Germs may play role in sudden baby deaths

A baffling phenomenon known as sudden infant death syndrome is one of the leading causes of death for children under 1. Now, researchers say they may have found a contributing factor: bacteria.

They found potentially dangerous bacteria such as Staphylococcus aureus and E. coli in nearly half of all babies who died suddenly and without explanation over a decade at a London hospital. Their findings are in Friday's Lancet medical journal.

"This may be another piece to the puzzle,'' said Marian Willinger, a SIDS expert at the U.S. National Institute of Child Health and Human Development who was not connected to the British study.

The researchers cautioned, however, that while the bacteria were found in the SIDS babies, that does not necessarily mean the bugs were responsible. Bacterial infections have long been suspected by some doctors to play a role in SIDS.

"We don't know whether it's a cause or if it's identifying another potential risk factor,'' said Dr. Nigel Klein, a professor at the Great Ormond Street Hospital for Children, where the study was conducted, and one of the paper's authors.

He said that the higher level of bacteria might be evidence of another condition that killed the baby, such as a room that was too hot or had poor ventilation. Or it may have been coincidental.

A SIDS diagnosis means that no other cause of death can be found in an otherwise healthy infant who dies suddenly, usually in their sleep. In the United States, SIDS kills more than 2,000 infants every year.

The researchers used autopsy samples from 470 infants who died suddenly and unexpectedly between 1996 and 2005. They found dangerous bacteria in 181 babies, or nearly half of the 365 whose deaths were unexplained. There were similar bacteria in about a quarter (14 of 53) of the babies who died of known causes, excluding those who died of bacterial infections.

Bacteria found in lungs, spleens
Most of the bacteria were detected in the babies' lungs and spleens.

At birth, mothers transfer some of their antibodies against infection to their babies. But when babies are from 8 to 10 weeks old, the maternal antibodies have nearly run out and the babies typically have not started producing enough of their own.

That could make them particularly vulnerable to bacterial infections, said James Morris, a pathologist at the Royal Infirmary in Lancaster, who co-authored an accompanying commentary in the journal.

SIDS typically strikes when babies are between 8 and 10 weeks old.

"The study is a good indicator that certain bacteria might be involved in causing sudden infant deaths,'' he said.

Willinger suggested that bacterial infections in infants might simply aggravate other risk factors for SIDS, such as smoke exposure or babies sleeping on their stomachs.

"The bacteria in combination with other co-factors might push these babies over the edge,'' she said.

Recommendations for preventing SIDS include putting babies to sleep on their backs and avoiding putting too many blankets on them.

A Pollutant with an Effect on Baby's Gender?

By now, most of us have heard of PCBs. Polychlorinated biphenyls, or PCBs, are man made chemicals. The chemicals were widely used in industry for decades. In 1976, the federal government in the US banned the production of the chemicals.

However, there is still significant contamination of PCBs in the environment. This is largely due to contamination resulting from improper disposal of the chemicals. PCBs have been found in newborn babies and breastmilk, over thirty years after the chemicals were banned.

One of the problems with PCBs is they are not soluble in water. This results in a process known as bioaccumulation. They bind to sediment at the bottom of rivers and are eaten by small fish. These fish hold the chemicals in their tissues and are eaten by larger fish, birds and people. The accumulation up the food chain results in high levels in organisms higher on the food chain, including people.

The result can be high levels of PCBs in the bodies of pregnant women. When high levels of PCBs are present, problems such as reduced IQ and developmental disorders can occur in the babies. Over a lifetime, problems ranging from skin conditions to cancer are the result of repeated exposure.

Researchers have discovered another possible effect of exposure to PCBs, a higher rate of giving birth to female children. A study published in the Journal of Environmental Health studied women in the San Francisco Bay area who were exposed to high levels of PCBs in the 1950s and 1960s. These women were found to have a much greater chance of having female children.

The women in the study who were exposed to PCBs were found to be 33 percent less likely to have male children, compared to women not exposed to the chemicals. The higher the levels of PCBs in the blood, the greater the chance the woman had a female child.

Researchers aren't sure why there appears to be a connection. There are several theories. One is that high levels of PCBs may increase fertilization rates for female sperm. Another theory is the presence of high levels of PCBs may result in a higher risk of loss of male embryos, resulting in more female live births. Further research is planned in this area.

