Give Your Baby the Best Start

From the WebMD Archives

From car seats to child gates, and corner bumpers to outlet covers, we take a lot of precautions to protect our children. Here, we tackle the room your baby will spend most of her time in, the nursery, with eight simple recommendations that are important to giving your baby a healthy start in life.

Topping the list of concerns is something you may think is history: lead poisoning. "Lead poisoning is still a big problem, a huge problem," says Philip Landrigan, MD, a pediatrician and director of the Children's Environmental Health Center at Mount Sinai School of Medicine in New York City.

Lead poisoning has long been recognized as a serious public health risk. "Lead has been well-studied," says Landrigan, "and is known to cause brain damage in children -- loss of intelligence, shortening of attention span, impulsive and aggressive behavior."

While lead was banned from gasoline and paint in the mid-1970s, it's still pervasive in the environment. "Lead paint was so widely used, there are still hundreds of thousands of homes and apartments with lead paint," he says.

And lead paint on imported toys and jewelry continues to be a problem, despite a number of recalls in recent years, he says. Beyond lead, questions have been raised about potentially toxic chemicals in plastic baby products and bedding -- all things to consider when you're creating a healthy nursery.

Fortunately, there are many safe options for your child's room. Here are some tips on giving your baby the best start:

1. Test your home for lead paint. If you live in an old apartment or home (built pre-1978), there's likely lead paint on walls and window frames. Find out how big your lead problem is. Have your home tested before you renovate or redecorate the nursery. In fact, Landrigan advises doing it even if you don't redecorate, since your infant will be crawling on the floor.

The main source of lead exposure is chipped paint and dust formed when the paint starts eroding. Scraping and sanding lead paint also releases lead dust into the air. Ingesting the lead-filled dust is how young children can get serious lead exposure.

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Landrigan has seen it happen: A young couple with an older home renovates a room to create a nursery. "Three, four months pregnant, they start sanding down the old paint," he says. "Then mom shows up at the hospital with a blood level of 50 or 60 -- sky-high -- which will go from her bloodstream and poison the baby."

You have several options when it comes to testing for lead. A lead paint test runs about $100 to $200. You need a properly certified inspector from the EPA or your state health department to do the testing in your home.

A less expensive method is a paint chip test, which your local health department can do; it costs from $20 to $50.

The Consumer Product Safety Commission has a safety alert on its web site about lead-based paint, testing, and guidelines on how to remedy the situation.

If you can't remove the lead paint, you may want to consider finding a new place to live, says Landrigan. There's little chance of lead poisoning with a house built after 1978. Sellers and landlords are required to disclose known lead hazards in houses and apartments built before 1978.

2. Cancel the pest control service. Heavy use of pesticides has the potential to damage a baby's brain, says Landrigan. "These chemicals were developed to destroy an insect's nervous system -- and they have the same effect on a child. It just takes more of the stuff," he says.

What can you do? Instead of spraying pesticides, use the concept of Integrated Pest Management (IPM). It suggests that chemical pesticides be used as the last resort. Instead, reduce pests by simple measures:

  • Meticulously cleaning food residues off plates and cookware.
  • Sealing cracks that are a point of entry for roaches.
  • Remove any sources of water.
  • Get rid of any breeding places (like litter or standing water outside the house).

The EPA provides easy-to-understand guidelines on IPM at two sources -- a brochure titled "Citizens Guide to Pest Control and Pest Safety" and a fact sheet, "Do's and Don'ts of Pest Control." Or, you can check with your local USDA extension office. The nonprofit organization Beyond Pesticides has information about potential health impacts of pesticides and nontoxic alternatives for almost any type of pest problem. They also have a list of companies that employ safer methods if you need to call in experts.

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"It's basic stuff, but it works," says Landrigan. "In East Harlem in New York City, we have shown that families who use these methods actually get better pest control than families who bring in the exterminator every month."

In one study, the family using IPM had a serious reduction in the number of roaches after the first month. The family with the exterminator had roaches back just two or three days after the spraying.

3. Replace wall-to-wall carpeting. "Carpeting is an incredible sink for dust, mold, and mildew -- and those all can trigger asthma in children," says Landrigan. Pesticides, pet dander, lead dust, and chemicals from cleaners and other household products can settle into the fibers.

Some things to consider about carpet:

VOCs: New carpeting has many chemicals -- including formaldehyde -- in its adhesives, glue strips, and rug pads. These volatile organic compounds (VOCs) evaporate into the air, causing chemical fumes that can irritate eyes, nose, and throat as well as trigger headaches. That new carpet smell? Those are VOCs you're breathing in.

Most of these fumes "off-gas" into the air within a few months of installation, but some fumes may linger as long as five years later.

PBDEs: Another set of chemicals -- polybrominated diphenyl ethers (PBDEs) -- are also a concern. This family of flame-retardant chemicals is used to slow a fire, and carpet padding is full of it. They're also found in TVs and electronic devices, upholstered furniture, and mattresses. PBDEs end up in household dust, exposing everyone in the family.

