當馬克遇上莎莉

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When should I start brushing my baby's teeth?

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On average, babies

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Have you seen stories in the press about potentially harmful chemicals in your baby's bottles, toys or nursery equipment? Quite possibly, as there have been several media scares about this issue over the years.
But where do these stories originate from and is there really any cause for concern? BabyCentre takes a look at the facts behind the headlines.

Some background
For some time now, environmental campaigners have been worried about the presence of certain chemicals in our environment. These man-made chemicals cause concern because of their persistence -- they accumulate in the environment, or in our bodies, without being broken down. No-one is yet sure what the long-term effects of these chemicals will be in humans, but there is already evidence that they are harming wildlife.
Greenpeace toxics campaigner Mark Strutt says: 'Some experts argue there is sufficient evidence to suggest these chemicals disrupt the body's endocrine system (which controls hormones and growth) and are linked to chronic diseases such as cancer. We want them banned and substituted with safer chemicals.'

How does all this affect me and my baby?
 



Some of these chemicals are used in the manufacture of baby equipment, such as plastic (polycarbonate) feeding bottles, cot mattresses and plastic toys. Environmentalists say they can be ingested by children and may build up to harmful levels in their bodies, although some manufacturers dispute this.
 

Exactly which chemicals are we talking about?
There are four groups of chemicals used in the manufacture of household goods that environmental campaigners have expressed concerns about:
• Phthalates These are chemicals used to soften PVC plastic and are often found in toys. Research has shown that phthalates can build up in the body, and tests on animals have shown they can damage the development of reproductive organs.
Until recently they were used in babies' dummies and teething rings, but the European Union has now banned their use in products "intended to be chewed or sucked in children under three". However, these chemicals are still used in soft plastic toys, such as bath toys and squeezy toys, so it is still possible for your baby to ingest them.
• Organotin compounds These chemicals are used as a stabiliser in PVC. They are found in vinyl flooring and harder PVC toys. These have been found to cause hormonal changes in animals.
• Bisphenol A This chemical is used in babies' feeding bottles. There is some concern that it can leach out into milk if the bottle is old and cracked, although this is disputed by some scientists and manufacturers.
• Brominated flame retardants These chemicals are used to treat clothing, household furnishings, prams, buggies and mattresses, including cot mattresses, to make them less flammable. Research has shown they can leach out and be absorbed into the body, and they have been found in blood and breast milk. They can act as hormone disrupters, and animal tests have linked them to learning disabilities, cancer, miscarriages and changes in the immune system.

How can I tell if baby products are free of these chemicals?
Unfortunately, the short answer is that you can't. At the moment manufacturers are not obliged to state which chemicals are present in their products, but this may be about to change. The European Union is currently drafting a new law, called the Registration, Evaluation and Authorisation of Chemicals (REACH), which would make it compulsory for manufacturers to provide more information about what their products contain.
Greenpeace and other environmental groups believe REACH doesn't go far enough. They want manufacturers to substitute potentially harmful chemicals with safer alternatives. The REACH law will not come into effect until 2006 at the earliest.

What do manufacturers say?
Robert Chancery-Price, secretary of the Baby Products Association (BPA), says manufacturers take safety concerns seriously. "Many responsible manufacturers are aware of the problems with phthalates, for example, and are using alternatives or are using them within prescribed limits," he says.
"There is some debate over whether polycarbonate bottles are a hazard, but some manufacturers are producing alternatives now that do not contain bisphenol A," he adds. "The BPA has also lobbied the Department of Trade and Industry arguing there is no need to flame retard many baby products, such as prams and pushchairs, but our concerns have fallen on deaf ears."

What do are high-street companies doing?
Lots of high-street companies are starting to look at phasing out potentially harmful chemicals in baby equipment and other households goods. Mothercare, the Body Shop, Ikea, Homebase, Debenhams, Argos, Marks & Spencer, the Co-op, Boots, B&Q and the Early Learning Centre have all signed a pledge drawn up by Friends of the Earth to remove risky chemicals from their products.
Boots confirm that Bisphenol-A is still used in its plastic (polycarbonate) feeding bottles, but said it is converted into an insoluble form and tightly bound into the plastic matrix during manufacture. A spokesman said there was not any convincing evidence that polycarbonate products are not safe. However, as a precautionary measure, Boots has commissioned some independent testing on polycarbonates.
Boots do not sell products containing phthalates intended to be placed in the mouth of children under three, but phthalates may be present in a very small number of soft PVC products for over threes. A spokesman said they are investigating alternatives.
If you have any concerns over the chemical content of any Boots product, contact customer services on 0845 0708 090.
Marks & Spencer spokesman Mike Barry says brominated flame retardants are not used in any M&S children's clothing. M&S have banned phthalates in food packaging and have phased them out of 85 per cent of all product packaging. They are also looking to phase out phthalates from all soft PVC toys. For more details, contact customer services on 0845 302 1234.