Common Questions About Pregnancy Safety

During your pregnancy you're bound to have many pregnancy safety questions about how your lifestyle, or certain substances you're exposed to either at home or work, could affect you. Get the answers to your pregnancy safety questions and learn some pregnancy safety tips that will keep mom and baby health and happy.

Is hair coloring safe during pregnancy?
There's no proof that the chemicals in hair dyes cause birth defects, miscarriages, or any other complications — nor are there reliable studies that prove these substances are safe. Because we don't yet know enough about these chemicals, some doctors say that pregnant women should avoid hair dyes (or at least minimize their contact with them), especially during the first trimester.

Highlighting or streaking your hair, both processes that involve less scalp contact, may be safer. Vegetable-based products, such as henna, are also considered safe.

If you decide to color your hair yourself, wear plastic or latex gloves to minimize absorption of the chemicals through your skin, and don't leave the product on your scalp any longer than necessary.

Is painting the nursery safe during pregnancy?
It's probably safer to let someone else paint the nursery for you. All paints contain chemicals, and few have undergone safety studies focusing on exposure during pregnancy. If you do decide to help paint the nursery, be sure there is good ventilation (keep the windows open), wear gloves and protective clothing, and don't eat or drink in the room you're painting.

Some studies suggest that women who work with solvents called glycol ethers, present in some paints, have an increased risk of miscarriage. Other solvents are also suspected of causing miscarriage and possibly birth defects. Oil-based paints and paint thinners contain more solvents than do their water-based counterparts — but all paints contain numerous ingredients of unknown safety.

Is exposure to insecticides a threat during pregnancy?
So far there is little evidence that exposure to these chemicals at common levels significantly increases the risk to your fetus. All insecticides are poisons, however, and some studies have suggested that high levels of exposure to them might increase the chance of birth defects. If you must have your home or yard property treated:

    * Don't apply insecticides yourself. Local application of a liquid or powder where it's needed is safer than widespread spraying.
    * Clear away all food, dishes, and utensils from areas to be treated, including cabinets or drawers.
    * Stay out of the house while it's being treated and for at least several hours thereafter.
    * If insecticides are used outdoors, close all windows and turn off the air conditioning so that fumes won't be drawn into the house.
    * Wear rubber gloves when gardening to prevent skin contact with residues of insecticides or herbicides (weed killers) that have been used on your property.

Is secondhand smoke a threat during pregnancy?
Some studies suggest that the babies of nonsmoking women who are regularly exposed to cigarette smoke are at an increased risk of intrauterine growth retardation, low birth weight, subtle deficits in learning and behavior, and, possibly, certain childhood cancers.

A 1998 study suggests that a father's smoking may also cause genetic changes in a baby that have been linked to childhood leukemia. Because the chemicals present in passive smoke are at least potentially harmful to your baby, try to avoid exposure to cigarette smoke.

Are hot tubs and saunas safe during pregnancy?
The March of Dimes recommends that pregnant women and women attempting to conceive avoid hot tubs and saunas. A number of studies have suggested that a body temperature of 102 degrees or higher during the first four weeks after conception increases the risk of neural tube defects, problems with closure of the baby's spinal cord or skull.

Besides steering clear of hot tubs and saunas, avoid exercising strenuously on hot days. And contact your health-care provider if you develop a fever over 100 degrees.

Is dental work safe during pregnancy?
Generally, yes. Local anesthesia isn't thought to have any negative effect on the fetus. If possible, postpone x-rays or surgeries requiring general anesthesia until after your baby is born. If an x-ray is necessary, be sure that the dentist knows you're pregnant so he can shield your abdomen to minimize the radiation that reaches the fetus.

Is aspartame safe during pregnancy?
Aspartame — commercially called NutraSweet and found in many diet sodas, sugar-free foods, and the sugar substitute Equal — appears to be safe for most pregnant women. However, women with an inherited inborn error of body chemistry called phenylketonuria (PKU) should avoid foods and drinks containing aspartame.

In 1998, the Food and Drug Administration (FDA) approved a new sweetener called sucralose for use in a wide variety of foods and drinks. This sweetener, which is made from sugar, is safe for everyone, including pregnant women, according to the FDA. Still, since the long-term effects of sucralose are not yet known, it's best to opt for natural sweeteners when possible.

