hold head steady when uprightJust when you thought things couldn’t get any better (and baby couldn’t get any cuter and more endearing), they do. During the fifth month, your baby continues being endlessly entertaining company—picking up new tricks almost daily, never seeming to tire of social interaction with his or her most favorite companions (you!). And with a (relatively) longer attention span, the interaction’s a lot more dynamic than it was even a couple of weeks ago. Watching that little personality unfold is fascinating, as is baby’s growing captivation with the world around him or her. Baby’s doing more than looking at that world now—he or she is touching it, too, exploring everything that’s within reach with those hands, and everything that can fit (and many things that can’t), with that mouth.
All babies reach milestones on their own developmental time line. If your baby seems not to have reached one or more of these milestones, rest assured, he or she probably will very soon. Your baby’s rate of development is normal for your baby. Keep in mind, too, that skills babies perform from the tummy position can be mastered only if there’s an opportunity to practice. So make sure your baby spends supervised playtime on his or her belly. If you have concerns about your baby’s development (because you’ve noticed a missed milestone or what you think might be a developmental delay), don’t hesitate to check it out with the doctor at the next well-baby visit—even if he or she doesn’t bring it up. Parents often notice nuances in a baby’s development that doctors don’t. Premature infants generally reach milestones later than others of the same birth age, often achieving them closer to their adjusted age (the age they would be if they had been born at term), and sometimes later.
By five months, your baby … should be able to:
hold head steady when upright
on stomach, raise chest, supported by arms
By the month’s end, a few babies will be able to manage unassisted sitting when propped up by their hands, but most will still tumble forward from this position.
pay attention to an object as small as a raisin (but keep such objects out of baby’s reach)
squeal in delight
reach for an object
smile spontaneously
smile back when you smile
grasp a rattle held to backs or tips of fingers
keep head level with body when pulled to sitting
… will probably be able to:
roll over (one way)1
bear some weight on legs
say “ah-goo” or similar vowel-consonant combinations
razz (make a wet razzing sound)
turn in the direction of a voice
… may possibly be able to:
sit without support
… may even be able to:
pull up to standing position from sitting
stand holding on to someone or something
object if you try to take a toy away
work to get to a toy out of reach
pass a cube or other object from one hand to the other
look for dropped object
rake with fingers a tiny object and pick it up in fist (keep all dangerous objects out of baby’s reach)
babble, combining vowels and consonants such as ga-ga-ga, ba-ba-ba, ma-ma-ma, da-da-da
Most doctors do not schedule regular well-baby checkups this month. On the bright side, that means no shots for another month; on the downside, you won’t be able to see how far baby’s growth shot up on the charts. Keep your list of questions for next month, but don’t hesitate to call the doctor in between visits if there are any concerns that can’t wait until then.
It’s the moment you’ve been waiting for. As daddy stands by with the video camera, ready to capture the momentous event, baby is decked out in a freshly laundered bib, propped up and secured in that spanking new high chair. As the camera rolls, baby’s first bite of solid food—heaped on the engraved sterling silver spoon from Great-Aunt Alice—is lifted from the bowl to baby’s mouth. Baby’s mouth opens, then, as the food makes its bizarre first impression on inexperienced tastebuds, screws itself into a knot of displeasure, and spews the alien offering onto chin, bib, and high chair tray. Cut!
The challenge to get your child to eat (or at least eat what you’d like him or her to eat), a challenge that’s likely to continue as long as you share the same dining table, has begun. But it’s more than a matter of promoting good nutrition; it’s one of instilling healthy attitudes toward meals and snacks. As important as ensuring that the food that goes into your baby’s mouth is wholesome is ensuring that the atmosphere in which the food is eaten is pleasant and noncombative.
GOOD EARLY FOODS TO OFFER BABY
Before the gastronomic world can be a baby’s oyster (or filet or lasagna), the land of bland must be conquered. Which means baby must take baby steps at the table—steps that are listed below in the order they’re generally suggested (though the times for introduction might be later in a baby with a history or a family history of allergy). The foods, which can be prepared at home or purchased ready to use, should at first be very smooth in texture—strained, pureed, or finely mashed, and thinned with liquid if necessary to the consistency of thick cream. The texture should continue to be smooth until the sixth or seventh month, becoming progressively thicker as baby becomes a more experienced eater. Babies usually take less than half a teaspoon at first, but many work up to two to three tablespoons, sometimes more, in a surprisingly short time. Food can be served cold or at room temperature (which most babies prefer) or slightly warmed, though heating is usually done more for the adult’s taste than the baby’s—and is largely an unnecessary hassle.
In the first few months of solid feedings (which should begin when baby’s ready, somewhere between the ages of four and six months), the actual quantity of food consumed is not of great significance as long as breast or bottle feeding is continued. Eating at first is less a matter of gaining sustenance than of gaining experience—with eating techniques, with different flavors and varying textures, with the social aspects of dining.
Bringing out the video equipment isn’t the only preparatory step you’ll have to take to ensure a memorable first eating experience. You’ll also want to pay attention to the timing, setting, and props to make the most of this feeding—and future ones.
Time it right. If you’re breastfeeding, the show should go on when your milk supply is at its lowest (in most women this is late in the afternoon or early in the evening). If, on the other hand, your baby seems hungriest in the morning, you might offer solids then. Don’t worry if the menu is cereal and the serving time is 6 P.M.; baby will hardly be expecting steak. Start with one meal per day, then move up to a morning and evening meal for the next month or so.
Humor your headliner. You’ve slotted a 5 P.M. performance only to find that the star is cranky and overtired. Postpone the show. You can’t introduce your baby to anything new, food included, when he or she is out of sorts. Schedule meals for times when your baby is alert and happy.
Don’t open to a full tummy. Whet baby’s appetite before offering the solids, but don’t drown it. Start off with an appetizer of a small amount of formula or breast milk. That way, your baby won’t be too ravenous to put up with the new experience, and won’t be so satiated that the next course will have no appeal. Of course, babies with small appetites may do better starting solids hungry; you’ll have to see which works best for yours.
Be ready for a long production. Don’t try to schedule baby’s meals in five-minute segments between other chores. Baby feeding is a time-consuming process, so be sure to leave plenty of time for it.
Set the stage. Holding a squirming baby on your lap while trying to deposit an unfamiliar substance into an unreceptive mouth is a perfect script for disaster. Set up a sturdy high chair or feeding seat (see page 332) several days before the first feeding experience and allow your baby to become comfortable in it. If your baby slides around or slumps, pad it with a small blanket, quilt, or some towels, or if the seat allows, put it in a semireclining position. Fasten the restraining straps for baby’s safety and your peace of mind. If your baby can’t sit up at all in such a chair or seat, it’s probably a good idea to postpone solids for a bit longer.
Also be sure you have the right kind of spoon. It doesn’t have to be a family heirloom, but it should have a small bowl (perhaps a demitasse or iced-tea spoon) and, possibly, a plastic coating, which is easier on baby’s gums. Giving baby a spoon of his or her own to hold and attempt to maneuver discourages a tug-of-war over each spoonful, and also gives your budding individualist a sense of independence. A long handle is good for your feeding baby, but choose a short one with a curved handle for baby’s use to avoid unintended pokes in the eye. If your young gourmand insists on “helping” you with your feeding spoon, let a little hand hold on to the spoon as you firmly guide it to the target—most of the time you’ll get there.
Finally, use a big, easy-to-clean, easy-to-remove, comfortable bib. Depending on your preference, it can be made from firm or soft plastic that can be wiped or rinsed off, cloth or plastic that can be tossed into the wash, or a paper disposable. You may not be concerned about your baby getting cereal stains on almost-outgrown sleepers now, but if the bib habit isn’t instilled early, it is often difficult (if not impossible) to instill later. And don’t forget to roll up long sleeves. An at-home alternative to the bib (room temperature permitting) is to let baby eat topless, in a diaper only. You’ll still have to do some wiping off (of baby’s face, neck, tummy, arms, legs), but stains won’t be a problem.
Play a supporting role. If you give your baby a chance to run the show, your chances of succeeding at feeding are much improved. Before even attempting to bring spoon to mouth, put a dab of the food on the table or high chair tray and give baby a chance to examine it, squish it, mash it, rub it, maybe even taste it. That way, when you do approach with the spoon, what you’re offering won’t be totally foreign. Though offering new food in a bottle (with a large-holed nipple) might seem like a good way to give baby a chance to self-feed, it’s not recommended. First, it reinforces the bottle habit and doesn’t teach a baby how to eat grownup-style, which after all is what early feedings are all about. And, second, because babies tend to eat too much this way, it can lead to excessive weight gain.
Start with coming attractions. The first several meals won’t be real meals at all, but simply the prelude for those to come. Start with a quarter to a full teaspoon of the selected food. Slip just the tiniest bit of it between baby’s lips and allow some time for baby to react. If the flavor finds favor, the mouth will probably open wider for the next bite, which you can place farther back (but not so far back that baby gags) for easier swallowing. Even if baby seems receptive, the first few tries may come sliding right back out of his or her mouth; in fact, the first few meals may seem like total flops. But a baby who is ready for solids will quickly start taking in more than he or she is spitting out. If the food continues to slide out, baby is probably not developmentally prepared for the big time yet. You can continue wasting time, effort, food, and laundry at this fruitless pursuit—or wait a week or two, then try again.
Know when to end the show. Never continue a meal when your baby has lost interest. The signals will be clear, though they may vary from baby to baby and meal to meal: fussiness, a head turned away, a mouth clamped shut, food spit out, or food thrown around.
If your baby rejects a previously enjoyed food, taste it to be sure it hasn’t gone bad. Of course, there may be another reason for the rejection. Maybe your baby’s tastes have changed (babies and young children are very fickle about food); maybe he or she is out of sorts or just not hungry. Whatever the reason, don’t force the issue or the food. Try another selection, and if that doesn’t go over, bring down the curtain.
Everyone agrees that the perfect first liquid for baby is mother’s milk. But is there a perfect first solid? Though there’s little substantial scientific evidence that points to any single, best first solid food, and many babies seem to do as well on one as on another (assuming it’s appropriate fare for an infant), there is one clear first-food front-runner, and a couple of runners-up, listed below. Ask your baby’s pediatrician for a recommendation. Keep in mind that you won’t be able to accurately assess baby’s reaction to first-time foods by his or her expression—most babies will initially screw up their mouths with shock no matter how pleased they are with the offering, particularly if the taste is tart. Instead go by whether baby opens up for an encore.
These foods will have to stay off baby’s menu for at least the first year:
Nuts and peanuts (see box, page 491)
Chocolate
Egg whites
Honey (see box, page 318)
Cow’s milk
Some doctors okay these foods during the last few months of the first year; others recommend holding off on them until baby’s birthday, especially if there’s a family history of allergy:
Wheat
Citrus fruits and citrus juice
Tomatoes
Strawberries
Rice cereal. Because it is easily thinned to a texture not much thicker than milk, is very easily digested by most infants, is not likely to trigger an allergic reaction, and provides needed iron, iron-enriched baby rice cereal is probably the most commonly recommended first food and the number-one first-food choice of the American Academy of Pediatrics. Mix it with formula, breast milk, or water. Resist the temptation to stir in mashed bananas, applesauce, or fruit juices, or to buy prepared cereal with fruit (even down the road, after you’ve introduced these fruits), or your baby will quickly come to accept only sweet foods, rejecting all else.
