The safety issue relates to the way that the safety belts themselves restrain the child.  In order for the belt to restrain the child without causing injury, the belt must nestle against the child’s bones, rather than soft tissue.

Delaware law (click here for interesting info) requires kids to be in their car seats while travelling until the 8th birthday, or 65 pounds, whichever comes first.  But following this rule does not guarantee safety, especially for smaller kids, because of the geometry of safety belts.

To convince yourself (and your child, if she is agitating to get rid of the booster seat), you can try this test:

Let your child (over 8 years old and 65 pounds) sit in the back seat of your car, with just a seat belt on.  Drive around the block once or twice, then park in your driveway.  BEFORE the kids get out of the car, go to the back seat and check the position of the seat belts on the child’s body.

The lap belt should strike the child’s lower hip bones.  And the shoulder belt should be laying across the hard clavicle (collar bone).  If the lap belt has slipped up across the soft tissues of the belly, or if the shoulder belt lays across the soft tissues of the neck, then it is not safe for the child to be transported this way: in an accident, the safety belts themselves could cause soft tissue damage.  The purpose of the booster seat is to raise the child, so that the safety restraints are in the proper position.

Frankly, I think the only reason that a child would want to get rid of a booster seat is to think of themselves as more “adult”.   But the booster seats let the kids see out the car window better!  My daughter, who was rather petite, needed to use a car booster seat until she was almost 10.  When she complained, I performed the demonstration above, and she quickly understood the need.

(For information about car seats for younger kids, click here.)

–  David Epstein, MD

But what about little babies under 6 months?

For decades, doctors advised against sunscreen for babies under 6 months.  However, there seems to be nothing in the sunscreen itself that’s actually bad for little babies.  (I’ve even spoken to the engineers at Johnson & Johnson; they can’t explain the recommendation!)  I suspect that the recommendation to avoid sunscreen under 6 months of age came about because somebody was afraid that parents might get too relaxed.  Might a parent apply sunscreen to a little infant’s skin, then take him out on the boat all day?  I hope not!  Common sense will help guide us.

I think it’s perfectly safe to apply sunscreen to the skin of little infants, even under 6 months.  (Avoid the eyes; it stings!!)  But I wouldn’t take the baby out in direct sun for very long (use your judgement), and certainly avoid direct sun between 11 am and 3 pm.  Re-apply the sunscreen every 2 hours or so, just as with the older kids.  If you’re on the beach or by the pool, or if it’s really hot, pay attention to the baby’s hydration status and give extra fluids (water or the baby’s usual feeds).

I’ve heard dermatologists say that 85% of a person’s lifetime risk of skin cancer comes from the sun exposure accumulated before 15 years of age.  So slather on the sunscreen, especially on an infant!

–  David M. Epstein, MD

Some pediatricians have recommended against having the ears pierced until the child is old enough to take care of them herself.  Usually this meant waiting until the child is school age.  However, I have rarely seen complications from infant ear jewelry, and my impression is that problems are no more common in infants than in older children, if care is taken.

There are potential complications.  Here are some of the more common ones.

Dangling jewelry may get hooked on something and get ripped out of the earlobe; or the infant’s fingers may clutch and remove jewelry, leading to a choking hazard.  I recommend screw-back earrings for infants and toddlers.  (Clip-on jewelry should not be used until the child is old enough to avoid a choking hazard, usually by school age.)

Infection can set in, especially in the first 6 months after piercing; I recommend removing the posts, cleaning and coating them with antibiotic ointment, and replacing them in the earlobe twice a day for at least 6 months, until the channel has epithelialized.

A metal allergy can develop, giving an inflamed appearance or a nasty discharge.  (Sometimes a doctor’s examination is needed to distinguish this from infection.)  For the first year, you should avoid 14 carat gold, silver, nickle, inexpensive “white metal,” or any plated metal.  18 carat gold, surgical steel, or titanium posts are better, although they are more expensive.

Occasionally, the earring or the back will get pulled too deep into the tissue of the earlobe.  This can be painful, especially if it becomes infected, and usually requires medical attention to remove.

Who performs ear piercings?  Gone are the days when it would be done at home with a hot sewing needle and a slice of raw potato!  In the past, I have recommended consulting a plastic surgeon; a plastic surgeon pierced my own daughter’s earlobes when she was two months old.  However, it appears that our local plastic surgeons in the Delaware area will no longer perform this procedure.  So you might be reduced to having it done in the local shopping mall, an alternative I don’t find appetizing.  I suggest that you size up carefully the skill and experience of anyone whom you contemplate piercing your daughter’s ears, and ensure that sterile (preferably disposable) equipment is used.

David Epstein, MD

Some people wonder if vaccination for chicken pox is necessary at all, since many cases are mild and self limited.  Unfortunately, there are some children who suffer severe or permanent damage from the complications of chicken pox.  And public health experts point out that the cost to society of the parents’ lost days from work and school, to care for a week-long contagious illness, adds up over an entire population!

– David Epstein, MD

A.  There is probably not much direct harm; no study has yet shown medical disease of any sort in children to be caused by artificial sweeteners, except for an occasional allergic reaction.  But I don’t think kids need them, unless they have a medical condition such as diabetes or obesity.

Although an occasional diet soda is probably fine, I’m not comfortable with kids having lots of artificial sweetener, for two reasons:

1) Even though there’s no studies showing actual harm, I’m concerned about the unknown effects of large amounts of these chemicals.

2) Even though artificial sweeteners have no calories, I worry that kids will get used to drinking sweetened drinks; if this becomes a habit, their learned preference for sweetened drinks may translate into excess calorie intake as older kids or adults.

People asK: “Which is best for kids, regular soda or diet?” But the question frames a false choice: to offer sugary drinks and snacks, or chemically sweetened ones.  There is a third choice, which is the one I recommend: unsweetened drinks such as milk, water, or unsweetened ice tea and flavored waters, and snacks (such as fresh fruits, vegetables, and crackers) which have no additional sweetener.

–  David Epstein, MD

A:  Absolutely.  Headphones pose a risk of hearing damage for children; this is an important issue.  Several recent news reports have spotlighted cases of permanent hearing damage in older adults due to their listening habits in childhood.

Noise induced hearing damage is caused by a combination of loudness and prolonged listening times; giving the ears a “break” of a quiet period after listening for a while may offer some protection.  Most people use open-air style headphones, or the “ear bud” style such as iPod earphones.  In noisy areas, users may crank up the volume in an attempt to drown out ambient noise.  Unfortunately, this puts the hearing at risk.  Noise-blocking or noise-canceling headphones may be less dangerous.

Some experts fear that aerobic exercise may increase the danger of noise-induced hearing loss, because blood is diverted from the organs of hearing (not to mention the risk of injury due to distraction from the music).

Permanent damage may occur before any symptoms (such as ringing in the ears or difficulty understanding speech) are apparent, so prevention of hearing loss by moderation of listening habits is crucial.

David Epstein MD