Your Toddler

High Chair Injuries on the Rise

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High chairs were designed to offer older babies and younger toddlers a safer place to eat at the table. They’re usually higher from the ground than a regular chair, so a parent or caregiver (or sibling) can spoon feed the baby comfortably. If there’s an infant in the family, more than likely there’s a high chair in the house.

They’re great when used properly, but when children aren’t secured correctly, accidents can and do happen. In fact, a new safety study reveals that high chair injuries increased 22 percent between 2003 and 2009.

Emergency rooms staffs are treating an average of almost 9,500 high chair related injuries every year – that equates to one injured infant per hour.

"We know that these injuries can and do happen, but we did not expect to see the kind of increase that we saw," said study co-author Dr. Gary Smith, director of the Center for Injury Research and Policy at Nationwide Children's Hospital in Columbus, Ohio.

"Most of the injuries we're talking about, over 90 percent, involve falls with young toddlers whose center of gravity is high, near their chest, rather than near the waist as it is with adults," Smith said. "So when they fall they topple, which means that 85 percent of the injuries we see are to the head and face."

Because the fall is from a seat that's higher than the traditional chair and typically onto a hard kitchen floor, "the potential for a serious injury is real," he added. "This is something we really need to look at more, so we can better understand why this seems to be happening more frequently."

Researchers analyzed data collected by the U.S. National Electronic Injury Surveillance System. The data concerned all high chair, booster seat, and normal chair-related injuries that occurred between 2003 and 2010 and involved children 3 years old and younger.

The researchers found that high chair/booster chair injuries rose from 8,926 in 2003 to 10,930 by 2010.

How are children getting injured? About two-thirds of the children had been either standing or climbing in the chair just before the fall, the study authors noted.

Either chair restraints aren’t working as they should or parents are not using them properly.

"In recent years, there have been millions of high chairs recalled because they do not meet current safety standards. Most of these chairs are reasonably safe when restraint instructions are followed, but even so, there were 3.5 million high chairs recalled during our study period alone," said Smith. However, even highly educated and informed parents aren't always fully aware of a recall when it happens, he noted.

Still, Smith believes that a 2008 Consumer Product Safety Improvement Act will lead to a notable drop in recalls in coming years because it calls for independent third-party testing of children's products before they're put on the market.

The most common diagnosis from a high chair fall is a concussion or internal head injury. This type of head trauma accounted for 37 percent of high chair injuries, and its frequency imbed by nearly 90 percent during the eight years studied.

Nearly 6 in 10 children experienced an injury to their head or neck after a high chair fall, while almost 3 in 10 experienced a facial injury, the study found.

When the researchers looked at falls from traditional chairs, children’s injuries were typically broken bones, cuts and bruises.

While the tray may look like it can block a child from climbing or standing, it’s not a restraint. Children need to be buckled in.

Supervision plays a key role in keeping your little one safe when in a high chair. Many falls happen when a parent or caregiver leaves the room or is not facing the baby.  "Even if a chair does meet current safety standards and the restraint is used properly, there's never 100 percent on this . . . Parents will always need to be vigilant." said Smith.

Some high chairs have wheels, so make sure that if yours does- they are locked when the baby is in the chair.

Also, never place the high chair next to a wall or counter where your baby or toddler can push against it, causing the chair to become unstable.

High chairs are convenient and can be very safe when used properly. Make sure your child is restrained properly and that you can see your baby whenever you move away from the chair.

The study was published online Dec. 9 in Clinical Pediatrics.

Source: Alan Mozes, http://www.webmd.com/parenting/news/20131209/rise-in-us-high-chair-injuries-stuns-experts

Your Toddler

Thumb Sucking

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I admit it – I was a thumb sucker for way too long. My thumb and mouth didn’t part company until I was in first grade. The fear of getting caught during a sleepover at a friend’s house was enough for me to finally call it quits.

It’s normal for babies and toddlers to suck their thumbs. Babies are born with the urge to suck as part of their survival. They also use it as a way to soothe themselves when they feel hungry, afraid, restless, sleepy or bored. Toddlers carry on that natural instinct as they find their way in the world.

By the time children are around four-years-old they’ve typically stopped sucking their thumb and found replacements for self-soothing. Occasionally, children (like myself) will continue to suck their thumb out of habit.

Some experts say that if a child is still sucking their thumb by the age of six, they may be doing so because of emotional distress such as anxiety.

