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.)