Sonya Lunder, MPH, a senior analyst with Environmental Working Group, has conducted several studies of PBDE exposures -- including one that found toddlers had three times the PBDEs in their blood that their mothers had. "It's because they're on the ground more, putting hands in their mouths, toys in their mouths," she tells WebMD.

PBDEs accumulate both in the environment and in our bodies. Studies of laboratory animals have shown that even small doses of these chemicals impair attention, learning, memory, and behavior. After research raised concern about toxicity, two types of PBDEs were voluntarily taken off the market in 2005. But other forms of PBDEs are still out there.

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Phthalates: Chemicals called phthalates -- used to soften plastics -- have a negative effect on sex hormones, like estrogen and testosterone. There's evidence they can cause reproductive defects and lower sperm count in boys. In one study, vinyl flooring in children's bedrooms was linked with symptoms of asthma, hay fever, and eczema. Phthalates can also be found in carpet, soft plastic toys, and some plastic baby bottles.

Better flooring options -- Wood, cork, and ceramic tile are better options for the family room and the baby's room, says Landrigan. Another option is natural linoleum (vinyl linoleum gives off VOCs).

A few tips:

  • When removing old carpeting, keep that room closed off from others in the house. Don't track dust into other rooms.Make sure you vacuum around the perimeter and in corners, where house dust tends to hide.
  • If you want a soft surface, get smaller rugs that you can wash.

If replacing your carpet isn't feasible, then you can minimize exposure to allergens by cleaning it frequently. Vacuum at least two times a week, using a HEPA filter. And have your carpet steam-cleaned, without using detergents or chemicals.

4. Opt for low-odor paints. There's a reason for that new-paint smell. Paints and lacquers, paint strippers, cleaning supplies, building materials, glues and adhesives -- thousands of products -- all emit VOCs. Solvents in new paint are associated with a number of health effects, from headaches to fatigue and dizziness. Some are suspected carcinogens.

To avoid irritation from VOCs, look for products with no or low VOC gases. Many major paint manufacturers are producing low-emission paints. A few independent agencies (like Green Seal) provide certification of eco-friendly products. In paint stores, you might see them labeled as "low-odor."

Even if you use low-odor paints, you should still wear a mask when painting, open windows, use fans, and allow some time for the room to air out and the fumes to "off gas." Pregnant women should avoid painting.

5. Choose bedding and baby products wisely. Your baby's mattress may seem like a safe, comfortable surface. But researchers are concerned about two types of chemicals that may show up in the mattress.

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Mattresses are typically treated with PBDEs -- a concern, researchers say, since a baby spends a lot of time on the mattress. And because they're usually encased in vinyl or plastic, new mattresses also emit VOCs.

One option is to choose a wool mattress. "Wool is naturally fire resistant," Lunder says, "although even a wool mattress might be treated with fire-retardants. At least it will have a lot fewer chemicals on it." If you're using a synthetic mattress, let it off-gas the plastic fumes in the garage for a few days. "That's what we did with my son's mattress," Lunder says. Then cover it with a wool mattress pad (preferably organic), to provide a barrier between baby and a synthetic mattress.

Other concerns:

  • Allergens (like dust mites) tend to accumulate in baby's bedding, potentially triggering an asthma attack. An allergy-proof mattress casing will help solve that problem -- as will washing your baby's bedding every week
  • Make sure your baby's personal products are the mildest possible. For the first few months, baby's skin doesn't need lotion or cream. When you do use soap, choose the mildest soap possible -- without fragrance or antibacterial chemicals. Opt for biodegradable, hypoallergenic laundry detergent.

6. Tackle the diaper dilemma. Cloth or disposable?Most U.S. families use disposable diapers, but many parents believe that cloth diapers are better for the environment. Research shows that both have some negative effects on the environment.

Disposable diapers require more materials to manufacture -- and produce more solid waste in landfills. Cloth diapers are often suggested as an alternative. But they require greater electricity and water for cleaning.

Other options:

  • The flushable hybrid diaper, which involves reusable cloth pants with disposable liners. When the liner is soiled, it is flushed down the toilet into the sewage system instead of going to the landfill.
  • Chlorine-free disposable diapers and baby wipes.
  • Organic cotton diapers (no pesticides are used on the cotton during growing).

Some parents may find that using both cloth and disposable diapers works best for them (for example, many day care centers require disposable diapers). Whether you use cloth or disposable, be sure to change diapers frequently. Minimizing the time a baby spends with a wet or soiled diaper helps prevent diaper rash.

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7. Play it safe with toys. Lead in toys and jewelry is a serious issue that continues to pose a threat to kids. About 30% of childhood lead poisoning cases tracked by the CDC are not believed to be caused by wall paint, but by lead in toys and jewelry. In 2006-2007, the Consumer Product Safety Commission recalled more than 31 million toys; of those, the cause was excessive lead in 4 million toys.

The majority of those recalled toys were made in China. Even more jewelry (mostly made in China) has been recalled, including 170 million pieces due to excessive lead.

Soft plastic toys, pacifiers, and teethers should also be considered carefully. The chemicals in soft plastics (phthalates) are possible human carcinogens. Phthalates disrupt hormones in animals, and have been linked to birth defects, breast cancer, and other health problems.

