Nearly half a billion eggs have been recalled due to an outbreak of salmonella. Even though it is a small number compared to the total number of eggs sold and consumed in the United States, it takes only one bad egg to disturb your family’s peace! Eggs are an excellent source of complete protein. And if your child enjoys them, there is no need to panic even though the screaming headlines in the media may prompt you to completely bypass the egg aisle at the store. Here are 7 ways to ensure your child’s health and safety despite this nationwide food safety issue.

Be informed: Keep an eye on the brands and manufacturing plant numbers affected by the salmonella recall. So far, it is limited to certain farms in Iowa, but eggs produced there are distributed and sold nationwide, If you live in one of the affected states where these eggs are sold, you have to be extra vigilant so you don’t end up bringing contaminated eggs home. Monitor credible websites like the CDC and Egg Safety Center (see links below) for updates.

Look carefully before buying: Every egg carton has number beginning with the letter P, usually stamped on the short side. This is not to be confused with the expiration date, or in some cases, best if used before date. The P number is mandatory, while the others are voluntary. An example of a P number is shown below:

The 4 numbers immediately after the letter P indicate the plant where the eggs were produced. The Julian date shows the date they were packaged. Julian date represents the consecutive days of the year with 001 for January 1 and 365 for December 31. In the above example, P-1946 is the plant number and 223 is Aug 11 in a non leap year like 2010.

According to the recall list, P numbers 1026, 1413, 1946 with Julian dates 136 to 225 are affected. Keep in mind that both the P number and the Julian date should match to be sure that the eggs in the carton are affected.

Even if the egg carton you are about to buy is not included in the recall list, pay attention to how the eggs are stored. They should be kept refrigerated and the egg shells should be clean and uncracked. Compare the Julian date to the current date to get an idea about how long they have been out since they were packed at the plant. Although eggs are considered safe even after 4-5 weeks from the Julian date if kept refrigerated, it is better to buy within 1-2 weeks after they were packed to make sure they are fresh.

Look for the USDA grade shield on the carton which means the eggs  were tested to meet established quality standards.

Ask questions when eating out: Eggs are used in many different dishes, not just what you might order at breakfast. And even if the restaurant makes a fresh dish, they may use many ingredients processed with eggs. Before you order your favorite omelet, or a fried egg with the sunny side up, ask questions to make sure they are using fresh, uncontaminated eggs. Do they use shell eggs or liquid egg mix? Liquid egg mix must be pasteurized. Pay attention to the overall hygiene of the cooking environment. Salmonella contamination can come not just from eggs but from other foods too.

Avoid eating raw eggs: It does not take long for bacteria to grow inside the egg because of their high nutrient density. Even 1-2 h at room temperature or under unrefrigerated conditions may be enough for bacteria to grow and multiply inside the egg. It is often very hard to tell just by looking at the raw egg yolk or white if it is contaminated by bacteria. As a result, eating raw eggs carries a higher risk of getting sick. It is better to cook them well and keep prepared dishes refrigerated until they are served.

Use safe cooking practices: Use common sense and good hygiene as you cook eggs and other foods. Wash hands, sanitized work surfaces and counter tops, use clean cutting boards, knives and utensils. Cook at a high enough temperature and cook completely. In case of eggs, both the yolk and white should be firm when properly cooked.

Limit processed egg products: Eggs and egg products are used in a lot of processed foods. The good news is that there are strict quality standards and pasteurization requirements before egg products can be used. However, the more processed a food is, the less information and control you have about its ingredients. In general, it is better to use fresh, raw and high quality ingredients to prepare your food. This is good not only for your health and nutrition but also to minimize the risk of food based sickness. Whenever possible, limit the consumption of processed foods.

Watch out for early signs of illness: Young children are at a higher risk of getting sick from contaminated eggs. Watch out for symptoms like fever, abdominal cramps and diarrhea within 12 to 72 hours of eating contaminated foods. Vomiting, chills, headache and muscle pains may also occur. Seek immediate medical attention to ensure timely treatment before it gets out of control. Serious sickness and even death can occur.

