Are Pacifiers Evil?

  My daughter still uses a pacifier at age two and a half and my wife and I have heard numerous times that if we don't wean her soon, she will have permanent dental problems. We were also told to avoid them soon after her birth, so as to not interfere with breastfeeding. There seems to be a lot of confusion regarding whether pacifiers are helpful tolls, or just plain evil. Here's a short review.


1) Pacifier use in newborns helps prevent SIDS (crib death)

TRUE

A review of seven studies published in 2005 by the University of Virginia School of Medicine showed a clear advantage in SIDS prevention among infants under one who used a pacifier for sleep. The researchers showed that for every 2733 babies of used pacifiers, one episode of SIDS could be prevented, which, when considering the terrifying outcome of SIDS, is certainly compelling.

2) Pacifiers can interfere with establishing breastfeeding in the first month

MAYBE BUT PROBABLY NOT

Several studies from different countries have corroborated data which shows that pacifiers can interfere with nursing. Each of these studies has some flaws, but together they seem to agree that pacifier use should be delayed until breastfeeding is established.

However, a mechanism to explain exactly why it is that pacifier use blocks successful nursing has not been found. Many lactation experts speak of “nipple confusion” as an explanation. In this hypothesis, the pacifier represents a “fake” nipple, eroding the child’s ability to learn correct latch and milk expression from a real, and very differently shaped nipple. La Leche League International states “Pacifiers can be risky for breastfed babies. When it comes to comforting newborns, they are not right for the job, and mothers should avoid them until breastfeeding is well established, at least for the first three or four weeks. “

Others have postulated that pacifier use decreases an infant’s frequency of nursing and ability to empty a breast. This leads to decreased milk production through a hormonal process. (see bottom of article for explanation)*

Both the above hypotheses have not, as of today, been proven. The lack of mechanism by which pacifiers interfere with breastfeeding creates a “chicken and egg” dilemma. While there is a clear association between pacifier use and breastfeeding disruption, there is no clear causation. In other words, it is unclear whether parents who chose to use pacifiers do so because they are having trouble with nursing in the first place. So we may be blaming pacifiers for diminished nursing when the initial problem may be unrelated.
Finally, a 2001 study, published in the Journal of The American Medical Association, looked at 258 infant-mother breastfeeding pairs who either used a pacifier or did not. They found no increase in breastfeeding weaning at age three months with pacifier use. Interestingly, the perception during the experiment was that pacifiers did cause earlier weaning. But when the statistical numbers were run, no such effect was calculated.

3) Pacifiers Cause Dental Problems

FALSE BEFORE AGE THREE

An "orthodontic" pacifier

Pacifier use in the first years of life is well known to temporarily change children’s tooth alignment. However, there is some, but relatively limited data to suggest that pacifier use is responsible for permanent dental changes.

A few studies conducted in the 1970s showed no or minimal relationship between pacifiers and permanent dental alignment issues. The lack of relationship was especially true when pacifier use was stopped prior to age four.

A newer study, published in “Pediatric Dentistry” in 2005, studied 444 children. Here, researchers found an increase in the occurrence of overbite in children who used a pacifier until ages two to four. A 2004 study, published in  2006, concluded that  “Pacifier use beyond the age of 3 contributes to a higher incidence in anterior open bite, posterior cross bite and narrow intercuspid width. The greater the longevity and duration of pacifier use, the greater the potential for harmful results”

In all studies, special “orhtodontic” versus regular pacifier shapes, made no difference in dental outcomes.

The bottom line is that the data on whether pacifiers cause permanent dental changes is somewhat mixed. There seems to be pretty clear evidence that pacifiers can lead to permanent dental alignment problems, but those tend to start with use past ages two to four. Also, it seems clear that the longer a pacifier is used, the more severe the problems may become. However, based on the data available, it seems very reasonable that the AAP has recommended avoiding pacifier use beyond age three.

4) Pacifiers can cause more ear infections

TRUE (but...)

There is strong evidence that using a pacifier increases the risk of ear infections by about 1.5 times. There are several studies that show this causation and one that even showed that the more pacifier use was reduced, the more the rate of ear infections decreased. However, breastfed babies using pacifiers had a decrease in ear infections compared to all infants who were not breastfed, regardless of pacifier use.There indeed seems to be a connection, but in general, the increase in infections may eliminated by breastfeeding.

