Child Health ALERT

Volume 14 A Survey of Current Developments Affecting Child Health Care June1996

Sun Protection Is For Everyone!

To most of us. summer means spending lots of time outdoors. which typically means being out in the sun for many hours a day. Unfortunately prolonged Sun exposure can lead to serious skin damage and other health hazards. such as skin cancer. Melanoma and other kinds of skin cancer are fortunately rare in children, but it is now clear that intense sun exposure in childhood increases the risk of skin cancer in adult life.

As a result. doctors and other public health experts have been educating adults and children about the importance of avoiding prolonged and intense sun exposure (it is particularly important to avoid this kind of exposure for babies under 6 months old). What follows is a number of recommendation that may he helpful:

- Choose and use a good sunscreen. That means using one with rays are sit est. an "SPF" ("sun protection factor") of 15 or greater for white children: an SPF of 15 means that it allows only 1/ 15 of the sun's rays to get through. so a child can spend longer in the sun without risking a burn.

- Be sure to apply enough sunscreen. Most people apply too little, and most products need to be applied every 3 to 4 hours and after swimming or sweating a great deal.

- Pay particular attention to areas that tend to bum. In most cases, these are the nose, ears, cheeks, and shoulders.

- Increase sun exposure gradually. If your child tans, try to limit time in the sun so a tan can build up slowly. If a child doesn't tan, always use a sunscreen.

- Avoid exposure between 10 AM and 3 PM, the time when the sun's rays are strongest.

- Remember that most of the sun's rays get through clouds, and that reflections off water. sand, and snow increase sun exposure.

- Wear a hat with a brim and clothing that is tightly woven.

- Wear sunglasses that meet "ANSI" UV requirements or that have a label with the words "UV absorption up to 400 rim", "maximum or 99% UV protection or blockage", or "special purpose".

- As you would for other health habit, set a good ex ample Wear sunscreen,. sunglasses and protection clothing yourself.

(Schmitt BD: Contemporary Pediatrics, May, 1996, pp. 57 & 59; Wagner RS: Contemporary Pediatrics. June. 1995, pp. 27-37,CHILD HEALTH ALERT July/ August, 1994 & July/August. 1995)

Treating a Sunburn:

The above recommendations should help prevent one of the more immediate effects of too much sun--sunburn. However, if a child gets a sunburn, there are certain things to do and not to do:

Things to do:

- Ibuprofen products (such as Children's Motrin or Children's Advil) can reduce discomfort.

-Nonprescription 1% hydrocortisone cream or moisturizing creams can reduce swelling and pain. These only work if they are applied when the burn first appears, but they may be effective in later stages if the bum becomes itchy.

- For broken blisters, trim off the dead skin and apply an antibiotic ointment, washing it off and reapplying it twice each day for three days.

- Take cool baths or apply cool, wet compresses several times a day. Adding two ounces of baking soda to a tubful of water may also help.

- Encourage the child to drink lots of fluids to replace the fluid lost into the swollen skin.

- When peeling begins in about a week, apply a moisturizing cream. Encourage your child not to peel off the dried skin before the skin underneath is completely healed.

Things NOT to do:

- Don't apply petroleum jelly or butter to the burn. They will prevent heat and sweat from escaping and they can be painful to remove.

- Don't use first-aid creams or sprays that contain benzocaine on bums because they can cause an allergic reaction.

(Schmitt BD: Contemporary Pediatrics, May, 1996, pp. 57 & 59)

For additional information on sun damage, sunscreens, or other issues related to sun protection, readers can contact the American Cancer Society at 800 ACS-2345. This organization has mounted an active educational campaign about sun exposure; for example, curriculum materials for preschool, elementary, and middle school children are available from many American Cancer Society offices, and interested readers should contact their state or local chapter.

PARENT/CHILD

Does Breastfeeding Increase A Child's Intelligence?