Stiffer standards regarding lead and phthalates in children's products will go into effect in February 2009, thanks to the Consumer Product Safety Improvement Act. That law applies to children's products regardless of where they were manufactured.

However, lead-painted and plastic toys -- trains, dolls, and others -- are still widely available on the market -- especially the Internet.

The Coalition to End Childhood Lead Poisoning advises:

  • Discard all brightly painted toys -- whether wooden, plastic, or metal -- that have been manufactured in Pacific Rim countries, especially China. Toys that are particularly risky are those where the paint can be peeled or chipped off, and those that are easily mouthed by young children.
  • Discard all ceramic or pottery toys manufactured outside the U.S., especially those made in China, India, and Mexico.
  • Remove all metal jewelry from children.
  • Buy only soy-based crayons. Other crayons may contain lead. Don't just rely on a "nontoxic" label.

Safer toys include:

  • Those manufactured in North America and the European Union.
  • Books, DVDs, and CDs.
  • Most plush toys, although two have been recalled for excessive lead.
  • Those made of solid wood (unfinished or with a nontoxic finish), organic cotton, wool, or hemp.

Pacifiers and teethers:

  • Choose silicone nipples over rubber (which break down faster and can hide bacteria). Silicone nipples are clear and can be safely put in a dishwasher.
  • Try natural wooden or organic cloth teethers.

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For more information on toy safety, consult the Consumer Product Safety Commission web site and HealthyToys.org.

8. Get picky about baby bottles. There's continuing controversy over whether plastic baby bottles are safe. That's because the chemical bisphenol A (BPA) can leach from plastic baby bottles made from polycarbonate plastic, potentially posing a health risk to infants. The same chemical is found in many other products -- especially food and drink packaging, like some reusable polycarbonate water bottles.

The FDA and the American Chemistry Council say bisphenol A is safe for use. However, an independent panel of scientists has criticized the FDA's stance on bisphenol A safety -- stating that more attention should be paid to infants' exposure.

The National Toxicology Program issued a report in September 2008, noting "some concern" about the effects on the brain, prostate gland, and behavior in fetuses, infants, and children. In animal studies, BPA mimics the effects of estrogen.

To reduce your infant's exposure to BPA, try the following:

  • Look for safer baby bottles -- either tempered glass bottles or plastic baby bottles made of safer plastics like polyethelene or polypropylene (recycling symbols 2 or 5).
  • Don't heat breast milk or infant formula in plastic baby bottles.
  • Don't microwave plastic containers with baby food or milk.
  • If you use formula, opt for powdered. Many formula cans are lined with a BPA resin and liquid formula is more readily contaminated than powdered.

Some plastic products may have labels saying they are free of bisphenol A. Products that do contain BPA are not required to list the chemical on the label.

WebMD Feature provided in collaboration with Healthy Child Healthy World Reviewed by Michael W. Smith, MD on December 23, 2008

Sources

SOURCES:

Philip Landrigan, MD, pediatrician; director, Children's Environmental Health Center, Mount Sinai School of Medicine, New York City.

Sonya Lunder, MPH, senior analyst, Environmental Working Group.

Environmental Protection Agency: "Lead-Based Paint," "Ten Tips to Protect Children from Pesticide and Lead Poisonings," "Protecting Children from Pesticides," "Citizen's Guide to Pest Control and Pesticide Safety," "Do's and Don'ts of Pest Control," "Introduction to Indoor Air Quality."

Environmental Working Group: "Health/Toxics: Lead," "Reducing your exposure to PBDEs in your home," "Toxic Fire Retardants in American Homes."

American Academy of Allergy Asthma & Immunology: "Tips to Remember: Indoor Allergens."

Healthy Child Healthy World: "Carpets and Rugs," "Rest Easy on a Safe Bed," "Nipples, Pacifiers and Teethers," "Feeding with the Bottle," Do You Know What's In Your Baby's Mattress?," "Household Dust Doesn't Pose a Fire Hazard. So Why is it Loaded with Flame Retardants?"

CDC: "Pediatric Environmental Health: The Child as Susceptible Host: A Developmental Approach to Pediatric Environmental Medicine."

WebMD Health News: "Plastic Chemicals Linked to Asthma, Allergies," "Fire Retardants Found in Children's Blood," "Study Shows Toxic Chemicals in Newborns," "Solving Your Diaper Dilemma," "Lead in Toys: Could It Be Lurking in Your Home?," "Panel Criticizes FDA Bisphenol A Report," "Bisphenol A: 9 Questions and Answers," "Safety Debate - Antibacterial Soap."

HealthyToys.org: "Chemicals of Concern."

ConsumerReports.org: "Clearing the shelves of lead-tainted toys."

Reuters.com: "President Signs Phthalate Ban Into Law."

GreenSeal.org

GreenGuide.com: "Flushable Diapers?"

Friends of the Earth: "Killer Cribs."

The Ecology Center.

Coalition to End Childhood Lead Poisoning.

Sources

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