Study: Bath Oils for Childhood Eczema Provide No Medical Benefit

“Bath oils used to help treat eczema in children offer no meaningful benefit as part of their care, a trial has found,” reports BBC News.

Childhood eczema, also known as atopic eczema, is a common condition that causes redness and soreness of the skin. Treatments include using moisturisers (emollients), which have been shown to work, and using emollients as soap substitutes in the bath or shower.

However, until now, there has been little evidence for a third type of treatment: adding emollient additives to baths.

In the first big study of its kind, researchers found commonly prescribed emollient bath additives – designed to be added to bathwater and leave a thin layer over the skin – made little difference to children’s eczema symptoms.

The study, carried out in England and Wales, involved 483 children aged 1 to 11 years. Half were randomly assigned to use bath additives regularly for a year – in addition to their usual treatments, including standard leave-on emollients – while the other half did not use them.

The results showed that bath additives made too small a difference to symptoms to be considered clinically important.

Find out more about treating childhood eczema.

Where did the story come from?

The study was commissioned by the UK National Institute for Health Research as part of a programme to investigate which treatments are effective and provide value for money, and carried out by researchers from Cardiff University, the University of Bristol, the University of Southampton and the University of Nottingham.

It was published in the peer-reviewed British Medical Journal and is free to read online.

The UK media reports were generally accurate and balanced.

What kind of research was this?

This was a randomised controlled trial, which is often the best way to investigate whether a treatment works.

To make results more accurate, many trials like this use a dummy treatment (placebo) so that patients don’t know if they are receiving the real treatment. However, in this case, the researchers decided they could not make a convincing placebo for emollient bath additives so did not include one in the study.

What did the research involve?

Researchers used records from 96 general practices in Wales, south England and west England to identify children diagnosed with eczema. The children’s parents or carers were then contacted and invited to take part.

After screening, half the children were prescribed bath emollient additives for a year and the other half were asked not to use them. Most of the experimental group were prescribed Oilatum, Balneum or Aveeno bath products.

All children continued their usual eczema treatments, which included using emollients as creams and soap substitutes, and using steroid creams where needed.

Parents or carers recorded children’s eczema symptoms – weekly for the first 16 weeks and then monthly for a year – using the standard patient oriented eczema measure (POEM). In children, this is usually assessed on how severe parents or guardians think a child’s eczema is.

POEM gives a score of 0 to 28, with 0 to 7 being no or mild eczema, 8 to 16 moderate eczema and 17 to 28 severe eczema. A drop of 3 points on the scale is considered enough to represent a clinically meaningful improvement in symptoms.

The parents or carers also recorded how often the children bathed and how often they used the bath emollient additives.

The researchers compared symptom scores for the 2 groups, adjusting for eczema severity at the start of the study, use of steroid creams and soap substitutes, and ethnic group.

What were the basic results?

The average symptom score at the start of the study was 9.5 in the bath-additives group and 10.1 in the no-bath-additives group, meaning most children had moderate eczema.

Over 16 weeks, the average symptom score was:

• 7.5 in the bath-additives group
• 8.4 in the no-bath-additives group

After controlling for confounding factors, such as use of other eczema medication, the average symptom score was 0.41 points lower in the bath-additives group (95% confidence interval [CI]-2.7 to +1.10). This was not a statistically significant difference and was well below the 3-point difference considered to be clinically important.

The researchers also looked at subgroups to see if any particular group of children were more likely to benefit from the bath additives. While they did find some effect for children under 5 years old, it still did not reach the 3-point threshold.

They did find a possibly clinically meaningful benefit for children who bathed 5 times or more a week (2.27-point improvement, 95% CI 0.63 to 3.91), but this analysis was based on fewer children, making it less reliable.

How did the researchers interpret the results?

The researchers said the trial “provides strong evidence that emollient bath additives provide minimal or no additional benefit beyond standard eczema care in the management of eczema in children”.

Conclusion

The study shows that bath emollient additives may not be a useful part of eczema care for children.

But it’s important to be clear this does not apply to the use of leave-on emollient creams and lotions, or to the use of emollients instead of soap. There’s evidence that leave-on emollient creams work, and doctors agree using emollients instead of soap is helpful.

This study’s results only apply to emollient products added to the bathwater. If you’re not sure of the difference, speak to a pharmacist or your GP.

