When then 2-year-old Ashley Armstrong developed diarrhea one day, her mother, Elizabeth, wasn't overly concerned. "Her 4-year-old sister was getting over a stomach bug too," says the Indianapolis mom. But when Armstrong saw blood in Ashley's stool, she headed to the hospital. While there, Ashley grew sicker. "She threw up black bile and screamed inconsolably," Armstrong says. Blood results showed Ashley's kidneys were failing as a result of an E. coli infection from something she'd eaten.
While Ashley was on around-the-clock dialysis, state health department officials tried to find the cause. "Signs of foodborne illness may not appear until days after eating contaminated food, so pinpointing the source is a challenge," says Yvonne Maldonado, M.D., chief of pediatric infectious diseases at Stanford University's School of Medicine, in California. In fact, it's rarely possible to trace foodborne illnesses to a source, except during an outbreak -- and as few as 5 percent of reported cases are officially associated with outbreaks. But Ashley's was identified as part of a nationwide recall of bagged spinach, which the family ate days prior.
Although that spinach was washed before bagging, bacteria can still be absorbed directly into the stems, leaves, and flesh of produce, whether fresh or frozen. "Once bacteria get inside, only cooking will make the food safe. No amount of rinsing will help," says Michael Doyle, Ph.D., director of the Center for Food Safety at the University of Georgia in Griffin. The Armstrongs couldn't have known that the spinach leaves had been exposed to feces from cattle and feral pigs while in the fields. Today, 9-year-old Ashley needs five daily medications to keep her weakened kidneys functioning. By puberty, she'll need a transplant.
"I never dreamed a healthy food like spinach would nearly cost our daughter her life," says Armstrong, who now considers grocery shopping "an act of faith."
A Daunting Problem
An estimated 48 million Americans -- that's one in six -- are stricken with foodborne illnesses each year and 3,000 die. (Of those 3,000, the vast majority are elderly and/or immunocompromised.) Many more cases go unreported. "The only way to link stomach upset to food bacteria is to test a stool sample," says Dr. Doyle. But most food-related gastrointestinal (GI) problems improve without any treatment. Even if you see a doctor, there are more than 250 foodborne illnesses, and labs typically only check for the most common ones such as E. coli, salmonella, and listeriosis. Regardless of the cause, your child should see a doctor for severe symptoms such as bloody diarrhea or vomit; continuous, watery diarrhea; or signs of dehydration such as sunken eyes or fontanelles (soft spots on an infant?s head), dry mouth, lethargy, or few wet diapers (or few bathroom breaks) in an eight-hour period.
Contaminated produce causes 28 percent of reported outbreaks of foodborne disease. But rare burgers and steaks, cookie dough made with uncooked eggs, and sushi can all harbor bacteria that boost the risk.
Unfortunately, bacteria have lots of opportunities to infect food. Feces from livestock and wildlife can befoul produce and meat; crops may be harvested with machines that pick up bacteria such as E. coli from the soil; foods can be irrigated, rinsed, or packed with polluted water or ice, or left unrefrigerated on distribution vehicles or loading docks for too long. Rodents also can harbor and spread bacteria. Over the past five years, thousands of jars of peanut butter have been recalled because of salmonella. "In one instance, it's believed that bird feces mixed with rainwater on roofs and then leaked into processing plants," says Dr. Doyle. The 2011 cantaloupe outbreak that sickened 147 people and killed 33 was the result of listeriosis bacteria that may have grown during processing. An organic label is no guarantee of safety, either: All produce should be washed, even if it won't remove all contaminants.
A healthy adult who eats food that's contaminated may not have any ill effects. Kids aren't so lucky. Half of all foodborne illnesses occur in kids, and those under 4 are particularly vulnerable. "Their immature immune system can't fend off contaminants; plus it takes a smaller amount of bacteria to sicken them," says Dr. Maldonado, a member of the American Academy of Pediatrics' committee on infectious diseases. Case in point: Armstrong and her older daughter, Isabella, ate the same E. coli-laced spinach that landed Ashley in the hospital, yet Armstrong never got sick and Isabella recovered after a few days of diarrhea. (The Armstrongs' experience doesn't mean kids should never eat spinach -- but cooking it is the only way to ensure the veggie is safe.)
Who's Protecting America's Food?