Fruit. Many babies are started off on finely mashed or strained banana (thinned with a bit of formula or breast milk if necessary) or applesauce. True, most take to these foods eagerly, but they also then tend to refuse less sweet foods, such as vegetables and unsweetened cereals, when they are offered later. Therefore, while some fruits make good early foods, they aren’t necessarily the best first foods.
Vegetables. Vegetables are, in theory, a good first food—nutritious and not sweet. But their strong, distinctive flavors make them less appealing to many babies than cereal or fruit, so they may not create a positive attitude toward the gastronomic experience. It’s smart, however, to introduce them before fruit, while baby’s palate is more receptive to less-sweet tastes. The “yellows,” such as sweet potatoes and carrots, are usually more palatable (as well as more nutritious) than such “greens” as peas or green beans. Again, good to introduce early, but probably not first.
Even if your baby devours her very first serving of breakfast cereal, don’t plan on presenting her with a lunch of yogurt and string beans and a dinner of strained meats and sweet potatoes. Each new food you introduce to your baby, from the first one on, should be offered alone (or with foods that have already passed muster) so that if there’s a sensitivity or allergy to it, you will recognize it. If you’re starting with cereal, for example, give it exclusively, at least for the next three or four days (some doctors recommend five days). If your baby has no adverse reactions to it (excessive bloating or gassiness; diarrhea or mucus in the stool; vomiting; a rough rash on the face, particularly around the mouth or around the anus; a runny nose and/or watery eyes or wheezing that doesn’t seem to be associated with a cold; unusual night wakefulness or daytime crankiness), you can assume he or she tolerates the food well.
If you spot what you think is a reaction, wait a week or so and try the food again. The same reaction two or three times is a good indication that your baby has a sensitivity to the food. Wait several months before introducing it again, and in the meantime try the same procedure with a different new food. If your baby seems to have a reaction to several foods or if there is a history of allergy in your family, wait a full week between new foods. If every food you try appears to cause a problem, talk to the baby’s doctor about waiting a few months before reintroducing solids.
Introduce each new food in the same cautious manner, keeping a record of the food, the approximate amounts taken, and any reactions (memory can fail). Be sure to begin with single foods—just strained carrots or strained peas, for example. Baby food companies make special single-food beginner lines for this purpose (which also come in small jars to avoid waste). Once a baby has taken both peas and carrots without a hitch, it’s fine to serve them up as a combo. Later, as baby’s repertoire expands, a new food that isn’t packaged solo can be introduced in a medley along with already accepted vegetables.
Some foods, because they are more allergenic than others, are best introduced later. Wheat, for example, is usually added to the infant diet after rice, oats, and barley have been well accepted. Occasionally, this happens as late as the eighth month, although the okay is usually given earlier for babies with no signs and no family history of food allergy. Citrus juices and fruits are introduced after other fruits and juices, seafood after meat and poultry. Egg yolks (scrambled, or hard-cooked and mashed) aren’t usually given until at least the eighth month; the whites, which are much more likely to provoke an allergic reaction, are often not given until near the end of the year. Chocolate, nuts, and peanuts have a high allergenic potential and also shouldn’t be given in the first year (and in some cases much later; see page 491 for the complete low-down on nuts and peanuts).
Right now your baby is only dabbling in solids; most nutritional requirements are still being filled with breast milk or formula. But from the sixth month on, breast milk or formula alone won’t be enough to meet all your baby’s needs, and by the end of the year, most of baby’s nutrition will come from other sources. So it’s not too early to start thinking in terms of good nutrition when planning your baby’s meals now, using a simplified Baby Daily Dozen (see opposite page) once your baby begins taking a variety of foods—usually at about eight or nine months. Don’t bother worrying about serving sizes or number of servings yet (see box, opposite). Instead, focus on making meals fun and nutritious—the best way to help ensure a healthy diet now and healthy eating habits later. (You’ll find recipes for the beginning eater starting on page 748.)
You may have noticed that when it comes to the Baby Daily Dozen, there aren’t any suggested serving sizes—or any recommended number of daily servings. That’s because the Baby Daily Dozen is offered only as a general guide to the type of foods your brand-new eater should be sampling, not as a dietary bible for parents to stick to strictly. In fact, trying to keep a running tab—or to cram a certain number of servings of each food group into your baby every day—is a sure way to drive yourself crazy (not to mention to set the stage for food squabbles in the high chair and, later, at the table). Babies are all over the appetite map at this stage of the game, when eating is still more for practice and pleasure than for filling nutritional requirements. Some babies eat a lot all the time, some eat very little most of the time, others eat like a mouse one day and a horse the next. Some are varied and adventurous eaters, others are particularly picky. But presented with wholesome foods and allowed to follow their appetite, almost all healthy babies eat as much as they need to grow and thrive. No pushing, no measuring, no counting necessary.
So your baby ate his or her way through a bread box of Whole Grains today, but completely snubbed the Protein? Had a bellyful of Calcium, but balked at the Green and Yellow Fruits and Vegetables? No problem. Just keep offering baby a wide variety of foods each day (as they’re introduced), and let his or her appetite determine how much or how little of each is actually eaten.
Calories. You don’t need to count your baby’s calories to tell if he or she is getting enough—or too many. Is he or she un-pleasingly plump? Too many calories are the likely reason. Very thin or growing too slowly? Then caloric intake is probably insufficient. Right now most of the calories that keep baby thriving come from breast milk or formula; gradually more and more of them will come from solid foods.
Protein. Baby’s still getting most of the protein he or she needs from breastmilk or formula. But since that picture will change once those first birthday candles are blown out, now’s a good time for baby to start sampling other protein foods. As they’re introduced, these can include egg yolk, meat, chicken and tofu. Calcium foods (see below) can double as excellent protein sources.
Calcium foods. Again, baby’s getting the lion cub’s share of calcium from breast or bottle (about two cups fills those needs until the first birthday, but many babies drink far more than that—and that’s fine). But baby-friendly calcium foods, such as hard cheese (Swiss, natural Cheddar, Edam are good choices) and plain whole milk yogurt, are yummy, nutritious additions once they’re introduced.
Whole grains and other concentrated complex carbohydrates. These high-chair favorites will add essential vitamins and minerals, as well as some protein, to baby’s daily intake. Good options, as they’re introduced, include baby cereal, whole-grain bread, whole-grain cereals (particularly those baby can self-feed, such as oat circles), cooked whole-grain cereal, pasta (bite-sized are always a big hit), pureed cooked lentils, beans, peas, or edamame (soybeans).
NO HONEY FOR YOUR LITTLE HONEY
Honey not only offers little more than empty calories, it also poses a health risk in the first year. It may contain the spores of Clostridium botulinum, which in this form is harmless to adults but can cause botulism (with constipation, weakened sucking, poor appetite, and lethargy) in babies. This serious though rarely fatal illness can lead to pneumonia and dehydration. Some doctors okay honey at eight months; most recommend waiting till year’s end.
Green leafy and yellow vegetables and yellow fruit. There are dozens of delicious vitamin A–rich fruits and vegetables under the green and yellow rainbow—experiment (as the doctor okays them) to see which ones your baby likes. Choose from winter squash, sweet potatoes, carrots, yellow peaches, apricots, cantaloupe, mango, broccoli, and kale (all pureed at first, chunky later). As baby moves on to finger foods, ripe fruits can be served in cubes.
Vitamin C foods. Most doctors don’t okay citrus, that vitamin C standard, until the eighth month at least; in some cases, the OJ may have to wait until after the first birthday. In the meantime, baby can take his or her C in mango or cantaloupe, broccoli, cauliflower, and sweet potato. Keep in mind, too, that many baby foods and juices are enriched with vitamin C.
Other fruits and vegetables. Still room in that cute little tummy? Fill’er up with any of the following: unsweetened applesauce, mashed banana, pureed peas or green beans, mashed potatoes.
High-fat foods. Babies who take most of their calories in the form of breast milk or formula get all the fat and cholesterol they need. But as the switch to a more varied diet takes place and a baby spends less time at bottle or breast, it’s important to make sure that fat and cholesterol intake doesn’t dip too low. That’s why most dairy products (cottage cheese, yogurt, hard cheese) you serve baby should be full-fat or made from whole milk. Unhealthy fats (those found in fried and many processed foods) are another story, however. Loading baby up with too many of those fats can lead to an unbalanced diet, unneeded pounds, and tummy troubles (since they’re hard to digest). It can also set up unhealthy eating habits that’ll be hard to break later on.
Iron foods. Bottle-fed babies get their full share of iron from fortified formula; after six months, breastfed babies need another source. Fortified baby cereal can fill the bill easily; additional iron can come from such iron-rich foods as meat, egg yolks, wheat germ, whole-grain breads and cereals, and cooked dried peas and other legumes, as they are introduced into the diet. Serving up iron-rich foods with a vitamin C food (a little cantaloupe alongside the rice cereal, for instance) increases absorption of this important mineral.
Salty foods. Pass on the salt shaker when you’re preparing baby’s food. Since their kidneys can’t handle large amounts of sodium (and because acquiring a taste for salty foods in the high chair can lead to unhealthy eating habits later on), babies shouldn’t have added salt in their diet. Most foods contain some sodium naturally (particularly dairy foods and many vegetables), so baby can’t possibly come up short.
Fluids. During the first five to six months of life, virtually all of a baby’s fluids come from bottle or breast. Now small amounts will start to come from other sources, such as juices, and fruits and vegetables. As the quantity of formula or breast milk taken begins to decrease, it’s important to be sure that the total fluid intake doesn’t. In hot weather it should increase, so offer water and fruit juices diluted with water when temperatures soar.
Vitamin supplement. Vitamin/mineral supplements are generally not needed for healthy infants (though there are exceptions; breastfed babies, for instance, need a vitamin D supplement). But if your doctor recommends it, or if you’ll feel better giving it (as a little extra vitamin/mineral insurance), give only vitamin/mineral drops especially formulated for infants. These drops should contain no more than the recommended daily allowance of vitamins and minerals for babies. Don’t give any other supplements without the doctor’s approval. See page 173 for more.
Use empty baby food jars, thoroughly washed in a dishwasher or by hand with detergent in very hot water, for heating and/or serving small portions of baby foods. Heat by placing the open jar in a small amount of hot water rather than in the microwave oven (it may heat foods unevenly). Even if you’re in a hurry (when won’t you be?), always test heated food to make sure it isn’t too hot for baby’s tender mouth.
“How can I tell if my baby’s teething? She’s biting on her hands a lot, but I don’t see anything on her gums.”
