Flattened head syndrome See positional plagio

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CEPHALY.

flu See INFLUENZA.

fluoride A mineral that occurs naturally in all water sources (including the oceans) and that has been proven to reduce cavities in both children and adults. The fluoride ion comes from the element fluorine, the 17th most abundant element in the Earth's crust. Fluoride works to prevent cavities by strengthening teeth under the gums in the jawbone, and by strengthening tooth enamel on the surface of the teeth.

Fluoride's benefits for teeth were discovered in the 1930s when dental scientists noted remarkably low decay rates among people whose water supplies contained significant amounts of natural fluoride. Several studies conducted during the 1940s and 1950s confirmed that when a small amount of fluoride is added to the community water supply, decay rates among residents of that community decrease.

Children between six months and age 16 should take fluoride every day, but only at appropriate levels, according to the American Academy of Pediatric Dentistry (AAPD).

Two of the most common sources of fluoride are via tap water and fluoridated toothpaste. Although fluoride occurs naturally in all water sources, in most major municipalities it has been added to the water to help prevent tooth decay for the past 50 years. The recommended fluoride level in community water systems is 0.7 to 1.2 parts fluoride per million parts water.

However, as more parents turn to bottled water for drinking and food preparation, pediatric dentists are concerned about whether children will get enough fluoride. Most bottled water brands do not contain fluoride, although some types of bottled water do add fluoride to the final product and are safe for children of all ages.

Pediatric dentists recommend that children who regularly drink well water or unfluoridated bottled or tap water take fluoride vitamins, drops, or tablets.

Families who use water filters need to understand whether the devices filter out fluoride. Countertop filters and pitcher-type filters usually do not remove fluoride, but more sophisticated, point-of-use filters can. Consumers who want to filter tap water but keep fluoride can use a charcoal-or carbon-activated filtration pitcher (such as Brita) that offers better-tasting water without removing fluoride.

It is also possible to obtain professionally applied fluorides in the form of a gel, foam, or rinse applied by a dentist or dental hygienist during dental visits. These fluorides are more concentrated than the self-applied fluorides and therefore are not needed as frequently. The American Dental Association (ADA) recommends that dental professionals use any of the professional strength, tray-applied gels or foam products carrying the ADA Seal of Acceptance; there are no ADA-accepted professional fluoride rinses for use in dental offices.

While fluoride is important, it only works when used at the appropriate levels. Too much fluoride can cause a harmless discoloration of the teeth known as enamel fluorosis, which is usually caused when children take fluoride supplements despite the fact that their tap water is fluoridated. If there is enough fluoride in children's primary source of drinking water, they do not usually need supplements. Since it is impossible to know how much fluoride is in a child's primary source of drinking water without having it tested, a pediatric dentist should test the fluoride level of bottled, tap, or well water before supplements are prescribed. However, it is important to remember that a child may be drinking fluoridated water from sources other than the home water supply, such as school or day care, water in processed beverages, and foods prepared with fluoridated water.

Regardless of whether or not their water is fluoridated, children need to brush with a pea-sized amount of fluoridated toothpaste after breakfast and before bed. Parents need to supervise children's tooth brushing until age eight, when most children have the manual dexterity to accomplish this task on their own.

Children also need to visit the dentist early in life to assess fluoride needs. Exactly when to schedule that first dental visit is controversial, however. Pediatric dentists recommend scheduling a child's first dental visit when the first tooth appears or no later than the first birthday, to evaluate fluoride needs before the child's permanent teeth come in. But the American Academy of Pediatrics recommends that barring risk factors for tooth problems such as sleeping with a cup or bottle, teeth staining, or thumb sucking, the first visit to the dentist should be scheduled by the third birthday.

Parents should be careful in using toothpaste with children under age two, since children this age cannot spit the toothpaste out after brushing and tend to swallow it. Too much fluoride taken internally between the ages of two and four can lead to discolored teeth. Alternatively, younger children can use a nonfluoridated toothpaste such as Baby Orajel Tooth and Gum Cleanser until they can spit out toothpaste.

While some critics worry that fluoride may be linked to problems such as lower IQ in children, the Centers for Disease Control (CDC) calls the fluoridation of drinking water as one of the 10 greatest public health achievements of the 20th century. It notes that water fluoridation has helped improve the quality of life in the United States through reduced pain and suffering related to tooth decay, reduced time lost from school and work, and less money spent to restore, remove, or replace decayed teeth. Fluoridation, according to the CDC, is the single most effective public health measure to prevent tooth decay and improve oral health over a lifetime, for both children and adults.

