Enterovirus D68

NOTE:  This post has been updated twice to follow new developments (see below).

The virus every parent is talking about.  Here are the facts:

According to the CDC, it has now been confirmed in 32 states, including Washington.  From mid-August to now, there have been 220 cases of confirmed Enterovirus D68.

Fear
I think whenever we as parents hear about a new threat to our children, we become at least a little more alert, if not downright afraid.  This virus is especially scary because it's spreading quickly, and it's landing kids in the hospital.  Find comfort in the fact that as of September 22, no deaths have been associated with Enterovirus D68 (Medscape).  Also, remember that every year the flu sends kids to the hospital too.  Finally, remember that not every child who goes to the hospital for respiratory distress tests positive for Enterovirus D68.  I say these things not to minimize the concern and the need for caution surrounding this virus, but to put those concerns in perspective for those of you who may be overcome with fear.

What You Can Do
A lot of what I'll suggest here echoes what I suggest every year as we go into cold and flu season.  Kids are starting school, the weather is changing, and with that come the inevitable runny noses, coughs, GI bugs and asthma attacks.  Basic precautions and a little kitchen table medicine go a long way toward keeping them well.

• Wash hands.  I know you hear this one over and over and over, but it's for good reason. Researchers recently found that a virus placed on a single doorknob spread to over 50% of hands in that building within 4 hours.  Remember that kids are constantly touching their mouths, noses, and eyes, thereby giving germs direct access.

Photo by SuSanA Secretariat; Flickr; no amendments

• Manage asthma.  Most (but not all) of the kids ending up in the hospital have asthma.  Be sure you have recently visited your doctor, and that you have an up to date asthma action plan.  Also, be sure you are using all your preventive medicines:  discuss a steroid inhaler with your doctor, as well as herbs and supplements that can decrease attacks and their severity.  Finally, be sure your child always has access to her rescue medication.
• Know the signs.  Respiratory distress can actually be missed quite easily.  The untrained eye might not notice anything wrong.  Review the signs with your doctor; any child can go into respiratory distress, not just those with asthma.  For more information on respiratory distress, see the "Unrecognized Respiratory Distress" section of my previous blog post.  If you do notice any difficulty breathing, call 911, go to the ER, or call your child's provider.
• Support the immune system.  Your Naturopathic Doctor can recommend his or her favorites to you, but here are some of my most basic and easy tricks for getting through the winter:  (NOTE:  you should ALWAYS discuss any supplements, herbs, or medications with your doctor before taking them.)

Photo by thedabblist; Flickr; no amendments

• Vitamin D: Your doctor can personalize your dose, but the American Academy of Pediatrics and the Institute of Medicine both recommend 600 iu daily for children over 1 year of age. 
• Fish oil:  Unless you and your kids eat fish high in omega 3s several times a week, taking a supplement is indicated (although there are some people who need to be cautious with omega 3 supplements, or must avoid them completely).  There is no set dosage; discuss with your child's provider.  Be sure to get a good quality product that tests for impurities.
• Probiotics:  Not just for the gut, these little guys are great at supporting the immune system.  As with fish oil, discuss dosing with your doctor as there is no set dosage, and be sure you get a good quality product so you know it will work.
• Bone broth:  extremely rich in nutrients, including those that kick start the immune system.  If you are new to bone broth, Nourished Kitchen has a great introduction and good recipes.
• Elderberry syrup:  Anti-viral, immune supportive, and great tasting, this is one I give myself and my kid every morning during the cold months.  Again, dosing varies widely, so discuss with your child's provider.
• Get enough rest: The immune system works best when we are well rested.  Be sure your child is getting plenty of sleep.
• Decrease sugar: this includes juice.  Studies have shown that sugar, including juice, dampens the immune response for hours after exposure.

Photo by Lindsey Turner; Flickr; no amendments

• Stay home.  As always, taking your sick child out not only spreads the illness to other people, but it makes recovery for him more difficult.  When we are sick, we should be home resting, not running errands, going to school or play dates.

