Posted in Parenting

Parent Fun: Daily Options in San Diego

Whether home on Parental Leave or Full-Time, or you just have a Day Off with the kid(s)–there are lots of things you can do!  Life can be unpredictable, so having some fun drop-in options (with an emphasis on parent happiness!) is great!  San Diego offerings are below (and seeing the type of options here might help you search for ones of interest in your area too)!  This continues to be a work in progress…feel free to Contact Us with more suggestions!

Any day activities!  There are a wealth of options anytime you can do it!  (When my baby gives me free time, I’ll insert more links, but you can google in the meantime!)

Additional Lists of Ideas:

There’s so much out there!  Enjoy!

Posted in Parenting, Pre-Parenting

New AAP Plastic&Chemicals Recs: What to Do?

The AAP recently released a study and new recommendations warning against plastics for children and infants, including not using plastics in the microwave and dishwasher (even BPA-free plastics). They also included other warnings of chemicals in various food packaging and other sources.

As a sleepy new parent with a sleepy 3 month old in my arms, the plastic warning was especially concerning for her baby bottles (and plastic pump parts) and plastic sterilizing kits that used the dishwasher or microwave.  I’d like to delve more into the science, but  below are the actual AAP recommendations and the purchases I made to decrease the risk in the meantime. (These are unpaid, unbiased recs for items I got to keep my own family safe.) Your own research or input is always welcome at the Contact Us section!

AAP recommendations (directly from their source here):

  • Prioritize consumption of fresh or frozen fruits and vegetables when possible, and support that effort by developing a list of low-cost sources for fresh fruits and vegetables.
  • Avoid processed meats, especially maternal consumption during pregnancy.
  • Avoid microwaving food or beverages (including infant formula and pumped human milk) in plastic, if possible.
  • Avoid placing plastics in the dishwasher.
  • Use alternatives to plastic, such as glass or stainless steel, when possible
  • Look at the recycling code on the bottom of products to find the plastic type, and avoid plastics with recycling codes 3 (phthalates), 6 (styrene), and 7 (bisphenols) unless plastics are labeled as “biobased” or “greenware,” indicating that they are made from corn and do not contain bisphenols.
  • Encourage hand-washing before handling foods and/or drinks, and wash all fruits and vegetables that cannot be peeled.

My Purchases and Actions to Decrease Risks:

