Archive for the ‘Health’ Category

Babies and Sunscreen

April 30, 2015

round-kids-sunglasses-2012-trends-for-babyOriginally posted here.

When is it OK for a baby to wear sunscreen?

Sunscreen is OK to use on babies 6 months or older. Younger babies should use other forms of sun protection. Consider these guidelines from the American Academy of Pediatrics, the Food and Drug Administration and the American Cancer Society:

  • For babies 6 months or older. If your baby is 6 months or older, liberally use sunscreen. Also, avoid exposing your baby to the sun during peak hours — generally 10 a.m. to 2 p.m. — and dress your baby in protective clothing, a hat with a brim and sunglasses.
  • For babies younger than 6 months. If your baby is younger than 6 months, keep him or her out of direct sunlight. Protect your baby from sun exposure by dressing him or her in protective clothing, a hat with a brim and sunglasses.

When choosing baby sunscreen, pick a broad-spectrum sunscreen with an SPF of at least 15. The American Academy of Dermatology recommends using a broad-spectrum sunscreen with an SPF of 30 or more. Apply sunscreen generously, and reapply every two hours — or more often if your baby is spending time in the water or perspiring.

To avoid irritating your baby’s skin and eyes, consider using a sunscreen that contains only inorganic filters, such as zinc oxide and titanium dioxide. Avoid using products that combine sunscreen and the insect repellent DEET, since sunscreen must be regularly reapplied and insect repellent typically doesn’t need to be reapplied.

Remember, just a few serious sunburns can increase your baby’s risk of skin cancer later in life. Taking simple steps now can go a long way toward protecting your baby from the risks of sun exposure.

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9 Energy Tips for Moms

August 13, 2014

high-energy-momOriginally posted here on WebMD.

Why is it that the kids have all the energy, but they’re the ones who get to nap?

Parenting is one of the most rewarding jobs in the world, but it’s also exhausting. You are on duty 24-7, no weekends off or sick days. It’s easy to focus on your kids and neglect yourself, but that’s not good for you or them.

Ideally, all moms would get eight hours of sleep and rise refreshed. But most of us know that’s not realistic. Instead, here are some quick and realistic tips from parenting experts on how you can recharge your own energy tank.

1. Guzzle a Bottle of Water.

Mild dehydration can affect your body even before you know you’re thirsty, and may leave you with headaches, fatigue, and lack of energy. “When I want a quick pick-me-up, I stop and drink a full bottle of water,” says Tammy Gold, a psychotherapist and parenting coach, and the mother of three girls ages 6 and under.

2. Take a Bath or Shower.

“There’s nothing like taking all your clothes off and taking a bath or shower in the middle of the day to make you feel like a totally new person,” Gold says.

3. Be a “Bad Mom.”

To get even five minutes for an energy boost, you may need a quick break from the kids. If they’re not in school or day care, that may mean relying on the dreaded TV for at least a short time. “I tell moms that it’s OK to put kids in front of the TV or put the baby in her crib or play yard for 15- 20 minutes to recharge yourself,” Gold says. “Turn on Sesame Street or an educational DVD. They’ll get a much more present, happier you if you occasionally allow yourself a break like that than if you’re watching them like a hawk every second.

4. Get Moving.

Studies have found regular exercise is better than a nap for boosting your energy levels. But constant reminders to fit an hour’s worth of exercise into every day can be daunting. Forget the perfect and go for what you can do instead. Take a quick walk around the block with your child in the stroller, or just stand up from your desk to do some stretches. (You can set your computer alarm to remind you.) Or take advantage of playtime with your kids: have a race in the park or roller skate. Too cold? Try a physically active video game like Wii tennis or put on some music and dance.

5. Don’t Skip Breakfast!

You’re vigilant about making sure your kids get a healthy breakfast before they head out the door. But what about you? A cup of coffee does not equal a healthy start to the day (and no, two cups don’t make it better). Studies have found that people feel more satisfied by food eaten in the morning, a feeling that can translate into better energy for your day.

6. Keep Your Blood Sugar Steady.

You feel drained. You grab a candy bar or a soda for a quick sugar rush. The energy burst lasts for a short time and then you crash, feeling more tired than before. Sound familiar? Wild fluctuations in your blood sugar can be rough on your energy level. Instead, eat regular small snacks to keep on an even keel. “Two hours after breakfast, I’ll have a banana with peanut butter,” says Gold. “Two hours after that, I’ll have Greek yogurt with honey.” Keep snacks in your purse that combine carbs with protein for a slow release of energy — like trail mix, peanut butter crackers, protein bars, and small containers of veggies and hummus.