A note on immune compromised children:  be especially sure that you have had a recent visit with your child's provider.  There may be extra steps you can take to protect your child, including certain vaccines not recommended for the general public.

While these tips may not keep your child from ever getting sick, they should lessen the frequency and the severity of illness.  As Benjamin Franklin said, "an ounce of prevention is worth a pound of cure."

Resources:
CDC 
WebMD
Your local Health Department 

I have no affiliations to disclose.  Please note that this blog does not constitute medical advice; even specific supplement recommendations should be cleared by your child's provider.  Always be sure that you address any questions or concerns directly to your child's provider.

UPDATE OCTOBER 3:
Unfortunately, Enterovirus D68 has taken a turn for the uglier.  It has been associated with paralysis in rare cases.  We do not yet know whether this paralysis is temporary or permanent.   We also are not certain that it is Enterovirus D68 causing the paralysis; it is possible that the people with Enterovirus D68 and paralysis have a co-infection with some other paralysis causing virus.

Furthermore, the CDC is currently investigating four deaths potentially associated with Enterovirus D68.  One of the deaths was not caused by Enterovirus D68, but rather by sepsis caused by the bacteria Staphylococcus aureus.  The girl did test positive for Enterovirus D68, but it is not entirely clear what role the virus played in her death.  The other three deaths occurred in patients who tested positive for the virus, but it is not clear yet what role the virus played in their deaths.

More resources:
Medscape "Paralysis in Children with Enterovirus D68"
Medscape "CDC Investigating Four Deaths Linked to Enterovirus D68"
CNN

UPDATE OCTOBER 6:
Sadly, there has now been one confirmed death attributed to Enterovirus D68.  A four year old in New Jersey stayed home from school with pink eye, went to bed with no other symptoms, and did not wake up the next day.  Officials have confirmed the cause of death to be Enterovirus D68.  As you all know, I am the parent of a toddler; obviously I find this news terrifying.  However, what we have to do at this point is two things:  remember our immune support protocol, and remember that viruses like the flu actually claim many more lives every year.  I don't mean to make us all terrified of the flu, but just to put Enterovirus D68 into perspective.  So let's take our supplements, wash hands, and go out and enjoy each day as it comes.

More resources: 
CNN 
CBS 
 

Don't Drink the Water?

Water.  Such a basic need that a lot of us take for granted.  In this country, we are so lucky to have (mostly) clean, safe water at our fingertips.   In Seattle, we are even luckier in that we have some of the best water in the country.

Water contamination does occur, but according to the EPA:  "actual events of drinking water contamination are rare, and typically do not occur at levels likely to pose health concerns."  But, what are the potential issues with water quality in this country?

Microbial Contaminants

• Bacteria, viruses, and parasites can all find their way into our water.
• In general, these contaminants cause diarrhea and vomiting.
• Shallow wells are most vulnerable to this type of contamination, particularly after flooding.

Chemical Contaminants

• Lead:  can get into your water from chipped lead paint or other contamination of source water (rare) or, more likely, comes from your own pipes.  Old homes are more likely to have leaded pipes, but new homes may have them too.  According to the EPA, certified "lead free" pipes may still contain lead that leaches into your water.  Find more information here.
• Arsenic:  occurs naturally in the earth, or can come from industrial / agricultural waste.  Find more information here.
• Other heavy metals:  cadmium, selenium, and chromium can all leach into water from the earth.
• Fluoride:  occurs naturally in the earth, and can leach into the water at amounts that are high enough to discolor teeth.  (Yes, I have an upcoming post exploring fluoride in more detail.)
• Nitrate: gets into the water via fertilizer.  High levels of nitrates can cause "Blue Baby Syndrome," which can be fatal.  It usually occurs in already ill babies who are drinking formula made with the water.

Photo by Adapting to Scarcity; Flickr; no amendments

Is It Safe Or Not?  
Annual quality reports should be readily available for your municipal water supply.  If your jurisdiction reports to the EPA, you can access a report here.  Otherwise, try doing an internet search, or call your local jurisdiction.

