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Pressure to have multiple babies putting surrogates ‘at risk’

After Elizabeth Roberts had her two kids, the 39-year-old knew she wanted to help someone else build a family. Having watched a friend volunteer to be a surrogate, Roberts signed herself up in 2016.

The Halifax nurse filled out an online application for one of the biggest surrogacy agencies in the country, and within days, her profile was live.

“I didn’t quite understand what I was sinking my teeth into. I just knew that I wanted to help people,” Roberts said.

In the years since, Roberts has been a surrogate twice. And while her pregnancies have been relatively uneventful, she is now preparing for a hysterectomy, which she believes is because of her back-to-back pregnancies. 

Dr. John Kingdom, a high-risk obstetrician at Toronto’s Mount Sinai Hospital and professor at the University of Toronto, said it’s possible that Roberts’s complications could have been caused by having pregnancies in quick succession.  

But he’s even more concerned that Canada does not have mandatory wait times for surrogacies. He said that leaves women like Roberts vulnerable to manipulation.

“I think we should recognize that surrogates are altruistic, kind people who are at risk of power imbalances,” Kingdom said. 

‘Like online dating for surrogacy’

Roberts said as soon as her profile went live in 2016, she was flooded by parent profiles and it broke her heart.  

“It was like online dating for surrogacy,” she said. “There are so many intended parents out there and only so many surrogates.”

Roberts connected with one couple right away, prepared her body with painful progesterone injections and estrogen patches and hoped for the best. 

“I had put a lot of pressure on myself, because literally all their eggs were in my basket. And I was just hoping that my basket would hold onto them.”


Two-time surrogate Elizabeth Roberts said there needs to be better medical standards for surrogates to prevent women from pursuing back-to-back pregnancies while they are emotionally vulnerable after giving birth. (Steve Lawrence/CBC)

The embryo transplant worked, and nine months later she delivered the couple’s baby girl. Roberts remembers the birth like it was yesterday. 

She recalls “looking over and seeing the parents hold their daughter, and the dad looked up at me and he just had tears streaming down his face, and he just said, ‘Thank you.’ Any questions that I had ever had through the entire journey just disappeared in that moment.”

CBC News spoke with dozens of surrogates as part of an exclusive investigation, and nearly every woman described the intense emotional high they experienced right after giving birth to surrogacy babies, some describing it as addictive.

“I think that is the thing that you’re searching for when you go into this,” Roberts said. “We’ve done this huge, incredible, amazing thing — what are we going to do now? And so I knew right away that… I was going to have to do it again.”

Surrogates say they’re ‘hounded’ to do it again

During CBC’s three-month investigation into surrogacy, multiple women said their agency sent them new, heart-wrenching parent profiles within days of giving birth. Some of the women said they felt “hounded” to commit to a new couple right away.

The demand for surrogates in Canada far outweighs the number of women willing to carry a baby for someone else, which can cause women to feel pressured to commit to subsequent pregnancies. And there’s a financial imperative for the agency — every couple the company connects to a surrogate represents thousands of dollars of revenue from consulting fees.

One woman, who CBC has agreed not to identify because she fears backlash from the surrogacy community, said she delivered one surrogate baby and was pregnant with another less than four months later.

The first birth ended in a C-section, and within two months she was taking hormone injections to prepare her body for another round of in vitro fertilization (IVF). The second pregnancy ended in twins for an American father less than a year later. 

She said she was initially shocked by the tight turnaround, but it didn’t really make her nervous.

“Honestly, I was OK. The dad was OK. Clinics were on board,” she said. “You know, there was no forcing matters of any sort.”

CBC spoke to another woman who pursued surrogacy after having three children of her own. She has given birth to three babies through surrogacy since 2016, and was pregnant with a fourth that ended in a miscarriage. She is currently pursuing her fifth surrogacy in under four years.  

‘A lot of surrogates feel lost’ 

Roberts was transferred with an embryo for a second couple six months after the first surrogate birth, and delivered the second surrogate baby nine months later. 

Reflecting on her decision to pursue the second surrogacy so quickly, she said the speed between pregnancies didn’t concern her much at the time. But she now admits she was in an emotionally vulnerable state in the initial weeks after giving birth.

“I think a lot of surrogates feel lost. I know I felt lost afterwards,” said Roberts. “I didn’t know what else to do.”

In the period leading up to her second surrogate pregnancy, Roberts said neither the doctors overseeing her care nor anyone from the surrogacy industry questioned the quick timing or warned her of any risks that could come from a back-to-back pregnancy. 

While she said she never felt direct pressure from the parents, she believes she could have benefitted from someone who asked tough questions about why she was committing to another pregnancy so soon.  

She doubts it would have changed her mind, but she said her own internal pressure should have been challenged.

“I didn’t want to waste anybody’s time or money. I wanted to make sure that we had a result,” she said. “I could have said, ‘No, I’m done.’ I didn’t want to. I kept telling the mom, ‘It’s not over until this baby comes out, until I have your baby.’ I was bound and determined to help this family.” 

While the pregnancy went off without a hitch, the second surrogacy birth left Roberts with severe physical complications and she will need to undergo a hysterectomy. As she waits for the surgery, she’s often in so much pain she takes painkillers to help her get through the day.

“I think that every single surrogate at some point in their journey questions what they’re doing,” said Roberts. “I think we are a certain brand of crazy, to put it kindly, but we do this because we want to help, and it is worth every second of it.”

Doctor says surrogates are ‘vulnerable’ 

Kingdom said any IVF pregnancy is complicated right from the start, and it’s even more risky for surrogates, for a variety of reasons.

“IVF is an unnatural mode of conception,” he said. Surrogates are being implanted with genetic material that is completely foreign to their body, and this can cause higher-risk pregnancies and potential complications.


