Interestingly, babies tend to suck more vigorously when a new flavor is introduced into their mothers’ diet (even if the mothers don’t notice the change in nursing, researchers can measure it). The babies’ bodies seem eager to learn new flavors. When that flavor has been repeated a few times, nursing returns to normal, suggesting that babies have indeed learned the new flavor.

Though the ability of breast milk to provide babies with exposures to a series of specific flavors is exciting, perhaps even more exciting is the ability of the variety of flavors in breast milk to help kids be more accepting of vegetables in general.

One interesting study looked at breastfed babies versus exclusively formula-fed babies and how quickly they learned to enjoy their first pureed vegetable. The babies were given either peas or green beans every day for ten days. Both groups of babies could learn to like the veggies with repeated exposures. But the breastfed babies learned to like them faster, even though their mothers hadn’t focused on either of these flavors during nursing. And after the full ten days of the experiment, the breastfed babies still tended to eat more of the veggies than did their counterparts with limited flavor experience.

Learn more in Feeding Baby Green Chapter 6, The First Months
Sullivan, S. A., and Birch, L. L. “Infant Dietary Experience and Acceptance of Solid Foods.” Pediatrics, 1994, 93: 271–277

I remember, not long ago, seeing many children with ear infections every day I was in the office – children that were often up screaming the night before. Today it’s not surprising to go an entire day in clinic without seeing a single one.

Visits to doctors’ offices for ear infections more than doubled between 1975 and 1990, from about 10 million per year to about 25 million per year. They kept increasing through about 1994, when they started to decline steadily by about 5% per year, now at their lowest level in three decades.

Over thirteen years, office visits for ear infections in kids under age 6 dropped from about 640 visits per 1000 children per year to about 380 visits. The drop for hospitalized children being diagnosed with an ear infection is even steeper. And the annual price tag for ear infection treatment in the US has fallen by about $2 billion.

Why the dramatic disappearance?

Several things have changed since the early 1990s. Air pollution, linked to ear infections, fell significantly after the Clean Air Act of 1990. Breastfeeding, protective against ear infections, increased modestly from less than 2/3 of babies starting on mother’s milk to more than ¾ today. A vaccine that may help prevent some ear infections came into wide use in 2002.

But the strongest link, according to a May 2011 study from researchers at Harvard University, came from a drop in tobacco smoke inside children’s homes. We’ve known since the 1990’s that exposure to second hand smoke causes millions of ear infections every year. In 1993, most US children were still exposed to tobacco smoke in their own home. Today only 14 percent of kids live in a home where smoking is allowed inside – a change big enough to account for the difference.

Four thoughts for responding to this good news.

1. If you smoke, smoke outside.
2. Keep the air in your home fresh. Avoid cleaners with harsh fumes. Consider houseplants to clean the air. Open windows when practical.
3. Given the option, breast feed. After weaning, choose foods that support healthy gut bacteria.
4. If your child does get an ear infection, choose a gentle treatment first, if appropriate. Antibiotics are wonderful, when needed, but each time they are given it makes another ear infection more likely. With more resistant bacteria.

Alpert HR, Behm, I, Connolly GN, Kabir Z. “Smoke-free households with children and decreasing rates of paediatric clinical encounters for otitis media in the United States.” Tobacco Control. May 2011; 20:207-211.

Bhattacharyya N and Shapiro NL. “Air quality improvement and the prevalence of frequent ear infections in children.” Otolaryngology – Head and Neck Surgery. Feb 2010; 142:242-246

A new Harvard analysis has calculated what we could accomplish if 90 percent of babies drank only breast milk for the first six months of life. The starting point for this analysis was a group of ten conditions identified by the lead Federal agency charged with improving the quality, safety, efficiency, and effectiveness of our health care – the Agency for Healthcare Research and Quality (AHRQ). Their data suggest that each of these ten conditions is at least slightly less likely in children who were breast-fed. Right now, only one in eight babies drink only breast milk for the first six months. If we could increase this to nine babies in ten, we would expect to see fewer cases of SIDS, childhood leukemia, type 1 diabetes, necrotizing enterocolitis, hospitalizations for pneumonia or bronchiolitis, childhood obesity, childhood asthma, gastroenteritis, ear infections, and eczema – enough less that we would prevent 911 unnecessary deaths in the US alone each year (more than half of these in babies) and save more than $13 billion each year. Eight babies in ten would still save more than seven hundred lives and more than $10 billion dollars annually.