Is computer use a threat during pregnancy?
During the 1980s, there were anecdotal reports of clusters of birth defects and miscarriages among computer users. But since then, a number of studies have provided reassurance that computer monitors (also called video display terminals or VDTs) are safe to use during pregnancy. In 1991, a large study by the government's National Institute of Occupational Safety and Health reported that women who work at VDTs all day have no more risk of miscarriage than women with similar jobs who don't use VDTs.

Are electromagnetic fields a threat during pregnancy?
Beginning in 1979, a few studies reported that children who are exposed to high levels of electromagnetic fields (EMFs) #151 produced by power lines and electrical appliances — may be at an increased risk of childhood leukemia. While other studies refute this, further research into health risks possibly associated with exposure to EMFs continues.

Researchers from the National Cancer Institute (NCI) reported in 1998 that mothers of children with the most common form of leukemia were slightly more likely than the mothers of unaffected children to have used electric blankets, mattress pads, or heating pads during pregnancy. While studies of EMFs continue, you might want to avoid using electric blankets while pregnant.

Food Allergies among Children

Dealing with an adult or even an older child with food allergies is not hard, but have you ever tried telling a two-year child that he cannot have a certain food because it will make him sick? Ryan (not his real name) was almost two years old when he discovered he was allergic to most of the things he liked the most - milk, cheese, ice cream, and apple juice.

From the time he was born, Ryan had not been able to sleep through the night. His mom knew something was wrong, but the pediatrician did not agree with her, claimed he was lactose intolerant, and told her to keep him away from dairy products. Ryan still woke up continually during the night, and his mom knew something was not right with her son. He had constant diarrhea, diarrhea that was so bad it would leave red blotches on his bottom. He would cry when his mom used baby wipes to clean him so she learned to use a plain wet washcloth. He would pass gas; sometimes his gas was so severe he would cry as he passed it. Other family members thought Ryan was a colicky baby, but, again, his mom's instinct told her that wasn't his problem.

One and a half years later, Ryan was tested for food allergies. Sure enough, just as his mom thought, Ryan was allergic to casein, which is a milk protein, egg whites, apples, oat and peanut. Ryan's mom used the avoidance diet. She took away all of the foods he ate and gradually put him back on one food for two or three days to see if he reacted to that particular food. If he did react, then he would have to avoid that food. If he did not react, then he was free to eat that food as he normally would.

As it turned out, Ryan was not able to eat any dairy products and any products with apple so his mom bought soy products and avoided anything with apple as an ingredient. She was constantly reading labels because she discovered casein was not only in dairy products but in such items as Ranch Doritos and sausage. She also had to make sure that anyone - daycare, school and other caregivers -, who fed Ryan anything, knew of his food allergies as well. His main reaction was more of a digestive one - stomach aches, gas, and diarrhea - than of a respiratory one. Once the foods were eliminated, Ryan was finally able to sleep through the night, and he no longer had diarrhea and redness on his bottom.

After nearly five years of sticking to that avoidance diet, Ryan is now finally able to eat like a regular child. By avoiding the foods to which he reacted, Ryan outgrew the allergies and is happily able to enjoy the foods he longed to eat.

How to Find a Good Baby Doctor

Locating a Doctor

Before baby arrives, you'll need to enlist a pediatrician. But how do you find a good one? The key to success is to get started early, preferably during your second trimester. You may not feel up to the search later, and you don't want to be scrambling around for referrals during the last few weeks of your pregnancy.

So where do you start? Arm yourself with the telephone book, suggestions from your childbirth educator, friends, or family with ties to the medical community. Take the time to meet with prospective physicians before baby is born. Ask questions and familiarize yourself with any health-care provider before committing your child's health to her. Don't feel shy about asking for interviews with several pediatricians. Your child's health is important, and choosing the right pediatrician should be on the very top of your to-do list.

A Checklist of Questions

Print out this checklist using the "Print" function on your Web browser, and take it with you for each visit with a prospective pediatrician.

