If it seems like nowadays there’s someone in every school classrooms with a food allergy, that’s because almost 1 in 12 kids today have food allergies – and 1 in 32 have serious food allergies, serious enough to have already caused the child to have symptoms like trouble breathing, a drop in blood pressure, or shock, according to a 2011 study of almost 40,000 US households.

Peanuts, milk, and shellfish were the top three foods kids were allergic to at any age. Milk was number one from birth to age 2, peanuts from 3 to 13 years old, and shellfish beyond the 14th birthday. Rounding out the top nine allergic foods throughout childhood, in order, were tree nuts, eggs, fish, strawberries, wheat, and soy.

More than half of those who were allergic to peanuts or tree nuts had experienced a severe reaction. Severe reactions were also found in more than 40% of those allergic to shellfish, soy, or fish. Among the top allergy foods, strawberries were the least likely to have triggered a severe reaction – but it still happened in 1 in 5 strawberry-allergic kids.

Other new findings: peanuts and fish both caused allergies in more kids than previously reported. And among kids allergic to any food, more than 30% had multiple food allergies. As one might guess, those with multiple food allergies were even more likely to have had a severe reaction (makes sense, but not demonstrated before).

Allergies can come and go. Food allergies were common in children of every age, but most common from age 3 to 5. Severe food allergies, on the other hand, got more common with age and were more than twice as likely in kids 14 and over than in those 2 and under.

Gupta RS, Springston EE, Warrier MR, Smith B, Kumar R, Pongracic J, and Holl JL. “The Prevalence, Severity, and Distribution of Childhood Food Allergy in the United States.” Pediatrics. Jul 2011; 128(1):e9-17.

Last year an advisory panel of independent experts convened by the FDA recommended that the FDA ban popular over-the-counter oral decongestants, antihistamines and cough suppressants for children under the age of 6 with colds. Recently large drug companies have voluntarily decided to advise parents not to give these medicines to kids under 4.

I agree with the American Academy of Pediatrics, many medical experts and many consumer advocates who support this ban. It’s not that we want to remove effective remedies for young children with colds. The problem is that they have not clearly been proven to be better than a placebo at treating cold symptoms at that age. These medicines were originally approved by the FDA based on studies conducted in adults. It turns out that children’s bodies before puberty behave differently than adults. These medicines appear to be both less effective and more risky.

In the absence of proven benefit, concern over their uncommon severe side effects becomes more important. Most of serious problems come from children unintentionally taking too much – often from mixing medicines that share an ingredient in common. And rarely children experience serious side effects even at the recommended dose. By giving them to tens of millions of children, it’s no surprise that around 7,000 children end up in ERs every year related to the medicines.

By volunteering to add a warning to drug labels, perhaps the drug companies hope that this will prevent the FDA from taking stronger action. With the voluntary label warnings by the drug companies, they don’t take any of their medicines off the market. The only change is that the small print that gives a dose for children age 2 to 6 will now give a dose for children 4 to 6 instead. Whatever their reasons, I don’t see this as a positive step for children’s health – but I do think it has a silver lining. Perhaps the media attention to this announcement will help people to learn that these medicines don’t work better than placebo for young kids.

When deciding about when to recommend a medication, I use something I call the Green Ratio (no ‘e’ on the end of Greene). It’s an ecological approach. The ratio is the Targeted Benefit over the Time-Tested Risk. You want the ratio to be high. If there is no proven benefit to the child, why tolerate any risk of serious side effects? On the other hand, if a remedy is gentle, with almost no risk of serious side effects, I might be willing to try something that may or may not help.

The Green Ratio for many popular over-the-counter cough and cold medicines is worst for kids under age 6, and I don’t recommend them for children under age 6.

Even for older children before puberty, I don’t see clear proof of benefit compared to a placebo for most kids. But because the risks are lower, I’m somewhat less concerned about parents trying them. Although benefit hasn’t been proven over large groups of kids, they may even work for some individual children – different people respond to medicines differently. There may be a targeted benefit for specific children.

Question: Who took cough and cold medicines the most?
Answer: Kids aged 2 through 5 years – the very group for whom the FDA expert panel voted to ban them last year (although the FDA has not done this as of August 2008).

Who took cough and cold medicines the second most?
Kids under age 2, for whom they are even more dangerous.

In general, about 1 in 10 kids were treated with an over-the-counter cough and cold medicine on any given day in the US, according to a study published in the August 2008 Pediatrics. About 1 in 3 kids have taken cough and cold medicines in any given month.