Our country's food supply is considered among the world's safest, yet there's still room for improvement. "More than a dozen agencies are responsible for food safety. What's needed is one watchdog," says Chris Waldrop, director of the Food Policy Institute at Consumer Federation of America, a Washington, D.C., nonprofit research and advocacy organization. Right now, the country's biggest player, the Food and Drug Administration (FDA) regulates 80 percent of our food supply, including imports. The U.S. imports food from more than 150 different countries; 85 percent of our seafood and 60 percent of our produce is imported. From 2005 to 2010, contaminated imports were responsible for nearly 40 outbreaks and more than 2,300 illnesses. The biggest culprits: fish and dried spices. Foods from Asia are responsible for nearly 45 percent of outbreaks (check labels and store displays for a food's origin). The Food Safety Modernization Act of 2010 ensures stricter oversight by the FDA of both imported and domestic foods because the agency can prevent a food from entering the country if the facility that produced it has refused a U.S. inspection. Check for recalls and sign up for alerts at these two sites:
The Smartest Food-Safety Rules
Many cases of foodborne illness that originate at home can be easily prevented. Take these steps to significantly lower your family's risk.
- Wash your hands for 20 seconds with soap before and after food prep as well as after using the bathroom, changing diapers, or handling or feeding pets.
- Designate separate cutting boards for meats and nonmeats such as produce and bread. Nonporous acrylic, plastic, glass, or wood ones are easily cleaned and dishwasher-safe.
- Use warm, soapy water to clean boards, utensils, countertops, and dishes. Dry with paper towels.
- Clean kitchen surfaces with paper towels. Wash cloth towels in hot water.
- Microwave wet sponges for one minute daily to kill bacteria. Or run them daily through the dishwasher top shelf with the drying cycle on.
- Always wipe can lids before opening.
- Opt for whole produce (a melon, a head of lettuce) over precut or bagged.
- Remove and discard outer leaves of lettuce, as well as damaged, bruised areas on produce, but only right before eating. Bacteria can thrive in those areas.
- When you're ready to consume, wash produce only with cool water. (Soap and produce cleansers can linger on food.)
- Scrub the rind of firm fruits like melons and pineapple before cutting.
- Rinse all fruits and veggies with water, scrub firm produce with a brush, and pat dry with a paper towel to remove more dirt and bacteria.
- Thoroughly cook sprouts to destroy bacteria. Eating raw sprouts is risky.
When you're handling it:
- Separate raw meats, poultry, seafood, and eggs from other foods in your grocery cart, shopping bags, and fridge. They can contain harmful bacteria such as campylobacter, salmonella, and E. coli, which can only be killed through cooking.
- Put raw meats in separate plastic bags provided at stores. Once home, keep meat in the bag. If you don't plan to cook it within a few days, freeze it.
- If you use a reusable "meats-only" shopping bag, clean it often. Cloth ones go in the washer and plastic ones should be washed by hand with hot, soapy water.
- Never place cooked food on a surface that held raw meat.
- Refrigerate or freeze meats within two hours of cooking or buying (one hour if it's above 90°F outside).
- Keep your fridge between 40°F and 32°F and your freezer at 0°F or below. (Get a refrigerator thermometer if your fridge only has a dial thermostat.)
- Don't rinse raw poultry. Harmful bacteria can splash onto your faucet, kitchen sponge, or countertop.
- Thaw food in the refrigerator, microwave, or under cold water -- not by leaving it on your counter.
- When dining out, ditch the doggy bag unless you'll be home within two hours of the meal being served (or one hour if the outside temperature is above 90°F).
When you're cooking it:
Use a meat thermometer to ensure that your food is adequately cooked (color is not a good indicator). Always wash the probe with hot, soapy water before reinserting into food. Follow these cooking temps from the FDA:
- Fresh beef, pork, veal, lamb: 145°F (allow meat to rest for three minutes before carving to let the center and outside temperatures even out)
- Ground beef, pork: 160°
- Poultry (including ground meat): 165°F
- Baked ham: 160?F (fresh, raw); 140°F (precooked)
- Egg dishes: 160°F (and when boiling, whites and yolks should be firm)
- Fish and shellfish: 145°F or opaque flesh that flakes easily
- Leftovers, casseroles: 165°F
Avoid raw milk and check labels to ensure that cider, juice, and certain soft cheeses like feta, brie, queso fresco, and goat cheese have been pasteurized. Unpasteurized products carry a high risk of E. coli, salmonella, listeria, campylobacter, and other pathogens that can cause kidney failure, paralysis, and even death. Pregnant women must avoid these foods because they're ten times more likely to develop listeriosis, a foodborne illness that ups the risk of miscarriage, preterm delivery, and stillbirths.
Affected by Foodborne Illness?
If you believe a contaminated food made your family ill, take these precautions:
- Go to your doctor to get a stool sample tested (but you can still report an illness without one).
- Visit foodsafety.gov to find the correct agency to call to report the incident.
- Write down everything your family has eaten within the past seven days.
If there's an outbreak, follow these wise moves:
- Bullet point Keep receipts from grocery stores and restaurants.
- Bullet point When you buy food and freeze it, store it in the original packaging. This will help to identify the source.
Originally published in the May 2014 issue of Parents magazine.
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