The recall includes select lots of Up & Up Fragrance-Free Baby Wipes and Up & Up Fresh Cucumber Scented Baby Wipes sold nationwide.

Here is a list of the recalled products including their UPC codes:

Up & Up Fragrance-Free Baby Wipes

• 20 Count: UPC 085239265956
• 72 Count: UPC 085239265949
• 216 Count: UPC 085239265963
• 800 Count: UPC 085239266137
• 1200 Count: UPC 085239266090

Up & Up Fresh Cucumber Scented Baby Wipes

• 72 Count: UPC 085239265970
• 216 Count: UPC 085239265994
• 800 Count: UPC 085239265987

Health Risks and Symptoms

While healthy people may experience mild symptoms such as skin irritation or rashes, Bcc can lead to more serious infections including pneumonia or sepsis in newborns, premature infants and immuno-compromised patients.

Cook Children’s Infectious Diseases specialists encourage families to stop using the recalled wipes immediately and monitor children for symptoms.

“Early warning signs may include redness, tenderness, warmth or swelling on the skin, especially around cuts or abrasions cleaned with the wipes,” said Mary Suzanne Whitworth, M.D., medical director of Infectious Diseases at Cook Children’s. “Infants and young children may also develop fever, poor feeding, irritability or lethargy.”

Families should contact their child’s primary care physician or seek care at one of Cook Children’s Urgent Care Center or Emergency Department if a child develops symptoms or appears ill after exposure to the wipes.

At this time, Cook Children’s infectious disease team has not evaluated any confirmed patient cases linked to the recalled wipes.

What Should Consumers Do?

The FDA advises consumers to stop using the products immediately and return them to any Target store for full refund. More information available on the FDA website.

Antibiotics have been one of the most amazing advances in medicine, preventing countless deaths and relieving suffering for conditions that historically had no treatment.

While antibiotics are critically necessary in particular infections, doctors must evaluate their necessity on a case by case basis. Bacterial infections often require antibiotics, but some infections (such as ear infections) that were once thought to require them, may be able to resolve on their own. Viral infections do not respond to antibiotics and thus should not be treated with them.

Two studies released in the past few months suggest that the use of antibiotics in infancy likely increases the risk of allergic disease in childhood. The research found the use of a particular type of antibiotic during the first trimester of pregnancy  (macrolides such as azithromycin), increases the risk of congenital anomalies.

Each year, thousands of kids flood the Cook Children's Emergency Department with bronchiolitis. Bronchiolitis is one of the most common illnesses pediatricians see. Lots of viruses can cause bronchiolitis, but the most well known is RSV.  In the past, doctors have tried breathing treatments like albuterol, steroid medicine, cough and cold medicine, and even sometimes antibiotics. We now know that these things don’t help and can make things worse.

"Antibiotics treat bacterial infections, not viruses like bronchiolitis. Giving your child antibiotics when they aren’t needed may cause diarrhea, and over time can cause bacteria to become resistant to antibiotics," Stacey VanVliet, M.D., wrote in her about post about this topic.

Even with more and more information warning against overuse of antibiotics, I hear from parents all the time wondering why I didn't prescribe them to their child.

So when should you give your child an antibiotic? Let's take a look.

What common bacterial conditions require antibiotics? The list is surprisingly short:

• Strep throat
• Whooping cough
• Urinary tract infection

The conditions require antibiotics, either for treating the infection or treating potential complications that can arise when they are not treated (or both). If you suspect your child has one of these conditions, it is important to have them evaluated.

Some common conditions for which antibiotics are often prescribed but could resolve on their own:

• Ear infections
• Sinus infections
• Bronchitis

For certain ear infections, antibiotics can be avoided. It is essential to talk with your doctor about your desire for this if you are interested. Many children with ear infections will get better without antibiotic treatment. Similarly, sinus infections can be both viral and bacterial. Talk with your doctor about whether treatment with antibiotics is necessary.

Bronchitis in kids is almost always a viral infection. It can be treated by treating the symptoms and allowing the passage of time.

