DC Child Accident & Safety Blog

It’s a Pavlovian response—you lick your thumb to clean the pureed peas off your baby’s face. But licking her pacifier clean after she knocked it onto the floor? Ewwww.

Get over it. According to a new study in the journal Pediatrics, that’s exactly what you should do. Parents who perform this protective act might be reducing the kid’s risk of developing allergies.

As explained on MedPageToday.com, the study suggests that transferring the microbes in your mouth to your baby’s mouth could modify its population of bacteria and cultivate a broader immune response to future invaders.

The researchers looked at kids who were 18 months and 36 months. In the younger group, children born to parents who said they cleaned their child's pacifier with their mouths were less likely than those born to parents who cleaned it with water to have asthma and eczema. At 36 months, the association remained for eczema, but not for asthma.

The benefit of this “oral hygiene,” the researchers suggest, might extend to a kid’s nether regions—because the baby swallows the newly transferred parental bacteria, they could affect the microbiology in the intestines, which could improve general gut tolerance.

Infants with less diversity among their gut microbes, according to MedPage Today, are more likely to develop allergies. That suggests that exposing youngsters to a wider variety of microbes could promote immune system function.

As Dr. Amal Assa'ad of Cincinnati Children's Hospital Medical Center told MedPageToday, "[W]e have to let nature play out a little bit and not be too clean and not be forming artificial barriers in the connection between the mother and the infant and the parents and the infant."

"We have to at some point reach a balance where we're making sure we're not predisposing [infants] to infections at the same time [we're making] sure we're giving them what they were naturally expected to get from the parents ... so we end up with a balanced body that doesn't veer towards allergies and doesn't veer towards serious infections and harm."

It’s interesting that, according to the study, the method of birth (cesarean or vaginal) was related to the likelihood of a parent sucking on the pacifier. Vaginal delivery and parental pacifier sucking independently were associated with a reduced likelihood of developing eczema; babies delivered vaginally and whose parents licked their pacifiers had a lower incidence of eczema.

The theory is that vaginal delivery, which also transfers bacteria from mother to infant, has a beneficial effect on allergy resistance.

Regarding the “ick” factor, and the concern that transferring a pacifier from a parent's
mouth to a child's could spread respiratory infection, the study showed no difference in the rate of such infections based on pacifier cleaning practices.

Keep in mind that this study had a relatively small sample size (184 kids), and that it’s relatively difficult to diagnose asthma in early childhood. So a larger study also involving older children is necessary to replicate—and confirm—these results.

But, for now, if you think it’s better to wash your kid’s pacifier under the tap than in your saliva, it’s probably time to think again.

It’s no surprise that vulnerable kids are ripe for bullying. Two recent studies found that children who suffer from food allergies and those involved in weight-loss programs reported being bullied by their peers. But it might surprise that those who are victimized because of their weight are sometimes bullied by their parents.

Both studies were published in the journal Pediatrics, here and here.

In one study, nearly one-third of children with food allergies reported bullying or harassment specifically related to their allergy, often involving threats with food. In the weight study, nearly two-thirds of teens at weight-loss camps reported weight-related victimization.

Bullying can cause great harm. See our post about the connection between bullying and suicide. Less dire consequences include social isolation, poor academic performance, depression, anxiety and chronic health problems.

As described on MedPageToday.com, surveys of 251 food allergy patients ages 8 to 17 and their parents were analyzed at a single allergy clinic.

Forty-five in 100 of the kids and 36 in 100 of their parents reported bullying or harassment. Eight in 10 bullies were classmates, and 6 in 10 bullying incidents happened at school. Verbal teasing was common, as was waving the allergen in front of the child; 12 in 100 kids had been forced to touch the food to which they were allergic.

Most of the bullied kids said they had reported the bullying, but parents knew in only about half the cases. When the parents did know, the situation improved for the kids.

The weight study included 361 kids ages 14 to 18 surveyed online while they attended two national weight-loss camps. One-third of the respondents were in the normal weight range; nearly one-quarter were overweight and 4 in 10 were obese. The first group represents many kids who previously had lost significant amounts of weight and had returned to the program for maintenance.

The more the kids weighed, the better their chances at being bullied, although many of the normal weight groups remained at risk.

Bullying came in the form of teasing, relational victimization (behavior aimed at damaging relationships or one's social reputation), cyberbullying and physical aggression. The most common bullies were:

• peers (9 in 10)


• friends (7 in 10)


• physical education teachers or sport coaches (4 in 10)


• parents (nearly 4 in 10)


• teachers (1 in 4)

The researchers said that some of the adults might have been well-meaning, but made clear that any bullying can be extremely damaging. As MedPageToday summarized, bullying has immediate and long-term effects, both physical and emotional.

The researchers concluded that pediatricians and other caregivers should become front-line interveners when a patient presents with symptoms or stories of bullying. That means helping kids and their parents anticipate and handle incidents, and teaching parents how to recognize bullying clues.

Even if your kid isn’t talking, sometimes you can recognize if he or she has been bullied. Physical clues include unexplained bruises, cuts and scratches; behavioral clues are avoiding school and social events, substance abuse, anxiety and depression. In addition, kids might have chronic headaches or stomach aches.