Thumb sucking isn’t a problem under the age of four, but if a child continues- with great intensity- after five or six years old, they could be setting themselves up for dental or speech problems.

Prolonged thumb sucking may cause their teeth to become improperly aligned (malocclusion) or push their teeth outward. If the thumb sucking stops, the teeth most likely will align correctly, but the longer the sucking continues the more likely orthodontic treatment will be needed.

Extended thumb sucking may also cause speech issues such as lisping, inability to say Ts and Ds, and pushing the tongue out when talking. A speech therapist may be needed to help correct these problems.

How do you help your child stop sucking their thumb? It takes a lot of patience.

One place to begin is to pay attention to what triggers the thumb sucking. Does your little one start when they are bored, sleepy, or unsure about something? Redirecting can help. Busy hands help keep thumbs from going into the mouth. Give your child a large stuffed animal to wrap their arms around or have them help hold the book when you are reading to them. Offer a squeezable rubber ball or finger puppets to grasp when they are watching TV.  The key is to offer an alternative at the times you notice they are the most likely to want to suck their thumb.

Ask your child to not suck their thumb in public and gently remind them when you see them doing it. Let them suck their thumb at home, but start the process of being self-aware in public. Kids often unconsciously slip their thumb into their mouth. A reminder helps them notice what they are doing.

You can also start talking to your child about why it’s time to give some thought to stopping. In age-appropriate language explain how thumb sucking is okay for younger children, but as children get older they learn how to stop. Ask them questions like “Do you see (insert name of an older child or adult here) sucking his or her thumb?” They’ll think about it more and start to decide whether they want to continue. It’s a process that takes time.

Punishing or shaming your child is absolutely the wrong method to address thumb sucking. This approach not only doesn’t work, but also lowers a child self-value and can create an even stronger desire to thumb suck. It’s like quitting anything you’re doing that may not be good for you in the long run- the worse someone tries to make you feel about it- the more you want to do it (think overeating, smoking, drinking.)

You can also talk to your pediatrician or family doctor for his or her suggestions on how to help your child. For older children, behavioral therapy may be beneficial.

There are products that are nasty tasting that can be swabbed on your child’s thumb, but some experts think that approach is cruel and more like a punishment than a humane way to help a child outgrow a natural inclination.

Most kids will simply quit sucking their thumb when they are good and ready. Helping your child reach that point may require patience and creativity, but in time his or her thumb will cease to be a constant comfort companion.

Sources: http://children.webmd.com/tc/thumb-sucking-topic-overview

Your Toddler

Toddler Snoring May Indicate Behavioral Problems

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Everyone snores at one time or another, even babies. Most of the time we have an occasional snort... maybe three or four. Children may snore because they have a stuffy nose, a cold, allergies or enlarged tonsils, but persistent snoring could indicate more.  

According to a new study focused on two and three year olds, persistent snorers are more likely to have behavioral problems such as hyperactivity, attention issues and depression.

Researchers studied 249 mother-child pairs and found the children who snored at both age 2 and age 3 were nearly 3.5 times more likely to have signs of behavioral issues when compared with those who did not snore at these ages, or who only snored during one of those years. Mothers were asked to report how often their child “snored loudly.”

The children were divided into 3 categories:

Non-snorers – those who snored less than once a week.

Transient-snorers – those who snored more than 2 times a week at age 2 or 3, but not both.

Persistent-snorers - those who snored more than 2 times a week at ages 2 and 3.

All the children were assessed for behavioral problems based on the Behavior Assessment System for Children, an extensively validated behavior questionnaire.

Among the children who snored at both ages, 35% showed signs of behavioral problems. Only 10% percent of non-snorers and 12% of transient snorers showed behavioral problems.

The findings show the importance of getting good sleep, the researchers said.

"We know that if you take away naps for preschoolers, and then give them challenging tasks, they're grumpier," said lead study author Dean Beebe, director of the neuropsychology program at Cincinnati Children's Hospital Medical Center.

From a neurological standpoint, lack of proper sleep inhibits the development of pathways between neurons in the brain, Beebe said. "We're talking about a brain that is constantly remodeling through early childhood, with connections being strengthened and weakened," he said. Fixing the underlying cause of snoring can help to reverse these effects, but because parents don't realize the problems with snoring, it often goes untreated.

Experts have also noted that many parents think that snoring is a sign of a deep restful sleep when in fact, it's often just the opposite. 