We’ve known that cough and cold medicines for children have been widely advertized and widely sold, but before this study, based on 1999-2006 data, we didn’t have a clear picture of how frequently they were being used. Their use is decreasing, but still quite widespread. Among the various ingredients, decongestants were the most often taken, followed by antihistamines and then cough medicines, but multi-drug combinations were by far the most common.

Almost 90,000 calls to poison control centers each year, more than 7,000 ER visits each year, and about 3 unnecessary deaths each year have been linked to over-the-counter cough and cold medicine use in children. And they are not effective.

With scant evidence that these medicines help young children any better than would a placebo, and with mounting evidence of reasons for concern, I hope the FDA does move to ban them for kids under age 6 before this cough and cold season soon gets underway.

^{Vernacchio LV, Kelly JP, Kaufman D, and Mitchell AA. Cough and Cold Medication Use by US Children, 1999-200: Results From the Slone Survey. Pediatrics. August 2008. 122:e323-329.}

MRSA infections now kill more Americans than does HIV/AIDS, according to a CDC report in the October 17, 2007 Journal of the American Medical Association. Most of these infections are in adults over age 65, but infections with resistant bacteria are on the rise, even among healthy children. The important bacteria for parents to know about are called Staph. Aureus,  often called just “staph”.

These bacteria are very common on the skin and in the noses of healthy kids. Sometimes they slip through a break in the skin and cause infections. In fact, they are among the most common causes of skin infections – usually just little pimples or boils.  In hospitals, though, the infections were sometimes lethal, because the bacteria became resistant to major antibiotics. Now resistant staph is showing up in schools. When the bacteria become resistant to antibiotics, they can spread rapidly through communities. In some places in the US, MRSA infections (methicillin-resistant Staph. aureus) now account for 75 percent of staph infections in otherwise totally normal children. These infections are more common where kids are in close skin contact, such as in daycare centers and in contact sports (perhaps daycare is a contact sport!). On average, they are more common in kids under 2 than they are in teens.

Most of these infections can be successfully treated, especially if caught early, but occasionally they progress to serious or even fatal infections.  This week, another previously healthy high school student died from MRSA. How do you know if your child might be infected? MRSA infections usually begin as infected bumps on the skin, or what people might think are just infected “insect bites” or “spider bites”. They usually start at a place with a scrape, bite, or cut – or a place on the body covered with hair. The American Academy of Pediatrics says in their 2007 MRSA management alert that any suspected insect bite or spider bite should now be considered MRSA until proven otherwise. And how do you prove otherwise? Have a doctor drain some of the pus from the middle of the lesion and send it for culture. In a previously healthy child, if the infection is small it can usually be treated with drainage (possibly adding a MRSA- appropriate oral antibiotic – TMP/SXT, clindamycin, or doxycycline for kids over age 8 – but NOT one of the typical antibiotics used to treat skin infections). If the wounds are large, though, or the children are very sick, they may need to be hospitalized for emergency treatment.

How do you help prevent MRSA? Keep scrapes and cuts clean and covered. Keep the hands clean with soap and water or instant hand sanitizers. Take a soapy shower after sports. Minimize sharing towels, razors, or other objects that rub the skin (and clean shared toys often).  But perhaps the most important take home message is just to be on the lookout for superbugs at school. Be sure your doctor knows about any red, swollen, or painful bumps that may be filled with, or draining, pus. Early treatment usually does the trick.

More than 10 percent of American kids between the ages of 2 and 5 are already overweight or obese, according to the January 2005 annual statistics report of the American Heart Association. This number comes from an analysis of children measured in 2002, and is the latest data available. It’s almost half-again as many as were overweight in 1994, when 7 percent of American preschoolers were already in weight trouble.

Given that most American children are hooked on junk food before age 2, these numbers do not surprise me. But they do alarm me. It’s more than a million overweight kids before they start elementary school. And the number swells to 4 million during the elementary school years. Our kids deserve to be taught to truly enjoy eating healthy amounts of healthful foods, and to enjoy, to revel in, active play – preferably before the bad habits even start. That’s one of the reasons I wrote From First Kicks to First Steps. These healthy habits are easiest for parents to teach before the toddler years, and can even be started before the baby is born!

Would you rather your kindergarten-age child had blood lead levels 3 times the safe limit (like children living next to a lead smelters – double the level of most kids with lead toxicity), or would your rather your child snored? The impact on the brain is about the same, according to a provocative study in the October 2004 Journal of Pediatrics.

Sleep-disordered breathing (SDB) is the name given to a spectrum of sleep breathing patterns ranging from mild snoring to obstructive sleep apnea. In this study of more than 200 children, those with SDB scored significantly worse on tests of behavior, memory, intelligence, and ADHD than did their peers – even if they only had snoring without sleep apnea.