7. Change Your Clothes.

No, really. If you’re sitting around in baggy sweats or your pajamas, it can actually make you feel more tired and rundown, Gold says. You don’t have to put on a skirt or suit, but a switch from sweats to slacks and a cute top can make you feel like a new person.

8. Give Yourself a Bedtime.

Maybe eight hours’ sleep isn’t realistic for a mom of young kids, but you can’t survive on five. “There’s no quick cure for a lack of sleep, no matter how much caffeine you ingest,” says Debi Silber, MS, RD, a personal trainer and lifestyle coach and the author of A Pocket Full of Mojo: 365 Proven Strategies To Create Your Ultimate Body, Mind, Image and Lifestyle. “Seeking energy through caffeine or sugar just leaves you tired and wired and prone to weight gain.” Try this experiment: for one week, go to bed one hour earlier than you usually do, every night. Don’t veg out in front of the TV or the iPad. See how much more energy you have by the beginning of the next week.

9. Spend Real Time with Your Child.

Sometimes taking a break from parenting can give you the energy you need — but the right kind of mommy-child time can refill your tank. “Take 15 minutes and just play with them. Abandon yourself completely to the play without a deadline or timeline or goal,” says Stephanie Somanchi, PhD, an executive life coach who has worked with Nike and U.S. Bank. “You’ll find yourself empty and dry at the end of the day if all your interactions with your kids are about getting dressed, eating meals, and getting in and out of the house.”

USDA Dietary Guidelines for Children

July 21, 2014

girl-eating-watermelonOriginally posted here.

If we are what we eat, then American kids are Fritos. That’s just one of the major findings from the new USDA Dietary Guidelines. Fries and chips are the only “vegetables” on the list of top 25 calorie sources; fruit juice is the sole “fruit” to make the leaderboard.

The prevalence of these foods plays a big role in the childhood-obesity epidemic, which affects far more than our children’s waist sizes. Many chronic conditions are on the rise among kids, including asthma, allergies, diabetes, and attention deficit hyperactivity disorder (ADHD). And all of these conditions have been linked to what kids eat. Improving children’s diets in the following three areas that were addressed in the report would go a long way toward helping our kids stay healthy:

Go low when it comes to salt. Most kids over 2 consume too much sodium, which can lead to high blood pressure. White bread is kids’ biggest source of salt because they eat so much of it. Excess sodium is also hidden in many processed, frozen, and restaurant foods. The fix: Go with low-sodium whole grains when choosing bread. Eat at home more often, and choose fresh foods over frozen or processed products.

Get off the SoFAS! This acronym may be the next buzzword in the childhood obesity discussion. SoFAS—“solid fats and added sugars”—make up a whopping 35 percent of our calories and have almost no nutritional value. These unhealthy fats, which are solid at room temperature, are found mostly in butter, stick margarine, and red meat. That means they’re in many children’s-menu staples: pizza, hot dogs, bacon, French fries, and desserts. The fix: Whenever possible, avoid these foods and use oils to replace solid fats when cooking.

Watch the added sugars. Sugars are healthy in whole foods like fruits and milk because these foods also contain nutrients that signal the body to use the sugar correctly. But when they are added to nutritionally empty foods (like many desserts), the natural process is thrown off. The fix: Make sweets an occasional treat in your family. Most important: View these findings as a road map to dietary change. Your children’s health depends on it.

Sun Safety: Sunscreen and Sun Protection

June 25, 2014

images

Originally posted here, on WebMD’s website.

Getting through the summer will involve sunscreen — lots and lots of it. But as you smear it onto your kids, you may have some qualms. What is really in this stuff? Is it safe? Are there chemicals or toxins you should be concerned about?

The Environmental Working Group and other organizations do have concerns with some sunscreen ingredients — especially oxybenzone. “It seems to be able to penetrate the skin and may have some hormone-like activity in the body,” Lunder says.

Some doctors and medical organizations disagree. “I recommend sunscreens with oxybenzone whole-heartedly,” says Kate Puttgen, MD, a pediatric dermatologist at Johns Hopkins Children’s Center in Baltimore. “I haven’t seen any data that suggest the miniscule amount of absorption causes any risks.” The American Academy of Dermatology continues to recommend sunscreens with oxybenzone.