Staying alert, buying smart and using safe cooking techniques will help you keep your family safe during the current and future food safety crisis. Stay safe and healthy!

Resources:

Egg Safety Center Recall List

CDC update on the outbreak of salmonella in shell eggs

Greetings! It’s Friday again, so here are 5 interesting nutrition stories of the week that caught my eye. Enjoy and drop a comment to let me know what’s on your mind.

Great ideas for nutritious snack combinations for kids

Check out these cool practical tips for snack combinations your kids are sure to enjoy! They are all very healthy and nutritious options, and best of all, you are likely to find most of the ingredients in your refrigerator or pantry already. Registered Dietitian Maryann Jacobsen, a guest writer on this blog, offers these ideas based on her knowledge of nutrition and real-life experience as a Mom. I am sure cookies and milk will be a hit with my son as well as whole wheat cracker with peanut butter or cheese! He also loves to snack on strawberries which are a great source of vitamin C. His twin sister on the other hand favors cheerios with milk and honey. Go for snacks that offer a combination of carbs, proteins and fat without too much sugar or salt. There is, after all,  a smart way to let your kids enjoy snacks!

The real cost of our addiction to cheap junk food

It is no secret anymore that we are a country of BIG people! What may surprise you, or even give you little shock, is new data from the CDC that the cost of treating obesity-related diseases soared to $147 billion in 2008. That’s about a 100% increase over the last 10 years! Obese people spent nearly $1500 more than what people of normal weight did on medical costs in 2006. Even though it probably does not include those without health insurance, the message should be clear to everybody. The Dollar Value Meal may not put a dent in your wallet, but the extra calories with each meal will continue to add on and hit you later in life! Of course, some will argue that it has nothing to do with junk food but the fact that people just don’t exercise anymore. Whatever! There is a lot of talk about fixing the Healthcare system so it becomes affordable for everyone. I am sure that bringing technology to the doctor’s office and going paperless for medical records will help. But maybe we should also tackle the hidden (and rapidly rising) cost of obesity head-on. Else, the whole thing might come crashing down under its enormous weight!

Fat tax will reduce obesity say “experts”

A new report from the Urban Institute says that a 10 percent tax on fattening food would reduce consumption while raising more than $500 billion over 10 years. The idea is that if you tax these foods, their price will go up and people will eat less of them so they will not get obese. Just the way we have reduced smoking by taxing, warning labels and education, we can reduce obesity by following a similar policy. I think there are two problem with this logic. Although the link between cheap, junk food and obesity is clear (see above), that is not the only factor. Obesity is a multi-dimensional problem and I don’t think we can solve it simply by taxing fatty foods. And I don’t really buy the tobacco example – even with heavy taxation, legislation and restricted advertising over many years, people are still smoking! Second, the final price of these foods that a consumer pays may not go up by that much. This is because an easy way of dealing with the extra cost of taxation is to reduce the cost of operation (fire people, improve efficiency etc.) and decrease the product quantity. How far should we go in raising taxes before a real effect in prices is seen at the store?

We need to address the fundamental reasons why people prefer these foods. They are cheap, convenient, readily available and taste good. Why can’t we do all that for nutritious foods? Simply by lowering the supply chain costs of fruits and vegetables, we can bring their prices down and improve their availability. That is just one idea.

I think the approach should rather be to create conditions that lower the price of healthy options. Taxing fatty foods, or sugary beverages, I think is a very short-sighted approach which lacks creativity.

