Many of the regulations that allow dairy products to carry the label “certified organic” revolve around farming practices. In general, organic milk should come from cows that eat only organic food and are not enhanced with hormones, antibiotics or other chemicals.

In February 2010, the USDA tightened its definition of organic milk to include stricter regulations about the pasture access. The new guidelines define organic milk as milk from a cow that grazes on pasture at least four months out of each year, with at least 30 percent of the feed coming from grazing. The old rules simply stated that animals had to have “access to pasture.” Ranchers must also have a plan to protect soil and water quality.

When breastfeeding women rely on organic milk vs. regular milk, their babies benefit from up to 36% higher levels of the heart-healthy essential fatty acid CLA (conjugated linoleic acid)¹.

Conventional milk contains an average of 2.5 pesticides, according to a USDA study of 788 milk samples in 2005.

The Organic Milk Suppliers Cooperative sponsored an independent study that found that organic milk contained an average of almost 70 percent more heart-healthy Omega 3 essential fatty acids than conventional milk. Other studies have revealed higher levels of other nutrients as well, such as vitamin E and beta-carotene.

Another study showed that the incidence of eczema in young children was reduced by 36 percent when children consumed organic dairy products.

The benefits of buying organic dairy products go beyond nutrition. More than 200 million acres of farmland in the US are dedicated to growing feed for livestock. Choosing organic dairy products creates a market for farms that avoid pesticides and other farm toxins.

If you need or want to avoid dairy products, organic soy milk, yogurt and other soy products are nice alternatives that allow you to reap the benefits of milk’s best nutrients while still choosing organic.

Today at our annual meeting in Boston, the American Academy of Pediatrics doubled the recommended amount of vitamin D that children get each day to 400 IU, in response to mounting evidence of the life-long health benefits of getting plenty of the sunshine vitamin.

I applaud this move, and have felt for some time that the old 200 IU recommendation was too low. Taking the vitamin daily will be important for many kids, because they do not get enough from their sun exposure and diet. Over the summer, research showed an astonishing forty percent of healthy babies and toddlers were not getting enough – and the same was true of American teens.

The more closely we look at vitamin D, the more we learn about how important this sunshine vitamin is to both short and long-term health for children. Exciting research has linked getting abundant vitamin D to helping to prevent asthma, eczema, diabetes, and cancer – among other things.

It’s become more difficult to get enough vitamin D in recent years because kids spend more time indoors, wear more sunscreen (appropriately), eat less tuna (because of mercury concerns), and drink less vitamin D-fortified milk (in favor of sweetened drinks with less nutrition). It would take a quart of milk a day to get the levels now recommended.

Eczema is a common skin condition in children, and has been getting more common in recent decades, now affecting as many as 1 in 3 babies in some parts of the world. We know that heredity plays a big role in a child’s odds of getting eczema, but the recent rapid rise of eczema suggests that something in the environment can trigger eczema or protect from eczema. What role does food play?

Many people still suggest delaying introducing eggs, milk, or fish to babies in an attempt to prevent eczema or other allergies – even though there is not good evidence to support this approach for otherwise healthy children born on time.

Now, researchers in Sweden have followed more than 8000 families to see if there was a correlation between the timing of certain foods and eczema. As expected, they found that having a family member with eczema raises the odds considerably, especially if it is a sibling (up 87 percent) or a mom (up 40 percent).

Starting fish before 9 months cut the odds of eczema considerably (down 24 percent). This study didn’t find any differences based on when children started eggs or dairy products.

Other studies have suggested that starting dairy early, choosing organic dairy, giving omega-3 fats, and giving probiotics may also reduce the risk of eczema.

Alm B, Åberg N, Erdes L, Möllborg P, Pettersson R, Norvenius G, Goksör E, and Wennergren G.Early introduction of fish decreases the risk of eczema in infants. Archives of Disease in Childhood.. 2008; doi:10.1136/adc.2008.140418.

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.

Kids who have low levels of vitamin D have a higher chance of asthma attacks, according to a study presented at the 2008 annual meeting of the American Academy of Allergy, Asthma, and Immunology. This study is preliminary, at best, but the results are consistent with a growing number of papers looking at how vitamin D might help prevent or reverse asthma and eczema. This is in addition to earlier studies suggesting that adequate vitamin D might slash the risk of some cancers and neurologic diseases. Vitamin D, the sunshine vitamin, can be formed when the skin is exposed to sunlight or can be obtained in the diet.

One recent study in kids suggested that being in the sun for just 15 minutes at a time 2 or 3 days a week, or taking a vitamin D supplement (e.g. 1000 IU/day), might decrease the odds of developing eczema and reduce eczema flare-ups in those who already have it. Other investigators even wonder if vitamin D deficiency is one of the explanations for the asthma epidemic in children in recent years.

Many children get suboptimal levels of vitamin D. It’s one of the Greene 13 – the 13 vitamins and minerals I’m most concerned about kids missing the mark nutritionally.

While these specific vitamin D associations are not yet proven, the connection makes sense to me. We know that vitamin D acts on both the smooth muscle cells in the airways and can help with some T cell problems in the immune system.