If your child has been prescribed bath emollient additives and is happy with them, there’s no reason to stop using them. The study found no increased risk of side effects – such as slipping in the bath, soreness or redness – among children who used them.

However, they may not make much difference to your child’s eczema, and it’s possible the NHS may decide to recommend that doctors stop prescribing these products in future.

The study was well conducted but had a few limitations, the main one being that, unusually for research of this type, there was no placebo. Placebos are normally included to control for the placebo effect – where people tend to feel better if they are taking a treatment because they expect it to work.

However, in this case, people that did receive the bath additives did not report symptoms significantly different from those not using the additives, which suggests the placebo effect did not have much influence in this study.

The study looked at lots of subgroups among the 483 children to see if any showed different results. However, this increases the likelihood that some of the results are due to chance.

We therefore cannot put too much stock in the finding that children bathing 5 times or more a week may get some benefit from emollient bath additives, as this analysis included just 143 children.

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Why Your Newborn Should Have a Blood Screening Test

Every baby is offered newborn blood spot screening, also known as the heel prick test, ideally when they’re 5 days old.

Newborn blood spot screening involves taking a blood sample to find out if your baby has one of 9 rare but serious health conditions.

Most babies won’t have any of these conditions but, for the few who do, the benefits of screening are enormous.

Early treatment can improve their health, and prevent severe disability or even death.

What does the blood spot test involve?

When your baby is 5 days old, a health professional will prick their heel and collect 4 drops of blood on a special card.

You can ease any distress for your baby by cuddling and feeding them, and making sure they’re warm and comfortable.

Occasionally, the sample may need to be taken when your baby is 6, 7 or 8 days old.

Sometimes a second blood spot sample is needed. The reason for this will be explained to you. It doesn’t necessarily mean there’s something wrong with your baby.

The test doesn’t carry any known risks for your baby.

Which conditions is the blood spot test for?

The blood spot test screens for the following 9 rare but serious conditions.

If you, your partner or a family member already has one of these conditions (or a family history of it), tell your health professional straight away.

Sickle cell disease

About 1 in 2,000 babies born in the UK** has sickle cell disease. This is a serious inherited blood disease.

Sickle cell disease affects haemoglobin, the iron-rich protein in red blood cells that carries oxygen around the body.

Babies who have this condition will need specialist care throughout their lives.

People with sickle cell disease can have attacks of severe pain and get serious, life-threatening infections. They’re usually anaemic because their blood cells have difficulty carrying oxygen.

The blood spot screening test means that babies with sickle cell disease can receive early treatment to help them live healthier lives. This may include vaccinations and antibiotics to prevent serious illnesses.

Pregnant women are also routinely tested for sickle cell disease early in pregnancy.

Read more about sickle cell disease, or download leaflets for parents whose child has sickle cell disease.

Cystic fibrosis

About 1 in 2,500 babies born in the UK** has cystic fibrosis. This inherited condition affects the digestion and lungs.

Babies with cystic fibrosis may not gain weight well and are prone to chest infections.

Babies with the condition can be treated early with a high-energy diet, medicines and physiotherapy.

Although children with cystic fibrosis may still become very ill, early treatment can help them live longer, healthier lives.

Read more about cystic fibrosis, or download a leaflet for parents whose baby has suspected cystic fibrosis.

Congenital hypothyroidism

About 1 in 3,000 babies born in the UK** has congenital hypothyroidism. Babies with congenital hypothyroidism don’t have enough of the hormone thyroxine.

Without thyroxine, babies don’t grow properly and can develop learning disabilities.

Babies who have the condition can be treated early with thyroxine tablets, and this allows them to develop normally.

See more information about congenital hypothyroidism (CHT).

Inherited metabolic diseases

It’s important to let your health professional know if you have a family history of a metabolic disease (a disease that affects your metabolism).

Babies are screened for 6 inherited metabolic diseases. These are:

• phenylketonuria (PKU)
• medium-chain acyl-CoA dehydrogenase deficiency (MCADD)
• maple syrup urine disease (MSUD)
• isovaleric acidaemia (IVA)
• glutaric aciduria type 1 (GA1)
• homocystinuria (pyridoxine unresponsive) (HCU)

About 1 in 10,000 babies born in the UK** has PKU or MCADD. The other conditions are rarer, occurring in 1 in 100,000 to 150,000 babies.