CDC offers interesting ideas for tackling obesity

When it comes to tackling obesity, the CDC suggests that we think global but act local. A new report entitled Recommended Community Strategies to Measure and Prevent Obesity in the United States offers simple ideas at the community level. Offer incentives for food retailers to locate in under-served areas, give out coupons to buy fruits and veggies, encourage people to buy “local” are some of the good ideas in this report. They came up with 24 strategies which can be organized in 6 categories -

1. promote availability of healthy foods and beverages
2. support healthy foods and beverages choice
3. encourage breastfeeding
4. encourage physical activities and limit sedentary activities among children and youth
5. create safe communities that promote physical activity
6. encourage communities to organize for change

I think these are smart ideas. Certainly, it will not happen overnight and will take resources and effort from everybody, but it reflects the right mindset on this problem. What do you think?

Hungry Monkey is now on my reading list

I love the title of this book! Ask any parent of a toddler and you will hear their struggles with a picky eater. This book is written by a “food-loving” father who wanted to find new recipes and new ways of cooking that could satisfy his own taste buds and still be acceptable to his 5 year old daughter. I came across a review of Hungry Monkey in the New Your Times which also offers a few selected recipes – they look very good. It is also a part parenting memoir, so I am sure there are some real-life examples and lessons learned. I definitely want to check it out, and when I do, I will write my review here.

Enjoy your weekend! And let me know what you think.

Photo source -Thiru Murugan on Flickr
©2009 Littlestomaks.com

Having read about the Food Allergy Awareness Week while researching for last week’s Five for Fridays, I wanted to dig into this topic a little more. This is a problem that an increasing number of parents are worried about these days. If you are one of them, I would love to have you share your personal experience and tips in the comments below. Here is a summary of my research from several good sources on food allergies.

I am also glad to announce that this is my 100^th post!

First the numbers

The Centers for Disease Control and Prevention (CDC) published a report on Food Allergy Among US Children in October 2008. Here are few interesting, and in my opinion a little worrisome, statistics from this report -

1. Almost 4 in 100 children less than 18 years old were reported to have some form of food allergy in 2007. This corresponds to a total of 3 million children. The rate of food allergy in children less than 5 years old is nearly 5 in 100.
2. Compared to 10 years ago, this represents an increase of 18%.
3. Children reporting an allergic response to food were 2 to 4 times more likely to develop asthma or other allergies compared to children without food allergies.
4. Eight types of foods account for over 90% of food allergies - milk, eggs, peanuts, tree nuts, fish, shellfish, soy and wheat.
5. Hospitalizations with diagnosis of food allergy have increased nearly 4 times compared to 10 years ago.

Why food allergies are on the rise

The exact reason why a child develops allergy to various foods are not well known. However a lot of experts believe that poor quality of early childhood nutrition may be a factor. In his book Disease-Proof Your Child, Dr. Joel Fuhrman writes that apart from non-dietary factors, following nutrition related issues are responsible for increasing the risk for asthma and food allergies -

1. Lack of breastfeeding
2. High ratio of omega-6 acids to omega-3 fatty acids. People on meat rich diets in the Western world typically get ratios around 10 to 1 and some get as high as 30 to 1. This ratio should be around 4 to 1 or lower.
3. High ratio of omega-6 to omega-3 in mother’s diet during pregnancy
4. Low vitamin E intakes
5. Lack of fruits and vegetables

The immune system of young children is not fully developed, which makes them more likely to develop food allergies especially if they do not get good nutrition. But the good news, according to Dr. Fuhrman, is that it is also easier for them to recover from food allergies when a program of good nutrition is adopted.

It is easy to confuse food intolerance with food allergies

Sometimes the first symptoms of a mild food allergy may be similar to food intolerance, so it is easy to get confused. The main difference is that food allergy is a response from the immune system while food intolerance is a problem with digestion. For example, people with lactose intolerance cannot digest milk because their bodies do not have an enzyme called lactase. Lactose intolerance can result in discomfort, gas, bloating or nausea or diarrhea, but is not life threatening. Allergy to cow milk on the other hand is a result of antibodies produced by the immune system as a reaction to milk protein and can cause a very severe reaction. Similarly, intolerance to gluten causes the celiac disease which affects the small intestine, but it is not the same as wheat allergy.