Simply realizing that if your child suffers from food allergies or excessive weight, he or she is particularly at risk; you can help him or her be prepared for what might occur.

If the bullying occurs at school and at home, the researchers said that "healthcare providers may be among their only remaining allies."

It might be the result of a bee sting or the ingestion of a peanut, but whatever the cause, when anaphylaxis occurs it can be life-threatening.

Anaphylaxis is an acute allergic reaction to a specific antigen (food, pollen, drugs, etc.); it’s the immune system’s whole-body response to the presence of an allergen it perceives as a threat. Symptoms generally occur immediately after exposure and might include respiratory distress, swelling of the lips, eyes and throat, rash, low blood pressure, bleeding and/or vomiting. It can result in cardiac arrest.

Parents of children with known allergies should ensure that their child’s school authorities are aware of the allergy and have a prescription on file for epinephrine in case of emergency. (Epinephrine is the hormone adrenaline and is the primary treatment for anaphylaxis.)

Epinephrine is generally safe, with few adverse effects, if given even when it is not needed.

But according to a recent story in the New York Times, school nurses can find themselves in a horrifying position if a child without such a prescription develops a sudden reaction to an undiagnosed allergy. If they inject epinephrine, they risk losing their nursing license for dispensing it without a prescription. Their only other option is to call 911 and hope the paramedics arrive in time.

Some states have passed laws to enable school caregivers to have epinephrine injectors on hand and to give a shot to any child with an emergency. Mylan, which markets Pfizer’s EpiPen, the most commonly used injector, is lobbying for such federal legislation. The company has lobbied individual state legislatures and has distributed free EpiPens this year to schools.

Sure, it’s a naked grab for market share, but it also makes medical sense.

As The Times reports, Mylan has spent millions on consumer advertising and has hired scores of sales representatives to help promote the product. It’s estimated that EpiPen sales will total $640 million this year, a 76 percent increase over last year, according to one analyst.

A study last year in the journal Pediatrics found that about 1 in 13 children had a food allergy, and nearly 40 percent of those with allergies had severe reactions.

Efforts to make epinephrine more widely available, The Times says, are an acknowledgment of the rising rates of food allergies among children and the handful of deaths from allergies across the country. Some children with known allergies carry their own epinephrine injectors to use themselves, if they’re old enough, or the devices are kept in their school nurse’s office.

It’s unclear why the rate of food allergies among children appears to be increasing. “I don’t think it’s overdiagnosis,” Dr. Scott H. Sicherer, a researcher at the Jaffe Food Allergy Institute at Mount Sinai Medical Center in Manhattan, told The Times.

A Mylan executive said schools were just the first place to make emergency epinephrine injectors more widely available. The company would like to see them as available as defibrillators—in restaurants, airplanes and other public places.

The Food Allergy and Anaphylaxis Network (FAAN) has not taken a position on placing injectors in public places other than schools, and Sicherer wondered about their suitability in settings such as restaurants, where staff might not be able to tell the difference among choking, a heart attack or anaphylaxis.

Next month, Sanofi plans to introduce a rival epinephrine delivery device, and in 2015, Teva may win approval of a less expensive generic version of the EpiPen, according to The Times. Sanofi’s Auvi-Q features voice instructions and Teva’s product, if approved by the FDA would closely mimic the EpiPen design and, like a generic drug, could be substituted by pharmacists even if doctors prescribed the EpiPen.

To learn about the latest developments in food allergies, visit the NAAN site. To learn about the widespread practice of bogus testing, see our blog about free allergy tests. To learn about the early signs of allergy, see our blog here.

The kid who started sneezing and itching and was diagnosed with an allergy when he was 3 might well have communicated sensitivity to the responsible allergens even before he could roll over.

A study in the American Journal of Respiratory and Critical Care Medicine indicates that an allergic future can signal itself within the first month of life, long before symptoms develop.

A certain protein expressed in infant urine predicted lung, nasal and skin irritation by the time children start school. The findings are useful, the researchers wrote, for prevention and to customize treatment when symptoms do manifest.

All of the infants in the study were symptom-free when they were tested at 1 month old. By the time they were a year old, 4% developed chronic respiratory problems (wheezing, coughing), and 27% developed eczema. By the time they were 6, 17% and 15% respectively developed those symptoms.

A new federal report says that food allergies have risen 18% among American children in the last decade.

From the article:

Eight types of foods account for 90 percent of all food allergies -- milk, eggs, peanuts, tree nuts, fish, shellfish, soy, and wheat. Allergic reactions to these foods can range from a tingling sensation around the mouth and lips, to hives and even death, depending on the severity of the reaction, the report's authors said.

The report also said that children with food allergies are two to four times more likely to have asthma or other allergies, compared to children without food allergies.

As discussed in the article, there is much we don't know about allergies. We don't know where they come from or why some children do not outgrow the allergies by adulthood, which is what happens in the majority of cases.

The full report can be found at the CDC (Centers for Disease Control and Prevention) website: Food Allergies Among U.S. Children: Trends in Prevalence and Hospitalizations.