Before the Interview

____ Do gender, age, or other factors make a difference to me?

____ Is the office convenient to my home, workplace, or child-care provider?

____ Are the office hours conducive to my family's needs?

During the Interview

____ Are evening and weekend office hours available?

____ What do I do in case of an emergency?

____ How are after-hours patient needs handled?

____ Is this office a participant in my health-care plan?

____ How are billing and insurance claims handled?

____ To which hospital(s) does this physician have privileges?

____ If this doctor is part of a group, how likely is it that you will see her personally and how often will you see a physician's assistant or other caregiver?

____ How does the office handle phone calls for advice? Is a nurse or other medical professional available for questions?

After the Interview

____ Do I feel I can build a cooperative relationship with this physician?

____ Is the staff cooperative and helpful?

____ Does the doctor respect my feelings regarding circumcision, immunizations, feeding, and use of medications? Are our philosophies similar?

Originally published in American Baby magazine, January 2001.

All content here, including advice from doctors and other health professionals, should be considered as opinion only. Always seek the direct advice of your own doctor in connection with any questions or issues you may have regarding your own health or the health of others.

Parenting style reflected in how children are fed

Parents' general approach to raising their children is often apparent in how they manage their kids' diets -- suggesting that efforts to control childhood obesity need to consider family dynamics, according to researchers.

In a study of 239 parents of first-grade children, researchers found that parents who were strict in general also tended to have an "authoritarian" approach to their children's eating -- banning certain foods, for instance, or using pressure to get them to eat fruits and vegetables.

Similarly, parents who were generally "permissive" in what they let their children eat tended to have similar parenting styles.

In between these two groups, the researchers found, were "authoritative" parents. These parents set limits on their children's diets, but often used more positive approaches -- like following a healthy diet themselves -- to get their kids to eat well.

The findings show that parents' general styles are important in their children's diets, according to Dr. Laura Hubbs-Tait and colleagues at Oklahoma State University in Stillwater.

They also suggest that efforts to help obese children lose weight are "not likely to be successful" unless the underlying family dynamics are addressed, the researchers report in the Journal of the American Dietetic Association.

In general, experts recommend that parents use positive approaches to get their children to eat right -- by setting a good example with their own diets, for example.

But in this study, both the strict and permissive parents typically failed to serve as good dietary role models for their children.

"Due to the infrequency of healthy eating modeled by both permissive and authoritarian parents," the researchers write, "food and nutrition professionals might encourage both to begin more healthy eating -- for the sake of their own health and that of their children."

A lack of attention to family dynamics may help explain why child obesity treatment is often less than successful, according to Hubbs-Tait and her colleagues.

"Food and nutrition professionals who are implementing dietary change or obesity treatment programs need to include more complex approaches to behavioral change that include parenting styles and family dynamics," they conclude.

Why Babies Puts Everything in His Mouth

I always wonder Why all Babies Puts Everything in his Mouth. Put an object in front of a baby, and you can bet he'll put it in his mouth. Toys, balls, pens, car keys—nothing is out of the question. Your urge may be to curb mouthing, but researchers say that it can be a critical path to learning. That juicy toy just might be providing your child with new sensory information about shape, texture, weight, and size.

A recent study has one more benefit to add to the list: the chance to practice making new sounds, such as consonants like d and k, says psychologist Mary Fagan, coauthor of the study and a postdoctoral researcher at the Indiana University School of Medicine in Indianapolis. Because consonants are made by pressing lips together or touching the tongue to the top of the mouth, gnawing on a safe object automatically gives the baby's tongue the shape changes it needs to create certain sounds.

But that's not to say that anything should go in a child's mouth. Keep all small objects, like buttons and pennies, out of reach: Anything that can fit through a toilet-paper tube is too small. You'll also want to double-check that none of your baby's favorite chompers have been recalled for lead paint or other safety issues (visit cpsc.gov for a list). Some good bets for safe and satisfying mouthing include plastic keys, stacking rings, rattles, and good old fingers and hands.

Kids and Cholesterol

In the past few years there's been a steady push to get kids with very high cholesterol on statins, the LDL-lowering drugs already found in the medicine cabinets of 13 million Americans. Now the American Academy of Pediatrics--the nation's most influential group of pediatricians--has gotten in on the act. On Monday it released new guidelines suggesting that docs should start testing overweight kids or those with a family history of heart disease for high cholesterol at age two--and that they should consider prescribing statins as early as age eight. Four of the drugs are already FDA-approved for use in kids. The new AAP recommendations are sure to be controversial, especially since the drugs' long-term effects on kids are unknown.