  • Boil materials to sterilize (?) rather then contaminate be microwave and dishwasher (but I do wonder about plastic contaminating my pots or leaching materials from pot chemicals…or if heating the plastic whatever way is the problem…I didn’t see a quick answer in the AAP report.  Regardless the CDC still recommends sterilizing bottles).  Picking a safe pot type: I use nonstick in general; however, for sterilizing I thought maybe it was safer to follow the Environmental Working Group (EWG) recs that cast-iron or stainless steel may be the safest material (although the $30 Made In China “stainless steel” pot I got from Amazon leached a chemical film on my bottles despite good reviews…paying more or purchasing from a reputable source or store is probably worth it if you’re replacing cookware!) AAP thoughts on non-stick pans:  Chemical PFCs like PFOA/PFOS are warned against by the AAP and can be in nonstick pans, especially before 2015. The chemicals in old nonstick pans and pots meant I replaced them, picking a mostly copper new nonstick pot similar to this from Marshalls…although I do wonder if it might have other variants of PFCs that still can cause harm.  Less scientific sources make claims of the safest cookware here or here, another slightly scientific chemistry-based source says “Overall all cookware made by reputable manufacturers using reputable coating systems is safe. One should only have concerns about low end low cost cookware made by unknown manufacturers.”   It can be tricky to know what is “best” though… Perhaps avoiding nonstick to pick a ‘purer’ boiling pot for sterilizing bottles would be best (like my stainless steel thought) as the AAP specifically says“Because of health and environmental concerns, US production of PFOS was phased out in 2002, and PFOA was phased out in 2015.107 However, these particular compounds are only 2 of more than a dozen members of the parent family. For example, closely related PFNA chiefly replaced PFOA; increasing PFNA concentrations were detected in the 2003–2004 NHANES and have remained stable thereafter.102“…In January 2016, the FDA banned the use of 3 classes of long-chain PFCs as indirect food additives.108 Yet, structurally similar short-chain PFCs, such as PFHxS, may continue to be used.”  In the very least, changing out my plastic bottle parts dishwasher rack for a purely silicone one might help…but I think I’ll avoid the dishwasher all together for sterilizing my plastic bottles and pump parts.  I still use it for the glass bottles and silicone nipples I bought below.  (I’m still in limbo of what seems best for sterilizing plastic parts, however!)
  • Buy glass baby bottles.  Evenflo brand is compatible with Medela pumps (as are Dr. Brown’s, Parent’s Choice at Walmart, and a few others, which I learned from the graphic for this product).  Evenflo glass bottles were relatively inexpensive on Amazon Prime for 4oz or 8oz (6 for ~$16), I purchased them and they’ve seemed durable and were made in Mexico. The nipples were silicone and milk only comes in contact with the silicone rather than the plastic cover and lid they still have.  Dr. Brown’s also sells glass bottles, but apparently only in the wide-neck version now that is not Medela compatible.  I also got a $6 Stainless Steel Parent’s Choice bottle from Walmart (sold in 5oz or 9oz), which still has a plastic lid but silicone nipple–being opaque makes it not as useful for pumping, but it is a non-breakable option for travel.  When I opened it had a heavy plastic/chemical smell (maybe from the packaging-but it made me wonder if such a cheap, Made in China version might have chemical issues and not be as good), but I haven’t noticed the smell as much after using the dishwasher…
  • Glass or Pyrex food storage for myself to avoid contamination of the microwave or dishwasher. After much trial and error I found some slightly more expensive glass&silicone only ‘Ultimate’ sets made by Pyrex (glass made in USA) that worked great and were much cheaper at Target, Williams Sonoma or sources than on Amazon (and less likely for the low-quality/false positive review/bait-and-switch error of other cookware I got from Amazon).  My searching process:  Well many Snap-on lids looked clear like glass and report a silicone seal, they are actually made of PP (polypropylene, #5) plastic–not the high risk#3,6,7 plastics the AAP warns against, but also still has unclear risks. My original compromise was to buy extra silicone lids to try, and not use the plastic lids or at least hand wash it and not microwave or dishwasher it. That opened many options of brands online of glassware storage with plastic lids/  After seeing reviews where even well reviewed ones would break, I originally chose to side with a reputable one like Pyrex; however, there were reports in Amazon of Pyrex breaking too, especially if they are in the cheaper ‘storage’ not the baking category and put in hot environments.  This set from Anchor Hocking is purportedly American made, but the lower quality plastic lids might not be (but in my selection I was less about the lid quality as I would try not to use the plastic lids; however, they arrived chipped and seemed cheaper than Pyrex so I returned them and don’t recommend!). There were also silicone containers that were more expensive but would be plastic free. They reportedly retain taste and smell more than others in reviews, and I’m not sure if low quality ones might have some contamination since silicone isn’t reported by the AAP (and apparently some silicone dyes might have issues). Generally pure silicone is safe for medical use, but I wasn’t sure quality online (it is generally endorsed as safe in not-super-scienc rticles). After much searching and some returns, I was happy with the Ultimate Pyrex Glass&Silicone only sets (available in many sizes and dishwasher safe and plastic free!), plus some extra flexible silicone lids filled the gap replacing old plastic lids I had (bonus those fit over multiple shapes and even foods and were dishwasher safe– replacing Syran wrap too).  
  • Silicone lids for food storage. These reportedly can fit on any container and I did not notice them on the AAP negative list. This could be an alternative to plastic for covering the glassware, and I ordered these to give it a try. They have been good so far and are reportedly dishwasher safe, although they are a Chinese company.
  • Got rid of old Tupperware and cheap baby plates once I knew my replacement worked well. This would help avoid my habit of putting them in the dishwasher or microwave, but others may be happy just keeping them and washing by hand if they are concerned. I wasn’t actually sure if my Tupperware was BPA free on reflection since it was quite old. I also reevaluated whether my current silverware was safe has a left metal marks on my bowls and it was cheap from Marshalls-I may get new stainless steel ones and do the Montessori approach of real glassware instead of plastic for kids &not my bpa-free plastic I got from Ikea once my baby starts on foods.

Lots to think about!  Those were things I ordered after a sleepless night researching and reading the AAP Recommendations.  They have a lot more in the article that is worth looking over the science and safety (I included some more relevant quotes from them below).  Hopefully I can look into more soon!

