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Lebanon News

For babies, cleanliness not next to godliness

Lebanese babies and toddlers are becoming less exposed to dirt and environmental pathogens, something doctors argue could hinder their ability to fight off diseases later in life.(The Daily Star/Mahmoud Kheir)

BEIRUT: For the first few months of her daughter’s life, Lama Kairouz kept her away from the abundance of kisses and hugs being proffered. If anybody wanted to hold her child, they had to wash their hands first.

It is only now, as her daughter approaches 9 months, that Kairouz has begun to allow her to be carried and kissed and to sit on the ground in preparation for taking her first steps.

In Lebanon, where mothers are more and more concerned about their children’s hygiene and there is a significant increase in urbanization, babies and toddlers are becoming less exposed to dirt and environmental pathogens, something doctors argue could hinder their ability to fight off diseases later in life.

“Any Lebanese mother is obsessive about hygiene with her babies, particularly small babies, and ... there is every good reason for that,” said surgeon Charles Akle, who is currently researching immunotherapy for cancer.

“However, we’re beginning to understand, now that we have become a much more urban society, we live in cities and the environmental milieu in which we live has changed, that maybe this is not such a good thing.”

In the first few months of a baby’s life, it has to learn how to cope with environmental exposure to immune system challenges. According to Akle, some exposure to germs early in a child’s life, such as not sterilizing a baby’s pacifier after falls to the ground, can greatly benefit their immune system.

“Maybe a little bit of dirt might just do that baby good, but don’t go over the top,” he said.

According to Salman Mroueh, pediatrician and professor of pediatrics at the American University of Beirut, babies develop immunity when they are exposed to bacteria or a virus, which is why children become sick so often for the first few years.

Of course, children still need to be vaccinated at an early age against dangerous diseases such as polio, measles and rubella and tuberculosis.

Yet it is a good thing to allow bodies to adjust to the environment around them.

“The lack of exposure to environmental organisms and challenges [means] diseases like asthma, eczema, diabetes, Multiple Sclerosis, Crohn’s disease have rocketed in the last 50 to 60 years,” Akle said.

The main thing that teaches the immune system to fight off disease is an individual’s internal bacterial environment. This is why live yogurt – i.e. not heat-pasteurized to kill off the bacteria – is good for the body. It is also the reason people who live on farms and eat fresh food from the source tend to be physically tougher and have less allergies, specialists have said.

Powerful epidemiological evidence also suggests that living in an agricultural environment and being exposed to cattle and sheep, or even house pets, makes a person healthier.

And perhaps to the dismay of many, having worms can actually be good for kids.

“As a doctor, I’ve certainly found worms in young girls or boys, and the mothers go berserk because they feel guilty that they failed their children, and I always say no, leave the worms,” Akle said.

Also important are mycobacteria, environmental bacteria of which the best known are tuberculosis and leprosy. Most of the rest, however, are benign, and exposure to mycobacteria is considered very important in tuning one’s immune system, particularly as a baby, Akle said.

“The important thing is you have to come to an equilibrium with your environment, and this has great effects therefore on your general health in terms of allergic reactions and the possibility of developing malignant diseases,” he said.

Early exposure to bacteria could also greatly help an individual deal with depression and stress because physical well-being equates to mental well-being for many. Children who spend more time indoors on computers or watching television could therefore be inadvertently hurting their immune system.

According to Mroueh, children nowadays were developing more allergies and he put this down to the controversial hygiene hypothesis, which suggests children are growing more susceptible to allergies due to lack of exposure to infectious agents.

“Infections will let their immunities mature,” Mroueh said, which increases the incidence of allergic reactions and autoimmune diseases.

Although this hypothesis has not been definitively proven and has its critics, it “definitely reflects the change of our lifestyle, which is responsible for the allergies we have,” said Mirna Waked, chest physician and head of the Lebanese Pulmonary Society.

“Definitely a non-Occidental natural environment does something that can protect us from developing asthma,” Waked said, adding that Western homes tended to be more hygienic and less exposed to dirt.

A lack of exposure to nature coupled with warm temperatures inside the house are all factors that could induce allergies, he said.

Children who spend their time at home and do not exercise are also more susceptible to obesity – a newly emerging phenomenon, particularly in the Arab world – and may have a higher risk of developing asthma, according to Mroueh.

“If you think of the incidents in recent years ... it’s incredible how common peanut allergies and food allergies have become; we never used to see this, and now we’re seeing these allergic reactions, which are completely alien,” Akle said. “But now so is our modern environment: it’s become completely alien.”

The food that is being consumed is overprocessed and is not ripe enough, he said, adding that this is especially true in Lebanon, where too much food is treated with chemicals and pollution is a major issue.

“There’s a lot of cancer now in Lebanon, and it may well be because there’s pollution; there’s a genetic propensity and we’re seeing more of it,” Akle explained.

“And maybe part of it has to do because we are more urbanized and we’ve lost the exposure to soil. All our towns have concreted over all the green spaces. My concern is we are buying trouble for ourselves.”

One of the ways that the matter can be counteracted is by exposure to environmental agents that develop the children’s immune system, although it is important to be very vigilant with kids if there is a history of allergies in the family, Waked said, and to consult specialists in order to detect problems early.

Mroueh and Waked echoed Akle’s advice, adding that lack of exposure to the natural world meant children could become more susceptible to indoor allergies. They cited as an example dust mites, small microscopic insects that live on mattresses, carpets and curtains in the house, as well as cockroaches.

Doctors also said that it was essential not to overtreat children with antibiotics whenever they become sick. An extreme attention to hygiene will “not help him [the child] develop his own immunity,” Waked said.

“Let them go out, let them get dirty, then clean them up afterward,” Akle added.

 
A version of this article appeared in the print edition of The Daily Star on April 30, 2014, on page 4.

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Summary

In Lebanon, where mothers are more and more concerned about their children's hygiene and there is a significant increase in urbanization, babies and toddlers are becoming less exposed to dirt and environmental pathogens, something doctors argue could hinder their ability to fight off diseases later in life.

In the first few months of a baby's life, it has to learn how to cope with environmental exposure to immune system challenges. According to Akle, some exposure to germs early in a child's life, such as not sterilizing a baby's pacifier after falls to the ground, can greatly benefit their immune system.

Most of the rest, however, are benign, and exposure to mycobacteria is considered very important in tuning one's immune system, particularly as a baby, Akle said.

According to Mroueh, children nowadays were developing more allergies and he put this down to the controversial hygiene hypothesis, which suggests children are growing more susceptible to allergies due to lack of exposure to infectious agents.

Mroueh and Waked echoed Akle's advice, adding that lack of exposure to the natural world meant children could become more susceptible to indoor allergies.


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