Dr. Sangeeta Chakravorty, director of the pediatric sleep evaluation center at Children's Hospital of Pittsburgh, wasn't surprised by the findings. "Snoring impacts sleep, and sleep loss impacts behaviors," she explained.

But, she noted that the study wasn't able to determine whether the behavior problems were just because the children were tired, or if their snoring was significant enough to cause a chronic lack of oxygen, because the study only included information from the children's mothers. There were no objective data, such as oxygen levels throughout the night.

Chakravorty added that snoring in this age group is actually common. She said enlargement of the adenoids was the biggest cause of snoring, followed by enlarged tonsils. Nasal allergies can also cause snoring, as can abnormalities in the facial structure or the structure of the airway. And obesity can cause snoring in children like it does in adults.

Researchers also found that persistent children snorers were more likely to have been exposed to environmental tobacco smoke, and come from lower socioeconomic households.

Both experts recommended bringing up any persistent snoring with your child's pediatrician. "If you hear your child snoring more than three to four times a week in the absence of an upper respiratory infection [cold], and it lasts more than a month, seek help from the pediatrician," Chakravorty said.

The study was published in the journal Pediatrics.

Sources: http://www.msnbc.msn.com/id/48648962/ns/health-childrens_health/#.UCqmK46f_zJ

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http://health.usnews.com/health-news/news/articles/2012/08/13/snoring-toddlers-may-have-more-behavior-problems

Your Toddler

Kid’s “Hypoallergenic” Products May Cause Allergic Reactions

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When a child has eczema, doctors often recommend that parents purchase hypoallergenic ointments, creams or lotions to ease the suffering from dry, inflamed skin.

However, according to a new study, many products labeled as hypoallergenic contain ingredients that can cause allergic reactions.

The Federal Drug Administration (FDA) does not regulate the “hypoallergenic” label, said Carsten Hamann, a medical student at the Loma Linda University School of Medicine in California and the lead researcher on the study.

“Kids who have eczema or atopic dermatitis use more lotions and creams and ointments, etc. Ostensibly, their caregivers who purchase these products to use on the kids' skin, give preference to products using these meaningless marketing terms,” Hamann told Reuters Health in an email.

Hamann and his colleagues tested products that might be used by kids with eczema, which affects 17.8 million people in the U.S., according to the National Eczema Association. Patients have patches of red, itchy skin, often on the arms, legs, cheeks, and behind the ears.

Doctors often advise people with eczema to apply moisturizer to the affected areas.  People with eczema tend to have a higher risk of so-called “contact allergies.” That is, they may have allergic reactions to substances that come in contact with their skin, including fragrances, preservatives, and other kinds of chemicals.

Researchers tested 187 cosmetic products found in 6 different stores in California, to see if they contained any of the 80 most common known allergens.  All of the products were specifically marketed as being safe for use by children and labeled as “hypoallergenic”, “ dermatologist recommended/ tested”, “fragrance-free,” or “Paraben free.” Most people assume that these types of products are actually designed to help people who have sensitive skin.

But, researchers found that 89 percent of the products contained at least one allergen, 63 percent contained two or more, and 11 percent contained five or more. The average number of allergens per product was 2.4, the researchers reported in the Journal of Allergy and Clinical Immunology.

Preservatives and fragrances accounted for 58 percent and 29 percent of the allergens, respectively. These ingredients often irritate a skin condition.

Ten percent of the products contained methylisothizolinone, a preservative that is about to be banned in the European Union because it can cause severe skin irritation, according to the researchers.

“It would be very difficult for even the most caring, intelligent and well-read parent to know the names of 80-plus allergens and their synonyms, let alone compare that list of allergens to a 15-plus long ingredient list on the back of a pediatric product,” Hamann said.

Dr. Michael Arden-Jones, a skin disease specialist at the University of Southampton in the U.K., said that defining something as an allergen can be complicated.

“Almost any chemical compound could be implicated as an allergen, so it is almost impossible for a cream to be truly non-allergic,” he told Reuters Health. “Thus, as there is no true ‘hypoallergenic’ cream, there is no agreed meaning of ‘hypoallergenic.’”

Skin experts say that ointments are generally the safest products for kids who have eczema. Creams and lotions contain water and therefore must contain preservatives, making them more likely to contain allergens. Prescription moisturizers are typically reliable. Products with artificial coloring or fragrances or do not have the ingredients listed on the box should be avoided.