Either way, it seems to me a good idea to make sure your young child is getting an adequate amount of vitamin D (the USDA Dietary Reference Intake is 200 IU daily throughout childhood, and I suspect that level will be raised in the next five years). This could be all the more important if your child has asthma or eczema, or either of those conditions runs in your family.

Get ready for some surprising recommendations. Eczema, asthma, and food allergies are all on the rise in children, each having more than doubled in the last several decades. This rapid increase has lead to many differing recommendations on the timing and selection of foods offered to babies, to err on the side of caution before scientific studies were completed.

A January 2008 evidence-based policy from the American Academy of Pediatrics turns some of this conventional wisdom on its head.

For preventing allergies, when is it best to start solids for babies?

Previously, it was recommended to delay solids until 6 months if possible, and to limit the choices to things like rice cereal, oatmeal, or barley if they must be started sooner. The new policy reports that solids should not be started before 4 to 6 months, but that there is no convincing evidence that delaying any solids beyond this period helps to prevent allergies.

In fact, with some foods, starting on the earlier side may even help. What about highly allergic foods such as eggs, peanuts, milk, or fish? The previous guidelines were that in allergic families, whole cow milk should be delayed until 12 months of age; eggs until 2 years; and nuts, peanuts, and fish until age 3. The new guidelines say that there is no convincing evidence that delaying even eggs (yolks or whites), fish, milk, nuts, and peanuts beyond 6 months prevents allergies!

A few things to keep in mind: First, this discussion is only about preventing asthma, eczema, and food allergies. There are other reasons to delay certain foods (e.g. honey to prevent botulism, whole peanuts to prevent choking). Second, if a child does show signs of an allergic reaction, removing the possible culprits from the diet is wise — these guidelines are about preventing, not treating allergies. Third, these new guidelines are not the final word, they are just the current state of the science. Other benefits of particular timing may one day be uncovered. Finally, I am a fan of introducing a wide variety of healthy foods to babies between 6 and 12 months old,  but I prefer organic foods for babies in the first year when possible. Particularly, if I were going to give some of the more allergenic foods like eggs, or cheese, milk, or nuts, I would be even more inclined to choose organic.

AAP Clinical Report: Greer FR, Sicherer SH, Burks AW, and the Committee on Nutrition and the Section on Allergy and Immunology. Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas. Pediatrics2008; 121: 183-191.

Zutavern A, Brockow I, Schaaf B, von Berg A, Diez U, Borte M, Kraemer U, Herbarth O, Behrendt H, Wichmann H, Heinrich J (The LISA Study Group). Timing of Solid Food Introduction in Relation to Eczema, Asthma, Allergic Rhinitis, and Food and Inhalant Sensitization at the Age of 6 Years: Results From the Prospective Birth Cohort Study LISA. Pediatrics 2008; 121: e44-e52

The breezy television ads for certain steroid-free eczema treatments have always bothered me. While they don.t say anything untrue, they do incorrectly imply that this treatment is gentler and safer than the more commonly used hydrocortisone. In March 2005 the United States FDA issued a public health advisory about a potential cancer risk from the topical use of Elidel cream or Protopic ointment, two potent immunosuppressive drugs.

Not surprisingly, I’ve been contacted by many worried parents who have rubbed one of these medicines into their children’s skin. Those who have already used these medicines needn’t panic, but those who are considering using them should think twice first, to be sure the benefits are worth the risks.

At least 20 percent of all children in the U.S. battle with eczema, including more than 1.5 million kids under age 2 with eczema at any given moment. In recent years, more than 5 million people have been treated with Elidel or Protopic. Since 2000-2001, when Elidel and Protopic obtained approval by the FDA, thirteen cases of lymphoma and sixteen cases of skin cancer have been reported in people being treated with these drugs.

We don’t know that the medicines caused these cancers. But we do know that in at least three species of animals (mice, rats, and monkeys), both drugs are linked with lymphomas and skin cancers when used topically at high doses for long periods. And we know that Prograf (the oral or injected form of Protopic that is used to suppress the immune system in organ transplant cases) causes lymphomas and skin cancers when taken internally.

Usually when the drugs are rubbed on children’s skin, not much is absorbed into the body. But high levels of the drugs have been found in the blood of some children being treated topically with either drug. We won’t know the long-term safety of these drugs for at least a decade, but the FDA is acting now to create a black box warning label to warn of the cancer risk – the strongest warning carried on medicines.

The FDA recommends that Elidel and Protopic not be used in children before their second birthday. (These drugs have never been approved for use in children under two, but I know many infants and toddlers treated with them). In older children, they recommend that Elidel and Protopic only be used if the children are unresponsive to or are intolerant of other eczema medicines, such as the steroid creams and ointments. If Elidel or Protopic is used, only the minimum amount necessary should be applied (higher doses increase the cancer risk in animals), and the medicines should only be used for short periods of time to stop an eczema flare-up. They are not recommended for continuous use.