Without treatment, babies with inherited metabolic diseases can become suddenly and seriously ill. The diseases all have different symptoms.

Depending on which one affects your baby, the condition may be life threatening or cause severe developmental problems.

They can all be treated with a carefully managed diet and, in some cases, medicines as well.

Does my baby have to have the blood spot test?

It’s not compulsory, but it’s recommended because it could save your baby’s life.

You can choose to have screening for sickle cell disease, cystic fibrosis or congenital hypothyroidism individually, but you can only choose to have screening for all 6 inherited metabolic diseases or none at all.

If you don’t want your baby to be screened for any of these conditions, discuss it with your midwife.

You should be given information about the blood spot test and the diseases it screens for in advance so you can make an informed decision for your baby.

If you change your mind, babies can be screened up to the age of 12 months for all the conditions except cystic fibrosis. Cystic fibrosis can only be screened for up to 8 weeks of age.

If you have any concerns about the tests, speak to your midwife, health visitor or GP.

When will we get the results?

You should receive the results either by letter or from a health professional by the time your baby is 6 to 8 weeks old.

The results should be recorded in your baby’s personal child health record (red book)(*health records). It’s important to keep this safe and take it with you to all your baby’s appointments.

If you haven’t received your baby’s results, speak to your health visitor or GP(*physician).

You’ll be contacted sooner if your baby screens positive. This means they’re more likely to have one of the conditions tested for.

You’ll be contacted:

• the day the result is available, or the next working day, if your baby is thought to have congenital hypothyroidism (CHT) – you’ll be given an appointment to see a specialist
• before your baby’s 4 weeks old if they’re thought to have cystic fibrosis
• before your baby’s 6 weeks old if they’re thought to have sickle cell disease

Screening for cystic fibrosis finds some babies who may be genetic carriers of the condition. These babies may need further testing.

Screening for sickle cell disease also finds babies who are carriers of this or other red blood cell diseases.

Carriers are healthy, although they can experience problems in situations where their bodies aren’t getting much oxygen – for example, if they’re having an anaesthetic.

Parents of babies who are found to be carriers should be told by the time they’re 6 to 8 weeks old.

Read more about what being a carrier means.

What do the results mean?

Most babies will have a normal result, which means it’s unlikely that they have any of the conditions.

A small number of babies will screen positive for one of the conditions. This doesn’t mean they have the condition, but they’re more likely to have it. They’ll be referred to a specialist for more tests.

It’s important to know that screening isn’t 100% certain. A baby with a negative screening result may later turn out to have the disease screened for. This is known as a false negative.

Babies with a positive result sometimes turn out not to have the disease – what’s known as a false positive.

Occasionally, other medical conditions are picked up by blood spot test screening. For example, babies with beta thalassaemia major, a serious blood disease, will usually be detected. These babies also need to be referred for early treatment.

More information

• Frequently asked questions about blood spot screening
• Find out what happens to your baby’s blood spot card
• Download a leaflet about the newborn blood spot test (PDF, 4.35Mb) – also available in other languages
• Listen to an audio guide on the blood spot test

Editor’s Notes:

*Clarification provided for our US readers

** Resources outside the U.K.

• For the individual state test conditions and screening programs in the US visit here.
• For more information on newborn blood screening visit the CDC bulletin here.

 

How Can I Make Sure My Toddler Eats Healthy: Meal Ideas

If you need some inspiration to help you cook healthy and tasty food for your kids, try these meal ideas.

They’re not suitable as first foods, but fine once your baby is used to eating a wide range of solid foods.

When preparing food for babies, don’t add salt, sugar or stock cubes directly to the food, or to the cooking water.

Breakfast ideas for babies and children

• unsweetened porridge or cereal mixed with milk, topped with mashed ripe pear
• wholewheat biscuit cereal with milk and unsweetened stewed fruit
• toast fingers with mashed banana
• toast fingers with a hard-boiled egg and slices of ripe peach
• unsweetened stewed apple and breakfast cereal with plain, unsweetened yoghurt

Children’s lunch or tea ideas

• cauliflower cheese with cooked pasta pieces
• mashed pasta with broccoli and cheese
• baked beans (reduced salt and sugar) with toast
• scrambled egg with toast, chapatti or pitta bread
• cottage cheese dip with pitta bread and cucumber and carrot sticks
• plain fromage frais with stewed apple