If you’re worried about chemical exposure, there is some common ground: both sides agree that titanium dioxide and zinc oxide sunscreens are safe and effective. They’re also ideal for young children and people with sensitive skin. Although these sunscreens used to have a reputation for leaving a chalky film, new formulations are micronized so that they’re barely visible.

What else should you know about using sunscreen?

  • Check the SPF for UVB protection. The SPF number indicates how well a sunscreen protects against ultraviolet B (UVB) rays. If you’d normally get a sunburn in 10 minutes, an SPF 15 extends that by 15 times. So you could last 150 minutes before burning. How high an SPF do you need? Puttgen recommends SPF 30 or higher.
  • Look for UVA protection. The SPF doesn’t tell the whole story – it only refers to protection against UVB rays. Ultraviolet A (UVA) rays pose their own risks. So make sure the label on your sunscreen states that it has UVA, broad spectrum, or multi-spectrum protection.
  • Look for water resistance. Keep in mind that these products are not water-proof. They will still wear off. But they will last longer than typical sunscreens.
  • Reapply regularly. A few dabs in the morning will not last the whole day. Follow the directions on the bottle for reapplying – especially after you’ve been sweating or in the water.
  • Not all sunscreens work as well as they should. The Environmental Working Group (EWG) tested nearly 1,000 brand-name sunscreen products and concluded that 4 out of 5 either contained chemicals that could potentially pose health hazards or didn’t adequately protect skin from the sun’s damaging rays. You can find the results of their findings and learn which sunscreens are best by visiting Skin Deep, the EWG’s cosmetic safety database.

Still, sunscreen isn’t enough. There are other precautions that you and your kids should take during the summer.

  • Wear broad-brimmed hats. Don’t forget to be a good model to your kids. If you keep your hat on, your kids might be more likely to do the same.
  • Keep sunscreen and lip balms in your car, in your purse, everywhere. You never know when you’ll need it.
  • Cover up with clothing to protect exposed skin. According to the Skin Cancer Foundation, the tighter the weave and the darker the color of a garment, the higher the SPF protection.
  • Avoid sun exposure, especially during the hours of 10 a.m. and 4 p.m., when UV rays are strongest. But remember that invisible rays can reflect up toward you from the ground, so you may still need protection even in shade.
  • Check the UV Index at the EPA web site (search for “sunwise”) when planning outdoor activities.
  • Be aware of reflective surfaces (water, cement, and sand), as they increase your chances of getting a sunburn.
  • You can still get too much sun on a cloudy or hazy day. UV rays are strong enough to burn your skin even on cloudy days.
  • Rinse off when you come indoors or at the end of the day.
  • A child’s delicate skin, if left unprotected and exposed to the sun’s harshest rays, can be damaged in as little as 15 minutes, but it can take up to 12 hours for skin to show the full effect of sun exposure. So, if your child’s skin looks “a little pink” today, it may be burned tomorrow morning. To prevent further burning, get your child out of the sun.
  • Wear sunglasses that protect against UVA and UVB rays to protect your eyes. Sun rays can also damage your eyes, potentially causing cataracts and vision loss as you age.

5 Tips for a Beach Vacation with Kids

June 18, 2014

cn_image.size.kids-beaches-children-playing-in-sand
Originally posted here, on the Conde’ Nast Traveler’s website.

My first few visits to the beach with kids along were a sandy, wet mess. Since then, I’ve learned a trick or two and I thought I’d share them here.

  • Rub on baby powder to remove sand from your body—don’t forget between the toes.
  • Instead of buying new beach toys at your destination, ask poolside or at your hotel’s concierge desk. Even if the hotel doesn’t provide beach toys for guests, there’s almost always a leftover bucket and shovel in a closet somewhere. (Don’t forget to leave your toys back with the concierge when you check out— items left in the hotel room are more likely to end up in the trash).
  • On a windy day, rain pants are the perfect way to keep out both sand and cold. Just slide them on over your child’s clothing and remove them before you get in the car.
  • Possibly the worst part of putting sunscreen on a squirming child is smoothing that gloopy stuff all over their face and eyes. Instead, invest in a high-quality powdered sunscreen. It doesn’t drip into their eyes, it’s quicker to put on, and my five-year-old daughter thinks it’s the most glamorous stuff on earth.
  • A toweling coverup is stretchy enough to allow your child to slip out of their swimsuit in privacy, and perfect for the car ride home.

Simple Strategies Aren’t Enough For Bed-wetting, Study Finds

March 12, 2014

Originally posted here.

child sleeping
Tue, Aug 27, 2013 (HealthDay News) — While techniques such as fluid restriction can help some children who have problems with bedwetting, alarms and medications are more effective, a new study finds.