When the teething fairy visits, there’s no telling how extended or how unpleasant her stay will be. For one child it may be a long, drawn-out, painful affair. For another it may seem to pass with a single wave of the wand in the middle of a restful night. Sometimes a lump or a ridge seems visible in the gum for weeks or months; sometimes there seems to be no visible clue at all until the tooth itself appears.
On average the first tooth arrives sometime during the seventh month, although it can rear its pearly white head as early as three months, as late as twelve, or, in rare instances, even earlier or later. Tooth eruption often follows hereditary patterns, so if either parent teethed early or late, their baby may do likewise. Symptoms of teething, however, often precede the tooth itself by as much as two or three months. These symptoms vary from child to child, and opinions as to exactly what these symptoms are and how painful teething actually is vary from physician to physician. A teething baby may experience any or all of the following:
Drooling. For a lot of babies, starting at anywhere from about ten weeks to three or four months of age, the faucet’s on. Teething stimulates drooling, more in some babies than in others.
Chin or face rash. In a prolific drooler, it’s not unusual for a dry skin rash or chapping to develop on the chin and around the mouth because of irritation from constant contact with saliva. To help prevent this, gently pat away the drool periodically during the daytime. Should a patch of dry skin appear, keep it well lubricated with a mild skin cream (ask the doctor for a recommendation).
A little cough. The excess saliva can cause baby to gag or cough occasionally. This is nothing to worry about, as long as your baby seems otherwise free of cold, flu, or allergy symptoms. Often babies will continue the cough as an attention getter or because they find it an interesting addition to their vocalization repertoires.
Biting. In this case, taking a nip is not a sign of hostility. A teething baby will gum down on anything she can get her mouth on—from her own tiny hand, to the breast that feeds her, to a perfect stranger’s unsuspecting thumb. The counterpressure will help relieve the pressure from under the gums.
Pain. Inflammation is the protective response of the tender gum tissue to the impending tooth, which it considers an intruder to fend off. It causes seemingly unbearable pain in some babies, but almost none in others. Discomfort is often worst with the first teeth (apparently most babies become accustomed to the sensations of teething and learn to live with them) and with the molars (which, because of their greater size, seem to be more painful, but which, fortunately, you won’t have to think about until sometime before or after baby’s first birthday).
Irritability. As inflammation increases and a sharp little tooth rises closer to the surface, threatening to erupt, the ache in baby’s gum may become more constant. Like anyone with chronic pain, she may be cranky, out of sorts, not “herself.” Again, some babies (and their parents) will suffer more than others, with irritability lasting weeks instead of days or hours.
Refusal to feed. A teething baby may appear fickle when it comes to nursing. While she craves the comfort of something in her mouth—and may seem to want to nurse all the time—once she begins to suck, and the suction created increases her discomfort, she may reject the breast or bottle she so passionately desired only moments before. With each repetition of this scenario (and some babies repeat it all day long when they’re teething), she (and mother) become more frustrated and more miserable. A baby who’s started solids may lose interest in them for the time being; this needn’t be a source of concern, since your baby is still getting almost all of her necessary nutrition and needed fluids from nursing or formula, and her appetite will pick up where it left off once the tooth comes through. Of course, if your baby refuses more than a couple of feedings or seems to be taking very little for several days, a call to the doctor is in order.
Diarrhea. Whether this symptom actually has a relationship to teething or not depends on whom you ask. Some parents insist that every time their babies teethe, they have loose bowel movements. Some doctors believe that there appears to be a connection—perhaps because the excess saliva swallowed loosens the stool. Other doctors refuse to acknowledge a link, at least for the record—probably not because they are entirely sure it doesn’t exist, but because they fear that legitimizing the theory could cause parents to overlook possibly significant gastrointestinal symptoms, attributing them to teething. So though it may be that your baby will have looser movements with teething, you should report actual diarrhea that lasts more than two bowel movements to her doctor whenever it occurs.
Low-grade fever. Fever, like diarrhea, is a symptom that doctors are hesitant to link to teething. Experts say that it’s a coincidence that fever sometimes accompanies teething. After all, the first teeth usually come in around six months, the same time that babies lose their immunities from their mothers, making them more susceptible to fevers and infections. Still, some acknowledge that a low-grade fever (under 101°F, rectally) can occasionally accompany teething as a result of inflammation of the gums. To play it safe, treat fever with teething as you would low-grade fever at any other time, calling the doctor if it persists for three days (see page 562 for more about fevers).
This illustrates the most common pattern of tooth eruption. While most babies do sprout their pearly whites by the book, a few seem to teethe to a different drummer—premiering with their top teeth instead of their bottom ones, for instance. Very rarely a tooth (or pair of teeth) never comes in—in which case the doctor will probably refer your baby to a pediatric dentist or to a general dentist who treats a lot of children. If your baby is an early or late teether now, the same is likely to be true with the second set of teeth.
Wakefulness. Babies don’t teethe only during the daylight hours. The discomfort that has her fussing during the day can keep her awake at night. Even the baby who has been sleeping through the night may suddenly begin night waking again. To avoid her lapsing back into old habits (which will continue long after the teething pain is gone), don’t rush in at the first peep. Instead, see if she can settle herself back down quickly. If she can’t, try some comfort that doesn’t involve feeding (some gentle lullabies and patting may do the trick). Night waking, like many other teething problems, is more common with first teeth and with molars.
Gum hematoma. Occasionally, teething initiates some bleeding under the gums, which may appear as a bluish lump. Such hematomas are nothing to worry about, and most doctors recommend allowing them to resolve on their own without medical intervention. Cold compresses may lessen discomfort and speed the resolution of gum hematomas.
Ear pulling; cheek rubbing. Pain in the gums may travel to the ears and cheeks along nerve pathways they share, particularly when the molars begin pushing their way in. That’s why some babies, when they are teething, pull at an ear or rub a cheek or the chin. But keep in mind that babies also tug at their ears when they have ear infections. If you suspect an ear infection (see page 553), teething or no, check with the doctor.
There are probably as many home-tested treatments for teething discomfort as there are grandmothers. Some work, some don’t. Among the best that old wives and new medicine have to offer are:
Something to chew on. This is not for nutritive benefits but for the relief that comes from counterpressure against the gums—which is enhanced when the object being chewed is icy cold and numbing. A frozen wet washcloth works wonders for a teething baby. For a more nutritious chew, try frozen fruit, such as bananas, peaches, or plums in a specially designed baby-feeder mesh bag which ensures that large chunks of food can’t be gummed off and turned into a choking hazard. Or, try a chilled carrot with the thin end sliced off (but don’t use carrots once teeth are actually in and can chip off chokable bits). If you use any food to soothe a teething baby, be sure your baby has it only while in a sitting position and under adult supervision. A bumpy rubber teething ring or other teething toy, even the plastic railing of a crib or play yard will also provide a good chew.
Something to rub against. Many babies appreciate a grownup finger rubbed firmly on the gum. Some will protest the intrusion at first, since the rubbing seems to hurt at the start, and then calm down as the counterpressure begins to bring relief.
Something cold to drink. Offer your baby a bottle of icy cold water. If she doesn’t take a bottle or is bothered by the sucking, offer the soothing liquid in a cup—but remove any ice cubes first. This will also augment the teething baby’s fluid intake, important if she is losing fluids through drooling and/or loose movements.
Something cold to eat. Once they’ve been introduced, applesauce, pureed peaches, or yogurt, chilled in the freezer, may be more appealing to a teething baby than warm or room-temperature foods.
Something to relieve the pain. When nothing else spells relief, baby acetaminophen should do the trick. Check with your doctor for the right dose, or see page 757 if he or she is not available. Or you can try a topical numbing agent or pain reliever as recommended by your pediatrician. Avoid giving any other medication by mouth or rubbing anything on baby’s gums unless recommended by the doctor. This caveat includes brandy or any other alcoholic beverage. Alcohol, even in drops, can be extremely harmful to an infant.
“For the last three weeks my baby has had a little cough. He doesn’t seem sick, and he doesn’t cough in his sleep—he almost seems to be coughing on purpose. Is this possible?”
Even as early as the fifth month, many babies have begun to realize that all the world’s a stage, and that nothing beats an admiring audience. So when a baby discovers that a little cough—either triggered by excess saliva or stumbled upon in the ordinary course of vocal experimentation—gets a lot of attention, he often continues this affectation purely for its effect. As long as he’s otherwise healthy, and seems in control of the cough rather than vice versa, ignore it. And though your little thespian may never lose his flair for the dramatic, he will probably give up this attention-getter as he (or his audience) becomes bored with it.
“My daughter has been pulling at her ear a lot. She doesn’t seem to be in any pain, but I’m worried that she might have an ear infection.”
Babies have a lot of territory to conquer—some of it on their own bodies. The fingers and hands, the toes and feet, the penis or vagina, and another curious appendage, the ear, will all be subjects of exploration at one time or another. Unless your baby’s pulling and tugging at her ear is also accompanied by crying or obvious discomfort, fever, and/or other signs of illness (see page 553 if it is), it’s very likely that it’s only a manifestation of her curiosity, not a symptom of an ear infection. Some babies may also fuss with their ears when teething or when they’re tired. Redness on the outside of the ear isn’t a sign of infection, just a result of constant manipulation. If you suspect a problem, do check with the doctor.
Peculiar mannerisms such as ear pulling are common and fairly short-lived; each is replaced by a newer and more exciting one once baby outgrows or grows tired of it.
“My baby is awake more during the day now and I’m not sure—and I don’t think he is either—how many naps he needs.”
It’s inevitable. The first couple of weeks home from the hospital the proud mom and dad, eager to begin active parenting, stand expectantly over their new baby’s crib, waiting for him to wake from what seems like endless slumber. Then, as he spends more time awake, they begin to wonder, “Why doesn’t he ever sleep?”
Though the typical baby in the fifth month takes three or four pretty regular naps of an hour or so each during the day, some babies thrive on five or six naps of about twenty minutes each, and others on two longer ones of an hour and a half or two. The number and length of naps your baby takes, however, are less important than the total amount of shut-eye he gets (about 14½ hours a day on average during the fifth month, with wide variations). Longer naps are more practical for you—and nobody needs to tell you this—because they allow you longer stretches in which to get things done. In addition, the baby who gets into catnapping during the day may follow the same pattern during the night, waking up frequently.
You can try to encourage longer naps by:
Offering a comfortable place to nap. Letting baby sleep on your shoulder will result not only in a stiff shoulder for you, but in a shorter nap for him. A crib, stroller, or carriage will keep baby down longer.
Keeping the room temperature comfortable, neither too hot nor too cold, and the clothing appropriate.
Timing it right. Don’t let baby fall asleep just before mealtime (when his empty stomach is likely to rouse him prematurely), when his diaper needs changing (he won’t sleep long if his bottom is drenched), when company (and noise) is expected, or any other time when you know the nap is destined not to last.