Well Water Quality
Wells have a special set of potential problems, and are not regulated by the EPA regulations that protect drinking water.   Here are some highlights of potential well water contamination sources (this list is by no means exhaustive):

• Radon
• Bacteria (from septic tanks)
• Barnyard runoff
• Pesticide and fertilizer residues on re-purposed former farmland

Bottled Water Quality
Why not just go with bottled water to be on the safe side? 

• You may be wasting your money:  bottled water may just be tap water!  This is according to an NRDC study; the same study found that bottled water was no safer or cleaner than tap water.  They found that some brands even contained contaminants above the legal limit allowed in tap water.
• You are exposing yourself to extra chemicals:  plastic bottles contain phthalates and BPA, which may disrupt your body's hormone production, and may cause asthma.  For more information on phthalates and BPA, see WebMD, Medscape, and CNN.
• You are increasing your carbon footprint:  all those bottles have to be made, and then recycled (if not put in a landfill); those processes have a great impact on the environment.  For more information on the environmental impact of bottled water, see this article.

Photo by epSos .de; Flickr; no amendments

What types of water are available in bottles?

• Distilled:  boiled and re-condensed, which removes microbes and minerals and electrolytes.  I don't recommend distilled water, since we need minerals and electrolytes.
• Spring:  collected straight from a natural spring.
• Artesian:  collected from a well that taps an aquifer directly.
• Purified:  could be collected from any source.
• Mineral:  groundwater that naturally contains a specific quantity of minerals.
• PWS:  public water supply

Water Filters
Water filters can be a great option if your tap water is less than ideal.  Consumer Reports has a useful article summarizing water filter options.  Remember to find out exactly what your filter can and cannot filter out!  Also, consider what's touching your water: if your water sits in a plastic reservoir or passes through plastic tubing, then you're getting filtered water at the high cost of BPA and phthalate exposure.

 

Photo by Sidney Brent Goodwin; Flickr; no amendments

Special Populations
Newborns drinking formula, young babies drinking water for the first time, elderly people, and people with immune compromise are all more susceptible to water-born contaminants.  Before giving your baby water, whether it's straight or mixed with formula, consult your child's health care provider for his or her opinion on the best water to use.


Drink Your Water!
I'm always telling patients to drink more water.  Without it we die; without adequate amounts of it, we fall ill or show symptoms such as headache and fatigue.  So, take a quick moment to assess the quality of your water, and then, go forth and drink! 

Resources:
EPA on drinking water
USGS on well water
EPA on well water
EPA on well water testing
NRDC on bottled water

Find more information on the problem of exposure to BPA and phthalates at:
WebMD
Medscape
CNN
WebMD Fetal Exposure to Plastics and Asthma Risk 

This blog does not constitute medical advice.  I have no affiliations to disclose.

Sneaky Chemical Exposures - Sunscreen?

Is your sunscreen poisoning you?  The Environmental Working Group has a fabulous database ranking sunscreens in terms of the safety of their ingredients.  But it can feel a little overwhelming.  So let's break it down.

What's So Toxic About Sunscreen?  (Endocrine Disruption and Allergic Reaction)
Sunscreens block sun using either chemical or mineral (physical) filters.  Unfortunately, any of these filters can pose a risk to human health; fortunately, the mineral filters seem to pose much less of a concern. 

Several of the chemical filters are "endocrine disrupters," meaning they disrupt normal hormone function in the body, and several pose a high risk for allergic reaction.  The concerns with the mineral filters (zinc oxide and titanium dioxide) are limited, for now, to inhalation concerns (which is why spray sunscreens are not recommended, even if they are "safe" and "natural;" see below).  For more detailed information, refer to this chart put together by the EWG.

Photo by Robert S. Donovan; downloaded from Flickr without amendment

What's an Endocrine Disrupter?
This is an umbrella term for anything that throws off the normal hormone balance and functioning of the body.  The list of symptoms and disorders that can result from hormone dysregulation is vast.  Specifically, the sunscreen chemicals researched by the EWG were found:

• To disrupt sperm production (animal studies);
• To be associated (meaning not proven to cause) with endometriosis in women;
• To mimic estrogen in the body (not just a problem for men);
• To disrupt thyroid and reproductive system functioning (animal studies); and finally,
• To cause behavioral problems (animal studies).