“Simple behavioral therapies such as rewarding the child for dry nights or taking the child to the toilet during the night can sometimes help with bedwetting, and is better than doing nothing,” said study leader Dr. Patrina Caldwell, a pediatrician at the Children’s Hospital at Westmead and senior lecturer at the University of Sydney, in Australia.

“However, there are more effective treatments such as bedwetting alarm training or medications,” she said. But alarm training is more difficult, she noted.

Bedwetting affects about 5 million children in the United States, with up to 20 percent of 5-year-olds having the problem. Most kids outgrow the problem, known medically as nocturnal enuresis, and only 2 percent of adults are affected. However, bedwetting can be frustrating, stressful and traumatic. Remedies and treatments abound, but with much debate about which are best.

In the United States, two medications are approved for childhood bedwetting — desmopressin (DDAVP) and imipramine (Tofranil) — although others are also used off-label.

Dr. Trevor Resnick, chief of neurology at Miami Children’s Hospital, said he only prescribes medication on an as-needed basis, such as to spare children embarrassment on a sleepover.

The new report was published recently in The Cochrane Library.

For the review, Caldwell’s team reviewed 16 published studies involving more than 1,600 children, with about half trying simple interventions. Among them were fluid retention, rewards for dry nights (such as stars on chart), and lifting children and taking them to the bathroom after they have been asleep.

No one simple strategy worked better than another, the researchers found. When they compared alarm training with the simple strategies, the alarm training was more effective. And treatment with medication alone was better than the simple interventions.

However, the researcher noted that “the findings from this review should be interpreted cautiously due to the poor quality and small sizes of the trials.”

Reasons for bedwetting are not totally understood, but experts think it may be associated with the time it takes children to develop control over the bladder, a complex milestone. The timing varies from child to child.

The findings suggest that parents may want to start with simple treatments, Caldwell said, “then move to alarm training or medication if simple treatments do not work after trying for six months.”

“Younger children generally take longer to respond to treatment,” she said. “Don’t get annoyed with the child, because bedwetting is usually out of their control.”

While the alarm system, which sounds an alarm when drops of urine are detected, is effective, it is difficult to do, Caldwell said. Another downside she has sometimes seen is when children become dry on alarm training then develop sleepwalking or night terrors. “Bedwetting and night terrors and sleepwalking are all parasomnias [sleep disorders] and are known to be associated,” she said.

The new findings mirror what U.S. expert Resnick has seen in his patients. “I’d say behavioral therapies work about 50 percent of the time,” said Resnick, who was not involved in the study.

If simple treatments don’t work, Resnick said he may consider medications, but he only prescribes them on an as-needed basis, since the medications have side effects.

He agreed with the review authors that many of the included studies did not have sufficient children participating or who were receiving a single treatment to produce definitive findings.

7 Ways to Make Breakfast Fun

February 19, 2014

7-Ways-Make-Breakfast-FunOriginally posted here.

We all know that a healthy breakfast is the most important meal of the day. The problem is getting kids to eat it. Some kids aren’t morning people; some want nothing but sugary cereal. Some kids want to eat the same thing every day, and others need some variety. I’ve come up with some creative and healthy new breakfast ideas so my own don’t get tired of the same old things.

These ideas are even more fun if you have your kids help you make them; they’ll enjoy helping in the kitchen, and they’ll be more than happy to eat their own creations.

1. Fruit Pizza
Make a pizza crust and let it cool, or use flatbread. Spread it with a favorite flavor of yogurt, then top with sliced fruits. Bananas, strawberries, grapes… almost any fruit will work.

2. Parfaits
In a parfait cup or a juice glass, alternate layers of yogurt with fruit, and top with granola or cereal. For a rainbow effect, use different flavors of yogurt and different fruits for each layer.

3. Fruit Kabobs
This is as easy as it gets. All you need is some bowls of various sliced up fruits and some skewers. Supervise the kids while they create the fruit combinations they prefer. Have some yogurt on hand for dipping.

4. Make-Your-Own McMuffins
Scramble an egg, and layer it with cheese and a slice of ham on a toasted whole wheat English muffin. For something different, try using Swiss, cheddar, or mozzarella cheese, or use turkey sausage or Canadian bacon instead of ham.