In other words, we could save an average of $4000 in medical costs for each extra baby where we delay formula to at least six months. To me the take home message of this study is that supporting nursing moms is a wise investment. It’s a smart choice for families, for employers, and for society at large. With health care costs still spiraling out of control, it makes all the more sense to celebrate and support breastfeeding – and to celebrate and support moms and babies whatever feeding choices they make for their family.

Bartick, M. and Reinhold, A. “The Burden of Suboptimal Breastfeeding in the United States: A Pediatric Cost Analysis.” Pediatrics. 2010, (doi:10.1542/peds.2009-1616).

Join me in support of California Bill SB 797. My three minute speech at the State Capitol starts 4 minutes into the rally video.  Actress and environmentalist, Amy Smart speaks next.

Former Surgeon General C. Everett Koop, M.D., once said, “If you don’t have oral health, you’re simply not healthy.” As with many health topics, the basis for a lifetime of good oral health begins when we’re very small.

The earliest threat to your child’s teeth is caused by giving your baby something that might be the right thing, but at the wrong time. Giving a child a bottle at bedtime can result in a condition called baby-bottle tooth decay. Baby-bottle tooth decay is the specific form of severe decay found in the teeth of infants and toddlers who habitually fall asleep with a bottle of milk, juice, or any sweetened liquid in the mouth. I’ve also seen it a few times in babies who fell asleep sucking on a pacifier dipped in honey. It is the most common severe dental disease found in children under three years of age.

Cavities result from the interaction between normal mouth bacteria and carbohydrates in the diet. The sugars are converted to acids as they are fermented by the bacteria. The acid then etches the enamel of the teeth if there is prolonged contact. Saliva helps to prevent cavities by diluting the sugars and by washing the teeth.

When one falls asleep, saliva production decreases rapidly. Swallowing also decreases, and liquids present in the mouth at the time of falling asleep tend to pool for long periods. Giving the bedtime bottle a bit earlier, so that your child is awake for even fifteen minutes after finishing, can significantly protect the teeth.

Unlike adult cavities, which are largely invisible to the untrained eye, baby-bottle tooth decay causes cavities which are easily visible on the front teeth. The top four central teeth are the ones most often affected. Their counterparts in the lower gum, protected by the tongue during sucking and washed by saliva, usually remain sound.

The process of tooth decay is quite gradual. Over time the teeth are weakened. Usually, the enamel is finally breached sometime between 12 and 18 months of age. The cavities first appear at the gum line as subtle, white, decalcified streaks. The process then begins to accelerate. In advanced cases, the crowns of the four upper incisors are completely destroyed, leaving decayed brownish-black stumps which distort the spacing of the permanent teeth. I have seen this way too often.

Even though it may seem loving to offer a bottle for going to sleep, it may be more loving to help him or her to fall asleep in other ways, or by giving a bottle with plain water instead of milk, juice, or sugar-containing liquid.

Like other pediatricians across the United States, today I received an E-Breaking News Alert from the American Academy of Pediatrics concerning news about bisphenol A (BPA), a chemical used in many hard plastic products (including baby bottles and sippy cups) and in the lining of many metal cans (including cans of infant or toddler formula). Now the panel of independent experts convened by the FDA has sharply criticized the previous FDA announcements that BPA is safe for infants and children in common exposure amounts. I agree with this criticism, and while there are many questions that still remain about the effect of BPA on kids, I can’t see a scientific basis for declaring it safe. I recommend that parents take prudent steps to decrease their children’s BPA exposure, such as breastfeeding, using BPA-free bottles, cups, teethers, etc., such as those made by BornFree*, and if formula is used, choosing powdered formula where practical (the BPA is more likely to contaminate a liquid), and avoiding heating any BPA-containing container. I also recommend avoiding phthalates and PVC in plastics. For more information, check out Raising Baby Green.