Mineral Sunscreen to the Rescue?
Not necessarily.  While mineral filters do have a better safety profile, you still have to be aware of the other ingredients in the sunscreen: certain ingredient combinations can cause a problem, and many "inactive" ingredients are less than ideal.  In fact, a whole host of problems can be associated with inactive ingredients.  The EWG database addresses the safety of inactive as well as active ingredients.  The EWG asserts that we need increased (FDA) regulation of these mineral sunscreens, and more research, before we can be sure that we are using the safest and most effective products.  But for now, it states that mineral sunscreens are nevertheless the safer option.  For more information on mineral sunscreen safety, read this article.

Sprays
Bottom line: don't use them.   The FDA, Consumer Reports, and the EWG all have concerns regarding the safety of allowing kids to inhale the ingredients in these sunscreens, no matter how "safe" or "natural" they may be.  Why?  In a nutshell, these chemicals have been studied for safety as applied on the skin; they have not been adequately studied for exposure via inhalation, a much more direct exposure than skin absorption.  Some studies have shown them to be dangerous when inhaled.

Photo by Trish Hartmann; downloaded from Flickr without amendment

Usability
Parents talk about how well their favorite sunscreen rubs in to the skin, and I'm sure some do better than others.  However, of the 4 that I have personally tried, none of them rub in any better than the other.  We look like ghosts for at least 10 minutes after applying.  So don't expect much - in my experience if it's a truly safe, natural product, it's not going to rub in well; it's going to absorb in slowly over time.  Take it as a reminder to apply well before going outside, which is what we should be doing for maximum efficacy anyway.

So How Do I Choose the Right Product?
The information available to us as sunscreen consumers is both vast and overwhelming, and frustratingly lacking.  I rely heavily on the research done by EWG in choosing sunscreens for my family.  I basically familiarize myself with their top rated products, and then make a final choice based on cost, availability, and what I do know of the ingredients.  They have not let me down yet.
 
What If I Use a Poorly Rated Sunscreen?
Don't get me wrong.  I believe that, in a pinch, any sunscreen is better than no sunscreen.  Skin cancer rates (melanoma) are on the rise.  Sun exposure does appear to increase risk for melanoma.  So if your choice that day is avoid the beach, get a sunburn, or wear a poorly rated sunscreen, then wear the poorly rated sunscreen.  But for the sunscreen that you will apply to your child, or yourself, day in and day out, I think it pays to find the safest one you can.

Photo by Alex Liivet; downloaded from Flickr without amendment

The Best Protection

Sunscreen is not the only factor in the sun safety equation.  Other important sun safety tips include:

• Avoid it:  Avoid sun exposure between the hours of about 10 and 3.
• Shade it:  Wear a broad brimmed hat that shades the face, ears, and neck.  They make great ones for kids that tie around the chin, contain SPF, and can be worn in the water.
• Wear it:  Wear protective clothing - long sleeve shirts and light pants are your best bet when possible.  There are long sleeve "rash guards" for kids that can be worn in the water and contain SPF.
• Protect the eyes:  Wear UV blocking sunglasses.
• Do it right:  Sunscreen should be "broad spectrum" meaning it blocks UVA and UVB rays.  It should be applied at least 15 minutes before going outside.  It should be reapplied frequently, as per package directions.  
• Don't tan:  All the evidence points to tanning beds being dangerous; don't use them, and don't allow your kids to use them.

Note:  The long held belief that using sunscreen decreases your risk for melanoma has become slightly controversial of late.  The controversy is outside the realm of this post, and I believe that protecting your child from prolonged sun exposure, and using sunscreen that blocks both UVA and UVB rays, is one of the best ways to keep her safe from melanoma.  

I have no affiliations or financial interests to disclose.  This post does not constitute medical advice.

First Food Choices - To Rice Cereal, or Not?