There isn't much controversy about most benefits of breastfeeding-for example, it has been proven that infants who are breastfed are less prone to certain kinds of infections. However, one very controversial issue is whether infants who are breastfed have higher intelligence than those who are bottlefed. What has fueled that controversy is the results of a number of studies which seem to show that breastfed infants have higher intelligence scores than bottlefed infants. However, it's been widely understood that these studies are complicated by the fact that breastfeeding tends to be more common among women who have higher lQs in the first place.

Now, researchers from Great Britain studied the lQs of almost 1,000 adults who had been born between 1920 and 1930. Just as in previous studies, these researchers found that adults who had been exclusively breastfed as infants had slightly higher lQs than those who had been exclusively bottlefed or who had been both bottle- and breastfed. However, when the scientists took other factors into account--and particularly the parents' lQs--there was no longer any link between adult intelligence and method of feeding in infancy. (Gale CR & Martyn CN: Lancet, April 20, 1996, pp. 1072-1075)

An accompanying editorial notes that "few issues in maternal and child health have generated as much discussion as breast-versus-bottle feeding." The writers point out that while most experts in child health agree that breastfeeding is the ideal form of infant nutrition, "mothers who cannot or who choose not to breastfeed... need no longer worry that their offspring will be less intelligent."

The editorial concludes that "nature and nurture confer intelligence. The method of infant feeding did not seem to matter in this study." Decisions about breastfeeding, the writers note, should be "based on the best available evidence. That best evidence is that intelligent, loving, and caring mothers are likely to have intelligent children, irrespective of how they choose to feed their babies." (Feldman W & Feldman ME: Lancet, April 20, 1996, p. 1057)

COMMENT. We think the editorial provides a thoughtful and accurate summary of what we know about breastfeeding and intelligence. There are certainly many reasons favoring breastfeeding, which benefits both the mother and baby. On the other hand, there are many situations in which breastfeeding can be difficult, and parents should not feel that they are compromising their child's future intelligence if the child is not breastfed.

ASTHMA/ALLERGIES

Peanut Alert!

No one expects that chocolate chip morsels may contain peanuts. but it turns out that the "New, Richer Taste!" brand of Nestle milk chocolate morsels does contain peanuts, which could cause a serious or even fatal allergic reaction in children with severe peanut allergies. Not all Toll House Nestle morsels contain peanuts, so when preparing your next batch of treats, be sure to double check the ingredient list if you need to avoid any peanut surprises. (Allergy and Asthma Network -Mothers of Asthmatics, Inc., January, 1996)

PRODUCT RECALLS

Child Safety Seats ...

Two child safety seats were recently, recalled. The Century Smart Move Model 4750 was recalled because the latching parts could allow the- buckle-to release during a crash. The recall involves over 11,000 seats made between November 27, 1995 and February 13 1996. A repair kit can be obtained. at no cost. from Century by calling 800 583-4093, or by writing the manufacturer, Century Products Co., 9600 Valley View Road, Macedonia, OH 44056. Parents with no alternative can use the seat until they receive and install the repair kit.

The Evenflo Trooper Adjustable Shield child safety seats are being recalled because the instruction pamphlet switched the instructions for toddler and infant use. This error could lead parents to think that infants smaller than 20 pounds can ride facing forward. The recall involves over 10,000 of the seats, which are models 219140, 219164, 219180, 219186, and 219188, which were manufactured between November 17, 1995 and January 22, 1996. A new instruction pamphlet can be obtained by calling the manufacturer at 800 837-4002 or writing Evenflo at 1801 Commerce Drive . Piqua, OH 45356.

... Wooden Caterpillar ...

Division Sales. Inc.. of Itasca. IL. is recalling 6.000 toy wooden caterpillars because the eyes can break off, presenting , hazard The toy measures 10 inches long, 4 inches tall, and 3 inches wide; it has a yellow painted body and green, red, and blue wheels. The toy is not labeled, but it comes in a blue cardboard box labeled "Wood Caterpillar ... Item No. 801 Made in China for Justen Products."