Newsweek's Mary Carmichael spoke with Peter Belamarich, a pediatrician at Children's Hospital at Montefiore Medical Center in New York City, who has prescribed statins to some kids but takes issue with the new guidelines. Excerpts:

You've written that "lifestyle modification is the cornerstone of cardiovascular prevention in childhood." Isn't that what the AAP should be focusing on? Are you worried that these guidelines will encourage doctors to prescribe drugs to kids with high cholesterol instead of changes in diet and exercise?
Dr. Peter Belamarich: No. If people read them carefully, they say that the statin medications should be targeted to very high-risk children. The kids who would qualify for drug treatment based on these guidelines are less than one percent of all children. Ninety-nine percent of children and adolescents still should be treated with what's called therapeutic lifestyle change: limiting animal fat, increasing physical activity to an hour a day.

So what is your problem with the AAP guidelines?
My criteria for what justifies medication are higher than the guidelines'. I tend not to start medication until after age ten. And I don't treat very high-risk girls as aggressively as I would treat very high-risk boys, for two reasons. One, women develop cardiovascular disease slightly later in life, so there's less urgency in initiating treatment in childhood. Two, there are data suggesting that statins can interfere with growth and development in utero, so we should not use them in anybody who might get pregnant unintentionally, and that would include adolescents.

What does "very high-risk" mean regarding children and heart disease? It's not like these kids are having heart attacks at 10.
I think the children who most deserve these meds, if anybody does, are children who have a direct family history of premature coronary heart disease in young relatives who are under 40 or 50. Often, those kids have very low HDL, or "good," cholesterol levels. So I tend to treat boys with low HDL, a positive family history, and "bad" LDL levels in the 190s [milligrams per deciliter]. What makes it tricky is that prescribing these drugs in kids requires a lot more clinical judgment than it does in adults. In adults, there are scores that put all the risk factors together--hypertension, age, smoking, diabetes, sex, LDL/HDL ratio--and in middle-aged men, you can predict the risk of heart attack in the following year using those scores. We don't have that kind of score for children. So we have to use our judgment.

Are there enough data to support the use of statins in kids?
There's unequivocal data that if you've had a heart attack you should be on statins. There's no question, this is a fantastic drug. It decreases your risk of another heart attack by 30 percent or more and it's very safe. But that's for middle-aged people at high risk. We need studies with a logical progression showing it's okay to treat young adults, then very high-risk adolescents, and then extremely high-risk children younger than that. And that data is not all there. Some people would say, look, we're in the midst of an epidemic and it's really unethical to wait to start treatment. And other people, such as myself, would say that we need to be absolutely sure that what we're doing is safe before we do it.

Tips for researching safe daycare options

There are plenty of issues to consider when it comes to daycare. You can skimp on some issues more than others. For example, a caring staff and first aid knowledge is more important than a large array of toys. However, there are some issues your chosen daycare should never skimp on. Pay the daycare you’re considering a visit and make sure of the following:

1. All babies are put to sleep on their back, each and every time. Staff should be trained on this important issue.

2. That the baby to staff ratio is at least 3 babies per 1 adult caregiver. If your baby is over the age of one year, but under three years the staff ratio should still be at least 4 babies per 1 adult. Ask about subs as well.

3. All staff who work with the children should be trained in infant CPR and first aid. No exceptions.

4. There’s a sick day policy you can live with. Some daycares won’t allow a baby in if he’s had a fever, until 24 hours have passed. I like this rule, because I knew my Cedar wouldn’t be exposed to other baby’s illnesses as often, but if 24 hours is too long, look for a center with more flexible rules, or even a sick room. Just be aware that if sick kids are allowed at the center, your child will also be exposed when he’s healthy.

5. There’s an open door policy. If parent’s aren’t welcomed happily at ANY time in the daycare area, then it’s a major red flag. Staff should seem fine with you being there, and not anxious or annoyed. If staff seem odd, or they have a more closed door policy, I’d look elsewhere.

Child Safety advice

The weather is getting warmer, pools are opening for the season, and schools are letting out. All this combines to increased outdoor time for children and their families. Keep these outdoor safety tips in mind to ensure your summer is a safe and pleasant one.