Avoiding predictable disturbances. You will quickly learn what disturbs your baby’s sleep. Maybe it’s wheeling his stroller into the supermarket. Or moving him from car seat to crib. Or the dog’s shrill yap. Or the telephone in the hallway near his room. By trying to control the circumstances under which your baby sleeps, you may be able to minimize these disturbances—though, of course, you can’t (and shouldn’t try to) eliminate all noise.
Keeping baby awake for longer periods between naps. Your baby should now be able to stay awake for about two and a half to three hours at a stretch. If he does, he’s more likely to take a longer nap. Try any of the infant-stimulating ideas on pages 242 and 366 to increase stay-awake time.
Though many babies regulate themselves pretty well when it comes to getting their quota of sleep, not every baby gets as much as he needs. It may be that yours isn’t napping enough or getting enough total sleep if he frequently seems cranky. If you believe your baby needs more sleep, you will have to intervene to increase sleeping time. But if your baby sleeps very little and seems perfectly happy, you will have to accept the fact that he’s one of those babies who just don’t need a lot of shut-eye.
“My daughter has begun to break out in a red rash on her cheeks. It must be itchy, because she keeps trying to scratch it.”
This sounds like a classic case of infantile eczema, also known as atopic dermatitis. Eczema is a skin condition that is believed to be a type of allergic reaction. Though it is present at birth in some babies, it typically shows up between two and six months of age. Its onset is often triggered when a baby is put on solids or switched from breast milk to formula or from formula to cow’s milk (at a year). It’s less likely in babies who are breastfed exclusively, and more common in those with family histories of eczema, asthma, or hay fever. In formula-fed babies, the rash usually first appears around three months of age.
A bright red, scaly rash commonly starts on the cheeks and often spreads elsewhere, most frequently to the area behind the ears and to the neck, arms, and legs. (It doesn’t usually spread to the diaper area until between six and eight months.) Small papules, or pimples, develop and fill with fluid, then ooze and crust over. The severe itching causes children to scratch, which can lead to infection. Except for the very mildest, self-limiting cases, eczema requires medical treatment to prevent complications. It clears by eighteen months in about half the cases, and usually becomes less severe by age three in the others. Approximately one in three children with eczema, however, will develop asthma or other allergies later or continue to combat eczema into adulthood.
The following are all-important in the handling of eczema:
Clip nails. Keep your baby’s fingernails as short as possible to minimize the damage caused by scratching her rash. You may be able to prevent her from scratching while she’s sleeping by covering her hands with a pair of socks or mittens.
Curtail bathing. Since prolonged contact with soap and water increases skin dryness, limit baths to no more than ten or fifteen minutes, using an extra-mild soap (Dove or Cetaphil, for example). Don’t allow baby to soak in soapy water, and as soon as baby is out of the water, use a moisturizer. Chlorinated and salt water can make eczema worse; if that’s the case with your baby, you may need to limit dips in pools or at the beach.
Lubricate lavishly. Spread plenty of rich hypoallergenic skin cream (one that her doctor recommends) after baths while the skin is still damp. Don’t, however, use oils or petroleum jelly (such as Vaseline).
Control the environment. Because excessive heat, cold, or dry air can worsen eczema, try to avoid taking your baby outdoors in extremes of weather; keep your home neither too warm nor too cold, and use a humidifier to keep the air moist.
Keep it cotton. Perspiration can make eczema worse, so avoid synthetics, wool, and overdressing in general. Also avoid itchy fabrics and clothing with rough seams or trim, all of which can exacerbate the condition. Soft cotton clothing, loosely layered, will be most comfortable and least irritating. When your baby plays on carpeting, which can irritate the skin, too, place a cotton sheet under her.
Control diet. Under the doctor’s supervision, eliminate any food that seems to trigger a flare-up or a worsening of the rash.
Get medical treatment. Eczema that comes and goes in infancy usually leaves no lasting effects. But if the condition continues into childhood, affected skin can become thickened, depigmented, and cracked. Therefore treatment is essential—and will usually include a steroid cream or ointment to spread on the affected areas, antihistamines to reduce the itching, and antibiotics if a secondary infection develops. The nonsteroidal creams and ointments (Elidel and Protopic) are only approved for children over age two if other eczema treatments have failed.
“Our baby is getting too big to lug around in a front baby carrier. Is it safe to use a back carrier?”
Once your baby can sit independently, even briefly, he’s ready to graduate to a back carrier—assuming it suits you both. Some parents find the conveyance a comfortable and convenient way to carry their babies; others find it awkward and a strain on the muscles. Some babies are thrilled by the height and the bird’s eye view a back carrier affords, others are frightened by the precarious perch. To find out whether a back carrier is right for you and your baby, take him for a test ride in a friend’s or in a store floor sample before buying.
If you do use a back carrier, always be certain baby is fastened in securely. Also be aware that the position allows a baby to do a lot more behind your back than sightseeing—including pulling cans off the shelves in the supermarket, knocking over a vase in the gift shop, plucking (and then munching) leaves off shrubs and trees in the park. Keep in mind, too, that acquiring this backpack will require you to judge distances differently—when you back into a crowded elevator or go through a low doorway, for example.
“Every time I go out with my son, I have to listen to at least a dozen strangers tell me that he’s not dressed warmly enough, what I should do for his teething, or how I could make him stop crying. How am I supposed to handle all this unwanted advice?”
When it comes to the raising of a baby, everybody thinks they know best—or, at least, better than baby’s mom or dad. And that includes the chiding voices of experience that chorus around the stroller every time you leave your home.
While you may, if you’re really discriminating, be able to glean an occasional bit of genuine know-how from those well-meaning know-it-alls, most of what you’ll hear is best dismissed. Of course, dismissing it graciously is the tricky part. You could come back with a snide retort (“Don’t you think he’d tell me if he weren’t warm enough?”) or spend ten minutes trying to back up your parenting position with facts (“Actually, research shows that babies don’t need to be dressed any more warmly than adults”). But smarter in most situations is to plaster on a smile, nod appreciatively, issue a perfunctory thank you, and move on as speedily as you can. That way, the advice givers will be able to go about their business thinking they’ve helped you (“Another baby saved from cold fingers!”); you’ll have the satisfaction of knowing otherwise. By letting those strangers speak their piece without letting what they have to say get under your skin, you’ll both have a better day.
If the advice that’s been offered seems as if it may actually have some validity, but you’re not sure, check it out with your baby’s doctor or with another reliable source.
“I don’t give my baby a bottle, but the doctor said I can give her juice now. Is it too early to start her on the cup?”
Whether baby is started on the cup in the fifth month, the tenth month, or the eighteenth month, it’s a sure thing she’ll eventually get all of her fluids from one. But teaching her to drink from a cup early offers certain important advantages. For one, she learns that there’s a route to liquid refreshment other than the breast or bottle, an alternative that will make it easier to wean her from either or both. For another, it provides an additional way to give fluids (water, juice, and, after a year, milk) when a mom isn’t available to nurse, or when a bottle isn’t handy.
Another advantage of early cup training: A five-month-old infant is markedly malleable, open to new experiences. But wait until your baby’s first birthday to introduce a cup, and you’ll likely encounter considerable resistance. Not only will she be stubbornly set in her ways, but she’s apt to sense that giving in to a cup will lead to her having to give up her bottle or breast. And even if she accepts the cup, it may be a while before she becomes skilled at using it, which means that it could be weeks or months before she will be able to drink significant amounts from it—and consequently weeks or months before you can wean her.
To ease your baby into using the cup early and successfully:
Wait until she can sit supported. Babies as young as two months can be started on the cup, but gagging will be less of a problem once a baby can sit up with support.
Choose a safe cup. Even if you’re holding the cup, baby may knock it down or swat at it impatiently when she doesn’t want any more, so be sure the cups you use are unbreakable. A cup that is weighted at the bottom will not tip over easily, a definite plus. A paper or plastic cup, though unbreakable, won’t work for training because—much to baby’s delight—it’s crushable or crackable.
Choose a compatible cup. The type of cup preferred differs from child to child, so you may have to experiment with several to find one yours really likes. Some children favor a cup with one or two handles they can grip; others prefer a cup without handles. (If such a cup tends to slip from baby’s wet little hands, wrap a couple of strips of adhesive tape around it, changing the tape when it becomes ratty.) A cup with a spouted lid (known in baby and toddler circles as a “sippy cup”) theoretically offers a nice transition from sucking to sipping (probably more so for babies who’ve taken a bottle than for those who are used to a human nipple), but some children just don’t like it—perhaps because they find the liquid more difficult to get at, perhaps because they want to drink from a cup that’s just like mommy’s or daddy’s. And though there will be fewer major spills at the start with a sippy cup (and probably none with the many spillproof varieties), baby will eventually have to face the hurdle of learning to do without its protection—which may result in more spills later on. (Plus, there are other sippy cup issues to consider; see box, previous page.)
To hear parents who’ve become dependent on them (or have kids who’ve become dependent on them), they’re the greatest invention since Velcro. They look harmless enough—cups with spouts. And their list of benefits is compelling: Since they’re practically spillproof and unbreakable, there’s no more crying over spilt milk or juice, fewer cleanups, and less laundry; unlike other cups and glasses, they can be used in the car, at play, in the stroller, and—here’s the biggie for busy parents—without supervision.
But research has pointed to some potential pitfalls in sippy cup use, too. Because they’re more like a bottle than a cup in the way liquid is extracted from them (it’s a slower process, allowing the liquid to spend more time pooling in the mouth and on teeth), extended, frequent use can lead to tooth decay. This is especially true if the sippy cup is used (as it so often is) between meals and between brushings, and even more likely a risk if it’s carried around all day for round-the-clock nipping (the way a bottle might be). Another problem when they’re carried around all day is that they become a breeding ground for bacteria (particularly if a child has a “favorite” that doesn’t often get washed thoroughly because it’s always being used, or if the cup gets left in a toy pile one day and retrieved and drunk from again the next day). Still another issue: Like a child nipping all day from a bottle full of juice, a child drinking all day from a sippy cup full of juice may drown his or her appetite for food and/or take in too many superfluous calories, and/or suffer from chronic diarrhea. A fourth problem that has been suggested is that kids who use sippy cups exclusively are slower in speech development, or are more likely to have temporary speech impediments. The theory goes that the sippy method of drinking—unlike drinking from a regular cup or with a straw—doesn’t give the mouth muscles the workout they need. More research needs to be done before that theory is given universal credence; in the meantime, it’s food (or drink) for thought.
Still, sippy cups offer a terrific transition from breast or bottle to traditional cups, minimize mess, and are an undeniable convenience on the road. To eliminate the potential risks that go along with those benefits:
Don’t start with a sippy. Make sure your baby has at least begun to learn the fine art of sipping from a spoutless cup—an important skill to master—before you bring on the sippy. Then use both, rather than switching over to the sippy full-time.