There are some standard conditions for which treatment with antibiotics is not indicated. These infections are caused by viruses such as:

• Common cold
• Viral sore throat

Being cautious with antibiotic use is important for preventing unnecessary complications and side effects for you and your children. If you’re not sure, ask your doctor. The CDC provides a helpul guide on when antibiotics are necessary. Here's a quick version for you:

If you want to learn more about these or any other conditions, Cook Children's offers a great service "Ask a Librarian." Click here to learn more, but a Cook Children's librarian can send you information that is up to date and most importantly from reliable sources.

We've also written a ton on this topic for the newsroom:

• Does My Child Really Need An Antibiotic?
• What Is Cook Children's Doing About the 'Antibiotic Crisis'?
• Too many antibiotics not helpful, could cause harm
• 3 Myths About Antibiotic Use Every Parent Should Know
• Probiotics for Tummy Bugs: Do they Help Your Child?
• Is It Strep Throat or the Flu?
• Is It Croup or Whoop?
• Let's Learn About Whooping Cough?
• When It Comes to Your Kid's It's Never Just a Virus

WHO says the list is an effort to “guide and promote research and development of new antibiotics.”

Antibiotic resistance is growing, according to WHO, which means “we are fast running out of treatment options.”

Mary Suzanne Whitworth, M.D., medical director of Infectious Disease at Cook Children’s, says the best way both the medical community and parents can prevent the spread of these dangerous bacteria is the judicious use of antibiotics.

Some infections in kids require antibiotics for improvement. Some strep throat, urinary tract infections and skin infections will need antibiotics to treat and prevent worsening of the symptoms.

Ear infections don’t always need antibiotics. In older children with less severe disease, a period of waiting can allow the infection to go away without treatment.

Many infections in children are caused by viruses. Colds and sore throats that aren’t strep and many other infections in children simply need a little time and TLC.

“Most viral upper respiratory tract infections start with clear runny nose, maybe fever, and maybe a cough. After a few days the nose drainage is green and then after a few more days it goes away on its own. Antibiotics are not needed for these viral illnesses. The child might have bacterial sinusitis and need antibiotics if the green runny nose lasts for over 7 to 10 or if symptoms worsen after a few days.”

Children can have severe, even life threatening, allergic reactions (even if they have taken that antibiotic before and been fine). Because these are rare, they are not a reason to avoid antibiotics when necessary but they are a reason to use caution when antibiotics are not the right treatment in the first place.

Antibiotics can also cause other side effects, most commonly diarrhea. This diarrhea can last weeks and can be quite severe. If the diarrhea is severe (especially if blood or mucous is present) your doctor might have to consider testing for C. difficile which is a potentially serious infection that can be the result of antibiotic use.

Physicians say they are seeing an increase in the number of infections caused by bacteria that do not respond to the antibiotics we have traditionally used for them.

“This requires us to use stronger antibiotics which can often cause more side effects,” said Justin Smith, M.D., a pediatrician at Cook Children’s. “You can see why people are concerned if we continue along the same path but fast-forward 25 or 50 years. What types of bacteria would emerge? This is why we must use extreme caution.”

Dr. Whitworth adds, “Antibiotics are important and often life-saving. But each time they are used there needs to be a conscious decision made about exactly why they are indicated, what the best choice is for patient compliance, and what the risks and benefits are. They should not be used just because they are expected or requested.”

A new study in Nature Medicine started the process of trying to answer this exact question

You might be thinking, “What the?” But there is some logic to this:

1. Babies born via C-section have been shown to have slightly higher risk of some diseases (obesity, allergies and asthma for example).
2. We are beginning to understand how the makeup of bacteria in our intestines affects many different diseases.
3. Babies born via C-section are not exposed to the normal bacteria that line the birth canal

The question then would need to be asked: Can you reverse this process by exposing babies to the vaginal flora after they were born via C-section? This small pilot study of four babies seems to suggest that you can.

The process: Within in the first two minutes after birth, take a piece of gauze, which has been placed in the vagina. Swab the babies mouth, forehead and the rest of their body. Test these babies to see what bacteria are present in their bodies.

The answer: Those C-section babies who were swabbed with vaginal secretion showed that the bacteria they carried more closely resembled babies who were delivered vaginally.