RICE CEREAL
Everyone asks about it.  Some doctors still recommend it.  A lot don't. So what's so special about rice?

Iron Supplementation
When babies hit about 6 months of age, they start absorbing less iron from breast milk.  This happens about the same time that iron stores from birth drop.  This will be a problem for some babies, but not all.  There are symptoms of iron deficiency anemia, but most babies with low iron will show no symptoms at all.  So there's no way to know if your baby needs extra iron-rich foods or iron supplementation.  The idea behind rice cereal was to address this issue by supplementing every baby; add iron to rice, which is a food that most babies will not react to, and give it to every baby as a first food. 

Photo credit Melissa Doroquez; downloaded from Flickr without amendment

The Problem
When you add iron, a constipating nutrient, to rice, a constipating food, you get a lot of constipated babies.  Furthermore, white rice turns to sugar quite quickly in the body.  Feeding babies rice cereal may be associated with problems such as diabetes and obesity in later life.   Note that this is certainly not a proven fact, and it is a hot and controversial topic right now.  One of the most noted rice cereal opponents is Alan Greene, MD.  You can read his piece on rice here.

Most importantly, there is arsenic in rice.  Brown rice used to be a good alternative to white rice, including for babies: it does not turn quickly to sugar in the body and has health benefits that white rice lacks.  However, there is more arsenic in brown rice than in white.  The FDA, Consumer Reports, and The American Academy of Pediatrics (AAP) all advise parents to provide a variety of grains to children, rather than just rice.  The AAP goes on to advise that it is best to provide children with a varied diet in general, and that vegetables, meat, and other grain cereals are all reasonable alternatives to rice cereal as a first food for baby.

The Solution
I do not recommend rice cereal, or any cereal as a first food.  I think cereals are a fine and necessary food for children, but they are not super foods like yams, spinach, blueberries, and salmon are.  Eventually you will introduce your child to grains; I just don't think there's any rush.  I recommend starting grains once you've established a good variety of vegetables, meat, and fruits.  At that point, whole grains can be a tasty, nutritious, and filling supplement to your child's diet.  Once you do introduce grains, limit rice, both white and brown, until the arsenic issue is resolved. 

Photo credit @rsseattle; downloaded from Flickr without amendment

Finally, let me be clear: some babies do need extra iron.  Some may even need supplementation.  This is something you really should discuss with your child's provider.  BUT, there are iron-rich foods that are not rice cereal.  Meat, broccoli, and dark leafy greens are all high in iron and great choices for first foods.   Note, however, that meat may also cause constipation in your little one.

OTHER FIRST FOODS
I typically recommend yams / sweet potatoes (these are always mislabeled in the store - I'm talking about the ones with reddish skin and orange flesh), winter squash, and avocado as first foods.  Yams and winter squash are high in nutrients and lend themselves quite easily to baby food.  Avocado is rich in fats and also lends itself well to baby food. 

Photo credit Katie Tegtmeyer; downloaded from Flickr without amendment

I do think it's a good idea to give vegetables before fruits.   Although there is no scientific proof to the idea of discouraging the sweet tooth by starting with veggies, it certainly doesn't hurt to try.  There's no limit to the veggies and fruits you can offer, but here are some factors to keep in mind:  broccoli, cauliflower, brussels sprouts, and cabbage may cause gas; bananas and apples may cause constipation.

ADVENTUROUS PALATES
There is evidence that baby's preferences for certain foods begin developing in utero, based on exposure via the placenta, and continue through exposure via the breast milk, and on through early food experiences.  For more on this idea, see this article.  In other words, now is the time to expose baby to a wide variety of foods and spices.  Keep this in mind as you are choosing first foods.

Resources
Iron Deficiency Prevention

Sneaky Chemical Exposures - the Nursery

Baby's on the way.  You're busy nesting.  Painting the nursery, buying the crib, the dresser, the glider, the toy chest.  It's an exciting time.  But, the hundreds of decisions that have to be made regarding exactly what to buy can be stressful.  Well, add another stressor:  between flame retardants, formaldehyde-laced particle board, and volatile organic compounds (VOCs) in paint, you have a lot of chemicals to try to block at the door of baby's room.