Summary

• Pacifiers can decrease the chance of SIDS
• There is a chance that pacifiers interfere with nursing, but a causation has not been well proven
• Pacifiers can permanently interfere with normal tooth development, but the likelihood of this happening is small under age three
• Pacifiers increase the chance of ear infections but not by much and these infections can be avoided with nursing

The Verdict On Pacifiers

Pacifiers can be extremely useful to families. They can provide hard working, breastfeeding mothers with much needed breaks and fussy infants with oral soothing they require. There are significant advantages to pacifiers and they can even help save lives. An overly strict policy of no pacifier use until good nursing is established might be unnecessary as a true connection between use and breastfeeding failure has not been yet established. In situations where breastfeeding is proving very challenging, parents may want to meet with a lactation consultant when possible for a more comprehensive review. From the available data, it seems that the risk for permanent dental problems with pacifier use is minimal, if children are weaned from use before age three. Finally, while there is an increased risk of ear infections with use, parents should balance that information with the risks of SIDS and try to breastfeed if possible.




* Explanation from above: Milk is produced by lactocytes (milk cells) in the milk collecting channels of the breast. When milk is not frequently removed from the breast, a hormone called FIL (feedback inhibitor of lactation) is released. This tells the breasts to gradually produce less milk over time. Based on this, some have hypothesized that actions which decrease the number of breastfeeding sessions (such as choosing to give a crying baby a pacifier as opposed to a breast), leads to increased milk retention. This retention then triggers release of FIL and diminishes milk volume over time.

5 Pediatric Misconceptions: Colds and Mucus

Snot.

The matrix of existence in which a Pediatrician spends the work day. The number one culprit of mucous production: the common cold (AKA "You got a virus"). More than any other infectious disease, the common cold is responsible for missed school and work days, doctor visits and misconceptions. Here are some myths and clarifications:

1) When a child has a cold, it's important to get the mucous out

     Colds happen when a virus passes from one person to another and infects the victim's eyes, nose, mouth, throat and lungs. Viruses cause the body's defenses (its immune system) to go into battle mode. In this mode, chemicals, called interleukins, are released by the body into the bloodstream. Those interleukins reach the nose and throat area and, as part of the body's way of protecting itself, cause a flood of mucous to be released. Enter mom with tissues and a firm "blow" command as she pinches a tiny red nose.

     Blowing your nose is great for getting that annoying drip to go away for a short interval, but it will not bring a quicker end to the cold. As long as the battle between the immune system and the virus rages, interleukins, and therefore mucous, will be continuously released. When the body starts winning (usually after day 3 or 4 of illness), the snot faucets will begin to shut off. In the meantime, a nasal saline spray can really help for temporary relief.

2) Antihistamines can help a runny nose

     Allergies cause lots of mucous too and antihistamines are great for helping noses when pollen counts are high. So one would think it makes sense that those medicines can help the common cold as well. Unfortunately, those runny noses are not caused by the interleukins described above. In allergies, histamine is the chemical messenger instead. Antihistamines (Benadryl, Zyrtec, Claritin) , do what their name implies: they block the ability of histamine to do its job of making mucous. But in the common cold, caused by viruses, there is no histamine involved. So antihistamines are pretty useless.

3) When the color of the mucous changes from clear to yellow, it's time to panic

     When those pesky viruses take charge of your body and attach to the inside of your nose and throat, they cause blood vessels in that area to become leaky. Those vessels are not leaky enough to let blood out, however, white blood cells, the immune system's soldiers, can slip out of the blood stream and out to the nasal mucous. This changes the color of the mucous and makes it thicker. Changes in color and thickness do not necessarily mean the child is getting sicker, it's just part of the process. Expected mucous colors include: clear, green, yellow and whitish. Mucous that looks like pus (white or gray), merits a visit to the Pediatrician.

4) A child who gets too many colds must have a broken immune system

     On average, kids will experience 6-8 common colds a year! And that's with a fully working, healthy immune system. When someone has a broken immune system (immunocompromised), they not only get many infections, but often they will have "weird" infections. In other words, common colds are common, so there's not much to worry about. But when children experience infections with germs that are very uncommon and experience severe or unusual symptoms (infections needing hospitalizations, brain infections, never healing infections) then we worry about their immune systems.

