One of the most important parts of keeping your child’s mouth healthy is to take that mouth for regular dental visits, at least every 12 months throughout life. Not only will this keep your child’s mouth its healthiest, but the dentist can be the first one to notice the clues of important systemic diseases, even as serious as AIDS, so that early treatment can prevent later complications.

The American Academy of Pediatrics recommends starting regular dental visits at age three. The American Academy of Pediatric Dentistry and the American Dental Association recommend the first visit at age one. I recommend a first visit by the age of two (and at any point earlier if there are any dental questions or concerns) mainly to make sure your dentist can screen for baby-bottle tooth decay before too much damage is done. If your pediatrician or family practitioner is observant and concerned about oral health, waiting till the end of the recommended spectrum should be fine.

Pick a dentist who seems great with kids. The dental office in our building has a great rocking horse, video games and a wall where shooting stars fly through space. If you invest a little silliness into making visits to the dentist fun, your little ones will be more likely to enjoy dentists and practice what they preach.

As you did when choosing an ob/gyn, you want to find a pediatrician who is top-notch medically. How much better if he or she is also on the journey to an environmentally sustainable perspective on pediatrics!

This may be the first time you have selected a pediatrician; if you al­ready have children, you may have an established relationship with their pediatrician—or you may have inherited a treasured family doc from when you were a child. In any case, here are five representative questions you may want to ask politely to gauge physicians’ thoughts on things green:

1. What advice do you give to new parents about introducing solid foods? If their first suggestion is to begin with processed white rice flour cereal or processed conventional jarred foods, they may still be working from a twentieth-century industrial mind-set. To learn more, continue the conversation by asking for their advice about introducing whole grains, fresh tastes, or organic foods. Green pediatricians are often conscious of nutrition and care about establishing the nutritional habits of today’s babies in ways that are better than those of previous generations.
2. How do you recommend treating ear infections? If they say that all ear infections should be treated with antibiotics, they may be behind the times. The Academy of Pediatrics now teaches that, in many situations, ear infections will heal better on their own, without antibiotics (but pain relief should be given for the ear pain). (See Chapter Five for discussion of this newer approach.) The first steps toward sustainability that pediatricians often make in their practices are to reduce the un­necessary use of antibiotics.
3. How do you recommend treating eczema in babies? If their first response is to use steroids or prescription drugs, they may not yet be thinking green. Often, a better first approach is to reduce exposure to eczema triggers or to gently moisturize the skin. Green-oriented physicians are more likely to treat the cause rather than just the symptoms and will opt for the gentlest treatment possible.
4. What kind of baby shampoo do you recommend? If they mention a conventional brand, they may not yet be thinking about sustainable and pure products. If they mention any of a number of greener op­tions, such as Baby Avalon Organics, Burt’s Bees, or Tom’s of Maine, that’s a good sign that they are at least aware of a variety of greener op­tions for common baby products.
5. Do you buy organic foods for your own family? Or What kind of car do you drive? The answers to these types of questions will help you get a sense of their own green lifestyle outside the practice of medicine. Often physicians will start thinking about green issues for their own lives before they start integrating them into their practices. If they have made even small steps in this regard, they may be more supportive of your efforts to raise your baby green.

In addition to conversations with prospective pediatricians, you can also get some insight into the green potential of a medical practice by making an office visit simply to observe. What kind of lighting is used? (Incandescent bulbs are very nongreen.) What kinds of cleaners are used? (A strong scent of bleach or ammonia is the tip-off that green cleansers are not yet in use.) Are there any babies in the waiting room who are wearing cloth or hybrid diapers? (This is a good sign that other parents with environmental concerns have chosen this doctor.)

And from the comfort of your home, you can learn a lot about some physicians and their practices by looking at their Web sites — many pediatricians have them now, but not all — and by talking to other parents.

Almost half of the pregnant women in the in the United States receive prescriptions from their doctors for medications that the FDA has determined have no evidence to suggest safety during pregnancy, or worse, that evidence has shown can harm the baby developing within, according to a report from the Agency for Healthcare Research and Quality published in the August 2004 American Journal of Obstetrics and Gynecology.

Nearly 5 percent of pregnant women are prescribed medicines with definite risks to their babies . risks that outweigh any possible benefits. The FDA categorizes drugs as A, B, C, D, or X, depending on what we know about their effects during pregnancy. Category A medicines are most likely to be safe. There is also evidence that category B drugs are probably safe. Category C medicines have no evidence of human safety, and might have evidence of reproductive harm in animals. Category D medicines are known to be dangerous to babies, but might have enough of a benefit to mothers that their use may be justified. Category X medicines are known to be dangerous, with risks that outweigh any possible benefit. They should not be used during pregnancy.

In the United States each year, more than a quarter of million pregnant women are prescribed category D or X medicines . often without their knowing about the dangers. This number is probably an underestimate, because it does not take into account pregnancies that end in the first trimester. Double check that any prescription or over-the-counter medicine you take during pregnancy is safe for you and your baby. According to this study, the most common category D and X medicines taken by pregnant women are: doxycycline (an antibiotic with brand names like Adoxa, Atridox. Doryx, Doxy-Caps, Monodox, and Vibramycin), atenolol (Tenormin), secobarbital (Seconal), lorazepam (Ativan), clonazepam (Klonopin), alprazolam (Xanax), propylthiouracil, diazepam (Valium), tetracycline, nortriptyline (Pamelor), temazepam (Restoril), ergotamine (Bellamine, Bellaspas, Bel-Tabs, Cafergot, Duragal, Eperbel, Spastrin, or Wigraine), testosterone, flurazepam (Dalmane), triazolam (Halcion), warfarin (Coumadin), simvastatin (Vytorin, Zocor), misoprostol (Arthrotec, Cytotec), atorvastatin (Caduet, Lipitor), and fluvastatin (Lescol).* The list of common category C drugs would be far longer. Medicines in any category might be wonderful to take when one is not pregnant, but women who are expecting deserve to be alerted to the risks during pregnancy.

*Note: This is not an exhaustive list of category D and X medicines.

Women who take folate during pregnancy appear to reduce the chances that their children will later develop acute lymphoblastic leukemia (ALL). A study published in the December 8, 2001 issue of The Lancet found that children whose mothers did not take supplemental folate during pregnancy were more than 2.5 times more likely to eventually develop ALL.

Cancer prevention can now be added to the prevention of neural tube defects as good reasons to take folate during pregnancy. Prenatal vitamins are more than just a nice idea. They solidly contribute to the health of children.