For Older Children

* The first, and best, line of defense against the sun is covering up. Wear a hat with a three-inch brim or a bill facing forward, sunglasses (look for sunglasses that block 99 percent to 100 percent of ultraviolet rays), and cotton clothing with a tight weave.
* Stay in the shade whenever possible, and avoid sun exposure during the peak intensity hours — between 10 a.m. and 4 p.m. The risk of tanning and burning also increases at higher altitude.
* Sunscreen with an SPF (sun protection factor) of 15 should be effective for most people.
* Reapply sunscreen every two hours, or after swimming or sweating.
* Some self-tanning products contain sunscreen, but others don't, so read the labels carefully. In addition, tanning oils or baby oil may make skin look shiny and soft, but they provide no protection from the sun.

For Young Children

* Babies under 6 months of age should be kept out of the direct sunlight. Move your baby to the shade or under a tree, umbrella or the stroller canopy.
* Dress babies in lightweight clothing that covers the arms and legs, and use brimmed hats.
* If you cannot keep your child covered and in the shade, sunscreen can be applied. However, before covering your baby with sunscreen, be sure to apply a small amount to a limited area and watch for any reaction.

Heat Stress in Exercising Children

* The intensity of activities that last 15 minutes or more should be reduced whenever relative humidity, solar radiation and air temperature are high. One way of increasing rest periods on a hot day is to substitute players frequently.
* At the beginning of a strenuous exercise program or after traveling to a warmer climate, the intensity and duration of exercise should be limited initially and then gradually increased during a period of 10 to 14 days to accomplish acclimatization to the heat. When such a period is not available, the length of time for participants during practice and competition should be curtailed.
* Before prolonged physical activity, the child should be well-hydrated. During the activity, periodic drinking should be enforced, eg, each 20 minutes, 5 oz of cold tap water or a flavored salted beverage for a child weighing 88 lbs, and 9 oz for an adolescent weighing 132 lbs, even if the child does not feel thirsty. Weighing before and after a training session can verify hydration status if the child is weighed wearing little or no clothing.
* Clothing should be light-colored and lightweight and limited to one layer of absorbent material to facilitate evaporation of sweat. Sweat-saturated garments should be replaced by dry garments.

Pool Safety

* Never leave children alone in or near the pool, even for a moment.
* Make sure adults are trained in life-saving techniques and CPR so they can rescue a child if necessary.
* Surround your pool on all four sides with a sturdy five-foot fence.
* Make sure the gates self-close and self-latch at a height children can't reach.'
* Keep rescue equipment (a shepherd's hook — a long pole with a hook on the end — and life preserver) and a portable telephone near the pool.
* Avoid inflatable swimming aids such as "floaties." They are not a substitute for approved life vests and can give children a false sense of security.
* Children are not developmentally ready for swim lessons until after their fourth birthday.
* Swim programs for children under 4 should not be seen as a way to decrease the risk of drowning
* Whenever infants or toddlers are in or around water, an adult should be within arm's length, providing "touch supervision."

Lawn Mower Safety

* Try to use a mower with a control that stops the mower from moving forward if the handle is let go.
* Children younger than 16 years should not be allowed to use ride-on mowers. Children younger than 12 years should not use walk-behind mowers.
* Make sure that sturdy shoes (not sandals or sneakers) are worn while mowing.
* Prevent injuries from flying objects, such as stones or toys, by picking up objects from the lawn before mowing begins. Use a collection bag for grass clippings or a plate that covers the opening where cut grass is released. Have anyone who uses a mower wear hearing and eye protection.
* Make sure that children are indoors or at a safe distance well away from the area that you plan to mow.
* Start and refuel mowers outdoors, not in a garage or shed. Mowers should be refueled with the motor turned off and cool.
* Make sure that blade settings (to set the wheel height or dislodge debris) are changed by an adult, with the mower off and the spark plug removed or disconnected.
* Do not pull the mower backward or mow in reverse unless absolutely necessary, and carefully look for children behind you when you mow in reverse.
* Always turn off the mower and wait for the blades to stop completely before removing the grass catcher, unclogging the discharge chute, or crossing gravel paths, roads, or other areas.
* Do not allow children to ride as passengers on ride-on mowers.The weather is getting warmer, pools are opening for the season, and schools are letting out. All this combines to increased outdoor time for children and their families. Keep these outdoor safety tips in mind to ensure your summer is a safe and pleasant one.