This was a small study, which needs to be repeated on a larger scale and there are still many questions to answered:

• Does changing the bacteria that a baby carries actually help to prevent diseases?
• How do we make sure this procedure is safe? How do we screen moms to make sure there is no added risk to the baby?
• What is the best means of transferring the bacteria? Is there a better way that what was done in this study?

The role that the bacteria we carry play in our health is gaining interest. I’m sure that we will continue to see studies like this and many others in this area. Stay tuned.

We give vitamin K supplementation as an injection in babies following birth to prevent a condition called Hemorrhagic Disease of the Newborn. This devastating condition was, prior to the institution of the supplementation, a significant contributor to infant death, which ravaged society in the pre-twentieth century period. Vitamin K is necessary to make the clotting system in humans work properly. It basically allows clotting factors to be turned on so they can work correctly. As children and adults, we get most of our vitamin K from our diet (eat your green vegetables!) and surprisingly from bacteria, which normally live in your intestines. These bacteria process the components of food which we don’t, and produce the vitamin as benefit to us.

This vitamin dissolves in fat so adults generally store it well. Infants however do not have a good storage or supply of the vitamin. The placenta does not transmit it to the infant well and breast milk has very little vitamin K in it. Newborns also have no bacteria in their intestines to produce the vitamin; so, the end result is, without good storage of this vitamin, infants are at risk for severe bleeding problems. While this can present in the first week of life as bruising and bleeding from the umbilical cord stump, the most devastating effect is bleeding inside the brain which can occur up to 12 weeks after delivery.

Most of this bleeding risk can be avoided with an injection into the muscle of vitamin K at the time of birth. This provides a source of this valuable vitamin to tide the baby over until intestinal bacteria build up enough to produce the vitamin for the baby. As far as dietary sources, breast milk does not encourage the bacteria which produce this vitamin to grow well. Formula is supplemented with vitamin K, but importantly the different sugars in the formula do encourage the bacteria to develop, but it takes time.

Parents often hear stories about the vitamin K injections causing side effects, particularly a risk for cancer later in life (this was related to an old version which had a chemical called phenol in the formulation and never proven even when it was in there), worsening jaundice (again an old formulation used in the mid -twentieth century) and possible liver damage (which can happen from a large overdose, but highly unlikely with the standard amount given to infants).

Some have proposed alternatives methods as the safest and most effective means to administer vitamin K, generally giving the vitamin by mouth to the baby. The big problem with this strategy is absorption of the vitamin is not guaranteed in infants so we have to give a large dose for a long time to do this. With high doses over a long time you do run the risk of getting too much vitamin K and causing liver problems. There are no commercial liquid forms of this drug, so often the injection solution is just fed to the infant. Over the counter vitamins K pills are not well absorbed at all and there is no certainty in these preparations how much vitamin K the infant will get. In a misguided effort to protect their baby from harm, parents end up exposing them to much more risk.

The American Academy of Pediatrics does not recommend oral supplementation, because it has significant risks compared to the simple vitamin K injection, which has proven both safe and very effective to prevent this condition for decades.

About the author

Donald Beam, M.D., is a hematologist and the medical director for the Life After Cancer Program at Cook Children's. Learn more about the Hematology and Oncology Progam at Cook Children's today.

Along with this goal of each child’s attendance, we have to balance the goal of keeping others safe from infectious diseases. Our contagious students need to stay home when they are sick to keep the rest of their classmates safe. (This is why I don’t really care for perfect attendance bike raffles. I prefer responsible attendance.)

Balancing these tensions is often hard for the parent, the school and the pediatrician because we often don’t know exactly when a child is no longer contagious. This is why I got so geeky excited last week to see a new study released in the Pediatric Infectious Disease Journal about the contagiousness of strep throat.

The study looked at 111 children with strep throat over two days.

Day 1: Children who tested positive for strep were given their first dose of amoxicillin before 5 p.m. (They also had cultures taken which allow to see if bacteria will grow from a swab of their throats.)

Day 2: Children were retested and cultured for strep in the morning to determine if they still carried the bacteria in their throats.