Paint
VOCs are what gives paint that terrible chemical smell.  The EPA lists the following as side effects of exposure to VOCs:  "eye, nose, and throat irritation; headaches, loss of coordination, nausea; damage to liver, kidney, and central nervous system, as well as cancer.  Granted, the health effects of VOCs vary by specific compound (some compounds are not known to have any side effects) and by length and route of exposure to the compound(s).   Pregnant women and young children may be especially sensitive to VOCs.  You can find more information on VOCs here and here.

Photo by Dave Matos; downloaded from Flickr without amendment

Fortunately, paint has come a long way.  There are now plenty of low- and no-VOC paints on the market.  Taking the VOCs out not only means your house doesn't stink to high heaven while you're painting and for days afterward, but also that you and your family are not sucking in hazardous chemicals all day and night.  These paints vary in price, just as high-VOC paints do, and are not necessarily more expensive.  Quality and performance can vary, just as they do with high-VOC paints.  So you'll want to research these matters.  Also, there doesn't seem to be a lot of oversight to the industry, and it seems some low- or zero- VOC paints do still put out that smell, leaving me to wonder if they are mislabeled.  So you'll need to research that as well.  When you're painting the room baby will spend half of his life in, it's time well spent.

Furniture
Flame retardants and formaldehyde are the big ones to be aware of here.  Exposure to both has been linked to serious health problems. 

Flame Retardants are found in upholstered furniture, mattresses, carpet, and children's items such as car seats, changing pads, infant sleep positioners, nursing pillows and strollers.   

Photo by Joel; downloaded from Flickr without amendment

The following list references those problems that have been directly studied and shown to be linked to flame retardant exposure:

• Thyroid problems in pregnant women
• Depression of learning and memory (rat study)
• Attention span; attention span, cognition, fine motor development, lower IQ
• Advanced puberty
• Neurotoxicity
• Cancer: see this NCBI report and this report from the California EPA; or this study on abnormal pap smears

Formaldehyde is found in composite woods including MDF, plywood, and particle board; paneling; and some insulation.  

The following list references those problems that have been directly studied and shown to be linked to formaldehyde exposure:

• Asthma
• Eye, nose, throat irritation, Bronchitis
• Possible menstrual disorders
• Possible cancer: see this EPA report and this National Cancer Institute report

Other
Unfortunately, a blog on home safety would not be complete without a discussion of lead, radon, and air freshener.

Photo by Steve Snodgrass; downloaded from Flickr without amendment

Lead is found in the paint of old homes (pre 1978).  It can also be found in your soil, if the outside of your home was ever scraped or sanded improperly.  Most landlords tend to gloss over the lead clause of their leases, saying something like, "don't lick the walls."  There are two problems with this attitude.  One is that if you live with kids, they just might lick the walls, and eat the paint chips.  The other is that lead turns to dust easily.  That dust falls to the furniture and floor.  Your children then end up with that dust on their hands and lick them.  Also, everyone breathes in the dust.  Lead is the most problematic where paint is chipping and where doors or windows rub against wood frames causing lead paint to turn to dust.  If you have lead in your soil outside, your children may play in the dirt and thereby ingest it, or you may grow edible plants that may absorb it.  

Lead exposure in children can lead to decreased IQ; neurotoxicity; behavioral problems; anemia; liver and kidney problems; hearing problems; developmental problems; and in extreme cases, even death.  It can cause a multitude of problems in adults as well.  See more from the US EPA.

Radon is found in some homes and causes cancer.  It's quite easy to test for and can be an easy problem to fix.  See more from the US EPA.

According to the National Resources Defense Council (NRDC), air freshener may contain allergens, VOCs, and phthalates.  A study done by UC Berkeley found other harmful chemicals, as well as some which may be benign on their own, but react when sprayed to form such chemicals as formaldehyde.  Phthalates are associated with reproductive and fertility problems, possible insulin problems, possible weight gain and possible cancer.