Fluoridation to prevent tooth decay has been endorsed by the AAPD, ADA, American Academy of Pediatrics, American Medical Association, U.S. Public Health service, and the World Health organization.

food allergy An immune system response to a food that the body mistakenly believes is harmful. once the immune system decides that a particular food is harmful, it creates specific antibodies to it in an attempt to protect the body. The next time the child eats that food, the immune system releases massive amounts of chemicals (including hista-mine) in order to protect the body. These chemicals trigger a cascade of allergic symptoms that can affect breathing, the heart, the skin, or the gastrointestinal tract. Most food allergies trigger reactions such as itching, hives, and swelling, but in some cases a more serious response known as ana-phylactic shock can occur. This leads to a loss of consciousness or even death.

scientists estimate that between six and seven million Americans suffer from true food allergies. Many food allergies disappear as the child gets older; about a third of cases disappear in one to two years if the child carefully avoids the offending item. However, allergies to peanuts, nuts, fish, and shellfish often do not disappear with time.

Many different common foods may trigger an allergic reaction, including citrus fruits, dairy products, wheat, eggs, fish, cola drinks, artificial coloring, shellfish, berries, tomatoes, pork, and nuts. Infants prone to allergies may be especially sensitive to milk and milk products, wheat, eggs, and citrus fruits. Allergic reactions can be caused by even very tiny (even undetectable) amounts of the food. For example, a child who is allergic to peanuts could go into anaphylactic shock after eating a food that only has been touched by peanuts. Food additives also may cause problems. About 15 percent of children who are allergic to aspirin are also sensitive to Yellow Dye # 5 (tartrazine).

Although a child can be allergic to any food, the following eight foods account for 90 percent of all food-allergic reactions: milk, egg, peanuts, tree nuts (such as walnuts or cashews), fish, shellfish, soy, and wheat.

Milk There are a number of hidden sources of milk that can be of concern to children with food allergies:

• Deli meats Meat slicers are frequently used for both meat and cheese products and so could contaminate sliced meats.

• Casein some brands of canned tuna fish contain a milk protein derivative called casein. Many nondairy products also contain casein, listed on the ingredient labels. some meats also may contain casein as a binder.

• Steaks Many restaurants put butter on steaks after they have been grilled to add extra flavor. The butter is not visible after it melts.

• Goat's milk Because goat's milk protein is similar to cow's milk protein it may cause a reaction in milk-allergic individuals. Goat's milk is not a safe alternative for children allergic to cow's milk.

• Coffee drink foam Eggs and/or milk are used to create the foam topping on specialty coffee drinks; they are also used in some bar drinks.

Kosher symbols may help parents determine if a product is milk-free. A system of product markings is used to indicate whether a food is kosher (produced in accordance with Jewish dietary rules). A "D" or the word "dairy" on a label next to "K" or "u" (usually found near the product name) indicates the presence of milk protein; a "DE" on a label indicates that the food was produced on equipment shared with dairy. If the product contains neither meat nor dairy products it is Pareve (Parev, Parve). Pareve-labeled products indicate that the products are considered milk-free according to religious specifications. However, under Jewish law, a food product may be considered Pareve even if it contains a very small amount of milk, which means it could potentially have enough milk protein in it to cause a reaction in a milk-allergic individual.

A number of ingredients that may seem to include milk or dairy products in fact do not and can be eaten by a child with a milk allergy. These include:

• calcium lactate

• calcium stearoyl lactylate

• sodium lactate

• sodium stearyl lactate

Eggs Influenza vaccines are grown on egg embryos and may contain a small amount of egg protein. The pediatrician should be notified before giving a flu shot to a child who is allergic to eggs. The recommendations of the American Academy of Pediatrics (AAP) acknowledge that the MMR

vaccine can be safely administered to all children with egg allergy. The AAP recommendations are based in part on overwhelming scientific evidence supporting the routine use of one-dose administration of the MMR vaccine to egg-allergic patients, even among children with a history of severe, generalized anaphylactic reactions to egg.

other egg sources include egg substitutes and pasta. Some commercial brands of egg substitutes actually contain egg whites. Most commercially processed cooked pastas (including those used in prepared foods such as soup) contain egg or are processed on equipment shared with egg-containing pastas. Boxed, dry pastas are usually egg-free. Fresh pasta also is usually egg-free. Read the label or ask about ingredients before eating pasta.

Peanuts Children who are allergic to peanuts need to be particularly careful about the food they eat, because these types of nuts can cause severe allergic reactions in the tiniest doses. Although once considered to be a lifelong allergy, recent studies indicate that up to 20 percent of children diagnosed with peanut allergy may outgrow it.

All too often, peanuts are hidden in many foods so that it can be difficult to tell which ones contain nuts. All labels should be checked carefully. To be safe, children who are allergic to peanuts should avoid chocolate candies unless there is absolutely no risk of cross-contact during manufacturing procedures. African, Chinese, Indonesian, Mexican, Thai, and Vietnamese dishes often contain peanuts or are contaminated with peanuts during preparation of these meals. Many brands of sunflower seeds are produced on equipment shared with peanuts. In addition, foods sold in bakeries and ice cream shops often come in contact with peanuts. Therefore, experts recommend that peanut-allergic individuals avoid these types of foods and restaurants. In addition, peanuts may masquerade under other names; for example, mandelonas are peanuts soaked in almond flavoring, and arachis oil is peanut oil.