It was sold for about $5 to $ 10 at various retail and discount stores nationwide between July, 1994 and February, 1996. Consumers should return to toy to the store where it was purchased for a full refund; for more information, call Division Sales at 800 621-8134.

... Activity Set ...

Dollar Tree Stores, Inc., of Norfolk, VA. is recalling about 23,000 stationery activity sets because the sets include a plastic cutter with a metal blade that could cut someone if the cutters handle is compressed. exposing the blade. The plastic cutters have a black button and a handle in a variety of colors. They measure 6.25 inches long, 0.5 inches wide, and 0.5 inches thick. The cutters were sold as part of an activity set, which also included a clear plastic tape dispenser and two yellow, fine tipped highlighters.

They were blister-packaged on green, violet, or blue cardboard labeled "Item #STNY 85 5TPJ3... UPC # 0 4038801113 7... Made in Indonesia", and were sold from July to August 1995, for $1 each. Consumers should return the sets to a Dollar Tree Store for a full refund; for more information, call 800 876-8077 between 9 AM and 5 PM EST.

... Baby Pillow ...

Bucky Products, Inc., of Seattle, WA, is recalling over 3,000 Baby Bucky baby pillows. Baby and infant pillows have been banned because they pose a potential suffocation hazard to infants. The C-shaped pillows are intended for use in infant car seats and strollers to keep children's head from rolling from side to side as they sleep. They measure about 10 by 10 inches, weigh about 10 ounces, are covered in French blue, pink, or emerald jade Polartec fabric, and filled with buckwheat hulls. The tag reads in part "baby BUCKY ... Seattle USA... Pillows"

They were sold for $22 each in travel, variety, drug, and department retail stores nationwide from December, 1993 to June, 1995. Consumers should return the pillow to store where purchased for a full refund or send them to P.O. Box 31970, Seattle, WA 98103 for a full refund plus mailing costs. For more information, call Bucky Products at 800 692-8259.

... Color 'N Contrast Crib Book...

Dutton Children's Books, a division of Penguin USA of New York, NY, is recalling about 24,000 "Color 'N Contrast Crib Books" because straight pins used during the manufacturing process were mistakenly left in some of the books. They were sold under two titles, "Kitty And Friends" and "Puppy And Friends", under the Playskool name. Each book consists of five attached plush fabric panels; each panel has a black and white picture on one side and a color picture on the other. The first and last panels have Velcro tabs so that the unfolded panels can be attached to crib slats and used as a crib decoration. The books measure about 5 by 5 inches when folded and about 5 by 26 inches when extended. A label on the fabric flaps read, in part, "Dutton Children's Books, a division of Penguin Books USA Inc... Playskool... Hasbro, Inc." and "ISBN 0-525-45468-3 or "ISBN 0-525-45469-1". The books were sold in various retail stores (including book stores) nationwide from November, 1995 to March, 1996 for 4.99 each. Consumers should return the books to the store where purchased for a full refund, or mail them to Penguin USA, 100 Fabrite Road. Newbern, TN 38059-1334-, attn: Cloth Book Department, for a full refund plus postage costs. For more information, call 800 477-9911.

... Repair For Star Cruiser Swing...

Hedstrom Corp., of Bedford, PA. is offering a modification to 180.000 metal and wood backyard -A in sets that will fix a potential flip-over problem with the sets' Star Cruiser two passenger swing. The modification attaches to the rear chains of the swing to prevent children from flipping the swing over backwards. Owners can identify the red or yellow plastic swing by the name "Star Cruiser" molded on the front below the handle. To receive a free kit to fix the swing on metal and wood gym sets, call Hedstrom Corp. at 800 2333271 or write the company at Sunnyside Rd.. Bedford. PA 15522. Make sure you have the model number of the gym set to receive the correct size modification kit.