Photo by Emi Moriya; downloaded from Flickr without amendment

Action
So what can you do to decrease your child's exposure?  

• Buy zero-VOC paint from a reputable source
• Don't buy composite woods
• Buy products known to be free of unnecessary chemicals
• There's not a lot of regulation here, so an "organic" or "natural" label may not mean it's 100% safe
• Buy products from a reputable source, or those that have been studied and proven safe
• Check out Healthy Child for further guidance
• Vacuum frequently with a HEPA filter
• Wash hands frequently, especially before eating
• Damp clean floors and surfaces frequently
• Test your paint, inside and out, for lead
• Test your soil for lead (note that this is controversial, and can lead false negative results) 
• Avoid the use of air fresheners, even those labeled "natural"

For more information:
Healthy Child on Formaldehyde
EWG on Flame Retardants
Surprising Health Hazards in Your Home
Flame Retardants are Everywhere
Hazards in Berkeley Homes
Four Lessons About Formaldehyde
Furniture and Flame Retardants
Radon Resources
NRDC on Air Fresheners
NRDC on Air Fresheners
Science Daily on Air Fresheners

Sneaky Chemical Exposures - The Garden Hose?!

It's a tough world to navigate.  Parents make hundreds of choices a day; all of which can potentially impact their children's health.  No pressure.  Unfortunately, some of the choices we make are ill-informed.  The worst is when you don't even realize you're ill-informed.

The other day, my son was happily filling his pool with the garden hose.  When the obvious next thing happened and he drank from the hose, I was hit by a powerful "ick" factor.  However, when all the other adults found it hilarious, my son did too, and kept it up for the sake of performance.  I wanted to stop him, but I just couldn't bring myself to crush his joy.  Reassuring myself with thoughts of how many people have drunk copious amounts of hose water during endless summers, I allowed him to continue, stifling my gut reaction.

 Photo by Mark Turnauckas; downloaded from Flickr without amendment

The next day, I told the story to my friend.  Feeling it was a stupid question since she was talking to her doctor friend (yours truly) who happens to be quite proactive about chemical exposures, she asked anyway: "your hose is lead free, right?"  Well, I should have known this, but it turns out, many of the garden hoses sold in the United States right now do contain lead, as well as BPA and phthalates.

The good news is that, according to a study by HealthyStuff.org, the number of hoses containing lead  did drop from 2012 to 2013.  However, even in 2013, 14% of the hoses they measured contained greater than 100 parts per million of lead.  When no amount of lead is safe for any living being, particularly a child, this is 14% too many.

And, for someone who assiduously avoids plastic, letting my son drink from a BPA- and phthalate-ridden hose was a major lapse in judgment.

Photo by Marc Lagneau; downloaded from Flickr without amendement

So, how can you save your children from the garden hose?  Buy a lead-free hose that is food grade polyurethane or rubber, "drinking water safe," and outfitted with non-brass fittings, such as nickel, aluminum, or stainless steel (brass may be okay if it is certified lead free).  Also, be sure to store your hose in the shade, and let it run for a few minutes before watering edibles or filling the kiddie pool.

Find more information on garden hose safety at:
HealthyStuff.org
Time Magazine
The Environment Report

Find more information on the problem of lead exposure at:
CDC
Kids Health
Mayo Clinic
Bioscience Technology

Find more information on the problem of exposure to BPA and phthalates at:
WebMD
Medscape
CNN
WebMD Fetal Exposure to Plastics and Asthma Risk 

Summer!

Summer is upon us, even in the Pacific Northwest.  And with it come adventures and great fun.  But let's keep those kids safe, healthy, and intellectually stimulated also.

Keep Them Safe
A little caution goes a long way toward a great, safe summer.