What else can I do to protect my child?
Unfortunately, the onus is still very much on consumers to find out if potentially toxic chemicals are used in baby products. If you feel you would like to avoid these chemicals:
• Don't buy PVC toys or, if you do, check with the manufacturer first to see if they contain phthalates or organotin compounds.
• Throw away old or cracked plastic feeding bottles to avoid the possible risk of bisphenol-A leaching into milk.
• When buying a cot mattress, check with manufacturers to see if it has been treated with a flame retardant and that it meets British Safety Standard 1877 part 10.
• Don't pass mattresses on to siblings -- buy a new one for each child.
• Write to manufacturers or call their customer services lines asking if their products contain any of the chemicals listed above.

Where to find out more
• Greenpeace runs a toxics campaign and provides information on potentially harmful chemicals and their impact on babies and children. Log on to www.greenpeace.org.uk
• Find out more about the REACH legislation.

What are the new rules?

Children under three: until his third birthday, your baby or toddler must use a child car seat appropriate for his weight in any vehicle (including vans and other goods vehicles) regardless of whether he is sitting in the front or the back. If you can't fit a child seat for your baby or toddler then he can't travel legally. In addition, the new rules also say that rear-facing baby seats MUST NOT be used in a seat protected by a frontal air-bag unless the air-bag has been deactivated. If you are using a forward facing child seat, see what your car's handbook says about children in seats with frontal air-bags. The advice can vary from car to car.
Children three and over: until he is 135cm tall (approximately 4ft 5in), your child must use an appropriate car seat. Using an adult seat belt for a child who is under 135cm tall is no longer legal.
Are there any exceptions?





Children under three: there is only one exception to the new law for children under three. If you are travelling in the rear of a taxi and you don't have a car seat with you your baby or toddler can travel without a seatbelt.
Children three and over: there are only three occasions where children over the age of three and under 135cm tall can travel in the back of a car using an adult seat belt. These are:
• In a taxi, if an appropriate child seat is not available.
• For a short distance "in an unexpected necessity". This exception is designed to cover situations where you might have to collect your child, or someone else's, at short notice and don't have the right car seat with you.
• Where you need to carry three children but can only fit two car seats in the back of the car. In this case the third, and preferably tallest, child could use an adult seat belt.
A very few cars, for example classic cars, don't have any seat belts fitted at all. If you are travelling in a car like this, children aged three and over are allowed to travel in the back unrestrained. However, just because it is legal doesn't make it safe.

 
Why is the law changing? 

The government estimates that more than 2000 children are injured or killed each year through not being properly restrained in a car. The old rules generally say that child seats and boosters should be used if they are available. This is a bit vague and as a result, many parents stop using car seats for their children long before it is really safe to do so. The government believe that parents and children will benefit from always using child seats and boosters. 

What is wrong with children using adult seat belts? 

If your child uses an adult seat belt before he is tall enough to, the lap part of the belt sits too high on his stomach and in a crash it could damage his internal organs. There is also a risk of him slipping under the belt.

I need to buy a new child seat. What should I look for?

Modern child restraints are designed for specific weight ranges of child so check your child's weight before you go shopping. There are different categories of car seats suitable for different age ranges. They have to be marked with a label (showing an "E" and "44.03" or ".03", meaning it meets with European safety regulations) and the Group number, or weight range of child, for which it is designed. These can vary from one manufacturer to another but generally, they follow these guidelines:
• Group 0 and Group 0+. These are infant carriers - rear-facing and for children up to 10kg and up to 13kg respectively (approx age birth to 9-12 months);
• Group I. Child seats - forward facing and for children 9kg to 18kg (approx 9 months to 4 years);
• Group II. Booster seats - for children from 15kg to 25kg (approx 4 to 6 years), or 15kg up to 36 kg);
• Group III. Booster cushions - for children from 22kg and up to 36kg (from approx 6 years).
See our buying guide for more information on car seats. 

What are the penalties for breaking the new law?

A £30 fixed penalty notice. If your case goes to court, the maximum fine is £500. Penalty points are not applicable.
Further advice can be found at: www.thinkroadsafety.gov.uk.
Created September 2006

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Approved by the BabyCentre Medical Advisory Board
It is important not to lump all immunisations together in terms of their safety record. Different vaccines are made in different ways and so have different risks and side effects:

Diphtheria

Immunisation has dramatically cut the number of diphtheria cases in this country. The disease is extremely rare in the UK now, whereas in 1940 nearly 50,000 cases were reported. However, cases of diphtheria are still seen in other countries.
Diphtheria immunisation works by stimulating the body to produce an anti-toxin to the diphtheria toxin. This is done by using an inactivated form of the toxin. Mild swelling and redness at the injection site are common, but more severe reactions to diphtheria immunisation are rare.