5. Strawberry Pinwheels
Start with a small whole grain tortilla. Spread it with low fat cream cheese – regular is fine, but you can also use cream cheese that comes in flavors like strawberry or blueberry. Top it off with sliced strawberries, then roll up the tortilla and slice it into pinwheels.

6. Put Peanut Butter On It
Peanut butter is an excellent source of protein and most kids love it. It’s good for so much more than sandwiches and actually makes a great breakfast food. Spread it on toast or English muffins, or even pancakes or waffles, then top with banana slices, preserves, or raisins. Or make ants on a log by slicing a banana lengthwise, spreading the flat sides with peanut butter, and sprinkling with raisin or dried cranberry “ants.”

7. Breakfast Smoothies
Throw some milk, yogurt, and protein powder in a blender, and then add some frozen fruit, like strawberries or blueberries, and a sliced banana. Blend, pour, and go.

When all else fails, forget the rules. Some people, kids included, simply don’t care for “breakfast food.” And that’s okay. What matters is that they get a healthy meal in the morning. A turkey and cheese wrap or an English muffin pizza made with tomato sauce and low fat mozzarella is healthy too. Include a piece of fruit and a glass of milk, and you have a healthy lunch for breakfast.

Encourage Adventurous Eating

December 10, 2013

urlOriginally posted here.

Use these tips and your child may finally eat his broccoli!

Be patient. A typical toddler needs multiple exposures to a new food before he’ll risk tasting it – and 10 to 20 tastes before he actually likes it. So put the food on the table and let him decide if he wants to try it. Offer a variety of foods – like a main dish, rice or bread, a vegetable and/or fruit, and some milk – so there’s something he’ll want to eat. If he still won’t try the “new” food after ten exposures, take it out of rotation for six months or so.

Cut back on portions. A toddler’s stomach is the size of his fist, and he’s growing only one-tenth as much as he did as a baby, so he likely needs less food than you think. Dainty portions are also more appetizing. A few spoonfuls will appeal more to your child’s natural curiosity.

Involve your child. He’ll be more interested in eating the final product. Ask, “Should we have green beans or broccoli?” But don’t offer too many options – he might feel confused. Share kitchen duty, too. Have him tear the lettuce for a salad or pour ingredients. At the grocery store, invite him to pick a new fruit to try or to select a different colored veggie every week.

Get creative. Try presenting foods in new and fun ways:

Set the bar. Have a salad-bar night at home with lots of cut-up veggies so your child can create his own combination.

Make art. Give your child a pita as a base, and have him decorate it with a face: olive eyes, tomato ears, carrot nose, and green-bean smile.

Rename it. Call broccoli “tiny trees,” baby carrots “logs rolling across a plate,” or banana slices “banana wheels.”

Ditch plates. Use an ice cube tray or a muffin tin to serve small portions of colorful foods, or put chicken or tuna salad in an ice cream cone.

Roll it up. Instead of making sandwiches, try rolling some lunch meat and cheese slices in a tortilla, or some turkey around a mozzarella stick.

Stick it. Thread strawberries, banana chunks, and apple slices onto wooden skewers with blunt ends. Or put bite-sized food on toothpicks so your child can “sample” everything.

Add flavor. Kids have delicate taste buds, but that doesn’t mean they can’t enjoy flavorful food. In fact, with their naturally sensitive palates, children really notice when something tastes good. So toss some garlic or olives with pasta sauce, use ginger in a chicken dish, or sprinkle cinnamon on cooked carrots.

Appeal to her toddler ego. Grab a veggie off her plate, say “Mine!” and eat it. Your child may just eat one herself in protest. If she has an older sibling, say, “I see you’re not eating your chicken. Mind if I give it to your brother?” Your child’s competitive urge might kick in, and she’ll try some for herself.

Be sneaky. What kids don’t know won’t hurt them and in this case, it’ll be good for them!

  • Puree cooked peas, carrots, or peppers, then mix into pasta sauce. (Or just add some baby-food veggies.)
  • Substitute half whole-wheat flour for white flour when making baked goods.
  • Mash up cooked cauliflower and add to mashed potatoes.
  • When heating up a can of cream-based soup, substitute milk for water.
  • Add shredded zucchini or carrots to quick bread or muffin batter.

Checklist: Choose the Right Pediatrician

December 6, 2013

imagesOriginally posted here.

You’ve got a baby on the way–now’s the time to find a doctor you can trust. Below is our guide to choosing the pediatrician that’s right for you and your little one.

You’ve got a baby on the way–now’s the time to find a doctor you can trust. Below is our guide to choosing the pediatrician that’s right for you and your little one.