1. Drowning, Dry and Wet:  Drowning typically occurs quietly and with little commotion.  A child can simply slip under the water and not come back.  Also, drowning can occur hours after the initial scare; this is usually referred to as "dry" or "secondary" drowning.  If you notice that your child is coughing, has chest pain or difficulty breathing, is fatigued, or is acting strange, consider secondary drowning and call your doctor, 911, or go to the Emergency Room.  For more information on drowning or secondary drowning, see my post, or this WebMD article.
2. Sunburn:  Sun damage, especially sun burns, in childhood increase the risk for skin cancer later.  Sun damage can be prevented with a few steps.  Use an adequate amount of sunscreen with an SPF of 30 or higher with "broad spectrum" protection (UVB protection as well as UVA), and be sure your sunscreen is not expired.  Apply at least 15 minutes before going outside and reapply frequently (time depends on the product).  Experts recommend staying out of the sun between 10 and 3, and wearing protective clothing and UV blocking sunglasses when you are in the sun.
3. Hydrate:  It's pretty easy to get behind on fluids, especially when you're a kid on the run in the sun.  Be sure your children always have a water bottle them, and figure out a way to make sure they drink from it even when you're not around.  Push fluids first thing in the morning, and whenever you have the opportunity.  We do lose electrolytes through sweat, so be sure to replenish these too.  However, you do not have to use major brand name sports drinks (they are high in sugar, and contain high fructose corn syrup and other ingredients I don't love).  Coconut water, miso soup, vegetable and chicken or beef broth all have great electrolytes.  You can simmer carrot or celery chunks in water for 30 minutes to make your own electrolyte rich vegetable broth.  Finally, there are some natural products on the market that you can buy (effervescent tablets or packets, and liquids); just be sure you read the labels!
4. Concussions:  Obviously this is one to think about all year long.  Anytime a child is on any sort of moving vehicle, whether it's a bike, a balance bike, a scooter, or a skateboard, he needs a helmet, fastened, at all times.  Of course, concussions can happen any time; with a simple fall, or an injury sustained despite the helmet, or while playing sports.  If your child sustains a head injury, even if it seems minor, go see the doctor.  Concussions can be very serious, and education is very important.
5. More summer safety articles can be found on MedicineNet, Baby Center, and Parents. 

Photo by Guillermo Viciano; downloaded from Flickr without amendments

Keep Them Moving
Not everyone gets extra time off over the summer.  This can mean the kids are at home while parents are at work.  It can be challenging to keep the kids stimulated while you're concentrating on work just as much as ever.  As a result, many kids actually gain weight over the summer.  I firmly believe in the importance of keeping kids active and intellectually stimulated (see "Keep Them Learning," below) throughout the summer.  One of the best solutions here is to sign up for summer camps.  Parent Map has a good list of camps; I especially like the "Camps In a Class By Themselves." Seattle Parks and Recreation also offers a wide range of camps, as does the YMCA.  Other solutions are to exercise or play as a family after work and on weekends, to start a "get moving" program in the family, and to limit access to screens and cars or buses.  Fortunately, most day cares and summer camps do include physical activity in their programming, but if the kids are home with a nanny, be sure you set the expectation for physical activity with the nanny.

Keep Them Learning
We know that all kids who do not participate in educational activities over the summer experience the "Summer Slide;" they lose math and reading skills, and perform more poorly on standardized tests at the end of the summer.  Kids from lower socioeconomic brackets experience even more of a slide than those from the upper brackets (another volunteer opportunity).  So be sure you continue your daily routine of reading with your kids every day throughout the summer.  And find some time to add in museums, summer camps (see links in "Keep Them Moving," above), and visits to the library.  (The Seattle Public Library has great summer reading and education programs). 
 

Photo credit Pratham Books; downloaded from Flickr without amendements

Keep Them Eating
Unfortunately, summer is a time of hunger for countless children. Some of the free meal programs are not available over the summer. If your family is more fortunate, you can benefit greatly by volunteering. Volunteering brings family together, strengthens family bonds, and exposes kids to other socioeconomic groups, along with empowering them to instigate change. So, why not find a place to volunteer this summer? Make it part of your weekly routine. Here's a great Seattle's Child article with more information including volunteer opportunities, and how to access summer eating programs for your own family.

Happy summer!  Be safe, and have fun!

I have no affiliations to disclose.  This post does not constitute medical advice.  If you have medical questions or concerns, call your doctor or 911.