Limit sippy sipping to meal and snack times. Don’t let your child drag the sippy cup around the house and the playground; don’t always use a sippy to placate your baby in the car or stroller. Limits help protect teeth and speech, prevent overdosing on juice, and keep sippy use from slipping into sippy abuse.
Buy multiples. Many children play favorites—and will demand the same sippy cup at every sitting. To make sure you have one to use while others are in the dishwasher, buy several of the style your child favors.
Fill it with water. If the sippy becomes a comfort object (much as a bottle can), don’t deny the comfort, but fill it with water instead of juice. That will avert many of the problems associated with sippy cup use.
Know when to stop. Once your child can easily and proficiently sip from a glass or cup, ditch the sippy.
Food poisoning is one of the most common illnesses in the United States. And it’s also one of the most easily prevented. Other hazards that originate at the feeding table (glass splinters, passing of cold germs) can also be avoided. To make sure you do everything you can to make eating safe for your baby, take the following precautions every time you prepare food:
Always wash your hands with soap and water before feeding baby; if you touch raw meat, poultry, fish, or eggs (all of which harbor bacteria) during the feeding, wash them again. Wash your hands, too, if you blow your nose or touch your mouth. If you have an open cut on your hand, cover it with a Band-Aid before feeding your baby.
Store dry baby cereals and unopened baby food jars in a cool, dry place away from extremes of heat (over the stove, for example) or cold (as in an unheated cellar).
Wipe the tops of baby food jars with a clean cloth or run them under the tap to remove dust before opening.
Make sure the button is down on safety lids before opening a jar for the first time; when opening listen for the “pop” to make sure the seal was intact. Discard or return to the store any jar that has a raised button or that doesn’t pop. If you use ordinary canned foods for an older baby (or anyone else), discard cans that are swollen or leaky. Don’t use foods in which a liquid that should be clear has turned cloudy or milky.
If a jar is hard to open, run warm tap water over the neck or pry the side of the lid open with a bottle opener until you hear a pop; don’t tap the top, as this may splinter glass into the contents.
Whenever you use a can opener, make sure it’s clean (wash it in the dishwasher), and discard it when it begins to look rusty or you can’t get it clean.
Don’t feed baby directly out of a baby food jar unless it’s the last meal from that jar, and don’t save a bowl of food baby’s eaten from for the next meal, since enzymes and bacteria from baby’s saliva will begin “digesting” the food, turning it watery and causing it to spoil more quickly.
Remove one serving at a time from a jar of baby food with a clean spoon. If baby wants a refill, use a fresh spoon to scoop it out.
After you’ve taken a serving out of a jar, recap the remainder and refrigerate until it’s needed again; if it hasn’t been used within three days for juices and fruits, and two days for everything else, discard it.
It’s not necessary to heat baby food (adults may have a preference for warm meats and vegetables, but babies have developed no such taste bias), but if you do, heat only enough for one meal and discard any unused heated portion. Do not heat baby’s food in a microwave oven; though the container may stay cool, the inside continues cooking for a few minutes after you take it out, and may get hot enough to burn baby’s mouth. Heat instead in an electric feeding dish or in a heat-resistant glass bowl over simmering water (hot water feeding dishes won’t heat foods but will keep them warm). When testing the temperature, stir up the food, then splash a drop on the inside of your wrist rather than taking a taste from baby’s spoon; if you taste, use a fresh spoon for baby.
When preparing fresh baby foods, be certain utensils and work surfaces are clean. Keep cold foods cold and warm foods warm; foods spoil fastest between 60° and 120°F, so don’t keep baby’s food at those temperatures for more than an hour. (For adults, the safe period is closer to two or three hours.)
When the doctor okays eggs for your baby, cook them well before serving. Raw or uncooked eggs can harbor salmonella. (To be extra safe, you can use pasteurized eggs.)
Do not give baby unpasteurized juice, milk, cheese, or other “raw” dairy products.
Peel vegetables and fruit, when possible, unless they are certified organically grown, and wash all fruits and vegetables well. Melons should be scrubbed before slicing into them.
When tasting during food preparation, use a fresh spoon each time you taste, or wash the spoon between tastings.
When in doubt about the freshness of a food, throw it out.
On an outing, take unopened jars or dehydrated baby food (to which you can add fresh water). Carry any open jars or containers of anything that needs refrigeration in an insulated bag packed with ice or an ice pack, if it will be more than an hour before you serve it. Once the food no longer feels cool, don’t feed it to the baby.
Protect all concerned. Teaching your baby to drink from a cup won’t be a neat affair; for quite some time you can expect more to drip down her chin than into her tummy. So until she becomes proficient, keep her covered with a large absorbent or waterproof bib during drinking lessons. If you are feeding her on your lap, protect it with a waterproof square or apron.
Get baby comfortable. Seat her so she feels secure—on your lap, in an infant seat, or propped up in a high chair.
Fill it up with the right stuff. It’s easiest and least messy to start with water. Once that’s mastered (sort of), you can move on to expressed breast milk or formula (but not regular cow’s milk until age one), or (once it’s introduced) diluted juice. Play it by baby’s tastes; some children will initially accept only juice in a cup and not milk, others take only milk.
Use the sip-at-a-time technique: Put just a small amount of fluid in the cup. Hold the cup to baby’s lips and slowly pour a few drops into her mouth. Then take the cup away, giving her a chance to swallow without gagging. Stop each session when your baby signals she’s had enough by turning her head, pushing the cup away, or starting to fuss.
Even with this technique, you can still expect that almost as much liquid will exit your baby’s mouth as enters it. Eventually, with plenty of practice, patience, and perseverance, more will hit its mark than not.
Encourage participation. Your baby may try to grab the cup from you, with an “I’d rather do it myself” attitude. Let her try. A very few babies can manage a cup even at this early age. Don’t get upset if she spills it all—that’s part of the learning process. She can also learn by sharing the job, holding the cup along with you.
Take no for an answer. If your baby resists the cup, even after a few tries, and even after you’ve tried several different liquids and several different types of cups, don’t pressure her to accept it. Instead, shelve the project for a couple of weeks. When you try again, use a new cup and a little fanfare (“Look what Mommy has for you!”) to try to generate excitement. Or you might try letting your conscientious objector handle an empty cup as a toy for a while.
“Both my spouse and I have a lot of allergies. I’m worried that our son may have them, too.”
Unfortunately, it isn’t just the better traits—lustrous locks, long legs, musical ability, mechanical aptitude—that are inheritable. The less desirable ones are, too, and having two parents with allergies does make a baby much more likely to develop them than if he has two allergy-free parents. But that doesn’t mean your baby is destined for a lifetime of hives and sneezing. It does mean you should discuss your concerns with your baby’s doctor, and if necessary with a specialist in pediatric allergies.
A baby becomes allergic to a substance when his immune system becomes sensitized to it by producing antibodies. Sensitization can take place the first time his body encounters a substance or the hundredth time. But once it does, antibodies rev into action whenever the substance is encountered, causing any one of a wide range of physical reactions, including runny nose and eyes, headache, wheezing, eczema, hives, diarrhea, abdominal pain or discomfort, violent vomiting, and, in severe cases, anaphylactic shock. There is even some evidence that allergy may also manifest itself through behavioral symptoms, such as crankiness.
The most common food offenders include milk, eggs, peanuts, tree nuts (such as walnuts, pecans, almonds, and so on), fish, shellfish, wheat, and soy. In some cases even a tiny amount of a food causes a severe reaction; in others, small amounts don’t seem to cause a problem at all. Children often outgrow some food allergies but later develop hypersensitivities to other substances in the environment, such as household dusts, pollens, and animal dander.
Not every adverse reaction to a food or other substance, however, is an allergy. In fact, in some studies of children, specialists were able to confirm allergy in fewer than half the subjects—all of whom had been previously diagnosed as “allergic.” What appears to be an allergy may sometimes be an enzyme deficiency. Children with insufficient levels of the enzyme lactase, for example, are unable to digest the milk sugar lactose, and thus react badly to milk and milk products. And those with celiac disease are unable to digest gluten, a substance found in many grains, and thus appear to be allergic to those grains. The workings of an immature digestive system or such common infant problems as colic may also be misdiagnosed as allergy.
For infants in families with a history of allergy, doctors generally recommend the following precautions:
Continued breastfeeding. Bottle-fed babies are more likely to develop allergies than breastfed infants—probably because cow’s milk is a relatively common cause of allergic reaction.2 If you are nursing your baby, continue, if possible, for the entire first year. The later cow’s milk becomes a mainstay of his diet, the better. Using a soy-based formula when a supplement is needed is often suggested in allergic families, but some babies turn out to be allergic to soy, too. For those babies, a protein hydrolysate formula will be needed.
Delaying solids. It’s now believed that the later a baby is exposed to a potential allergen, the less likely it is that sensitization will take place. So most doctors recommend postponing the introduction of solids in babies of allergic families—usually until at least six months, and occasionally later.
More gradual introduction of new foods. It’s always wise to introduce new foods to a baby one at a time, but this is especially important in allergic families. It may be recommended that you give each new food every day for an entire week before starting another. If there is any kind of adverse reaction—looser movements, gassiness, rash (including diaper rash), excessive spitting up, wheezing, or runny nose—it’s generally advised that the food be discontinued immediately and not be resumed for several weeks at least, at which time it may be accepted without distress.
Introduction of less allergenic foods first. Baby rice cereal, the least likely cereal to cause allergy, is usually recommended as a starter food. Barley and oats are less allergenic than, and are generally given before, wheat and corn. Most fruits and vegetables cause no problems, but parents are often advised to hold off on introducing berries and tomatoes. Shellfish, peas, and beans can also wait. Most of the other highly allergenic foods (nuts, peanuts, some spices, and chocolate) can usually be introduced after three years of age.
Elimination diets and special liquid diets can be used to diagnose allergies, but they are complicated and time-consuming. Skin tests for food allergies are not highly accurate; a person can have a positive skin test to a particular food, yet have no reaction at all when he eats it. “Food sensitivity” screening tests that claim to diagnose allergies from blood samples are even less accurate, extremely expensive, and have not been approved by either the FDA or the American Academy of Pediatrics.
Happily, many childhood allergies are outgrown (though certain food allergies, such as those to peanuts, nuts, shellfish, and fish tend not to be). So even if your baby turns out to be hypersensitive to milk, wheat, or other foods, he may no longer be in a few years—or even less.
“So far I’ve been feeding my baby on my lap, but it’s very messy. When can I put her in a high chair?”
There’s no perfectly neat way to feed a baby (you’ll be a two-ply, jumbo-roll paper-towel family for many months to come). But the messiest, and most logistically challenging, is the baby-on-the-lap maneuver; a feeding chair of some kind will make the job much more efficient. While a baby still needs some support to sit, an infant seat (with baby strapped in and under your constant supervision) can double as a feeding seat. Once she can sit up fairly well by herself, it’s time to switch to a high chair. See page 313 for more on keeping a baby from slipping, sliding, and slumping in her new seat, and page 332 for feeding chair safety tips.