The FDA now suggests that parents who are concerned should discuss the matter with their pediatricians. While the AAP acknowledges the ongoing controversy about the safety of BPA, it alerted pediatricians and provided them with advice to give parents who want to reduce BPA exposure:

Advice for Parents

Breastfeeding is one way to reduce potential BPA exposure. The American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for a minimum of 4 months but preferably for 6 months. Breastfeeding should be continued, with the addition of complementary foods, at least through the first 12 months of age and thereafter as long as mutually desired by mother and infant.

Parents considering switching children from liquid to powdered formula should be reminded that mixing procedures may differ, so they should pay special attention in preparing formula from powder.

Parents with babies on specialized formulas to address medical conditions should not switch children off those formulas, as the known risks of doing so would outweigh any potential risks posed by BPA.

Concerned parents can take the following precautionary measures to reduce babies’ exposure to BPA:

• Avoid clear plastic bottles or containers with the #7 imprinted on them. Many contain BPA
• Consider using certified or identified BPA-free plastic bottles
• Use bottles made of opaque plastic. These bottles (made of polyethylene or polypropylene) do not contain BPA
• Glass bottles can be an alternative, but be aware of the risk of injury to baby or parent if the bottle is dropped or broken
• Because heat may cause the release of BPA from plastic, consider the following:
  • Do not boil polycarbonate bottles
  • Do not heat polycarbonate bottles in the microwave
  • Do not wash polycarbonate bottles in the dishwasher
  • Risks associated with giving infants inappropriate (home-made condensed milk) formulas or alternative (soy or goat) milk are far greater than the potential effects of BPA

Note: Dr. Greene teamed up with BornFree in September of 2008 to help teach families about important issues concerning BPA, phthalates, and PVC.

There is an intense ongoing debate about the safety of bisphenol –A, or BPA, an ingredient found in many plastic products including many baby bottles and reusable water bottles. BPA acts like a hormone in the human body. More than 90 percent of us do have small amounts of BPA in our bodies.

On the one hand, the plastics industry and the FDA assure parents that BPA is safe. They have no concern, even for babies, at the doses we are commonly exposed to. Meanwhile, scientists in another part of the federal government, NIH’s National Toxicology Program and the Center for the Evaluation of Risks to Human Reproduction, do have some concern that these low doses affect “the brain, behavior, and prostate gland in fetuses, infants, and children at current human expo¬sures to bisphenol A.” They also think it possible that BPA is causing lasting changes in girls’ breasts and that it is causing an earlier age of puberty for girls who are exposed as fetuses, babies, or children “at current human exposures to bisphenol A.”

Many scientists and children’s health advocates with expertise in this issue think that BPA is a real problem. I agree, and choose to avoid BPA-containing products for my family.

A September 2008 study in the Journal of the American Medical Association reports urine BPA testing of over 1400 adults, and found that the higher the level of BPA, the higher the odds of diabetes (about 40 percent higher for every standard deviation above the average). Critics argue that even though BPA exposure and diabetes are associated, it’s not clear which is causing which, or if something else is causing both. And it would be hard to intentionally give humans extra BPA to prove that it made them sicker. But when the same thing has been done to other animals, who otherwise had the same food, exercise, and environment, low-dose BPA exposure similar to what a baby would get drinking from a BPA-containing bottle raises the risk of many health problems time and time again.

Parents should not be alarmed, but should be educated. BPA exposure doesn’t mean a child will have more health problems, but I do believe that it raises the odds of a child’s health problems.

I strongly encourage my patients and their families choose BPA-free products for food preparation, serving, and storage, for baby bottles and water bottles for the whole family, and for objects that go in the mouth, such as pacifiers and teethers. BPA is just not worth the risk.