What you should find out

To begin your search, get referrals from your obstetrician/gynecologist or nurse-midwife, other parents in the neighborhood, the public affairs department at the nearest hospital, a pediatric floor nurse at a local hospital or medical center, or by checking the pediatrician referral database at the American Academy of Pediatrics (www.aap.org).

Once you have a few recommendations, check these doctor’s credentials. The American Board of Medical Specialties Web site (www.abms.org/) is a good source.

 Find out:

  1. Is the pediatrician certified by the American Board of Pediatrics (AAP)? This means the doctor passed a specialized exam in pediatrics.
  2. Is the pediatrician a member of the AAP? If so, the doctor will have an “FAAP” after his or her name. This means he’s met established standards for providing child healthcare.
  3. If you choose a family physician, is he certified by the American Board of Family Medicine (ABFM)?Family doctors are trained to care for patients of all ages–including children–but they do not have specialized training in pediatrics.
  4. Does the doctor have specialized training? This is particularly important to know if you think your child will have special medical needs.

When you’ve narrowed your choices down to two or three doctors, you’re ready to get specific questions answered. If possible, set up interviews–face-to-face meetings will give you the opportunity to get to know the doctor and his staff and to ask about office policies.

Questions you should ask the doctor: 

  1. How long have you been in practice? If you don’t have this information already, this would be the time to ask.
  2. What is your childcare philosophy? Talk to him about breastfeeding, circumcision, alternative medicine, vaccinations, sleep and discipline issues.
  3. Do you have children? It may be comforting to know if your doctor has children the same gender.
  4. Are you part of a group practice? If you go with a doctor in a solo practice, find out who covers when he’s away. If he’s part of a group practice, ask about the background of the other doctors. Some practices have pediatric nurse practitioners. They are fully trained nurses often with an MA and specialized training. Physician assistants are not nurses. They have college degrees and two years of physician assistant training.
  5. How long does a typical check-up last? Ideally, at least 20 minutes.
  6. What are the office hours?
  7. How are emergencies handled? Some offices accommodate same-day walk-in visits. Ask how after-hours emergencies and questions are handled.
  8. Is there a call-in policy? Some pediatricians have a specific call-in period each day. In some practices, a nurse answers routine questions. Find out how such phone calls are taken and if there is a charge.
  9. Do you make house calls?

Evaluate the office:
Consider location when choosing a pediatrician. If your baby is sick, you won’t want to travel far to get to the doctor, so it’s a good idea to find one in your community.

  1. Is the waiting area clean, and does it have clean toys and books?
  2. Is there a separate waiting area for sick kids?
  3. Is the staff friendly and helpful?
  4. Do other patients seem to be waiting for a long time?

Ask the staff about:

Insurance

  1. Does the practice accept your insurance?
  2. Does it accept a variety of plans in case your coverage changes?
  3. Is a payment plan possible if you are not covered?

Hospital Affiliation

  1. Which hospital is the doctor affiliated with?
  2. Does your insurance cover services there?
  3. What specialists are on staff?
  4. Is there 24-hour visiting for parents?
  5. If your child has to be admitted, can you stay overnight with him or her?

Strapped In, but Still at Risk

November 20, 2013

Car Seats Remain a Vexing Safety Issue
Originally posted on nytimes.com.

CARSEAT-articleLargeGAITHERSBURG, Md. — For more than two hours, Xiaopeng Li struggled to securely install two rear-facing car seats for his young children in his Toyota Sienna minivan. 

Even then, Mr. Li, a research scientist, could not be sure he had done so correctly. So he drove to a nearby car dealership, where the Montgomery County Fire Rescue unit regularly offers help installing car seats.

“I thought I got it, but after I came in here, they said, ‘No, it’s wrong,’ ” said Mr. Li, 38, who has a Ph.D. and works at the National Oceanic and Atmospheric Administration.

He has plenty of company. Despite being in use for decades, car seats remain a vexing safety issue for families unable to figure out how to install them correctly.

About three of every four car seats are installed improperly, according to the National Highway Traffic Safety Administration. In some communities that lack safety checks or education programs, the figure is even higher.

Automobile crashes remain the leading cause of death for children 13 and younger, according to federal regulators. A large number of the fatalities involve children in car seats.

Deaths of children in car seats declined to 397 in 2011 — the last year data was available from the traffic safety agency — from 614 in 2002. But auto safety experts say the numbers could be much lower with easier-to-use car seats and better instructions on how to strap them into vehicles.

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