The National Eczema Association reviews products and offers the “NEA Seal of Acceptance” for those that do not include known irritants. Depending on the product, the NEA Seal of Acceptance™ Review Panel considers testing data on sensitivity, safety, and toxicity, as well as the ingredients, content, and formulation data. There is a tab on the website dedicated to information on child eczema in infants to older children. Their website is: http://nationaleczema.org.

Sources: Madeline Kennedy, http://www.reuters.com/article/2014/11/21/us-eczema-products-safety-idUSKCN0J529L20141121

http://nationaleczema.org.

Your Toddler

Allergy Drops & Sprays Poisonous If Swallowed

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Spring and fall are both beautiful seasons, but for some people they are the time when allergies flare up and cause a lot of misery. This is also when you start seeing a lot of prescription and over the counter nose sprays and eye-drops around the house.

These products work great when used as directed, but the Federal Drug Administration (FDA) warns that they are poisonous if swallowed.  It only takes less than a fifth of a teaspoon to seriously harm a child.

Parents and caregivers often leave these products out where curious toddlers can find them. Since they do not come in child-resistant packaging – little ones can easily open them.

Eye drops injured more than 4500 children under the age of 5 from 1997 to 2009. Nasal sprays injured more than 1,100 children in the same age group during those years according to the U.S. Consumer Product Safety Commission (CPSC.)

The eye drops in question work by causing blood vessels in the eye to constrict. The nose sprays work in a similar fashion by constricting vessels in the nose. Visine is one of the most popular eye drop brands purchased and Afrin, Dristan and Mucinex nose sprays are often used for nasal allergies.

All these products contain a class of drugs called imidazolines. The active ingredients are  tetrahydrozoline, naphazoline, or oxymetazonline. When applied as directed, the drugs only affect the area where they are used - such as the eyes or nose. If any of these chemicals are swallowed, then they quickly affect other areas of the body.

"Generally, symptoms can occur in as little as one hour, peaking at eight hours, and resolving after 12-36 hours," a CPSC briefing paper notes. "Even though the symptoms resolve in a relatively short amount of time, ingestion of imidazolines can result in severe life-threatening consequences, such as decreased breathing, decreased heart rate, and loss of consciousness that require hospitalization to ensure recovery."

The CPSC has asked for a new rule that requires child-resistant packaging for eye drops and nose sprays but that hasn’t happened yet. If the rule should be finalized, manufacturers will still have at least a year to comply. 

Right now, there are lots of these products in use and in homes where small children live. The FDA has a list of suggestions to help avoid accidental poisoning.

  • Store medicines in a safe location that is too high for young children to reach or see.
  • Never leave medicines or vitamins out on a kitchen counter or a child's bedside.
  • If a medicine bottle has a safety cap, relock it each time you use it.
  • Remind babysitters, houseguests, and visitors to keep purses, bags, or coats that have medicines in them away and out of sight when they are in your home.
  • Avoid taking medicines in front of young children because they like to mimic adults.

Many parents or caregivers probably aren’t aware of how dangerous these products can be if swallowed. It’s a good idea to take a walk around the house and make sure that there aren’t any sitting on the counters or in a drawer where little hands can reach.

A list of products containing the drugs mentioned above can be viewed by clicking on the link below.

Source: http://www.webmd.com/parenting/news/20121025/child-poisonings-eye-drops-nose-sprays

Your Toddler

Think Twice Before Purchasing an Exotic Pet

A new report warns that young children should not keep certain exotic pets because of risks for disease.A new report issued by the American Academy of Pediatrics warns that young children should not keep hedgehogs, hamsters, your-baby chicks, lizards and turtles as pets because of risks for disease. The report, out in the October 2008 issue of Pediatrics says there is evidence that the animals can carry dangerous and sometimes potentially deadly germs. The report also says young children are at risk because of developing immune systems, plus they often put their hands in their mouths.

"Many parents clearly don't understand the risks from various infections these animals often carry," says Dr. Larry Pickering the reports lead author and an infectious disease specialist at the Centers for Disease Control and Prevention. About 11 percent of salmonella cases in children are thought to stem from contact with lizards, turtles and other reptiles. Hamsters can also carry this germ, which can cause severe diarrhea, fever and stomach cramps. According to the report, hedgehogs can be dangerous because their quills can penetrate skin and have been known to spread a bacteria that can cause fever, stomach pain and a rash. However, one of the study's co-authors pointed out that with supervision and precautions like hand-washing, contact between children and animals is a "good thing" but cautioned that families should wait until children are older before bringing home an exotic pet. More Information: American Academy of Pediatrics

Your Toddler

Babies, Toddlers and Discipline

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In a previous article we looked at the results of a study on whether spanking your child creates more disobedience instead of controlling bad behavior.  According to the research in this particular study, spanking is not an effective form of discipline; in fact, it’s not discipline at all. It only creates more problems down the road.