Both Elidel and Protopic work very well as eczema treatments. They are valuable medicines. Used at low doses and for short periods, they may prove to be quite safe for most children. But aggressive advertising, both to health care providers and to consumers, has created the false impression that these drugs are safe enough to use without a second thought. Not so. Perhaps the combination of the warmth of the ads and the chill of the FDA warning will create a more balanced impression.

It’s peak allergy season in many areas, with spring trees still pumping out millions of grains of pollen each day and the summer grasses already starting to contribute their share. Sneezing, running nose, and itching – itchy eyes, itchy nose, itchy throat – wouldn’t it be great to be able to prevent allergies before they even got started. Preventing asthma and allergies is possible, according to a study in the June 2003 issue of Thorax.

Children at high risk for asthma and allergies were recruited in 1990 to be part of this study. Half of them went about life as normal, and the other half had a low-allergy diet as infants – starting with breast milk (with moms on a low-allergy diet) or Nutramigen formula (no milk or soy-based formula). This group of families also undertook significant measures to avoid exposure to house dust during infancy. Both groups were followed for years, and those in the normal group were 4 to 5 times more likely to develop asthma, allergies, or eczema. Prevention worked! The authors conclude that avoiding allergens during infancy is what made the difference. I wonder, though…

Allergies happen when the body is tricked into thinking that harmless particles are dangerous invaders. The immune system tries to get rid of these allergens by sneezing them out, flushing them out with tears or mucus, or dislodging them with nose rubbing. It tries to prevent them from getting into the lungs by constricting the airways. These are all normal responses to toxins and viruses. They are allergies if the trigger is not really a problem.

To me it makes sense that infants’ avoiding those foods that commonly trigger allergies would result in fewer allergies. The immature gut allows intact proteins to slip into the body and trigger an immune response. Babies are built to start life with only one food, and then to have only a limited variety for a number of months. I believe that the hypoallergenic diet helped the children in the study.

Avoiding inhaled allergens, though, may be another story. Other studies have shown that babies who are exposed to dogs and cats before the first birthday, for example, are far less likely to develop allergies later. It seems to me that the nose is designed to detect changes (which is why you often no longer notice even very strong odors if you are around them long enough). It seems to me that a baby’s nose learns what is “normal” to have around them in the air during the first year or so, and then begins to consider some later arrivals as dangerous invaders – the body develops an allergic response to them. Perhaps the allergy prevention would have been even stronger without the mattress covers! Once allergies are present, avoiding the allergens – whether they are pollens, pets, dust, foods, or anything else – is a powerful way to reduce the allergies. Avoiding one item you are allergic to can even reduce your allergies to something else (some people are only allergic to certain foods during the pollen season, for instance). But for babies who have not yet developed allergies, too clean may make matters worse.

There may have been other differences between the two groups in the study. One half certainly worked harder and paid more attention to allergy issues. We still have a lot to learn. What’s exciting about this breakthrough study is that it demonstrates that preventing allergies, asthma, and eczema is truly possible. Now we just have to learn how best to do it.

Baby soft, smooth skin in young children could be partly the result of what their mothers ate during pregnancy and nursing, according to a study reported in the May 31, 2003 issue of The Lancet. Beneficial bacteria, such as those found in active culture yogurt, acidophilus milk, or probiotic supplements appear to be a gentle way to provide lasting protection against eczema.

For four years, investigators in this study have followed more than 100 children who were at high risk to develop eczema. All of them had a strong family history of eczema. Their pregnant mothers were given capsules that either contained active cultures of beneficial, probiotic bacteria or an empty placebo. For the first six months after delivery, the nursing mothers continued to take these capsules. Bottle-fed babies got either the active cultures or the placebo in their bottles. The results were striking.

Throughout infancy, toddlerhood, and the preschool years – up to the 4th birthday, so far — those children who had been in the probiotic group were significantly less likely to develop eczema. There was a 43 percent reduction in eczema over the placebo group.

Probiotics have been shown to benefit the developing immune system in a number of ways, from preventing and treating infections to preventing allergic reactions such as eczema.

Dr. Greene’s Answer:

Nine months is okay for yogurt for most babies. Yogurt is a wonderful food. It is rich in calcium, and the active cultures have many health benefits. Kids with a strong family history of milk-protein allergies (not just lactose intolerance) may want to wait, however.

There have been a few studies suggesting that yogurt helps eczema and other similar conditions. The beneficial bacteria in yogurt seem to help by bringing the immune system to a good, middle level of alertness. It boosts immunity if it is low, and calms the immune system down if it is overexuberant.

As with any new food, the best way to tell if your child is allergic is to only introduce one new food at a time over a three- to five-day period, then watch for any symptoms: tummy upset, worsening rash, crankiness. Start your child with about two to four ounces a day. There are some yogurts designed specially for babies–it’s wonderful. (I sometimes eat it as a treat for myself!) Some yogurts are nonfat or low-fat–good for adults, but the full-fat is best for babies. For a low sugar alternative to flavored yogurts, try mixing plain yogurt with a small amount of baby food fruit or pureed fresh fruit.