5) My child has had a cold for 3 months

Some Prolonged Colds Are Really Many Colds In Tandem

     Some viruses, like RSV can hang around for a long time, even as long as three weeks. But most viruses last about 5-7 days, with the first 3 to 4 days being the worst for the patient (feeling lousy, fevers, etc...). If your child seems to be having cold symptoms for more than 3 weeks, something else is likely going on. Allergies can mimic colds and last for months. Very prolonged colds can sometimes (but not always) be sinus infections. But, it is very common for children to get what's known as "back-to-back colds". In other words, virus A comes along, makes you sick. As soon as you start feeling better, virus B attacks. As soon as you start feeling better, virus C attacks. So when you look back, it feels like your child has been sick for many weeks. If your child has been sick for more than 2-3 weeks, or if fevers persist for five days or longer, go see your Pediatrician. He or she will help you figure out which of the above patterns your child is dealing with.

Do "Ferberizing" and "Cry-It-Out" Kill Brain Cells?

      Are you killing your baby's brain cells? According to Dr. Darcia Navarez and Dr. Bob Sears, if you use a "cry it out" (CIO) technique to get your baby to sleep through the night, you may be doing just that. In an article published in Psychology Today titled "Dangers of Crying It Out", Dr. Navarez outlines her case against the popular methods, sometimes known eponymously as "Ferberization." Navarez joins Sears and many parents in criticizing CIO to be, as an NPR reporter put it: "...just short of barbaric."

"I just felt so wrong with letting my child cry for any length of time." - a mother on "Circle of Moms" site

      On his webpage, Dr. Sears uses his family's MO for proving a point: using referenced studies that are not really about his theory as if they are directly corroborating it. In his web page "Science Says: Excessive Crying May Be Harmful," Dr. Bob references no less than 19 pieces of writing regarding children and crying. Shockingly (or maybe not so shockingly), Sears qaulifies such writings  as someone's non-published master's thesis and an interview transcript as "science." Actual peer-reviewed studies are referenced but most do not directly discuss crying and sleep. Some are rat or ape studies. Sears cobbles pieces of data about extreme situations in which infants and young children cry excessively and has magically linked them to CIO. One of the citations: "Incubated in Terror: Neurodevelopmental Factors in the Cycle of Violence,” is a well written chapter regarding the effects of repeated violence on children. This is what Sears is trying to pawn off as evidence for brain damage due to CIO. Does he really think parents are that stupid?

Dr. Richard Ferber

      Navarez implements similar techniques to Sears. By using data from studies looking to elucidate other questions, she creates the illusion of a problem. It becomes evident from her article that she is merely postulating a hypothesis and not actually proving a point. For example, regarding neuron death in stress situations: "when the baby is greatly distressed, the hormone cortisol is released. In excess, it's a neuron killer. A full-term baby (40-42 weeks), with only 25% of its brain developed, is undergoing rapid brain growth...Who knows what neurons are not being connected or being wiped out during times of extreme stress? What deficits might show up years later from such regular distressful experience?"

      

Here's the strategy: 

Step 1: Make big, scary statements: 

• Brain cells grow rapidly in infants
• Cortisol is released when the baby is "greatly distressed"
• In excess, cortisol can kill brain cells

Step 2:  Ask a scary question: How will this affect babies' brains?

      The question is absolutely valid. But Navarez neglects to present counter points:

• The fact that infant brain cells grow rapidly, does not necessarily increase their vulnerability
• There is no evidence that CIO constitutes "great" distress
• There is no evidence that cortisol is released in excess during CIO

If crying is so detrimental, why are Sears and Navarez insisting on letting infants cry ad-infinatum?

 Both Sears and Navarez use animal and human trials to show that stress-related physiological changes (increased blood pressure, elevated cortisol levels) occur in children while crying. They even extrapolate from extreme examples (prolonged neglect) which show how brain cells may be altered and even die under such circumstances. Two obvious problems with this line of thinking are left unaddressed: 

1) There are huge differences between CIO for a few days and prolonged child neglect or abuse. This is especially true when using Ferber's method, in which parents enter the room, remind the child they are there and can tell them " I love you, I'm right here", before they leave. 

2) If crying is so detrimental, why are Sears and Navarez insisting on letting infants cry ad-infinatum? If parents can prevent children from crying every single night for months or years by allowing them to learn to self-sooth over a few days...wouldn't that lead to less episodes of those bad physiological changes? I suppose their retort would be "when the parent soothes, those changes get better"...but there is absolutely no science to tell us what duration a cry should be to be "safe."

     

      And here's Navarez and Sears' biggest problem: an Australian study published this month in Pediatrics, which actually did look at children exposed to CIO. After five years of monitoring, the researchers showed no increase in cognitive or behavioral problems in two groups of children who underwent a form of CIO. They concluded:

"Behavioral sleep techniques have no marked long-lasting effects (positive or negative). Parents and health professionals can confidently use these techniques to reduce the short- to medium-term burden of infant sleep problems and maternal depression."