Diagnosing food allergies

It is good to take any reaction to food  seriously and consult with your doctor who can run tests to confirm if your child has food allergies. Physical examination and a comprehensive medical history is usually the first step. Use of blood tests to detect food related antibodies is becoming very common, but without a good interpretation and link to the medical history, these can be very misleading. In fact there is an increase in the number of misdiagnosis of food allergies based on blood tests which I wrote about recently in my Five for Fridays column. This can result in unnecessary over restriction of foods. Skin testing with known food allergens is another option but this is not routinely done. In some extreme cases, your allergy specialist may decide to do food challenges to find out which specific foods cause an allergic response. Do not try it at home! The key is to keep a watchful eye on the reaction of your child, and if you suspect food allergies or intolerance, contact your physician as soon as possible.

Tips for managing nutrition of children with allergy

In his book, Dr. Fuhrman provides examples of how food allergies and asthma can be managed, and in some cases, completely reversed by good nutrition. I like one example of 3 year old twin boys who had severe allergic reactions to almost anything like soy, milk, peanuts, corn, strawberries, cats, dogs, and how within a few years of his nutritional therapy he was able to resolve most of these problems. In general, he recommends a diet rich in vegetables, walnuts and fruits with DHA supplements and multivitamins and no processed foods, dairy fats or trans fats. Not that this can guarantee to result in reversal of food allergies, but it makes good sense to me.

I would love to hear your experiences and tips if your child is suffering from food allergies. I am sure it is very hard for you as a parent, and it is my sincere hope that things get better for you in time. Please leave a comment below if you want to share.

Photo source – laffy4k on Flickr
©2009 Littlestomaks.com

Do you find yourself wondering if your child is growing “normally”? Do you find yourself comparing your child’s height or weight with other children when you take her out to play in the park? Do you begin to make plans about how you will change her diet when your doctor informs you that she is below 50th percentile in weight for her age?

If so, you are not alone. It is a natural instinct for any parent to worry about the growth of their child. In my post on Take a Step on the MyPyramid for Preschoolers, I introduced you to how you could make a growth chart for your toddler based on his height and weight. In this post, I provide you more details and suggest a few actions for you to consider as you think about your child’s growth.

Growth charts are based on national population statistics

Data on physical measurements (weight, head circumference, length, standing height etc.) for children of different ages is collected from national surveys and analyzed using statistical methods to prepare the growth charts. These charts show lines for various percentiles, which are used as a reference for comparing the actual measurements. There are two limitations of this method that you should be aware of:

1. Just like the census, national health surveys are not done every year. In fact, the last National Health and Nutritional Examination Survey (NHANES III) was done during 1988 – 1994. This led to a revision of the 1977 growth charts in the year 2000. Amazing, isn’t it, that today’s growth charts are based on data that is 15 years old! Surely, a lot has changed since then.
2. Data is collected based on a “statistical sample”, which is supposed to represent the true nature of the whole population. Although there are some rules for estimating this “statistical sample”, no one can say with 100% confidence that it really represents everybody. In the interest of creating a “normal” growth profile, the researchers have to make some trade-offs and not include various special cases. It is important for you to be aware of what those special cases are. Your pediatrician should be able to advise you if you happen to be one of them.

Having said that, the current growth charts are still a very useful tool to evaluate the general growth pattern your child in relation  to what is normally expected. Recognize that the researchers do a very good job planning for a national survey to really “fill the gaps” in their current data and understanding. For example, in the NHANES III, they over-sampled infants and toddlers 2 months – 5 years old to properly account for the growth patterns in this age group. They also included a higher number of breastfed children to reflect the rising rates of breastfeeding compared to previous years. They utilized advanced statistical methods to create a better and smooth transition between infants/pre-schoolers and adolescents.