National Toxicology Program, US Department of Health and Human Services, Center For The Evaluation of Risks To Human Reproduction. Monograph on the Potential Human Reproductive and Developmental Effects of Bisphenol A. September 2008, NIH Publication No. 08 – 5994Lang IA, Galloway TS, Scarlett A, et al. Association of Urinary Bisphenol A Concentration with Medical Disorders and Laboratory Abnormalities in Adults. JAMA. 2008;300(11):1303-1310 (doi:10.1001/jama.300.11.1303)

Getting plenty of DHA, one of the important omega-3 fats found in breast milk, could help to prevent allergies, asthma, and eczema in young children. Dr. Eileen Birch, who has previously studied links between DHA and improved mental and visual development, followed 89 formula-fed children who received formula with or without DHA included.

Her results were presented at the 2008 Pediatric Societies Meeting. Strikingly, more than half of the children fed standard formula throughout the first year had been diagnosed with some form of allergy by the third birthday. By comparison, allergies, asthma, or eczema had been diagnosed in only 26 percent of those who were fed DHA formula for a year.

This small randomized study does not prove that DHA reduces allergies, but the idea is intriguing. Omega-3 fats including DHA are useful in reducing inflammation. Clearly, babies are designed to receive DHA in their diets.

I enthusiastically support the recommendation of the American Academy of Pediatrics that babies breastfeed throughout the first year, when possible, and for as long after that as both the mother and the baby desire. If nursing stops before age two or three, I recommend that babies get DHA from another source.

DHA is a valuable nutrient throughout life, but it is especially important for developing babies from before birth through age three.

One of the reasons I wrote Raising Baby Green was to help parents easily sort through and prioritize which baby products area healthiest and safest for their children. In the book I suggest alternatives for plastics containing Bishphenol A (BPA) – a hormone mimicker found in most baby bottles.

Within the last week BPA has been in the news as a draft report of the federal US Toxicology Program raised concern that BPA could trigger behavior problems and early puberty in children; Canada moved to ban BPA in baby bottles, citing evidence of increased risk of breast cancer, diabetes, and hyperactivity; Wal-Mart, Toys-R-US, and Nalgene announced that they are moving to phase out BPA in many products within a year; and the American Chemical Council announced that they still consider BPA safe for babies.

These are all important developments.

But BPA is found in other places besides baby bottles (such as the linings of food and formula cans). And BPA is only one of the concerning ingredients in some plastics. And plastics are only one group of concerning exposures during pregnancy and early childhood.

But there is no reason to be overwhelmed. By taking control of only a few routes of exposure you can change the impact of the environment on your child: things that go in the mouth, things that go on the skin, and fumes and aromas in the air. In each category, increasing healthy exposures and decreasing concerning ones can help tilt the odds in your child’s favor. Simple changes in each arena can make a big difference, without much cost or effort.

I received a letter expressing concern that some babies do not tolerate formula with added DHA/ARA and that parents are not aware of this possibility. DHA and ARA are important fatty acids, present naturally in breast milk and added to many formulas. About 4 million babies are born in the U.S. each year. Over the last several years, there have been at least 98 voluntary reports of babies who had diarrhea, vomiting, or other symptoms that went away when they switched to a non-DHA/ARA formula.

While this percentage is very low (much less than 0.0025%), the real number is inevitably higher, because many parents wouldn’t report it. On the other hand, whenever I see a baby with diarrhea lasting longer than a week or so, like most pediatricians, I investigate it until either the cause is found or the diarrhea has gone away. Looking at what kids eat or drink is one of the first steps. If your child has ongoing diarrhea or vomiting and is taking a formula with added DHA / ARA you may want to mention it to your child’s doctor.

Even though I’ve been looking, I have yet to see a case of DHA or ARA intolerance myself. Still, I think it is important for parents and physicians to be aware of potential intolerance to make it easier to recognize when it occurs.

Clearly, breast milk is the ideal food for babies. I encourage nursing throughout the first year if possible and as long beyond that as both mom and baby desire. When breast feeding decreases or stops while the brain is rapidly growing, I suggest finding another source for the DHA they are designed to get.