Summary of Other Chemicals and Risks relevant quotes from the AAP Article:

“The potential for endocrine system disruption is of great concern, especially in early life, when developmental programming of organ systems is susceptible to permanent and lifelong disruption. The international medical and scientific communities have called attention to these issues in several recent landmark reports, including a scientific statement from the Endocrine Society in 2009,42 which was updated in 2015 to reflect rapidly accumulating knowledge3; a joint report from the World Health Organization and United Nations Environment Program in 201343; and a statement from the International Federation of Gynecology and Obstetrics in 2015.44 Chemicals of increasing concern include the following:

  • bisphenols, which are used in the lining of metal cans to prevent corrosion45;

  • phthalates, which are esters of diphthalic acid that are often used in adhesives, lubricants, and plasticizers during the manufacturing process17;

  • nonpersistent pesticides, which have been addressed in a previous policy statement from the American Academy of Pediatrics and, thus, will not be discussed in this statement46;

  • perfluoroalkyl chemicals (PFCs), which are used in grease-proof paper and packaging47; and

  • perchlorate, an antistatic agent used for plastic packaging in contact with dry foods with surfaces that do not contain free fat or oil and also present as a degradation product of bleach used to clean food manufacturing equipment.48

Additional compounds of concern discussed in the accompanying technical report include artificial food colors, nitrates, and nitrites.

Environmentally relevant doses (ie, low nanomolar concentrations that people are likely to encounter in daily life) of bisphenol A (BPA)4 trigger the conversion of cells to adipocytes,9disrupt pancreatic β-cell function in vivo,49 and affect glucose transport in adipocytes.911Phthalates are metabolized to chemicals that influence the expression of master regulators of lipid and carbohydrate metabolism, the peroxisome proliferator-activated receptors,21with specific effects that produce insulin resistance in nonhuman laboratory studies. Some studies have documented similar metabolic effects in human populations.22 Some phthalates are well known to be antiandrogenic and can affect fetal reproductive development.18,19,50 Authors of recent studies have linked perfluoroalkyl chemicals with reduced immune response to vaccine27,28 and thyroid hormone alterations,29,51,52 among other adverse health end points. Perchlorate is known to disrupt thyroid hormone34 and, along with exposures to other food contaminants, such as polybrominated diphenyl ethers,5355 may be contributing to the increase in neonatal hypothyroidism that has been documented in the United States.56 Artificial food colors may be associated with exacerbation of attention-deficit/hyperactivity disorder symptoms.57 Nitrates and nitrites can interfere with thyroid hormone production40 and, under specific endogenous conditions, may result in the increased production of carcinogenic N-nitroso compounds.37,38

Other Resources (often summarizing AAP recs in layman’s terms):

Initial AAP News Release:

https://www.aap.org/en-us/about-the-aap/aap-press-room/Pages/AAP-Says-Some-Common-Food-Additives-May-Pose-Health-Risks-to-Children.aspx

Other related articles:

https://www.simplemost.com/american-academy-of-pediatrics-issues-new-warning-about-putting-baby-bottles-and-bowls-in-the-microwave-and-dishwasher/

Posted in Parenting, Pre-Parenting

Lead Risks and Testing

Flint, Michigan brought awareness to the risk of lead exposure–raising the question whether we should be testing for lead?  Lead is an odorless, tasteless material that can be found in paint (before 1978), water or other sources, which can cause serious neurological, behavioral, or health issues in children or adults.  (Breathing or swallowing lead paint dust can provide exposure without you even knowing it.) The American Academy of Pediatrics (AAP) says there is no safe level of lead and calls for stricter regulations and testing.

You’re at high risk for lead exposure effects if: you’re planning to become pregnant, already pregnant or nursing, or have young children at home (under the age of 6).  Young, rapidly growing fetuses or children incorporate lead more readily, but lead can affect everyone depending on its levels.  Lead testing is useful anytime if you are at risk–find out more about risks and testing below.  

Lead in Paint:

Lead paint was banned In 1978, so newer homes are generally safe.  Lead exposure is highest in older homes that have chipping or degrading paint, dust released by opening or closing doors/windows with lead paint, or soil that accumulated lead over time.  (More details of other risks from the EPA here).  For home testing, the EPA approves several lead paint tests kits, including 3M Lead Paint Sticks (8 for ~$24 on Amazon).  If the 3M Lead tests are positive/inconclusive, or your house is high risk: you can check the EPA for certified lead testers or google “lead testing” in your area to find companies that provide testing and hopefully piece of mind (~$250+ depending on your home/location).  

If you find you have lead paint: there are several ways to mitigate risks detailed by the EPA, including regular dusting, wiping areas with wet cloths and avoiding disturbing lead paint etc.  If you have lead paint, doing any renovations requires a certified lead specialist (as it can stir up more lead dust and increase your exposure risks)- find out more on the about renovations from the EPA here.