Children’s dinners

• mashed sweet potato with mashed chickpeas and cauliflower
• shepherd’s pie (made with beef or lamb) with green vegetables
• rice and mashed peas with courgette sticks
• mashed cooked lentils with rice
• minced chicken and vegetable casserole with mashed potato
• mashed canned salmon with couscous and peas
• fish poached in milk with potato, broccoli and carrot

Snacks for babies and toddlers

• fresh fruit, such as small pieces of soft, ripe peeled pear or peach
• canned fruit in fruit juice
• rice pudding or porridge (with no added sugar or salt)
• plain, unsweetened yoghurt
• toast, pitta or chapatti fingers
• unsalted and unsweetened rice cakes
• plain bagels
• small cubes of cheese

Getting your child to eat fruit and vegetables

Try these ways of increasing your child’s intake of fruit and vegetables:

• Put their favourite vegetables or canned pineapple on top of pizza.
• Give carrot sticks, slices of pepper and peeled apple as snacks.
• Mix chopped or mashed vegetables with rice, mashed potatoes, meat sauces or dhal.
• Chop prunes or dried apricots into cereal or plain, unsweetened yoghurt, or add them to a stew.
• For a tasty dessert, try mixing fruit (fresh, canned or stewed) with plain, unsweetened yoghurt. You could also try tinned fruit in fruit juice, such as pears and peaches, or unsweetened stewed fruit, such as apples.

Your baby and cows’ milk

From six months, keep giving your child mum’s milk or formula milk, as well as introducing solid foods, but don’t give cows’ milk as a drink. Whole cows’ milk can be used in small amounts in cooking or mixed with foods from the age of six months. You can give it to your child as a drink from the age of one.

Semi-skimmed milk can be introduced at two years old, providing your child is eating a varied diet and growing well for their age. From five years, you can give your child 1% or skimmed milk to drink.

Further information

• What to feed young children
• Vegetarian and vegan kids
• Fussy eaters

Choosing a C-Section: What Is It and When Is It The Best Option?

A caesarean section, or C-section, is an operation to deliver your baby through a cut made in your tummy and womb.

The cut is usually made across your tummy, just below your bikini line.

A caesarean is a major operation that carries a number of risks, so it’s usually only done if it’s the safest option for you and your baby.

Around one in every four to five pregnant women in the UK has a caesarean.*

Why caesareans are carried out

A caesarean may be recommended as a planned (elective) procedure or done in an emergency if it’s thought a vaginal birth is too risky. They’re usually performed after the 38th week of pregnancy.

A caesarean may be carried out because:

• your baby is in the breech position (feet first) and your doctor has been unable to turn them by applying gentle pressure to your tummy, or you would prefer they didn’t try this
• you have a low-lying placenta (placenta praevia)
• you have pregnancy-related high blood pressure (pre-eclampsia)
• you have certain infections, such as a first genital herpes infection occurring late in pregnancy or untreated HIV
• your baby isn’t getting enough oxygen and nutrients – sometimes this may mean the baby needs to be delivered immediately
• your labour isn’t progressing or there’s excessive vaginal bleeding

If there’s time to plan the procedure, your midwife or doctor will discuss the benefits and risks of a caesarean compared with a vaginal birth.

Asking for a caesarean

Some women choose to have a caesarean for non-medical reasons. If you ask your midwife or doctor for a caesarean when there aren’t medical reasons, they will explain the overall benefits and risks of a caesarean compared with a vaginal birth.

If you’re anxious about giving birth, you should be offered the chance to discuss your anxiety with a healthcare professional who can offer support during your pregnancy and labour.

If after discussion and support you still feel that a vaginal birth isn’t an acceptable option, you’re entitled to have a planned caesarean.

What happens during a caesarean

Most caesareans are carried out under spinal or epidural anaesthetic. This mean you’ll be awake, but the lower part of your body is numbed so you won’t feel any pain.

During the procedure:

• a screen is placed across your body so you can’t see what’s being done – the doctors and nurses will let you know what’s happening
• a cut about 10-20cm long will usually be made across your lower tummy and womb so your baby can be delivered
• you may feel some tugging and pulling during the procedure
• you and you birth partner will be able to see and hold your baby as soon as they’ve been delivered

The whole operation normally takes about 40-50 minutes.

Occasionally a general anaesthetic, where you’re asleep, may be used, particularly if the baby needs to be delivered more quickly.

