on their labels.

CHILD SAFETY

Winter Warning: Injury from De-Icing Salt

Last year at this time doctors in Switzerland reported a winter hazard that is worth bringing to readers' attention once more. They described an 8-year old boy who collected some whitish stones while hiking, which he put in his pants pocket. Later on he noticed a red area on his thigh, Under where his pocket bad been-and-during the next two days this area progressed to become black, dry, and dead tissue. The child required surgery and skin grafting.

The stones the child had collected turned out to be calcium chloride salt crystals used to de-ice roads and sidewalks. The doctors point out that while this problem is likely to be rare, it is serious enough that children should be warned about handling, de-icing salts. (Zurbuchen P et al: Pediatrics, February, 1996, p.258).

COMMENT: We hope this warning will help avoid similar injuries this year. Since children can't easily tell calcium chloride - from other de-icing crystals, they should be cautioned that all de-icing materials should be left where they're applied, and left alone!

RESOURCES

Poison Prevention: A Year-Round Goal

The Poison Prevention Week Council is offering a packet of materials that helps raise awareness about accidental poisonings and preventive measures that can be taken to reduce them. National Poison Prevention week on March 16-22 this year has as its theme (as it has in the past) "Children Act Fast ... So Do Poisons" to emphasize the need to be watchful when household chemicals or medications are being used.

Poison prevention efforts will go a long way toward reducing childhood poisonings, but prevention needs to be a focus every week of the year. Consumers can obtain the special packet, at no cost, that contains:

1) A colorful poster
2) A list of available booklets (most are free)
3) A fact sheet
4) A poison lookout checklist
5) a list of poison centers in the US

To obtain these materials, send a postcard with your name and address to: Poison Prevention Week Council, P.O. Box 15431, Washington, D.C., 20013. For the cost of a postcard, these materials are a real bargain

CHILD CARE ISSUES

Mary Ucci:
Gooey, Fun, And Educational

Winter is a season when children spend more time indoors, but that doesn't mean that there aren't plenty of things to do that are both fun and educational. Few materials are as appealing to young children as play dough. Children enjoy playing with gooey things, and at the same time these materials can be highly educational because they meet children's needs in four areas of development: physical, cognitive, emotional, and social.

Physical Development: When children squeeze and mold play dough and other gooey materials, they are also working to develop their small muscles which they will later use for holding pencils and pens, turning pages in a book, or pressing the keys on a computer.

Cognitive Development: Children who watch the changes in forms produced by rolling, dripping, squeezing, or pounding gooey materials begin to understand chemistry and physics--some of the principles of how our world works. In talking about their play, they get to practice words as they describe their experiences.

Emotional Development: For many children, playing with gooey things can be a calming activity; it feels great to a young child to sense the coolness or smoothness of these materials, and to have adult permission to play with something "nicely messy". Also, it's a relief to young children simply to be able to play (enjoy the process!) and not to have to always make something (end up with a product!).

Social Development: As children play with gooey things, they engage each other in conversation and get to practice sharing their excitement. "Look at my play dough!" "It looks like an apple pie!" or "You can sit next to me: I'm squeezing my play dough out as long as yours!"

The combination of fun and educational values make play dough a terrific indoor activity for young children in the wintertime (or for that matter, any time of year).

Play dough and other similar materials are widely available in stores, but here are a couple of recipes that can save money:

Playdough Recipe:
2 cups flour
2 cups water
1/2 cup salt
2 Tablespoons vegetable oil
1 Tablespn. cream of tartar
food color (optional)

Mix all ingredients together in a heavy saucepan until all lumps are -one. Heat mixture over medium-high burner, stirring constantly with a wooden spoon. Mixture will begin to thicken and form big lumps. Stir like crazy! When mixture is as clumped as you can get it and it resembles wet" scrambled eggs, it is done.

Dump warm mixture out onto clean surface (Formica is good). Allow to cool a bit while you clean the pot and spoon. Then begin to knead the playdough. DO NOT ADD FLOUR! Have faith; the playdough will become less sticky as it cools while you knead it. Thoroughly cool before storing in an airtight container.

Oobleck Recipe:
1.5 cups corn starch

1 cup water

food color (optional)

Mix the ingredients and allow children to play with the mixture.

When "pushed" together, the mixture will appear dry and solid; as children let go of the mixture, it flows like a smooth liquid.

Mary Ucci, who is Educational Director of the Child Study Center of Wellesley College, writes this periodic column on early childhood development; she welcomes questions from readers, which she will answer as space permits. Questions should be sent to her c/o CHILD HEALTH ALERT, P.O. Box 610228, Newton Highlands, MA 02461.