Here is what they found:

• 101 children tested negative for strep on the morning of day 2.
• 7 children had significantly decreased growth of bacteria from their throat cultures.
• 2 children continued to have high loads of bacteria.

The author’s conclusion: “all children treated with amoxicillin for streptococcal pharyngitis (strep throat) by 5 p.m. can, if afebrile (fever free) and improved, may be permitted to return to attend school on day 2.”

I’m pretty sure you’re not as excited as I am, but THIS IS HUGE!

Based on current guidelines, children must be treated for 24 hours before being allowed to return to school. If we treated according to the results of this study, it would allow for the child to be back in school and for the parent to be back at work a whole day earlier.

I feel like there is a lot of work to be done in this area and this type of study, along with other models of health care delivery, are good examples of the work that will be necessary.

Because I value education and our school districts so much, I want to be constantly thinking about ways we can do this better. As a general pediatrician, I can really boil down the goals of my job to these:

1.Keep kids growing and healthy.

2.Keep kids developing and learning.

Early in your baby’s life, this looks like frequent checkups for preventing illness, monitoring growth (and talking about diet) and teaching ways that parents can help their child with development. (Read: Everyone should homeschool.)

As your child gets older and starts school, my role changes a little bit. I don’t ask my elementary age patients about fractions or my high school students about “The Great Gatsby.” Instead, I might ask, “How is school going?” “Any problems I need to know about?” “Any way I can help?”

On a practical level, this means offering school aged children after school appointments when possible. It means getting sick kids in the same day so that we can start treatment and get them back in their desks as soon as possible.

In the future, this may mean totally different modes of delivering health care and working with the school and school nurses in order to decrease missed class time.

But I’m getting ahead of my geeky self again. I’ll save that discussion for later.

Here are five surprising insights about the germs that breed on your phones:

1. Cell phones reflect the personal microbial world of their owners. Scientists have found that cell phones represent our microbiome—the trillions of micro-organisms that live in and on our bodies. Cell phones are an integral part of our daily lives, so our own germs regularly spread from our mouths and skin onto our phones.

2. Have you ever heard of streptococcus, staphylococcus and diphtheroids? If not, these are colonies of bacteria that thrive on your phones. A little bit of bacteria is ok, but too much of it can cause a problem. Our phones are overwhelmingly covered in bacteria and we need to worry about other people’s germs. Think about the next time you set your phone down in a public area or share your phone with someone else. Your phone accumulates the other person’s germs as well as the bacteria they’ve picked up.

3. A cell phone has 18 times more harmful bacteria than a public restroom. This statistic is a little scary, but think about it--we use our cell phones after we eat, work out, use the restroom, etc. Several of us are guilty of using our phones with filthy hands. We don’t think about the germs that are transferred every time our hands touch our phones.

4. Cell phones are breeding grounds for bacteria because of their warmth. Warmth breeds bacteria and phones are always warm from the battery and body heat. We also put our phones in germ-infested places like our purses and pockets.

5. Cell phones can intensify face acne. Pressing your phone onto your face allows bacteria to get trapped into your pores causing unwanted blemishes.

Chris Curtis, clinical coordinator of Infectious Disease at Cook Children's, recommends good hand washing and hygiene to prevent unwanted germs on cell phones. “It is imperative for individuals to continually wash their hands after activities. I tell parents to have their child sing “happy birthday” or the “ABCs” while hand washing,” Curtis said.

Screen protectors for cell phones can guard against the little monsters as well. Reiterate to your child to not only wash his or her hands, but to also keep the phone shiny and clean. Diminishing germs on cell phones can prevent illness and lead to a healthier lifestyle.

- Article written by Amanda Burmeister

Advocating for breastfeeding is a big part of a pediatrician’s job in the first few months of life. We state the benefits of breastfeeding. We encourage families who are struggling and provide help with troubleshooting issues. We point them towards lactation consultants and other resources that can help when things are not going well.

But, is there a point where “breast is not best?”

Does all the conversation about breastfeeding pressure moms to seek out breast milk from other sources when they choose not to breastfeed or when breastfeeding does not work for them?

The answer is: Yes.