PRODUCT SAFETY

Anti-Scalding Device That's Easy To Install

A new device to prevent scalding is simple enough to be installed by almost anyone in just a few minutes. Part of a line of products called "Memry Safe". these devices contain a special metal alloy that expands when it reaches 120º F, and as it expands it chokes off the flow of hot water. When the water cools down, the metal contracts and allows it to flow again. Since this process only takes a few seconds, the hot water can be stopped before a child or adult is burned by it. (Wald ML: New York Times, May 2, 1996)

COMMENT: Too many children have been burned by scalding water coming from a faucet or showerhead. It takes only 5 seconds of contact with water at 140º F to produce a very serious ("third degree" burn). On the other hand. if the water is 120º F, it would take 10 minutes to produce a similarly serious bum.

In an effort to reduce that risk, many experts on injury prevention-along with the plumbing industry-have recommended making sure that water is no hotter than 120º F when it comes out of the tap. One way that can be accomplished is by keeping the hot water thermostat 120º. Unfortunately, efforts to reach that goal haven't been very successful.

The Memry Safe products don't affect the water temperature overall. but only the flow of the water that comes out of faucets fitted with these devices. In this way, the water to the washing machine or dishwasher could remain at 140º, while the water from taps that might come in contact with children could be protected. We thought this device might be particularly useful for homes, childcare centers, schools, and other places where children could be burned by hot water, whether it's from a spout in a sink or bathtub or a showerhead in a shower.

We've seen these devices and the background information provided by the manufacturer, Memry Corporation of Brookfield, CT. While we didn't conduct scientific tests, they did seem to be easy to install; we were impressed with how the flow of water cut down to a trickle when the water became quite hot, and how the flow returned when the water temperature cooled down. There are versions that fit in sink faucets (about $12), tub faucets (about $25), and showerheads (about $14). The manufacturer informs us that discounts are available for large group purchases. Readers who are interested can call Memry Corporation at 800 582-5454, ext. 134. 0

READER'S MAILBAG

Q: Many of our parents ask about "gripe water" and how it should be used, and I would appreciate any information on it that you could provide.

I. Castro
Long Island, NY

A: We last discussed gripe water a few years ago (CHILD HEALTH ALERT September & December 1991), but it seems to remain popular and a source of concern. Gripe water is a combination of ingredients that's promoted as a "safe and gentle way of relieving baby's wind" (gas, that is). It's been made popular through nannies who come from Britain or former British Colonies (like Jamaica and India). Since 1982, the U.S. Food and Drug Administration has asked customs agents to seize shipments coming into the U.S., since the product is considered a drug and has not been submitted to the FDA for evaluation of its safety and effectiveness.

The ingredients include dill water, sodium bicarbonate, and about 5% alcohol; however, one of our readers from England sent us a product called "Woodward's Gripe Water", which contained dill seed oil and sodium bicarbonate, but no alcohol.

Large amounts of any alcohol-containing product could be dangerous for a child, and particularly an infant. While it's important to know whether something can be harmful it's also important to know if it works. To our knowledge, there is no evidence that grip water actually reduces gas, so giving small amounts to a baby may do no good and giving larger amounts could potentially do some harm.

RESOURCES

Family Guide To Car Seats

The American Academy of Pediatrics (AAP), the organization representing pediatricians throughout the country, has just published a 1996 update of its guide that compares the features of more than 55 different infant, convertible, and booster car seats. The " 1996 Family Shopping Guide to Car Seats -- Guidelines for Parents" has been reviewed by medical experts to provide information to parents on the correct way to use car seats, and it provides tips on how to choose the most appropriate safety seat for a child. A single copy of the guide can be obtained from the AAP, at no charge, by sending a self-addressed, stamped envelope to AAP Division of Publications, Department C-Car Seat, P.O. Box 927, Elk Grove, IL 60009-0927.