Read more about how a caesarean is carried out.

Recovering from a caesarean

Recovering from a caesarean usually takes longer than recovering from a vaginal delivery. You might need to stay in hospital for three or four days, compared with one or two days for a vaginal birth.

You may experience some discomfort in your tummy for the first few days, and you’ll be offered painkillers to help with this.

When you go home, you’ll need to take things easy at first. You may need to avoid some activities such as driving for six weeks or so.

The wound in your tummy will eventually form a scar. This may be red and obvious at first, but it should fade with time and will often be hidden in your pubic hair.

Read more about recovering from a caesarean.

Risks of a caesarean

A caesarean is generally a very safe procedure, but like any type of surgery it carries a certain amount of risk.

It’s important to be aware of the possible complications, particularly if you’re considering having a caesarean for non-medical reasons.

Possible complications include:

• infection of the wound or womb lining
• blood clots
• excessive bleeding
• damage to nearby areas, such as the bladder or the tubes that connect the kidneys and bladder (ureter)
• temporary breathing difficulties in your baby
• accidentally cutting your baby when your womb is opened

Read more about the risks of a caesarean.

Future pregnancies after a caesarean

If you have a baby by caesarean, it doesn’t necessarily mean that any babies you have in the future will also have to be delivered this way.

Most women who have had a caesarean section can safely have a vaginal delivery for their next baby, known as vaginal birth after caesarean (VBAC).

However, you may need some extra monitoring during labour just to make sure everything is progressing well.

Some women may be advised to have another caesarean if they have another baby. This depends on whether a caesarean is still the safest option for them and their baby.

For more information, the Royal College of Obstetricians and Gynaecologists has a leaflet on birth options after previous caesarean section (PDF, 357kb).

Editor’s Note: *clarification provided for our US readers.

*1 in 3 pregnant women in the U.S. has a caesarean

 

How to Reduce Your Baby’s Teething Pain

Teething can be distressing for some babies, but there are ways to make it easier for them.

Every baby is different, and you may have to try a few different things until you find something that works for your baby.

Teething rings

Teething rings give your baby something to chew safely. This may ease their discomfort and distract them from any pain.

Some teething rings can be cooled first in the fridge, which may help to soothe your baby’s gums. The instructions that come with the ring should tell you how long to chill it for. Never put a teething ring in the freezer, as it could damage your baby’s gums if it gets frozen.

Also, never tie a teething ring around your baby’s neck, as it may be a choking hazard.

Teething gels

Teething gels often contain a mild local anaesthetic, which helps to numb any pain or discomfort caused by teething. The gels may also contain antiseptic ingredients, which help to prevent infection in any sore or broken skin in your baby’s mouth.

Make sure you use a teething gel that’s specially designed for young children and not a general oral pain relief gel, as these aren’t suitable for children. Your pharmacist can advise you.

It’s best to talk to your pharmacist or GP before using a teething gel for babies under two months old.

If your baby is chewing

One of the signs that your baby is teething is that they start to chew on their fingers, toys or other objects they get hold of.

If your baby is six months or older, you can give them healthy things to chew on, such as raw fruit and vegetables. Pieces of apple or carrot are ideal. You could also try giving your baby a crust of bread or a breadstick. Always stay close when your baby is eating in case they choke.

Find out what to do if your baby starts choking.

It’s best to avoid rusks, because nearly all brands contain some sugar. Avoid any foods that contain lots of sugar, as this can cause tooth decay, even if your child only has a few teeth.

Paracetamol (*acetaminophen) and ibuprofen for teething

If your baby is in pain or has a mild raised temperature (less than 38C), you may want to give them a sugar-free painkilling medicine that is specifically for babies and young children. These contain a small dose of paracetamol or ibuprofen.

Children under 16 years old shouldn’t have aspirin.

Always follow the instructions that come with the medicine. If you’re not sure, speak to your GP (*doctor or pediatrician) or pharmacist.

Comforting a teething baby

Comforting or playing with your baby can distract them from any pain in their gums.

Preventing teething rashes

If teething is making your baby dribble more than usual, gently wiping their face often may help to prevent a rash.

Caring for your baby’s new teeth

You’ll need to register your baby with a dentist when their teeth start coming through – find a dentist near you.

Start brushing your baby’s teeth with fluoride toothpaste as soon as their first milk tooth breaks through.