Breast milk donation can be used to provide much needed breast milk to premature babies. Many of these babies would otherwise not receive breast milk. This provides an amazing service to a vulnerable population. I strongly encourage moms who are interested and have extra breast milk to look into donating their milk to one of these organizations.

There are other means of exchanging breast milk that I am not as excited about. Families can buy and sell breast milk online via websites that link buyers and sellers (often called “communities” or “societies”).

But, is this method of obtaining breast milk safe?

A recent study showed that out of 102 samples of breast milk bought online, 10 of those samples contained more than 10 percent cow’s milk. This shows that at least some sellers are mixing cow’s milk with their breast milk, most likely to increase volume and income from their breast milk sale.

Why is this dangerous?

It is dangerous because previous studies have shown that 20 percent of online breast milk buyers are buying milk because of a medical condition in their child - many of those are listed as formula intolerance. Introduction of cow’s milk into the breast milk increases the odds that these children could have a reaction or problem with the purchased milk especially if they have a true allergy to cow’s milk.

While this risk is not insignificant, I feel the danger is much greater. I believe that the real danger lies more in the motivation of the sellers. If they are willing to actively deceive buyers by adding cow’s milk, what else are they willing to lie about in order to find a buyer for their milk? Anyone ever thought of why we do not pay blood donors or allow for payment for organ donation? The motivations matter.

Here are some other potential issues with breast milk sold online that you should be aware of:

1. Storage and bacterial contamination

Safe storage of breast milk is not as simple as just throwing it into the freezer. Transportation of sold milk also creates another potential source for unsafe storage. The same group of researchers showed in a previous study that 74 percent of the milk they bought online contained enough bacteria to question their safety for infants.

2. Medications/drugs/alcohol

Many of the sellers’ listings make a point to say that the milk is free of substances or that the donor did not engage in risky behavior. In fact, sellers who made such claims (in addition to claims for clean handling and infectious disease screening) were 6 times more likely to sell their milk than those who did not make those claims. Does this encourage honesty?

3. Infectious diseases

You would hope that donors would be honest about their infectious disease history because many diseases can be transmitted via breast milk. Also, there are some transmitted diseases that the donor may not be aware of at the time they pumped the milk.

Of course, I advocate for breastfeeding for moms who can. But, let’s be real. Formulas have come a long way since the days where it was practically evaporated milk. So, let’s be realistic about the lengths we will go to in order to provide our child breast milk.

How do you know when it is something else or when it could be more dangerous?

A report last week from the CDC described a cluster of infections caused by shigella, a bacteria that can cause severe diarrhea.

Shigella is common, causing an estimated 500,000 cases of diarrhea in the United States annually. But this group of infections is unique because it has been found to be resistant to the most common type of antibiotic used in adults used for shigella. Most cases have been located on the East and West coast and many have been associated with travel outside the United States.

Fortunately, there were no cases of this more severe form of shigella reported in Texas so I feel that we are pretty low risk at this point. I did want to take a second to tell you about warning signs that might alert you that diarrhea might be more than a stomach bug.

Here are some symptoms that might alert you that should trigger a call to your doctor:

1. Severe vomiting with decreased urine frequency or other signs of dehydration.
2. Fever more than 102.
3. Blood or mucous in the stool.
4. Severe belly pain.
5. Diarrhea that last more than one week.
6. Let your doctor know if your child has traveled recently.

What are Salmonella and Shigella?

Two of the most common bacterial causes of infection are salmonella and shigella. They are both fairly frequent causes of severe diarrhea in children.

They can both be transmitted by contaminated food or water but can also be spread from person to person. Salmonella is more frequently caused by transmission from contaminated food, but also can be contracted from infected reptiles. Shigella is more frequently acquired from other children and is much more contagious than salmonella.

(Just to give you an idea, stool of a child infected with shigella contains 100,000,000 bacteria per gram of stool. Ingesting just 200 bacterial cells is enough to cause infection. Because of this, outbreaks of Shigella are common in child-care settings.)

The most common symptoms with both infections are diarrhea, abdominal pain and fever. With shigella, fever is often higher and children are more likely to have blood or mucous in their stools.

For either infection, your doctor can run stool studies to confirm the diagnosis. This may not be necessary if there are known cases that the child has been exposed to.