Haemophilus influenzae type b (Hib)





Complications of the vaccine are mild, usually just some swelling and redness at the site of the injection, or a mild fever.
Before this vaccine became available more than 60 children per year died as a result of haemophilus infection and twice as many suffered permanent brain damage. When the Hib vaccination was introduced to the UK in 1992, and by 1995 there had been a 95 per cent decline in confirmed cases of Hib meningitis and septicaemia (blood poisoning) in children under one.
 

Meningitis C

This vaccine is made in the same way as the Hib vaccine and the complications are rare. The most common reactions are redness and swelling at the site of the injection, mild fevers, irritability and headaches.


Measles, mumps and rubella (MMR)

You may find that your child has a short reaction to this immunisation seven to ten days after the injection. This may consist of a mild fever and a rash.
There have been concerns that the vaccine may be responsible for causing a few cases of encephalitis each year. Research has shown that the numbers of cases which may be linked to the vaccine are tiny in comparison to the numbers caused by measles and mumps themselves. Meningitis and encephalitis resulting from measles itself is roughly one per 1000 notifications and from mumps it is one per 200-5000 notifications (it can vary from one outbreak to the next).
A research paper published in February 1998 raised concerns about a possible link between the MMR vaccine and autism and Crohn's disease, which causes inflammation in the bowel. Large studies have been done and are continuing to be done, but as yet there is no conclusive proof of a link.


Pneumococcal infection (PCV)

Some swelling and redness at the injection site and a mild fever are among the most commonly reported reactions. Other mild side effects such as a slightly raised temperature, irritability, sickness, diarrhoea and loss of appetite may also occur.
Experience of using PCV in other countries has shown this vaccine to have an excellent safety record. In the US, PCV has been part of the universal childhood immunisation programme since 2000. Since its introduction, the incidence of invasive pneumococcal disease (the most serious form of the infection) has fallen by 94% in children under five years. Estimates vary but at least 16 and as many as 53 children under the age of two die from invasive pneumococcal disease in England and Wales each year.


Polio

Adverse reactions are rare with this vaccine.


Tetanus

The tetanus vaccine contains an inactivated toxin from the organism. It is common to see swelling and redness around the injection site and, occasionally, the child will be off colour and mildly feverish. More severe reactions are rare.


Whooping cough (pertussis)

There have been concerns in the past about the safety of this immunisation. They originated in 1974 after the publication of a paper which suggested a relationship between the whooping cough immunisation and serious conditions of the nervous system, such as epilepsy and learning disorders. As a result of the anxiety, uptake of the immunisation dropped to between 30% and 40% for a number of years. Subsequently, there were whooping cough epidemics between 1977 and 1979, and 1981 and 1983.
In response to this, the National Childhood Encephalopathy Study was set up. It concluded that the risk of a previously normal child developing a serious problem of the nervous system due to whooping cough immunisation was one in 110,000, and the risk of suffering permanent brain damage was one in 310,000. Intensive research in this country and abroad has failed to find a definite link. Also, these complications are complications of whooping cough itself and are more common after the disease than after the immunisation.
There has also been a link suggested between the whooping cough immunisation and asthma. However, there is no conclusive evidence of this.
In the past, children with epilepsy or a family history of epilepsy were not given the immunisation. However recent studies have shown that it can be given with no adverse effects. However, if the child has a history of febrile convulsions or there is a family history, there seems to be an increased risk of developing a febrile convulsion after the immunisation, so it is vital that parents know how to treat a fever.
There may be swelling and redness at the site of the injection and babies may be quite irritable, feverish or, occasionally, distressed after the injection.


Can my child have the immunisations separately?

Doctors generally agree that there is no increased risk associated with giving certain immunisations, such as the DTaP/IPV/Hib, together. There are also difficulties with giving the vaccines separately. Firstly, some vaccines may not be available separately in this country (the rubella vaccine on its own is not licensed in the UK for children under 10, for example). Secondly, some vaccines have to be given at least four weeks apart, so giving them to your child separately would significantly delay and prolong her immunisation schedule.


Why does my baby have to have the immunisations so young?
Babies are given their first round of routine vaccinations at eight weeks to ensure that they are protected at a time when they are most vulnerable to the effects of infectious diseases. Plus, studies have shown that babies immunised at this age are less likely to have reactions to the injections. For doctors, early immunisations also mean higher compliance by parents, so more babies are immunised.
Reviewed May 2006