“My daughter seems very frustrated that she can’t get around yet. She’s not content to lie in her crib or sit in her infant seat, but I can’t carry her all day. Can I put her in a walker?”
Life can be frustrating when you’re all revved up with no place to go (or, at least, no way to get there without a grownup’s help). Such frustrations are often at a peak from the time a baby begins to sit fairly well until she can get around on her own (by crawling, creeping, cruising, or whatever method she’s first able to come up with). The obvious solution used to be a walker—a seat set inside a table framework on four wheeled legs that allowed babies to zoom around the house long before they achieved independent mobility. But because walkers are the cause annually of thousands of head injuries that require medical treatment, and thousands more that are kissed-and-made-better at home, they are no longer recommended and, in fact, the AAP has called for a ban on the manufacture and sale of all mobile walkers. (If you still decide to use a walker, see the box on page 334.)
Feeding baby safely doesn’t just mean introducing new foods gradually. In fact, feeding baby safely begins even before the first spoon is filled—when baby’s placed in a feeding chair. To help make sure every mealtime passes safely, follow these rules:
ALL FEEDING CHAIRS
Never leave a young baby unattended in a feeding chair; have the food, bib, paper towels, utensils, and anything else necessary for the meal ready so that you don’t have to leave your child alone while you fetch them.
Always secure the safety or restraining straps, even if your baby seems too young to climb out. Be sure to fasten the strap at the groin to prevent him or her from slipping out the bottom. (Many newer seats have crotch guards to prevent slipping—but do be sure to use the strap as well to prevent baby from climbing out.)
Keep all chair and eating surfaces clean (wash with detergent or soapy water and rinse thoroughly); babies have no compunctions about picking up a decaying morsel from a previous meal and munching on it.
HIGH CHAIRS, BOOSTER SEATS, AND LOW FEEDING TABLES
Always be certain slide-off trays are safely snapped into place; an unsecured one could allow a lunging and unbelted baby to go flying out headfirst.
Check to be sure that a folding-type chair is safely locked into the open position and won’t suddenly fold up with baby in it.
Place the chair away from any tables, counters, walls, or other surfaces that baby could possibly kick off from—causing the chair to tumble.
To protect baby’s fingers, check their whereabouts before attaching or detaching the tray.
HOOK-ON SEATS
Use the seat only on a stable wooden or metal table; do not use on glass-topped or loose-topped tables, tables with the support in the center (baby’s weight could topple it), card tables, or aluminum folding tables, or on a table leaf.
If a baby in a hook-on seat can rock the table, the table isn’t stable enough; don’t attach the seat to it.
Avoid using place mats or tablecloths on the table; they can interfere with the gripping power of the seat.
Be certain any locks, clamps, or snap-together parts are securely fastened before putting your baby in the seat; always take your baby out of the seat before releasing or unfastening it. Always be sure the clamps are clean and functioning properly.
Don’t put a chair or other object under the seat as a safeguard should baby fall, or position the seat opposite a table brace or leg; a baby can push off against such surfaces, dislodging the seat. And don’t allow a large dog or older child under the seat while baby is in it, because they might also dislodge it from below.
A somewhat safer choice is a stationary walker (like the ExerSaucer), which allows baby some movement with less potential risk than the mobile walker. But there’s plenty of downside to these, too. First, babies whose frustrations lie in not being able to get from A to B without hitching a ride from mom or dad won’t be any less frustrated in a walker that doesn’t move. They might even be more frustrated; since the ExerSaucer moves only in circles, it may fuel their fury (“I’m moving but I’m not getting anywhere!”). In addition, some studies have shown that both walkers and ExerSaucers can cause temporary delays in development if they’re overused; babies who spend a lot of time in them, according to the research, sit, crawl, and walk later than babies who don’t. That’s not surprising if you consider that a baby trapped in a walker (or in an infant seat or swing) doesn’t have the opportunity to flex those muscles necessary to practice and master those skills. In fact, babies use a different set of muscles to stay upright in a walker than they do to stay upright for walking. Research also shows that because babies can’t see their feet in a walker or ExerSaucer, they’re deprived of the visual clues that would help them figure out how their bodies walk through space (a key part of learning how to walk). What’s more, they don’t learn how to balance themselves, and how when balance fails them, to fall and pick themselves back up—also vital steps in becoming a solo walker.
If you do choose to use a stationary walker, follow these tips for keeping baby both happy and safe while she’s in it:
Take your baby for a test drive. The best way to assess your baby’s readiness for a stationary walker is to let her try one out. If you don’t have a friend whose baby has one, go to a store and let your baby try out a floor model. As long as she seems happy and doesn’t slump pitifully in it, she’s ready for a stationary walker.
Don’t walk out while she’s “walking.” A stationary walker isn’t a substitute for supervision. Leave your baby in her ExerSaucer only when she can be watched.
Don’t let her walk around the clock. Limit baby’s time in the ExerSaucer to no more than thirty minutes per session. Every baby needs to spend some time on the floor, practicing skills that will eventually help her to crawl, such as lifting her belly off the ground while on all fours. She needs the opportunity to pull up on coffee tables and kitchen chairs in preparation for standing and, later, walking. She needs more chances to explore and handle safe objects in her environment than a walker of any kind allows. And, she needs the interaction with you and others that free play requires and allows; stationary walkers (like infant seats and play yards) should not become baby-sitters.
Don’t wait until she can walk before you take away the walker. As soon as your baby can get around some other way—crawling or cruising, for instance—put away the stationary walker. Its purpose, remember, was to ease your baby’s frustration at being immobile. Keeping her in the walker not only won’t help her to walk sooner, but its constant use may cause “walking confusion” (much as giving a baby a bottle before she’s learned to suck at the breast can cause nipple confusion), because standing and moving in a walker (even a stationary one) and walking solo require different body movements.
Mobile walkers pose many safety risks (as well as developmental ones; see previous page). If you do choose to use a walker that moves, keep in mind that it doesn’t grant you freedom of movement—you must stay nearby and supervise closely every moment your baby is in it. To further ensure safety, you should:
Only use one that meets safety standards. Walkers made after June 30, 1997, are wider than a 36-inch doorway or have a braking device that stops the walker if any of the wheels drop lower than the riding surface (for example, at the beginning of a staircase). Don’t borrow one that doesn’t include these features.
Do your childproofing early. Most any trouble a crawling or walking baby can get into, a baby in a walker can get into, too. A push off the wall and a couple of quick strides, and baby could end up at the other end of the room—and out the door or down a flight of stairs. So even if your baby can’t get around without the help of a walker, he or she should be considered as hazardous to his or her own health as a mobile baby. Read Making Home Safe for Baby (page 402), and make all necessary adjustments before you let baby loose in the walker.
Keep dangers out of walker’s way. The most potentially dangerous place for a baby in a walker is at the top of a flight of stairs; don’t let your baby roam freely near a stairway in the walker, even if it is protected with a closed safety gate. Although most walker/stairway injuries occur on staircases where there is no safety gate or where a gate is left open, some do take place when a gate is not fastened to the wall securely. It’s best, therefore, when your baby is in the walker, to block off entirely—with a closed door or heavy obstacles—areas leading to staircases. Other hazards to the walker-walking baby, which should be removed or blocked off before letting him or her loose, include room thresholds, changes in grade (as from carpet to linoleum or blacktop to grass), toys left on the floor, loose area rugs, and other low obstructions that can topple the walker.
Other risks that can be encountered by a child in a walker: dangling cords that can topple appliances over, tablecloths that can be tugged off (bringing everything on a table, including hot dishes, down on baby).
“We received a jumping device, which hangs in the doorway, as a gift for our baby. He seems to enjoy it, but we’re not sure if it’s safe.”
Most babies are ready and eager for a workout long before they’re independently mobile—which is why many enjoy the acrobatics they can perform in a baby jumper. But the joy of jumping doesn’t come without potential problems. For one, some pediatric orthopedic specialists warn that too much jumper use can cause certain kinds of injuries to bones and joints. For another, baby’s exhilaration with the freedom of movement a jumper affords can quickly turn to frustration as he discovers that no matter how or how much he moves his arms and legs, he’s destined to stay put in the doorway.
If you do opt to use the jumper, make sure your doorways are wide enough. As with any baby-busying device (a walker, a swing, a pacifier, for example), be sure that you use it to meet your baby’s needs, not yours; if he’s unhappy in it, take him out immediately. And never leave your baby unattended in the jumper—even for a moment.
“My baby loves being in her infant swing—she can spend hours in it. How much time can I allow her to spend in the swing?”
You probably love having your baby in the swing nearly as much as she loves being in it. After all, it keeps her busy when you’re busy, holds her when your arms are otherwise occupied—and calms her down when nothing else will.
But while being in the swing of things is entertaining and soothing for baby—and convenient for you—it comes with a downside. Too much swinging can prevent your baby from practicing important motor skills, such as creeping, crawling, pulling up, and cruising. It can also cut down on the amount of contact your baby has with you—both physical (the kind she gets from being held by you) and emotional (the kind she gets from playing with you).
So keep on swinging, but with restrictions. First, limit swinging sessions to no longer than thirty minutes at a time, twice a day. Second, place the swing in the room you’ll be in and keep interacting with your baby even as she swings—play peekaboo behind the dish towel while you’re making dinner, sing songs while you’re going through the mail, swoop down for an occasional cuddle while you’re talking on the phone. If she tends to fall asleep in the swing (who can blame her?), be sure to complete the transfer to the crib before she nods off—not only so that her head doesn’t droop, but so that she’ll learn to fall asleep without motion. And, third, keep these safety tips in mind whenever she swings:
Always strap baby in to prevent falls.
Never leave your baby unattended while she’s in the swing.
Keep the swing at least arm’s length away from objects that your baby can grab on to—such as curtains, floor lamps, drapery cords—and away from dangerous items a baby can reach for—such as outlets, the oven or stove, or sharp kitchen utensils. Also keep the swing away from walls, cabinets, or any surface your baby might be able to use to push off from with her feet.
Once your baby reaches the manufacturer’s weight limit recommendation, usually 15 to 20 pounds, pack up the swing.
It’s a natural impulse—one that you share with most members of the animal kingdom: to keep your offspring safe and sound. Birds do it by feathering their nests atop trees, far from predatory beasts that might feast on their unborn flock. Alligator and crocodile mothers cover their buried clutches of eggs with vegetation that radiates heat as it rots, keeping nest temperatures within tolerable limits. Penguin mothers and fathers cuddle their eggs on their feet to keep them above the frozen land. Mother bears, wolves, and foxes build dens to shelter their vulnerable young from the elements. As a human, you do it by babyproofing the house, using car seats when you drive, choosing safe baby furnishings—and protecting your child from environmental hazards.