Most experts recommend peanut-allergic patients also avoid tree nuts (such as pecans or walnuts) as well (see below). Because many nut butters are produced on equipment used to process peanut butter, these butters are a somewhat risky alternative.

Studies show that most allergic individuals can safely eat peanut oil but not cold pressed, expelled, or extruded peanut oil, sometimes referred to as "gourmet oils."

if a pediatrician has prescribed injectable epi-nephrine (Epipen) it should always be carried by the child.

Tree nuts Tree nuts can cause severe allergic reactions, so if a pediatrician has prescribed injectable epinephrine (Epipen), it should always be carried with the child. Patients who have been diagnosed with an allergy to specific tree nuts should avoid all tree nuts to be safe; most experts advise tree nut-allergic patients to avoid peanuts as well.

in addition, tree nuts may be contained in a wide variety of products. Mortadella may contain pistachios, and natural and artificial flavoring may contain tree nuts. in fact, tree nuts have been used in many foods including barbecue sauce, cereals, crackers, and ice cream. in addition, hacky sacks, bean bags, and draft dodgers are sometimes filled with crushed tree nut shells.

A coconut is actually the seed of a drupaceous fruit and is not considered a tree nut. Therefore, coconuts are not typically restricted in the diet of a child who is allergic to tree nuts. However, some people have reacted to coconut, so potential reactions should be discussed with a doctor before introducing coconut to the child's diet. Likewise, nutmeg is obtained from the seeds of the tropical tree species Myristica fragrans and is considered to be safe for a child with a tree nut allergy.

Fish/shellfish Allergic reactions to fish and shellfish are commonly reported in children and can be severe. it is generally recommended that all types of fish should be avoided by children who have had an allergic reaction to one species of fish or positive skin tests to fish. The same rule applies to shellfish.

Fish-allergic individuals should be cautious when eating away from home and avoid fish and seafood restaurants because of the risk of contamination in the food-preparation area of their "non-fish" meal with a counter, spatula, cooking oil, fryer, or grill that was exposed to fish. in addition, fish protein can become airborne during cooking and cause an allergic reaction. in fact, some people have had allergic reactions just by walking through a fish market.

it is not always easy to spot fish or shellfish in food. For example, caponata, a traditional sweet-and-sour Sicilian relish, can contain anchovies, while Caesar salad dressings and steak or Worcestershire sauce often contain anchovies. Likewise, surimi (imitation crabmeat) often contains fish.

On the other hand, some products that may seem fish-related are not. Carrageenan (Irish moss) is not fish but a red marine algae that is used in a wide variety of menu items (particularly dairy foods) as an emulsifier, stabilizer, and thickener. it appears to be safe for most children with food allergies.

Despite common belief to the contrary, allergy to iodine, allergy to radiocontrast material (used in some lab procedures), and allergy to fish or shellfish are not related. A child with an allergy to fish or shellfish should not worry about cross-reactions with radiocontrast dyes or iodine.

Soy Soybeans have become a major part of processed food products in the United States, and it can be hard to avoid products made with soybeans. While soybeans alone are not a major food in the typical American diet, because they are contained in so many products, eliminating all those foods can result in an unbalanced diet. A dietitian should be consulted to help plan for proper nutrition. Soybeans and soy products are found in baked goods, canned tuna, cereals, crackers, infant formulas, sauces, and soups. At least one brand of peanut butter lists soy on the label.

Studies show that soy lecithin and soybean oil can be tolerated by most soy-allergic individuals.

Wheat it may not be obvious in what products wheat can be hidden, so labels should be read carefully. Wheat is contained in some brands of hot dogs, ice cream, and imitation crabmeat. Wheat flour is sometimes flavored and shaped to look like beef, pork, and shrimp, especially in Asian dishes. In addition, many country-style wreaths are decorated with wheat products.

There is a difference between celiac disease and wheat allergy, which are two distinct conditions. Celiac disease (or celiac sprue) is a permanent sensitivity to gluten, a protein contained in wheat flour. Those with celiac disease will not lose their sensitivity to this substance, but will have to restrict their intake of gluten all their lives. The major grains that contain gluten are wheat, rye, oats, and barley. These grains and their by-products must be strictly avoided by people with celiac disease.

On the other hand, children allergic to wheat have a reaction to wheat protein and must therefore avoid only wheat. Most wheat-allergic children outgrow the allergy.

Two alternatives to wheat are not safe for wheat-sensitive individuals. Kamut is a cereal grain related to wheat. Spelt is an ancient wheat that has recently been marketed as safe for wheat-allergic individuals, but this claim is untrue. Wheat-allergic patients can react as readily to spelt as they do to common wheat.

Symptoms

Symptoms of a food allergy include tingling sensations in the mouth, swelling of the tongue and the throat, breathing problems, hives, vomiting, abdominal cramps, diarrhea, low blood pressure, loss of consciousness, and death. Symptoms typically appear within minutes to two hours after the child has eaten.

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