     There is another issue Sears and Navarez forgot to mention: there is a significant increase in cases of maternal depression when children cry and do not sleep at night. What is the impact of that fact on the health of the infant-mother dyad?

      What is most striking to me are the outrageously exaggerated descriptions of  the supposed turmoils involved in the CIO process. Anti-CIO advocates make it seem like family hell. For the most part we're talking about a process that lasts 2-4 days. Sure, every child is different, some may take longer (some may stop crying after one day), but for many parents the experience is nowhere near as bad as they imagined. The process takes a few nights, those nights can be quite difficult and stressful, and then...it's over. The baby goes to sleep, the parents go to sleep and they all wake up in the morning. Some babies regress and wake up at night every once in a while, but for the most part, it is a tremendous de-stressifier for the whole family. Reading Sears', Navarez's and some parents' diatribes about the evils of CIO, makes one believe it is the Pediatric equivalent of Trial by Ordeal. In reality, parents are trading  months and possibly years of minimal sleep-related crying, for a few nights of extra crying. As new data directly testing CIO's influence on the Pediatric brain emerges, maybe we can all finally put unfounded fears to bed.

     

   

Your Baby's Smart, She Just Can't Read

Can your 3 year old read Harry Potter? No? Well parents in a Your Baby Can Read infomercial claim theirs can. For around $150 , kits containing “...multi-sensory learning techniques popular with families all around the world” can be purchased on Amazon. The kit can no longer, however, be purchased from the company’s website. That’s because the Federal Trade Commission recently filed fraud charges against the corporation, indicating that marketing of their product constituted false and deceptive advertisement. The company immediately shut down, citing insurmountable legal expenses.

Surfing to www.yourbabycanread.com runs you into this message:

“Your Baby Can, LLC has shut down all operations and is no longer in business. The developer of Your Baby Can Read!, Robert Titzer, Ph.D. has decided to take over maintenance of the Your Baby Can Read! website and of the Facebook page going forward. Your Baby Can, LLC, is no longer connected or affiliated with Robert Titzer, Ph.D. or his company the Infant Learning Company. We would like to take this final opportunity to thank all customers who supported Your Baby Can, LLC over the years.”

Robert Titzer

Dr. Titzer, the product's founder, possesses a Ph.D in human performance, a discipline unrelated to the study of pediatric acquisition of language and reading skills. While he does have three scientific publications to his name, in 1998 he admitted to the Los Angeles Times that the “main study for this theory, and for the book and video he sells via his website, is based on his own daughters.” The business took off, riding on the lift provided by an intense marketing engine. Commercials and infomercials, Facebook and Twitter were all used to promote the now defunct company. Featured in the campaign were infants and toddlers performing abilities usually expected at a minimum of ages 4 or 5. A two year old girl was featured in one commercial, reading an excerpt from “Charlotte’s Web.” 

The company reportedly sold over a million units in its more than a decade of existence, grossing approximately $185 million in sales. That is the exact amount the FTC has levied against them in fines.

Disney, Toys R Us and Nickelodeon all provided shelf space or airtime for the highly criticized product. Disney is no stranger to such controversy. In 2009 the company offered refunds for all purchases of its “Baby Einsteins” products. The company claimed at the time that those videos and audio CDs promote early learning despite clear indication from the American Academy of Pediatrics that prolonged screen exposure may delay normal development. Despite this history, Disney did not seem apprehensive about selling TV time to a company whose lack of evidence to support their product mirrored their own failure.

So, what has been actually shown to promote learning and skill acquisition in young children? Foremost: direct interaction between parents and their children. Hearing a parent or family member speak and spending one-on-one time is what helps brains develop. Reading to or with your child is very effective. Also important: routine interventions such as regular family meals, adequate sleep and breastfeeding have all been scientifically linked to improved learning and cognition. It is greatly lamentable that entrepreneurs hand out promises based on anecdotal or non-existent evidence to blindly promote products which do little to increase brain power and much to decrease wallet size.

Dr. Bill Sears' Dangerous Advice

Time's Clever Cover

Over four decades, Dr. Bill has accumulated a large body of personal experience which led him to deliver a message of mother (and somewhat father)-child bonding. Over time, previously theorized ideas by a British psychoanalyst combined with observations of South American mothers “wearing” their infants, gave rise to Sears’ blockbuster brand. The pillars of this theory, proposed as a way to raise happier, healthier children are: breastfeeding, babywearing and co-sleeping.