Growth charts are age and sex specific

Different measurements are made on infants (less than 36 months) and toddlers/adolescents (2 – 20 years). For infants, weight, head circumference and head-to-toe height is measured in a lying down position. The measured data is evaluated on these 4 types of growth charts:

1. Length for age
2. Weight for age
3. Head circumference for age
4. Weight for length

In most cases your pediatrician will show you the first two charts; usually blue for a boy and pink for a girl.

For toddlers/adolescents, weight and height is measured in a standing position. The measured data is evaluated on these 3 types of growth charts:

1. Weight for age
2. Stature (height) for age
3. BMI (Body Mass Index) for age

Again, your pediatrician will most likely show you the first two charts. However, the BMI for age is the most important chart in my opinion (see below)

Growth charts do not apply to preemies and other special cases

Data from very low birth weight (VLBW) is  not included in the infant growth charts since their growth patterns are known to be very different from higher weight, full-term infants. If this applies to you, there are other specialized growth rate charts you can ask your pediatrician about. The best general growth charts in this case are based on the the Infant Health and Development Program (IHDP) data, which can be used from 40 weeks to 36 months. It is not, however, without its limitations; so you should have a good discussion with your doctor.

Other special cases include health conditions such as Down syndrome, cerebral palsy and Turner syndrome. Special growth charts are available but again, they have many limitations.

Although, I did not find any discussion on the topic of multiples (twins, triplets etc.) I think that these too are special cases. Usually, multiples have low birth weight and do not go to full-term. Even though, the NHANES III data included low birth weight infants, I did not find any reference of categorizing data for multiples. Multiples may also show different growth patterns, where one of the child grows “normally” but the other(s) lag behind. It is my (selfish) hope that the next national survey will try to account for this gap.

Pay special attention to the BMI for age growth chart

Body Mass Index (BMI) is calculated using both weight and height. It is very easy, and you can use this online calculator simply by entering the age, weight and height. BMI is known to track very well with age, first increasing from birth to 8 months of age, then falling until age 6 and finally rising with age. There are two important things you can learn from the BMI chart with age for your child -

1. Percentile – Your child is at high risk of being overweight if the BMI is between 85th and 95th percentile for his age. If the BMI is over 95th percentile, then the child is considered overweight.
2. Trend in BMI for age chart – the sooner your child’s BMI hits its lowest number, the more likely he  is going to have a higher BMI percentile when he grows up, and greater is his risk of being overweight. Watch the trend in BMI for age over time closely and take action sooner than later.

BMI-for-age chart, Boys, >2 years old

Growth charts are used only as a screening tool

It is important to understand that growth charts are used only as a screening tool and not to diagnose a medical condition. The 5th percentile cut-off is useful to identify infants at risk of overall health and growth problems. The 95th percentile cut-off, especially on the BMI for age chart, is useful for early identification of childhood obesity. However, resist the instinct to be alarmed by a single point on these charts. You should look at a series of points over several visits to understand the overall pattern and assess if there is any unexpected change. If you have a concern, consider making these charts more frequently. With online tools, you don’t have to wait for your next doctor visit.

Take action

Here are 5 actions you can take:

1. Use information to manage your concerns and anxiety over what is a “normal” growth pattern for your child. Hopefully, this article is helpful; however there are a few more resources you can use to learn more about growth charts:
   • CDC’s growth chart website
   • Use and interpretation of growth charts – an instructional guide
   • Recommendations for growth references for VLBW infants
2. Resist the urge to make nutritional changes or goals based on a single data point on a growth chart.
3. If a single data point causes concern, track more often and then make a plan in consultation with your pediatrician.
4. Resist the urge to compare your child with others, or even with his own brothers/sisters. For example, two children with the same BMI could have very different risks based on their age.
5. Take a long term view to your child’s growth.

Feel free to share your personal experience and advice regarding growth charts.