Lead in Water:

Lead in water is especially high risk when using water to mix infant formula, or for pregnant women or young children (under the age of 6).  The EPA regulates lead levels in tap water to a maximum of 15 parts per billion (ppb) (which is believed not to raise lead levels in adults); however, despite these EPA rules there are several recent cases of high lead levels in Flint Michigan, or even school drinking fountains across San Diego. Even if city systems are tested and regulated, the CDC warns that lead can still get to your tap by water mains connecting to your house or older piping within your house (especially in houses built before 1986).   If you are concerned, you can bring a sample to an EPA certified lab for lead testing (using a certified bottle to collect the first sample in the morning from home sources).  I chose an EPA certified lab that was $25/sample rather than paying ~$15/sample for less accurate home test strips (home test kit reviews aren’t great).  For more testing info check out these links: from the EPA, info about collecting sample tips, San Diego specific testing info here (or find EPA approved laboratories by searching here or googling your own city). 

If you find you have lead in your water: the CDC has detailed tips for lead mitigation here (including running the tap on COLD for certain amounts of time before drinking, etc.)  Some people opt for water filtration systems attached to your faucet (however, I had difficulty finding exactly how much lead was removed by various systems).  Some people opt for bottled water.  The FDA regulates bottled water, setting maximum lead levels to 5ppb in bottled water vs 15ppb EPA regulation for tap water (however, many internet articles suggest FDA bottled water regulation might be more lax than desired–bottled water can be just tap water and might have less regular testing).  The FDA discusses bottled water regulation here, and the CDC has some limited tips here.  Some people bring up concerns about plastic levels (or BPA) in bottled water, which may be addressed in a future blog post.  

Blood Tests for Lead:

Lead is tricky to detect once it gets in the body because it creates an equilibrium of lead storage in bone versus other tissues like blood (and adults may not display obvious symptoms).  Lead blood test levels alone don’t fully rule out lead risk in adults (and environmental testing of lead paint, water etc if indicated is highly encouraged).  

Pregnant or Lactating Women: Beyond present environmental lead exposures, pregnancy or breastfeeding can also release old lead from bones due to increased bone turnover (especially with low calcium or anemia).  Lead is transmitted across the placenta and found in fetal brains as early as the first trimester.  While the American College of Obstetrics and Gynecology (ACOG) doesn’t recommend routine blood lead screening for ALL pregnant/lactating women–  with EVEN ONE lead exposure, ACOG recommends Lead Screening for Pregnant or Breastfeeding women.  (Full EPA lead exposure list here; full ACOG recommendations here for testing and treatment; additional CDC 2010 information here.)

Infants and Children:  Basically if you have known environmental exposure to lead, earlier or more frequent blood testing may be indicated tell your Pediatrician about specific lead exposures/risks to get lead blood testing.   (Age 6-12 months can be marked by rapid lead absorption- and all children under 6 years old are at increased risk for lead effects because of their small body size, higher percentage body water, rapid growth, and increased risk for lead dust/paint ingestions.)   Officially, the American Academy of Pediatrics (AAP) recommends a lead “risk assessment at the following well-child visits: 6 months, 9 months, 12 months, 18 months, 24 months, and at 3, 4, 5 and 6 years of age. The recommendation is to do a risk assessment, and do a blood lead level test only if the risk assessment comes back positive.  According to the AAP and CDC, universal screens or blood lead level tests are not recommended anymore except for high prevalence areas with increased risk factors as described in a 2012 CDC report, such as older housing.”   However, as many Medicaid-eligible patients are higher risk, the AAP may recommend standard screening Blood Lead Level at age 1 and 2 years for all Medicaid patients, depending on your state.  Further AAP lead information hereSummary: bring up any concerns (like older housing) to your Pediatrician to warrant blood lead testing.

If there is lead in the blood lead test:  Blood lead level under 5 micrograms per deciliter is generally considered low-risk; however, because lead is stored in bones and other areas it cannot be fully ruled out.  Known environmental exposures or higher blood levels may require repetitive monitoring, or even treatment (more info from ACOG or AAP).  Adequate intake of calcium, iron, zinc, vitamin C, vitamin D helps decrease lead absorption (ACOG)

Lead Testing Summary:

This article isn’t meant to alarm, but to inform.  If you find you are at risk for any environmental lead exposures, further lead testing AT ANY POINT is beneficial to your pregnancy or children.  Many good resources are linked in the article above.  A few more quality resources can be found below, including an image below from the EPA further detailing the effects of lead.  Many of the negative effects of lead can be treated, mitigated or prevented if you find out early and get tested.

More details of other lead risks from the EPA here: https://www.epa.gov/lead/protect-your-family-exposures-lead)

Consumer Report Review of Lead Test Kits: https://www.consumerreports.org/cro/lead-test-kits/buying-guide

Lead impacts on health: https://www.epa.gov/sites/production/files/2017-06/documents/pyf_color_landscape_format_2017_508.pdf ) (Source of the image below:)

EPA Lead Health Effects