So, what are some better alternatives to getting your child to behave? 

The first step is to understand what discipline is and how it works. Discipline is not punishment.

Punishment, defined by the Merriam-Webster dictionary is: suffering, pain or loss that serves as retribution or a severe, rough or disastrous treatment.

That’s not the goal of loving parents who are trying to stop a child’s unacceptable behavior.

Discipline, on the other hand, is about teaching. It helps a child learn what is expected and to gradually learn how to control their behavior.  Children learn best when they feel safe and secure and their “good behavior” is encouraged.  The key is to have a good relationship with your child as well as clear and realistic expectations.

There is no one discipline tool that fits all, but there are some guidelines for different age groups. As children mature, techniques need to change to fit your child’s mental and physical growth.

Ages 0-1 years of age (Infants):

Infants should never be disciplined. They are not capable of understanding the meaning of words or able to remember what you’ve asked of them. You’d think that this would be obvious, and to most parents or caregivers it is. But there are some people who don’t get it and not only try to discipline their baby, but get angry when the infant doesn’t do what they want.  Babies are not little adults who have an agenda. They are merely babies and depend entirely on their parents or caregivers for survival.

Loving touches and gentle words are just as important as food and clothing to these little ones.  They need to learn that their world is a safe and nurturing place and that they can trust those around them.  A baby never does anything to deliberately annoy someone. They simply aren’t capable of that kind of manipulation.

Ages 1-3 (Toddlers)

These are the ages when children first sample the world around them through mobility and touch. They are curious, excited and easily frustrated. They learn through touching and moving and oftentimes creating a mess. They get frustrated because they don’t have the skills to accomplish everything they want.  The word “no” can become a part of their limited vocabulary.

Discipline at this age is about setting a few simple boundaries and helping them learn new skills with patience and praise.

Avoid battles, particularly with eating and toilet training. It’s not a war between you and your toddler. Making a mess is normal. This age group demands a lot of attention and patience. Re-directing and praise works better than a constant stream of you saying “no, no, no.” The word no loses its power when repeated constantly.

Toddler-proof your home: The best way to help a toddler stay out of a dangerous situation, or not grab something you don’t want them to have, is to toddler-proof your home. Cover electrical outlets with plastic snap-ons. Move breakable objects to a higher place in the house. Make sure coffee tables don’t have sharp corners.  Secure your TV to the wall and make sure that bookcases are secured. Anything they climb on or pull over needs to be anchored. Make sure that drawers and cabinets cannot be accessed. Put in place kid-safe products designed to block access to these areas.

Toddlerhood is a challenging time, no doubt about it.  They have little self-control and are not rational thinkers. They want to be independent and discover things for themselves but don’t have the communication skills and forethought needed to do so safely so it’s up to you, the parent, to help keep them safe.

Routines, order and consistency: Routines, order and consistency are very important to helping this age feel that the world around them is a safe place. This means regular nap times, meal times and bed times as well as free time to play and explore.  

Since they are just beginning to experience a little independence, toddlers need to know what you expect of them. Terms have to be simple; consequences quick. If your child bites or hits or grabs the cat by the tail, you respond quickly with the appropriate words. “ Do not bite”, “Do not hit,”  “ Do not pull the kitty’s tail”.  Say it every time it happens, and redirect your child to an activity that you can praise. Be consistent in the idea that there are certain actions that are not acceptable and others that are not only acceptable, but also more interesting.

Avoid stressful situations. You’ve spent enough time with your child to know that there are situations that often trigger bad behavior. The most common ones are hunger, sleepiness, and quick changes of venue. Avoid these potential meltdown scenarios with a little advance planning. An example would be that you wouldn’t take your toddler to the grocery store when you know they haven’t had a nap or are hungry. You can pretty well predict how that is going to go.

If you’re taking your child out, keep excursions short unless it’s to the park or playground. Even those trips should have a time limit that you know works well.

Restaurants can be tricky with a toddler. There is a lot of stimulation and not a lot of room for exploring. Find “family friendly” locations and try not to go during the busiest times. If a meltdown occurs, take your child outside, explain the situation in a calm voice and redirect their attention again until he or she calms down. 