Dr. "Bill" Sears

-Where science exists, all doctors are ethically  mandated to present their advice in a risk-versus-benefit format-

Last week’s cover of Time Magazine, featuring the instantaneously famous image of a mother nursing a toddler with the headline  “Are You Mom Enough?” is designed to sell. The image and title, a supermarket checkout line impulse-buy machine, is a bit misleading. The actual article focuses very little on breastfeeding. For the most part, it is about Pediatrician Bill Sear’s version of the parenting philosophy known as “attachment parenting.”

 The article, with photos of Dr. Sears leaping with a granddaughter off a trampoline, or tan and smiling with his wife in their living room, may seem to be promoting his ideas at first. But on further reading, Time has taken a commendably careful look at the Pediatrician’s methods. Specifically, while they give him a chance to explain his rationale, the authors reveal what science has actually found regarding his claims. He is often just plain wrong.

         Dr. Sears, respected and loved has created a world which delivers 

parental advice based on “experience.” In the past, when little science existed regarding parenting issues, this was in essence, the only way to do it. Pediatricians are expected not only to diagnose and treat medical conditions, but also to be parenting coaches. The topics covered in a typical session can range from which pacifier to buy, to how to talk with teenagers. In the past, most of the Pediatric research had been focused on physical pathology such as infections and chronic disorders. But in the last few decades, more behavioral and social hard data have emerged. There are still many gaps in knowledge  however, and Pediatricians still have to fill those with personal experience and anecdotes. But where science exists, all doctors are ethically  mandated to present their advice in a risk versus benefit format.

For example, while co-sleeping with young children is hailed as emotionally healthy by Sears, when put in up against the cold hard reality of SIDS, it should be discouraged. To boot, there is no evidence that co-sleeping with children benefits them emotionally in any way. So what you are left with is Sears’ empty-bag: no known benefit, some risk. And folks, that’s the end of the story until further research states otherwise.

Sears’ forty years and thousands of patients of experience can’t even come close to the statistical value of population research. Would you rather take one doctor’s advice, based on a narrow geographic, socioeconomic population, uncontrolled and unmonitored - or would you trust a more robust, controlled study where the results are actually tracked?

I’ll admit, I would love to tell parents it’s OK to sleep with their babies. It’s a sweet and loving thing to do. But I can’t. It doesn’t matter what my personal philosophy is. I must have the humility to accept that my personal beliefs and instincts may be wrong. If even one baby died because a parent accidentally rolled over them at night, or the infant wiggled herself under a sheet or pillow...it would have never been worth it. And if anecdotal evidence is more important to some people, then I can tell you about the two beautiful infants who arrived dead while I was working in the Pediatric ER. Both times, the parents, who swore they could never possibly roll onto their sleeping babies, did.

		What Sears Says	What The Scientific Consensus Says
Co Sleeping (bed sharing)		Infants who sleep with parents are 4 times less likely to die of   SIDS.	Bed sharing may increase the risk of SIDS.
		Based on a few studies almost exclusively conducted on Japanese families, SIDS rates are lower in bed sharing families.	In looking at the entire body of evidence, some data show a decrease in SIDS with bed-sharing,but many others show significant increases. Japanese families often sleep on  mattresses on the floor. Hard surfaces are known to decrease SIDS. Most families in the US tend not to sleep this way. There is evidence for both theories. In these situations, it is better to avoid potentially fatal behavior until more data is obtained. A recent review of 11 studies showed that bed sharing may increase SIDS death by 2.88 times.
			Note: room sharing, without bed sharing has been shown to decrease the rate of SIDS. It is always recommended that infants sleep in the same room as parents.
		Babies who share beds have more "stable physiology" and experience better "long term emotional health."	Stable Physiology - described by Sears as "more stable temperatures, regular heart rhythms, and fewer long pauses in breathing ." Such findings are medically meaningless. They have no known link to outcomes such as SIDS. However, a 2010 British review of autopsies of infants who died of SIDS showed higher levels of hypoxia (low oxygen due to asphyxia) in those who bed-shared.
			Better long term emotional health - As the Time article states, the research does not agree  with this. Sears is quoting animal (rat) research, a far cry from human data.
		Bed sharing facilitates breastfeeding.	Bed sharing does facilitate breast feeding. This is the only point Sears makes which is corroborated by good science. However, parents can easily use a "co-sleeper" side bassinet without bed sharing, significantly diminishing the risks of SIDS.
Conclusions		Bed sharing is better for children.	There is no good evidence, other than its role in promoting breastfeeding, that bed sharing is beneficial in any way to children. There are, however, documented risks. The risks outweigh the benefits. Bed sharing is not recommended.