For more advice, read about looking after your baby’s teeth.

Editor’s Note: *clarification provided for our US readers.

Additional note: Avoid benzocaine teething gels – there are plant-based natural teething gels that do not have the same drug safety concerns as noted by the US FDA:
https://www.fda.gov/Drugs/DrugSafety/ucm250024.htm

 

How to Raise Healthy Vegetarian and Vegan Children

How Can I Raise A Healthy Vegetarian or Vegan Child?

If you’re bringing up your child on a diet without meat (vegetarian) or without any food from an animal (vegan), they’ll need two or three portions of vegetable proteins or nuts every day to make sure they get enough protein and iron.

Don’t give whole nuts to children under five years old as they could choke. Grind nuts finely or use a smooth nut butter.

Read Food allergies for important information about peanut allergy.

Weaning your vegetarian baby

The advice on introducing solids at about six months is the same for vegetarian babies as for non-vegetarian babies. However, as your child gets older, there’s a risk that a vegetarian or vegan diet may be low in iron and energy and too high in fibre.

You can make sure your child gets enough iron by giving them:

• fortified breakfast cereal
• dark green vegetables
• bread
• beans and lentils
• dried fruit, such as apricots, figs and prunes

Vitamin C in fruit and vegetables helps the body to absorb iron, so include these at every mealtime.

You can help ensure that your child gets all the nutrients they need by giving them smaller and more frequent main meals, with one or two snacks in between, and making sure they eat a good variety of foods. You’ll also need to make sure they get enough calcium, vitamin B12 and vitamin D.

The Department of Health recommends that all children aged six months to five years are given vitamin supplements containing vitamins A, C and D every day.

It’s also recommended that babies who are being breastfed are given a daily vitamin D supplement from birth.

Babies who are having more than 500ml (about a pint) of infant formula a day shouldn’t be given vitamin supplements because formula is fortified with certain nutrients and no other supplementation is required.

Read more about vitamins for babies and toddlers.

Vegan diets for children

If you’re breastfeeding and you’re on a vegan diet, it’s important that you take a vitamin D supplement. You may also need extra vitamin B12.

Take care when giving children a vegan diet. Young children need a good variety of foods to provide the energy and vitamins they need for growth.

A vegan diet can be bulky and high in fibre. This can mean that children get full up before they’ve taken in enough calories. Because of this, they may need extra supplements. Ask a dietitian or doctor for advice before introducing your child to solids.

Energy

Young children need lots of energy to grow and develop. Give vegan children high-calorie foods, such as hummus, bananas and smooth nut and seed butters (such as tahini and cashew or peanut butter). They still need starchy foods. However, don’t give only wholegrain and wholemeal versions to children under five years old because they’re high in fibre. For extra energy, you could add vegetable oils or vegan fat spreads to foods.

Protein

Pulses and food made from pulses are a good source of protein for vegan children. Nut and seed butters also contain protein. Always use smooth versions for babies and children under five years old. Breastfeeding until your child is two or more, or giving them soya-based formula milk if they are vegan, will help ensure they get enough protein.

Ask your GP for advice before using soya-based formula.

Calcium

Fortified soya drinks often have added calcium. Some foods are also fortified with calcium, so check the label.

Vitamin B12

Fortified breakfast cereals and some yeast extracts contain vitamin B12. Your child may also need a supplement.

Omega-3 fatty acids

Some omega-3 fatty acids are found in certain vegetable oils, such as linseed, flaxseed, walnut and rapeseed oils. However, these are chemically different from the long chain omega-3 fatty acids found in oily fish. Evidence suggests that these short-chain fatty acids may not offer the same protection against heart disease as those found in oily fish.

Editor’s Note: from PedSafe Expert, Pediatrician Dr Joe: The question “how can I raise a healthy vegetarian or vegan child is a challenging one”. Technically speaking, UK and US recommendations for vitamin supplementations are fairly similar. However, having read this article you’ll note that there is a significant responsibility passed onto the parents to know the exact content of every food in their childrens’ diets and look for any specific deficiencies based on all vitamins and minerals. This is a Herculean task as there is a plethora of information and disinformation out there that must be evaluated by parents. Therefore I would ask parents to seriously consider their reasons for adopting a diet like this for their children, and to discuss all food choices and diet changes with their pediatrician to ensure their child is maintaining a proper nutritional balance.

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