Validate their emotions: Let your child know you understand their frustration. Validate their emotions. “I know you don’t like the car-seat, but we have to use it when you ride in the car.” It’s not coddling, it’s validating their feelings but also setting boundaries. When we ride in the car- you’ll be in the car seat. I understand you don’t like it.

You can also bring something your child likes to hold – a stuffed animal, blanket or toy. You can offer a healthy snack or give them a choice between the two, so they feel like they have a measure of control in their life. It’s a learning experience every day for parents as well as toddlers.

Time-outs? A lot has been made of “time-outs.” Time-outs are helpful when used as a discipline tool, but typically they don’t work well for toddlers. They are too young to really understand what it is you’re asking of them and it can be too confusing.  Distraction and redirecting tend to work better for this age.

Praise good behavior: You can correct bad behavior, but don’t forget to praise good behavior.  When a little one only hears what they are doing wrong, they don’t get a sense of the difference between acceptable and unacceptable behavior.  Sometimes re-phrasing in a more positive tone helps. “The puppy likes to be petted, not have her tail pulled. Let’s pet the puppy like this. Look- see the puppy likes that – you’re such a good puppy petter!”

Stay calm: Toddlers can push your buttons.  It’s important to stay calm and to know when you’re getting too upset to parent well.  Losing control can quickly escalate into yelling, hitting and doing or saying something you regret. If your child is home and having a tantrum or repeating the same behavior over and over, give yourself some time to cool down.

When they are in a safe environment like the home, ignoring the tantrum may work best. Sometimes, you just have to let them exhaust themselves while screaming, lying on the floor and flailing about. It’s part of learning that they won’t always get what they want.

Once they settle down, hug them and let them know that you love them and then find something better to do. 

Toddlers will test your patience, your sanity and your self-control. They’ll also make you find creative ways to teach them. Each child is different and requires an approach tailored to their personality and maturity.

And yes, sometimes you reach a point where the battle is more damaging than giving in. Be flexible and give in, but redirect the behavior towards something that you want them to learn or do.

“Alright, mommy is going to give you this piece of candy, and then you’re going to help me put away your building blocks. That’s the way we’re going to make this moment work for both of us. Sound good?”

Toddlers and babies are precious little beings that can make your heart burst with joy and love. Yes, they can be demanding, but they are so worth the extra effort.

In later posts we’ll look at discipline techniques for older children.

Sources: Stephanie Watson, http://www.webmd.com/parenting/guide/7-secrets-of-toddler-discipline

http://www.cyh.com/HealthTopics/HealthTopicDetails.aspx?p=114&np=122&id=2429

Your Toddler

Liquid Nicotine Poisonings up 300 percent!

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Most people are familiar with e-cigarettes. New e-cigarette stores are popping up almost every day. City councils around the country are debating the pros and cons of setting age limits to buy them and banning them in places where smoking cigarettes is already forbidden.

There’s another e-cigarettes related story that’s is much more alarming that is beginning to surface - the potentially deadly liquids that are often bought and used to refill the e-cigarette vaporizer.

These “e-liquids,” the key ingredients in e-cigarettes, are powerful neurotoxins. Tiny amounts, whether ingested or absorbed through the skin, can cause vomiting and seizures and even be lethal. A teaspoon of even highly diluted e-liquid can kill a small child.

According to an article in The New York Times, e-liquids are being mixed on factory floors and in the back rooms of shops.

Toxicologists warn that e-liquids pose a significant risk to public health, particularly to children, who may be drawn to their bright colors and fragrant flavorings like cherry, chocolate and bubble gum.

Many users, unaware of the toxicity of the ingredients, are casually leaving replacement bottles around the house where children are finding and ingesting them.

“It’s not a matter of if a child will be seriously poisoned or killed,” said Lee Cantrell, director of the San Diego division of the California Poison Control System and a professor of pharmacy at the University of California, San Francisco. “It’s a matter of when.”

Nationwide, the number of poison cases linked to e-liquids jumped to 1,351 in 2013, a 300 percent increase from 2012, and the number is on pace to double this year, according to information from the National Poison Data System. Of the cases in 2013, 365 were referred to hospitals - triple the previous year’s number.

As two examples, of the 74 e-cigarette and nicotine poisoning cases called into Minnesota poison control in 2013, 29 involved children age 2 and under. In Oklahoma, all but two of the 25 cases in the first two months of this year, involved children age 4 and under. That age group is considered typical.