Both infections will typically go away on their own in seven days or less. Most healthy children do not require antibiotics. I do not routinely recommend anti-diarrheal medications in children because they can prolong symptoms with some infections.

If you suspect your child has one of these infections, consult with your doctor and keep them out of day care until we are sure they will not put other children are risk.

In the state of Texas, it's illegal for anyone under 18 years of age to use an indoor UV tanning facility, even with a parent's permission. But recent studies show that the use of tanning beds can become an obsession and parents need to make sure their child is not finding a way to work around the law.

Why?

The dangers of cancer:

• Ultra-violet (UV) light in tanning bed is known to cause cancer.
• Every year, more than 170,000 cases of skin cancer related to indoor tanning are diagnosed.
• One indoor tanning session increases your risk of getting melanoma skin cancer by 20 percent.
• Melanoma is the second most common type of invasive cancer in teens and young adults and is the leading cause of cancer death in women ages 25 to 30.
• One indoor session increase your riks of getting squamous cell carinoma by 67 percent.

"While all tanning is bad, tanning bed usage exposes people to ultraviolet A rays," said Sandra Peak, M.D., a Cook Children's pediatrician in Lewisville. "UVB rays cause sunburn, but UVA rays penetrate much deeper into the skin."

Other icky health risks may also be found at your local tanning salon, including bacteria that can lead to staph infection. Regular trips to the tanning bed can also change skin texture and cause sunspots, which probably aren't what your teen is after.

So what if your child begs you to go? It's time to talk.

"Parents should sit down and discuss the risks of indoor tanning with their children," Dr. Peak said. "Melanoma has become the cancer of young people."

Instead encourage your children to use a self tanner to get that summer glow, and urge them to always apply a broad-spectrum sunscreen with a minimum sun protection factor of 15 before heading outdoors, even during winter months. Dr. Peak recommends staying away from spray tans, since the chemicals can damage delicate mucus membranes.

About the author

Sandra Peak, M.D., joined Cook Childrens Physician Network in Lewisville in 2004. Dr. Peak enjoys gardening, yoga, and boating and in her spare time can be found at the lake with her husband Jay, stepson Sage and the world’s most amazing Lab, Sugar Mae.

People tell me all the time that I am strong, but that’s only because they don’t know my twins. Born at 24 weeks, Houston and Quinn Villarreal each weighed 1 pound, 8 ounces and were 12 inches long.

Both of my little ones have gone through so much. At different times in their lives, they were given a 50/50 chance of survival, but they kept fighting. During their time at Cook Children’s they've had many blood transfusions, were on a high frequency jet ventilator for two months and intubated for three months.

Quinn was born not breathing and needed to be resuscitated. At 2 months old, she had patent ductus arteriosus (PDA) surgery at Cook Children’s to control the blood flow to her heart and lungs. On the day I’m writing this blog, Quinn had surgery to remove two cysts in her esophagus that were obstructing her airway.

At 4 days old, Houston had emergency surgery for a bowel perforation. At 2 months old, on the same day of Quinn's PDA surgery, Houston needed treatment after became septic and had bacteria in his blood. Within that same month, he needed surgery to re-attach his intestines and remove his ostomy bag. One month later Houston had another operation to repair two hernias.

But my kids are strong. Today Houston and Quinn are 5 months old. They are on 1/16th liter of oxygen, and eating almost all of their bottles. These little miracles have completely beaten all odds. They have been fighting for their lives from their very first moment. So when people say I'm strong, I say my strength is nothing compared to my little blessings. Strong is these AMAZING babies that came into this world and have already dominated it! Strong is Houston and Quinn.

I truly believe we could not have picked a better hospital to take care of our babies than Cook Children's. From day one, the focus has been on our babies and our entire family. Day in and day out, they made sure our stay at Cook Children’s was as comfortable as possible. We have had the most amazing nurses, doctors, surgeons, respiratory therapist, child life specialists and many more staff members that have impacted our stay. All of whom have said our babies have touched their lives. I don't think they know how much each and every one of them touched ours. This is an unbelievable unit, and we're honored to call them our little NICU family.