For Older Children

* The first, and best, line of defense against the sun is covering up. Wear a hat with a three-inch brim or a bill facing forward, sunglasses (look for sunglasses that block 99 percent to 100 percent of ultraviolet rays), and cotton clothing with a tight weave.
* Stay in the shade whenever possible, and avoid sun exposure during the peak intensity hours — between 10 a.m. and 4 p.m. The risk of tanning and burning also increases at higher altitude.
* Sunscreen with an SPF (sun protection factor) of 15 should be effective for most people.
* Reapply sunscreen every two hours, or after swimming or sweating.
* Some self-tanning products contain sunscreen, but others don't, so read the labels carefully. In addition, tanning oils or baby oil may make skin look shiny and soft, but they provide no protection from the sun.

For Young Children

* Babies under 6 months of age should be kept out of the direct sunlight. Move your baby to the shade or under a tree, umbrella or the stroller canopy.
* Dress babies in lightweight clothing that covers the arms and legs, and use brimmed hats.
* If you cannot keep your child covered and in the shade, sunscreen can be applied. However, before covering your baby with sunscreen, be sure to apply a small amount to a limited area and watch for any reaction.

Heat Stress in Exercising Children

* The intensity of activities that last 15 minutes or more should be reduced whenever relative humidity, solar radiation and air temperature are high. One way of increasing rest periods on a hot day is to substitute players frequently.
* At the beginning of a strenuous exercise program or after traveling to a warmer climate, the intensity and duration of exercise should be limited initially and then gradually increased during a period of 10 to 14 days to accomplish acclimatization to the heat. When such a period is not available, the length of time for participants during practice and competition should be curtailed.
* Before prolonged physical activity, the child should be well-hydrated. During the activity, periodic drinking should be enforced, eg, each 20 minutes, 5 oz of cold tap water or a flavored salted beverage for a child weighing 88 lbs, and 9 oz for an adolescent weighing 132 lbs, even if the child does not feel thirsty. Weighing before and after a training session can verify hydration status if the child is weighed wearing little or no clothing.
* Clothing should be light-colored and lightweight and limited to one layer of absorbent material to facilitate evaporation of sweat. Sweat-saturated garments should be replaced by dry garments.

Pool Safety

* Never leave children alone in or near the pool, even for a moment.
* Make sure adults are trained in life-saving techniques and CPR so they can rescue a child if necessary.
* Surround your pool on all four sides with a sturdy five-foot fence.
* Make sure the gates self-close and self-latch at a height children can't reach.'
* Keep rescue equipment (a shepherd's hook — a long pole with a hook on the end — and life preserver) and a portable telephone near the pool.
* Avoid inflatable swimming aids such as "floaties." They are not a substitute for approved life vests and can give children a false sense of security.
* Children are not developmentally ready for swim lessons until after their fourth birthday.
* Swim programs for children under 4 should not be seen as a way to decrease the risk of drowning
* Whenever infants or toddlers are in or around water, an adult should be within arm's length, providing "touch supervision."

Lawn Mower Safety

* Try to use a mower with a control that stops the mower from moving forward if the handle is let go.
* Children younger than 16 years should not be allowed to use ride-on mowers. Children younger than 12 years should not use walk-behind mowers.
* Make sure that sturdy shoes (not sandals or sneakers) are worn while mowing.
* Prevent injuries from flying objects, such as stones or toys, by picking up objects from the lawn before mowing begins. Use a collection bag for grass clippings or a plate that covers the opening where cut grass is released. Have anyone who uses a mower wear hearing and eye protection.
* Make sure that children are indoors or at a safe distance well away from the area that you plan to mow.
* Start and refuel mowers outdoors, not in a garage or shed. Mowers should be refueled with the motor turned off and cool.
* Make sure that blade settings (to set the wheel height or dislodge debris) are changed by an adult, with the mower off and the spark plug removed or disconnected.
* Do not pull the mower backward or mow in reverse unless absolutely necessary, and carefully look for children behind you when you mow in reverse.
* Always turn off the mower and wait for the blades to stop completely before removing the grass catcher, unclogging the discharge chute, or crossing gravel paths, roads, or other areas.
* Do not allow children to ride as passengers on ride-on mowers.