The e-liquids are much more dangerous than tobacco because liquid is absorbed quickly into the skin, even in diluted concentrations. Initially, many of the e-cigarette brands were disposable devices that looked like regular cigarettes. However, many of the newer e-cigarette vaporizers are larger and can be refilled with liquid that is generally nicotine, flavorings and solvents.

Unlike nicotine gums and patches, e-cigarettes and their ingredients are not regulated. The FDA has said it plans to regulate e-cigarettes but has not disclosed how it will approach the issue.

Chip Paul, chief executive officer of Palm Beach Vapors, a company that operates 13 e-cigarette franchises, estimates that there will be sales of one to two millions liters of liquid used to refill e-cigarettes.

If you look online, you can buy e-liquids anywhere from a liter to 55 gallon containers with 10 percent nicotine concentration.

Mr. Paul said he was worried that some manufacturers outside the United States — China is a major center of e-cigarette production — were not always delivering the concentrations and purity of nicotine they promise. Some retailers, Mr. Paul said, “are selling liquid and they don’t have a clue what is in it.”

The nicotine levels in e-liquids can vary. Most range between 1.8 percent and 2.4 percent, concentrations that can cause sickness, but rarely death, in children. But higher concentrations, like 10 percent or even 7.2 percent, are widely available on the Internet.

A lethal dose at such levels would take “less than a tablespoon,” according to Dr. Cantrell, from the poison control system in California. “Not just a kid. One tablespoon could kill an adult,” he said.

Many people believe that e-cigarettes are a new and valuable tool in the battle to quit smoking. The science isn’t there yet to say whether they actually help or just replace conventional cigarette addiction. But one thing is for sure, if you have e-cigarettes and in particular, e-liquid refill containers in the home, they should be kept out of a child’s eyesight and reach.

Source: Matt Richtel, http://www.nytimes.com/2014/03/24/business/selling-a-poison-by-the-barrel-liquid-nicotine-for-e-cigarettes.html?_r=1

Your Toddler

Family Time Fosters Kid’s High-Emotional Health

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How important are family activities such as eating dinner together, storytelling, singing and playing together to a child’s present and future emotional health? According to a new study, quite a bit.

Researchers believe young children cared for in stimulating and nurturing environments, with regular participation in predictable family routines, reflects greater family organization and may provide a sense of security and belonging. It also may positively impact children's social-emotional health (SEH) before school entry and contribute to their future school and life success.

What is social-emotional health and why is it important? SEH is when someone exhibits the ability to understand emotions, express empathy with others, demonstrates a certain degree of self-regulation and can form positive relationships with others. It’s important because without these attributes it’s terribly difficult to experience self-value and find your way in the world.

High SEH in early childhood is thought to help a child adapt to the school environment and perform well academically. High SEH also is a good predictor of children's long-term outcomes.

"High social-emotional health has been associated with greater academic performance and improved behavior in the school environment," said Elisa I. Muñiz, M.D., M.S., developmental-behavioral pediatrician, Department of Pediatrics, Bronx-Lebanon Hospital Center, who led the research. "Our findings suggest that parents with preschool aged children who regularly practice family routines together have greater social-emotional health and so we encourage families to sing, read, play and eat together on a regular basis."

Researchers examined the parental responses of 8,550 children to questions such as how many times families eat dinner together per week, how often they sing songs, read books and tell stories to their children and how often they play together. Results showed that 16.6 percent of the children had high SEH with approximately 57 percent of those reporting that they participate in three or more family routines.

Experts say that children who enter school with low SEH are at greater risk of developing difficulties in reasoning and problem solving, as well as having reduced attention spans and experiencing decreased social acceptance. This can impact their academic achievement and overall health and wellbeing through adulthood.

Families, particularly when both parents work, are often strapped for time because of busy schedules and job requirements.  But simple family activities such as singing together in the car, reading to your child before bedtime and eating dinner together can help your child feel like an integral part of the larger human family.

The study was conducted by investigators at The Children's Evaluation and Rehabilitation Center (CERC) at Albert Einstein College of Medicine of Yeshiva University, Bronx New York, affiliated with The Children's Hospital at Montefiore (CHAM). It was published in the Journal of Developmental and Behavioral Pediatrics.

Source: http://www.sciencedaily.com/releases/2014/03/140304125423.htm

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