Readers are invited to copy this article for posting on bulletin boards or distribution to parents.

PRODUCT RECALLS

Recalls: Levi's Koverall and Shortalls...

Levi Strauss & Co. of San Francisco, Calif., is recalling about 3,000 Little Levi's Koveralls and Shortalls because the snap fastener on the inside legs may separate, creating a potential-choking hazard. They were sold in retail stores nationwide beginning in November, 1996. Koveralls is a youth version of traditional adult overalls and Shortalls is a short pant length version. The recalled items are styled for boys in sizes 12 to 24 months and 2T to 4T: they were sold in indigo denim with product codes 29028-2891 and 22028-2891 (Koveralls) and 22020-2891 and 29020-2891 (Shortalls).

The company is also recalling infant sizes 12 to 24 months of its Levi's brand Girlswear Koveralls and Shortalls with product codes 38806-0817 and 38880-0881 (Koveralls) and 39867-0881, 39867-0817, and 39867-9281 (Shortalls). The girls' garments were sold in stonebleach denim, pink twill, or pink check fabric with an elastic back. The product codes are located on the back of the care label sewn in an inside seam of each garment. Consumers should return - these products to the store where purchased for a full refund. For questions, call Levi Strauss at (800) USA-LEVI, or write the company at Levi's Plaza, P.O. Box 7215, San Francisco, CA 94120.

... Paperweights & Pens...

Shelby Ltd., of Wang's International in Memphis, Tenn., is recalling about 40,000 paperweights and pens because they contain kerosene or other petroleum products and because many were sold to children. If these products were to leak (and there are reports that some do), the liquid can be hazardous if inhaled or swallowed. The liquid could be combustible and could therefore pose a fire hazard. The plastic paperweights came in five styles: "Ocean In The Box", "Floating Eye", "Antique Car", "Magic Diamond", and "Water Timer". They were packaged individually in cardboard boxes bearing the name of the style. The pen is clear plastic with an eyeball in the middle, and was packaged in cellophane wrap without any labelling. These products were sold nationwide by school stores to children from kindergarten through the sixth grade from October through December, 1996 for about $4 to $5. Consumers should remove these from children and call Wang's at (800) 829-2647 for instructions on how to return the items for a full refund.

... Wooden Bunk Beds...

Five bunk bed manufacturers are recalling about 100,000 wooden bunk beds because they have openings on the top bunk that present a potential entrapment hazard to young children. The spaces can be large enough for a child's body to pass through, but small enough to entrap a child's head. Since 1990, the U.S. Consumer Product Safety Commission has received 32 reports of children who died from becoming caught in bunk beds with this kind of opening, and 31 of those children were under the age of 4. Beginning in November, 1994, 26 manufacturers have announced recalls involving over 400,000 wooden bunk beds with similar hazards. The current recall adds additional models to the list, all of which were distributed on the West Coast.

Beds involved were distributed by Bedder Bunk Co. between 1984 and 1992 in Northern California, Oregon, and Washington; Oakland Wood Shop Mfg. between September, 1994 and October, 1996 in California, Oregon, and Washington; P.J. Sleep Shop between 1981 and October, 1996 in Portland, Oregon-, Stoney Creek between 1980 and 1993 in Oregon and Washington; and Wholesale Importers and Exporters (models 1040 Deluxe and 1051 Clover) between 1984 and March, 1996 in California, Oregon, and Washington.

Newer standards for bunk beds require guardrails on both sides of the top bunk, but also that all spaces between the guardrail and bed frame and those in the head and foot boards of the top bunk should be less than 3.5 inches. Beds now produced by these companies adhere to the new standards. Consumers who have one of the beds involved in this recall should stop using it and call the retailer for a replacement guardrail, retrofit kit, or instructions to help eliminate the potential entrapment hazard. Consumers who are unsure about the manufacturer or have questions about this recall can call the CPSC hotline at (800) 638-2772.

... And Century Travel Playards

Century Products Co. of Macedonia, Ohio, is recalling over 210,000 of its model 10-710 and model 10-810 Travel Playards (also known as playpens) because they may collapse unexpectedly. The company is offering a free repair kit consisting of new top rails with Posi-Locks to prevent the rails from collapsing when a child is in the playpen. For questions, call the CPSC hotline at (800) 638-2772 or the Century Co. at (216) 468-2000. (Letter to doctors from Century Co.)

(Unless noted otherwise, reports above come from the U.S. Consumer Product Safety Commission, Washington, D.C.; telephone (301) 504-0580)

Winter Hint:

To limit the spread of head lice, children's hats should not be piled together, but rather should be tucked into the sleeves of their coats - and coats should not be piled together either, but hung on individual hooks or kept in each child's cubby.