Hi, I'm Your Pediatrician and I Don't Respect Your Opinion

Last week, at my new practice, I was told by a patient’s mother that I seemed like a “lovely individual” but I was not practicing as “open mindedly” as she hoped I would be. She complimented me on my  bedside manner and listening skills, but ultimately felt that I was not respecting her opinions. I told her that in all honesty, she was right.

I replaced her previous Pediatrician who had been in charge of the practice for over ten years and moved. In looking back at her children’s charts, I found several correspondences between the previous doctor and her. The mother had raised concerns over a decade regarding vaccines and the previous doc documented several hours worth of visits, phone calls and emails on the topic.

Her opinions, the ones I apparently did not respect, were a selected few from vaccino-phobia’s greatest hits. The MMR causes autism. Too many too soon. HPV vaccine is dangerous, etc...etc...So, I calmly and gently put it to her that all of these theories have been powerfully disproven. She calmly and gently responded that there was not enough research. I calmly and gently told her that there is so much science at this point, that there are very few other things a Pediatrician can recommend that are so supported.

There were pauses and smiles and overall disagreement. Finally she responded “I know you have a lot of training and schooling. but I’m smart too.” I smiled and said “I have no doubt you are.” I meant that. But the problem is, intelligent as we may be, the science is smarter than all of us. No matter how smart we may be, as Richard Feynman once said: “It doesn't matter how beautiful your theory is, it doesn't matter how smart you are. If it doesn't agree with experiment, it's wrong.”

I consider myself open-minded. But as James Randi would say “not so open minded that my brain falls out.” In her defensive stance, this mother extrapolated my disrespect for unproven, disproven and dangerous theories to mean disrespect of her as a person. It did not. She and her children have moved on to a new Pediatrician, maybe one who accepts her refusal to vaccinate. Maybe that doc makes her feel more respected. But for me, the disrespect of science is a spit in face of all our at-risk children.

4 Things You Should Know Before Getting Your Child Food-Allergy Tested

Myths about allergies abound. Foods and their components (like gluten, which is very popular right now) are blamed for everything form eczema to autism. Many parents come in the office and ask me to get their child tested for food allergies. The most common reason is usually a rash that appeared around the time something was eaten. Unless the rash sounds like a real allergic reaction (like hives or anaphylaxis), I work very hard to talk parents out of getting their kids tested.

Here’s why:

1) There are two main types of initial tests:

a) A blood test, which your regular pediatrician can get or
b) A skin test which is only done at the Allergist’s office

2) Allergy blood tests are usually not very helpful

The blood test can be used to check  if a child is “sensitized” to something (like tree pollen, cats or wheat). However, “sensitized” does not equal “allergic”. The difference is that a “sensitized” child’s blood test is positive for a given substance, but that child will have no symptoms or problems if he/she eats or comes in contact with it.

Example:  Sarah routinely eats eggs without having any allergic problems, but Sarah’s allergy blood test came back positive for eggs. In this case Sarah can continue eating eggs. She is sensitized, but not allergic.

3) There is never a need to test for “everything”

If Danny ate an egg, and within minutes broke out in hives, there is good reason to think he may be allergic to eggs. A positive blood test in this situation can help confirm the allergy.

But there is no need to test Danny for other food allergies.

Testing should be limited only to those substances to which the child has appeared to have a reaction to. Adding additional tests for substances which the child has never had a problem with can cause problems.“Positive” results for those other substances can unnecessarily put parents in a situation where they are constantly trying to avoid foods the child is not allergic to. It doesn’t take long before one learns that lots of foods contain soy or wheat and avoiding them is a large undertaking. This can lead to unneeded changes in the child’s diet and lots of avoidable stress.

4) The ultimate test is a “food challenge”

So, this may sound a bit scary, but the ultimate way to find out if a child is truly allergic to a food is to give him/her some and see what happens. And yes, I mean doing this at the allergist’s office by an allergist (not at home). A food challenge is done in a safe and controlled setting. The child is given increasingly larger pieces of the suspicious food. If there is no reaction, the child is not allergic, or has outgrown their allergies (something that commonly happens). If there is a reaction, the allergist is right there to administer epinephrine, an injection that shuts off an allergic reaction.