Given the poor scores on wide variety of tests, it’s not surprising that their school performance also suffered. Thankfully, treating snoring at this age seems to improve performance. The authors suggest that 3 to 6 years old is the peak period where snoring is harmful to development, and also the peak age at which treating snoring can make a big difference in behavior and learning. Overall, about 1 in 10 children this age snore.

The heavier kids are during the toddler, preschool, and school years, the greatest the chance they have of developing cancer as young adults, according to a study published in the November 1, 2004 International Journal of Cancer. Researchers in the Boyd Orr Study of Diet and Health in Pre-War Britain measured the heights and weights of more than 2,000 children between the ages of 2 and 14 during 1937-1939. These children were then followed for 50 years, into their 50.s and 60.s – the longest follow-up we have for study like this.

A total of 380 of the people developed cancer (188 men and 192 women). Those who developed cancer were more likely to have been obese as children. Body mass index (BMI), calculated from the heights and weights, is the best measure of obesity. For every standard deviation increase in BMI in the children, there was a 9 percent increase in cancer risk, after accounting for other factors. For smoking related cancers, the risk increased 30 percent for every standard deviation increase in BMI.

Right now, we are raising the most obese, the most sedentary generation in history. Unless cancer risks change dramatically, we are heading for an unprecedented cancer epidemic in the years ahead. Taking action to prevent or reverse obesity in your children is one of the greatest gifts you can give as a parent.

What’s your three-year-old’s blood pressure? August 2004 guidelines from The National High Blood Pressure Education Program Working Group on Children recommend that blood pressure screening begin at age 3 for all healthy children, and even earlier for those at high risk (such as those who were born early, small, or who are taking medicines that might raise the blood pressure). Childhood is the key time to influence future heart health.

As obesity and physical inactivity become more common in children, so do hypertension and pre-hypertension. There are also important connections between high blood pressure and snoring, type 2 diabetes, and high cholesterol. If a child has one, consider whether the others may be present or on the way. Hypertension and pre-hypertension are silent stalkers. Unless the blood pressure is checked, you won’t be alerted to their presence. The earlier these silent conditions are identified and addressed, the healthier your child (and future adult) will be. So, what’s a normal blood pressure in children? At age three, you don’t want your child’s blood pressure to be above 107/69. At the kindergarten physical, you don’t want the blood pressure to be above 109/69. At age 10, it’s time to make a change if your child’s blood pressure is above 117/75.

I love watching young children at play. Kids are designed with energy to burn. Unfortunately, though, they’re not burning it!

Preschoolers are so naturally full of curiosity and energy that it’s almost a cliché – but today’s screen-time activities have taken that curiosity and funneled it into a sedentary lifestyle. A disturbing study in the July 17, 2004 Lancet followed the daily routines of three-year-old children, and found that they spent most of the day sitting around.

Television, videos, computers, and video games can be quite mesmerizing. The kids in the study average only 20 to 25 minutes a day in active play – only about a third of the (conservative) 60 minutes a day usually recommended. I recommend that kids get at least two hours a day of active play to truly thrive now and in the future. We are raising the most sedentary generation of children in the history of our planet. If we want to improve the health of our children we urgently need to help them make a habit of active fun.

Most parents would be surprised to learn that in the US the 6th leading cause of death among children under 4 years old is the flu and its complications. We know the elderly are at risk; but so are young children. Overall 114,000 Americans each year are hospitalized with the flu, and more than 36,000 die (mostly those over age 65) – yet the flu is often prevented easily with an annual flu vaccine.

The CDC has launched their 2003-2004 campaign to be sure those at high risk receive the vaccine. This includes healthy children age 6 to 23 months and children over 24 months who have a chronic health problem such as asthma, diabetes, sickle cell, heart disease, kidney disease, or an immune disease (including HIV/AIDS). It also includes all kids on chronic aspirin therapy. Sadly, only 9 to 22 percent of children with asthma get the vaccine each year!

The flu is extremely contagious, and often spreads from children to seniors (those at the highest risk). Vaccination may not only protect your child, but also others you love. Parents most often hesitate either because the flu seems mild (it can be, but it can also make children very, very sick) or because they are afraid their children will get the flu from the shot (they won’t). Children can have flu-like symptoms as side effects.  I suspect that those who get the side effects might also be more likely to have serious cases of the real flu.

The flu season is just winding down in the Southern Hemisphere, where it was moderately severe. Influenza A (H3N2) was the main strain. It can be quite nasty, but is targeted in this fall’s vaccine. The best time to be vaccinated in the Northern Hemisphere is October or November. Children over age 5 can use the nasal spray instead of the shot. Supplies of the vaccine look to be plentiful this year.