So you read the paper, you turn up the volume when a report about these hazards comes on the TV, you skim through childcare books, and, if you’re like most parents, you do a fair amount of worrying. (And if you’re like some parents, a whole lot of worrying.) But is the world around your baby really as dangerous as you’ve heard? On the other hand, can it be as safe as you’d like? Though you certainly have it easier in your quest to shelter your brood than your furry and feathered friends do, you still have your work cut out for you. It may not be a jungle outside where you live, but protecting your baby from the potential hazards in his or her environment isn’t a walk in the park, either.
Fortunately, there are many more factors influencing a child’s long-term well-being that are within your control than factors that aren’t. Ensuring adequate well-baby and sick-baby care from birth, for instance. Getting baby off to the best nutritional start possible. Not letting anyone smoke around your baby. Encouraging healthy lifestyle habits, such as exercise and good diet, and discouraging unhealthy ones, such as smoking and alcohol abuse, through example. Take care of these, and you’re already doing an excellent job of protecting your young.
But there are some hazards in our environment that aren’t completely within our control and that, despite best efforts, can be controlled only partially or indirectly. And though most of these pale in significance when compared to the factors that are within your control, they do pose some risk. In general, the risks are greater for babies and young children, for a few reasons. One reason is their smaller body size—the same dose of a hazardous substance in a child is more powerful than it would be in an adult. And since, pound for pound of body weight, they drink more water, eat more food, and breathe more air, they actually take in more toxins. Another is the fact that their organs are still growing and maturing and thus are more vulnerable to environmental assaults. Their propensity for putting their hands in their mouths also increases the risk for them (since they touch almost everything, and since more things that they touch will ultimately end up in their mouths and thus their systems), as does the fact that they’re built close to the ground and often play there, too (they’re nearer to the toxins in dust, soil, carpets, and grass). Yet another reason is that today’s child is looking forward to a longer life span than earlier generations did, and since the damage often takes many years to develop, there are more years available in which it can develop.
Even so, the relative risks are small and in most cases—particularly when viewed with some perspective—not worth losing sleep over. It’s important to keep in mind, too, that no matter how hard parents try, it’s just not possible to create a completely risk-free environment for their offspring. But following that natural instinct to protect, by taking all the steps you can to minimize the hazards in your child’s life, makes sense. It’ll also help you sleep better at night. Here’s how.
Household pests are aesthetically unappealing and annoying, and in some cases can even transmit disease or inflict painful and dangerous bites. But most of the pesticides used in the home to eliminate pests are dangerous poisons, particularly in the hands (or mouths) of infants and toddlers. You can minimize the risk while achieving the benefits of keeping home and hearth free of infestation with the following:
Blocking tactics. Use window screens, and screen or otherwise close off entry points for insects and vermin.
Sticky insect or rodent traps. Not dependent on killer chemicals, these trap crawling insects in enclosed boxes (roach traps) or containers (ant traps), flies on old-fashioned fly paper, mice on sticky rectangles. Because human skin can stick to these surfaces (the separation can often be painful), these traps, when open, must still be kept out of the reach of children or put out after they are in bed at night and taken up before they are up and around in the morning. Those used for rodents have the disadvantage of prolonging the death.
Box traps. The tenderhearted can catch rodents in box traps and then let the victims loose in fields or woods far from residential areas, though this isn’t always easy. Because these rodents can bite, the traps should be kept out of the reach of children or put out when children are not around.
Safe use of chemical pesticides. Virtually all, including the much-touted boric acid, are highly toxic not just to pests but to humans as well. If you opt to use them, do not spread them (or store them) where babies or children can get to them or on surfaces where food is prepared. Always use the least toxic substance (check with your state EPA or health department). If you use a spray, keep the children out of the house while spraying and for the rest of the day, at least. Better still, have the spraying done while you’re on vacation, visiting grandma, or otherwise away from home. When you return, open all the windows to air out the house or apartment, and scrub all surfaces that baby might touch or that come into contact with food.
For years it has been known that large doses of lead could cause severe brain damage in children. Now it is also recognized that even in relatively small doses, lead can reduce IQ, alter enzyme function, retard growth, damage the kidneys, and also cause learning and behavior problems, hearing and attention deficiencies. It may even have negative effects on the immune system.
It makes sense, then, for parents to know what sources of lead are in their baby’s environment and what can be done to minimize exposure.
Lead paint. In spite of legislation prohibiting its use, lead paint continues to be the major source of a child’s exposure to lead. Many older homes still harbor lead paint, often containing very high concentrations of lead beneath layers of newer applications. As paint cracks or flakes, microscopic lead-containing particles are shed. These end up on baby’s hands, toys, clothing—and eventually in his or her mouth. If there is the possibility of lead in your house paint, check with your local EPA to get advice on whether and how to remove it. And be certain that any painted object—toy, crib, or anything else your baby comes in contact with—is lead free. Be particularly wary of antique items, as well as those that are imported or were purchased outside the United States.
Drinking water. The EPA estimates that the water in tens of millions of American homes is probably contaminated with lead. The lead usually leaches into the water in buildings where there are lead pipes or where pipes are soldered with lead, especially where the water is particularly corrosive. Since most of the contamination occurs once the water has entered individual buildings rather than in the public water supply, most communities haven’t made major efforts to correct the problem. If you’re concerned that your drinking water may be contaminated by lead (or other hazardous substance), have it tested by the local water department, department of health, or EPA, if they do such testing, or by a state-certified private testing agency. If lead is found, you can install a reverse osmosis filter (which removes the lead) on your kitchen sink, or use bottled water for drinking and formula preparation. Letting the tap water run for at least three minutes also makes it safe for drinking or cooking, though it’s admittedly wasteful. Avoid using water from the hot tap for cooking, since it leaches more lead; don’t boil water longer than five minutes, which concentrates the lead.
Most sand sold for sandboxes is perfectly safe and ready for your child’s digging pleasure. But an occasional batch of sand may be contaminated with a type of asbestos called tremolite. The tremolite fibers float in the air and can cause serious illness if inhaled. The problem is more severe indoors, where sand tends to be dry and dusty, than outdoors, where it is often damp. Though it’s virtually impossible for you to learn if the sand your baby digs in (at home or at a day-care center or in the playground) is contaminated, you can determine if it is dusty and possibly risky to breathe. Return or get rid of the sand (or if it’s from a playground, frequent a safer sandbox) if it makes a cloud of dust when you dump a pailful, or if, when you mix a spoonful in a glass of water, the water remains cloudy once the sand settles. Find another source, preferably ordinary beach sand (a lot of play sand is ground-up stone or marble).
Soil. Lead house paint that flakes off, industrial residue, dust from the demolition of houses that have been painted with lead can all end up contaminating the soil. Though you needn’t be fanatic, do try to keep your baby from ingesting fistfuls of the stuff.
In addition to keeping your child away from known sources of lead, you should also try to increase his or her resistance to lead poisoning with good nutrition, particularly adequate levels of iron and calcium. And ask the doctor about screening tests for lead (some doctors screen routinely).
Most tap water in the United States is fit to drink, but a small percentage (about 2 percent) of community water supplies contain substances that pose significant health risks. Water systems purified with activated charcoal rather than chlorine are believed to provide safer water, but only a few water districts presently use this type of purification. Well water, too, is often contaminated. If you suspect your water is not safe, check with your local EPA about how to have it tested. Should it turn out to be contaminated, a water purifier can often make it safe to drink. Which type of purifier will be best for your home will depend on the contaminants in your water and how much you can spend.
Most babies spend a great deal of time indoors, so the quality of the air they breathe there is extremely significant. To keep baby’s air clean and safe, watch out for the following indoor air risks:
Carbon monoxide. This colorless, odorless, tasteless but treacherous gas (it can cause lung ailments, impair vision and brain functioning, and is fatal in high doses) that results from the burning of fuel can seep into your home from many sources: improperly vented woodstoves or kerosene heaters (have the fire department check venting); slow-burning woodstoves (speed up burning by keeping the damper open); poorly adjusted or unvented gas stoves or other appliances (have adjustment checked periodically—the flame should be blue—and install an exhaust fan to the outside to remove fumes); gas ranges each time they are turned on (an electric ignition reduces the amount of combustion gases released); fireplaces with residue-blocked chimneys (fires should never be left to smolder, and chimneys should be cleaned regularly); an attached garage (never leave a car idling, even briefly, in a garage that shares a wall or ceiling with your home, since the fumes can seep through). For safety, install a carbon monoxide detector on each floor of your home, not too close to major appliances (as you would with smoke detectors).
Here are some acronyms that can come in handy. The Environmental Protection Agency (EPA) has established an Office of Children’s Health Protection (OCHP) with the goal of protecting children from environmental and other hazards through public information and government action. You can get information on pollutants and other child health issues by contacting the EPA at 1200 Pennsylvania Avenue, NW, Mail Code 1107A, Room 2512 Ariel Rios N, Washington, DC 20004; 202-564-2188; www.epa.gov/children.
Benzopyrenes. A long list of respiratory illnesses (from eye, nose, and throat irritation to asthma and bronchitits to emphysema and cancer) can be linked to tarlike organic particles that result from the incomplete combustion of tobacco or wood. To prevent your baby’s exposure, allow no tobacco smoking in your home, be sure the flue that vents smoke from a wood fire does not leak, vent combustion appliances (such as clothes dryers) to the outdoors, change air filters on various appliances regularly, and increase ventilation in your home.
Particulate matter. A wide variety of particles, invisible to the naked eye, can fill the air in our homes. They come from such sources as household dust (which can trigger allergies in susceptible children), tobacco smoke, wood smoke, un-vented gas appliances, kerosene heaters, and asbestos construction materials. The same precautions (no smoking, proper venting, filter changing) discussed above can minimize this threat. Air-filtering units can often remove many of these particles and are particularly useful if someone in the family has allergies. If you find asbestos in your home that may need removal, get professional assistance in dealing with it before particles begin to fly.
Be extra careful if your baby wants to get up close and personal with the goats and sheep at the petting zoo or farm. Though they’re cute and cuddly, these animals can also carry the dangerous E. coli bacteria, which they can pass on to little petters. E. coli infection causes severe diarrhea and abdominal cramps, and in some cases it can be fatal. So be sure you wash your baby’s hands with soap and water (most petting zoos have a sink handy right outside for this purpose), or with an antibacterial wipe or gel after any petting session. If you didn’t take these precautions in previous visits but your baby didn’t have any subsequent symptoms, there’s no need to worry. Just take the precautions next time.
Miscellaneous fumes. Fumes from cleaning fluids, from some aerosol sprays (if they contain fluorocarbons, they can also be hazardous to the environment), and from turpentine and other painting-related materials can be highly toxic. If you use these substances at all, always use the least toxic product (water-based paints, beeswax floor waxes, paint thinners made from plant oils), use it in a well-ventilated area (even better, outdoors), and never use it when infants or children are nearby. Store these, like all other household products, safely out of reach of curious little hands. They are best stored in outdoor storage areas where, if they begin to evaporate, fumes won’t seep into living areas.
Formaldehyde. With so many products in our modern world containing formal-dehyde (from the resins in particle-board furniture to the sizing in decorator fabrics and the adhesives in carpeting), it isn’t surprising that the gas, which causes nasal cancer in animals and respiratory problems, rashes, nausea, and other symptoms, is everywhere. To minimize the potential risk, look for products that are formaldehyde free when building or furnishing your home. To reduce the effects of formaldehyde already in your home, seal such materials as particle-board with an epoxy sealer—or, even simpler and nicer, invest in a small indoor garden. Fifteen or twenty houseplants can apparently absorb the formaldehyde gas in an average-size house. But make sure they’re not plants that are poisonous if ingested, just in case baby ends up doing some munching.
Mold. Fungi, which thrive in damp locations such as basements, are known to cause breathing problems, croup, bronchitis, and other illness in infants. Look out for wet spots and mold in your home and take steps to eliminate them. Also consider measuring household fungi levels if your baby has been experiencing breathing problems.
Radon. This colorless, odorless, radioactive gas, a naturally occurring product of the decay of uranium in rocks and soil, is the second leading cause of lung cancer in the United States. Breathed in by unsuspecting residents of homes in which it has accumulated, it exposes the lungs to radiation, which over many years can lead to cancer.
Accumulation of radon occurs when the gas seeps into a home from decaying rocks and soil beneath it and is retained because of poor ventilation in the structure.
Taking the following precautions can help prevent the serious consequences of radon exposure:
Before you buy a home, especially in a high-radon area, have it tested for radon contamination. Your local or state EPA can give you information on the radon levels in your area and where to turn for testing.
If you live in a high-radon area, or suspect your home may be contaminated, have it tested. Ideally, testing should take place over a several-month period to obtain an average. Levels are usually higher in seasons when windows are closed.
If your home turns out to have high levels of radon, consult the EPA for help in locating a radon-abatement company in your community, and ask them for any written material they have on radon reduction. The first step will probably be to seal cracks and other openings in the foundation walls and floors. More important will be increasing ventilation by opening windows; installing vents in crawl spaces, attics, and other closed spaces; and eliminating airtight weather stripping and air-to-air heat exchangers. In some cases, a housewide ventilation system may be needed.
In this world of mass production, manufacturers have learned to use chemicals of various sorts to make the foods they produce look better, smell better, taste better (or, in the case of processed foods, at least more like the real thing), and last longer. But even foods that haven’t passed through a manufacturing plant are often contaminated—by pesticides or other chemicals used in growing or storing, or picked up incidentally from water or soil. In many cases, the risks from such chemicals to humans are either unknown or believed to be small. Nevertheless, it’s prudent to protect your child (who is, again, more vulnerable to these chemicals than adults are) by following these basic rules when selecting and preparing foods:
Stay away from processed foods with a lot of chemical additives, at least when shopping for baby. Not only are such foods usually less nutritious than fresh, but the chemicals they contain may be of questionable safety. Though many common food additives are believed to be safe, others may not be. Be particularly wary of foods containing any of the following: brominated vegetable oils (BVO), butylated hydroxyanisole (BHA), butylated hydroxytoluene (BHT), caffeine, monosodium glutamate (MSG), propyl gallate, quinine, saccharin, sodium nitrate and sodium nitrite, sulfites, and artificial colors and flavors. Considered questionable are carrageenan, heptyl paraben, phosphoric acid, and other phosphorus compounds.
Though it makes sense to limit chemicals in your family’s diet when you can, fear of additives and chemicals can so limit the variety of foods your family eats that it can interfere with good nutrition. It’s important to remember that a well-balanced, nutritious diet, high in whole grains and fruits and vegetables (especially cruciferous ones like broccoli, cauliflower, and Brussels sprouts, and those high in vitamin A, such as green leafies and deep yellows), will not only provide the nutrients needed for growth and good health, but will also help to counteract the effects of possible carcinogens in the environment. So limit chemical intake when practical, but don’t drive yourself and your family crazy in the process.
It’s not just those handfuls of dirt from the park, or the dried flowers on display at the department store, that you need to keep out of baby’s mouth. There are plenty of foods (besides those listed on page 315), as well as drinks and other ingestibles that don’t belong in a baby’s diet, including:
Unpasteurized (raw) dairy products, juice, or cider. These can contain dangerous bacteria that can cause life-threatening illness in babies and young children.
Smoked or cured meats, such as hot dogs, bologna, and bacon. Usually high in fat and cholesterol as well as in nitrates and other chemicals, these should be served to babies rarely, if at all. (Cold cuts must always be heated until steaming to protect against the bacterial infection listeria.)
Smoked fish, such as smoked salmon, trout, or whitefish. There are two reasons why these shouldn’t find their way onto the high chair tray: One, they’re usually cured with nitrites to protect freshness. Two, they may be contaminated with listeria.
Any fish that might be contaminated with high levels of mercury, including shark, swordfish, king mackerel, and tilefish, as well as any fish from contaminated waters. Because tuna can also contain a fair amount of mercury (canned contains somewhat less than fresh), the amount of this fish a baby or young child eats should also probably be limited (though there’s not yet a formal ruling from the FDA or the EPA). It’s also recommended that a child’s intake of freshwater fish caught recreationally (as opposed to commercially) be limited to 2 ounces (cooked weight) a week. Your local department of health should be able to give you more information on which fish are safe and which aren’t at any particular time in your community, which should never be served to a child and which should be served only occasionally. For the latest on fish safety, you can also contact the FDA at 800-332-4010 or <www.cfsan.fda.gov>, or the EPA at 800-490-9198 or www.epa.gov/ost/fish.
Raw fish, such as in sushi. Young children don’t chew well enough to destroy the parasites that might dwell therein and that could cause serious illness; they’re also at greater risk from the illnesses themselves.
Foods or beverages, such as coffee, tea, cocoa, and chocolate that contain caffeine or related compounds. Caffeine can make a baby jittery; worse, it can interfere with absorption of calcium and can replace worthwhile dietary items.
Imitation foods, such as nondairy creamers (full of fat, sugar, and chemicals) and fruit “drinks” (which contain little actual juice, unneeded sugar, and, often, plenty of chemicals).
Herbal teas. These often contain substances that can be dangerous for babies. For example, tea made from Chinese star anise—a traditional treatment for colic in some cultures—has been shown to cause seizures, jitteriness, irritability, and vomiting in infants. Use only those recommended by your baby’s doctor.
Alcoholic beverages. No one would put this in a baby’s regular diet, but some do think it’s fun to give a baby a sip—a dangerous game, because alcohol can be poisonous for a baby. Same goes for putting a drop on baby’s gums during teething.
Tap water that is contaminated with lead, PCBs, or any other hazardous material. Check with your local EPA or water department, or have your water tested privately if you suspect contamination.
Vitamin supplements, other than those designed for infants (and given as directed by your baby’s doctor). Excessive vitamins can be particularly harmful to babies, whose bodies don’t process them as quickly as do adult bodies.
Don’t serve up artificial sweeteners to your baby. Plenty of questions about the safety of some sweeteners still need to be answered. Though some appear to be safe (especially sucralose, or Splenda, a low-calorie sweetener made from sugar), since they’re designed for calorie restriction (and babies should never be on a calorie-restricted diet), they don’t have a place in a baby’s diet.
Buy organic, when possible. (But don’t worry when it’s not possible, since risks from chemical residues are generally believed to be small.) Locally grown produce in season tends to be safest, since large quantities of chemicals aren’t needed to preserve it during shipping or storage. Also safer are foods with heavy protective husks, leaves, or skin (such as avocado, melon, and bananas) that keep out pesticides. Produce that doesn’t look perfect (has blemishes) may also be safer, since it’s usually chemical protection that keeps foods looking beautiful. In most instances, U.S. produce is less contaminated than imported.
Peel fruits and vegetables that aren’t certified organic before using (particularly those with a waxy finish), or thoroughly wash with water and, possibly, an all-natural produce wash (but rinse very thoroughly), scrubbing with a stiff brush when feasible. Don’t try the brush on lettuce or strawberries; do use it on apples and zucchini.
Keep your child’s diet as varied as possible once a wide range of foods has been introduced. Variety adds more than spice to life—it adds a measure of safety (not to mention better nutrition by providing a wide range of vitamins and minerals from different sources). Instead of always offering apple juice, vary the juices from day to day (apple one day, grape the next, apricot the third, and pear the fourth). Vary the protein foods, cereals and breads, and fruits and vegetables you serve, too. Though this won’t always be easy—many young children fall into, and won’t be coaxed from, food ruts—it’s important to make the effort.
Limit your baby’s intake of animal fat (other than that in dairy products or formula), because the fat is where chemicals (antibiotics, pesticides, and so on) are stored. Trim fats from meat; trim fat and skin from poultry. And keep portions of beef, pork, and chicken small. When possible, choose dairy products that are labeled “organic”; choose meat and poultry raised without chemicals or antibiotics.
Follow the guidelines in the box above for fish safety.
ORGANIC FOODS—GROWING AVAILABILITY
Organically grown foods appear regularly in health food stores and most supermarkets, and since the USDA passed new federal standards regulating them and establishing clear labeling criteria, it’s easier to spot them on the shelves. But for many shoppers, it still isn’t possible to fill their shopping carts with only the purest organic foods. Not enough of them are being produced, and what is available is often expensive.
As demand grows, so will supply. And as supply grows, the prices will continue to drop. Fortunately for young children and their parents, more and more jarred organic baby foods are already available. Everything a fledgling eater can desire can be found in an organic line, from beginner cereals and strained fruits, vegetables, and meats, to combination main courses. Even organic formula is now available.
Buying organic, when you can find what you need and can afford the often higher prices, serves a couple of purposes. One, of course, is protecting your family from unwanted chemicals. The second purpose is to encourage markets to stock organic products—from dairy products to meat to baked goods to produce. If organic foods are not available in your neighborhood, ask your supermarket or produce store to carry them; consumer interest will help bring the supply up and the prices down. And, again, don’t worry if you can’t find or can’t afford organic produce—just wash thoroughly and peel when possible.
Once they have been introduced into baby’s diet, feed foods that are believed to have protective effects against environmental toxins. These include cruciferous vegetables (broccoli, Brussels sprouts, cauliflower, cabbage), cooked dried peas and beans, foods rich in beta carotene (carrots, pumpkin, sweet potatoes, broccoli, cantaloupe), and those high in fiber (whole grains, fresh fruits and vegetables).
In taking your precautions, don’t forget to keep your perspective. Even by the gloomiest estimates, only a small percentage of cancers are caused by chemical contamination of foods. The risks to your child’s health from tobacco, alcohol, poor diet, lack of immunization, or ignoring safety precautions in the car are considerably greater.
See, keeping your baby safe isn’t so tough after all.
1. Babies who spend little time on their stomachs during playtime may reach this milestone later, and that’s not cause for concern (see page 210).
2. Occasionally, breastfed babies can have an allergic reaction to nuts, egg, or cow’s milk protein from their mothers’ diet that has been passed through the breast milk (see pages 97 and 177).