Dr. John Kingdom, a high risk obstetrician, says the lack of medical standards for surrogacies is leaving women vulnerable and open to risk. (Sue Goodspeed/CBC)

Kingdom said the risks of IVF are compounded for surrogates because these women are often older, and since they’ve likely had multiple births, there is a greater chance they’ve had at least one C-section.

General guidelines from the Society of Obstetrics and Gynecologists suggest women should wait a minimum of six months after a natural birth before embarking on another pregnancy — longer if the previous pregnancy ended in a C-section. However, the society does not establish mandatory guidelines specific to surrogate pregnancies.   

Since most surrogacies are managed through the private fertility industry, Kingdom said there should be mandatory pre-pregnancy counselling built into the process.

Counselling might result “in a decision not to be a surrogate, or to delay it for further investigations or to reflect more carefully on whether they really want to embark on those risks,” said Kingdom. “That’s what informed choice is, and really, every woman in this country deserves a really good, informed choice.”

Health Canada is responsible for administering and enforcing the Assisted Human Reproduction Act, the legislation that governs surrogacy. The agency says the AHRA does not provide the authority to prescribe the amount of time a surrogate must wait between giving birth and having an embryo transfer.

Determining whether a woman is medically fit to undergo a transfer is a medical decision, which Health Canada says is regulated by the provinces and territories.

Surrogates aren’t ‘breed mares’ 

Dr. Tom Hannam, the lead doctor and founder of Hannam Fertility in Toronto, said in the absence of a national medical standard for surrogacy pregnancies, his clinic has established its own standard of a nine- to 10-month wait period between a surrogate birth and a subsequent embryo transfer. 

“If you were going to have shorter wait times, it would be incumbent on you as a clinician doing the extra work with the individuals involved to make sure that was really the right choice for everyone involved,” Hannam said. 

“Choosing to get pregnant again just four months after that is a big choice — one that is being made with a series of choices all at the same time. Sometimes a pause is the more appropriate course of action.” 

As Roberts awaits her surgery this summer, she’s advocating that surrogates become better informed about the risks of back-to-back pregnancies. 

“As unfortunate as the term may sound, surrogacy is an industry,” Roberts said. “It’s insensitive not to consider what the surrogates go through. They’re not breed mares — we’re people.”

Send tips on this story to chelsea.gomez@cbc.ca or call 416-475-5778

 

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‘It’s everywhere in the food system’: Added sugar found in the diets of many babies, toddlers

Meal time at Alynn Casgrain’s home requires some co-ordination.

While her 11-month-old twin boys, Sam and Jake, wait patiently in their high chairs, four-year-old big sister Noelle cuts the vegetables for a pizza the whole family will soon be eating.

Casgrain and her husband, David Upper, believe their children should eat the same things they eat. That’s because the Toronto mom was surprised by the added sugars she found in products designed for infants and toddlers.

“Those yogurt drinks were shocking. Low fat, all sugar,” said Casgrain.

A recent study published in the Journal of the Academy of Nutrition and Dietetics backs that up. It found that nearly 61 per cent of infants (6-11 months) and 98 per cent of toddlers (12-23 months) consumed added sugars as part of an average daily diet.

The added sugars were mainly found in flavoured yogurts and fruit drinks.

“We wanted to understand what the consumption of added sugars were among infants and toddlers. It’s a group that’s not very well studied, so we wanted to add to the research base,” said lead investigator Kirsten Herrick, with the U.S. National Cancer Institute in Bethesda, Md.


Nutrition experts warn us to try to limit our intake of added sugars, but they are everywhere: in breakfast cereals, baked goods, even yogurt and pasta sauces. (Jonathan Hayward/Canadian Press)

Herrick’s team analyzed data from 1,211 young children. They found that infants consumed about one teaspoon of added sugars daily; toddlers consumed about six teaspoons.

Experts, including the World Health Organization, say children should consume no more than six teaspoons of added sugar daily — an amount equal to about 25 grams.

“What was surprising was how early added sugar consumption started and how quickly it increased,” she said.

‘Kids eat like we do’

Herrick describes added sugars as an extra amount of sweetener that’s added to any food product. It could be table sugar, honey, maple syrup or fruit concentrate. And it’s “everywhere in the food system,” she said, from fruit drinks and baked goods, to yogurts.

Jess Haines, an associate professor of applied nutrition at the University of Guelph, isn’t surprised by the findings.

“Kids eat like we do. And adults, both in the U.S and Canada, we eat a fair bit of sugar,” she said.

Haines said the university came to similar conclusions in its long-term Guelph Family Health Study, where researchers looked at various routines of children between 18 months and five years of age. When it came to diet, it found that 54 per cent of them exceeded the six teaspoons of sugar per day.


Jess Haines is an associate professor of applied nutrition at the University of Guelph. (Craig Chivers/CBC)

Haines says that all this added sugar can have long-term health effects, starting with cavities.

“We also see that when kids have higher intakes of sugar that’s sustained over their lifetime, we can see an increased risk for cardiovascular disease, Type 2 diabetes later in life.”

As a parent herself, Haines understands that many babies and toddlers can be picky eaters. She also knows the time constraints many mothers and fathers face during the day, so she tries to recommend solutions that involve re-imagining what a snack can look like.

“Think of snacks, really, as mini-meals. Why not take some of the foods that you’ve had for either breakfast or lunch, make it smaller and they can have a snack like that during the day,” she said.

Alynn Casgrain agrees. She and her husband try to control the added sugar intake of their children, particularly at home, by making much of their food from scratch.

Casgrain hopes this will lay the groundwork for healthy eating decisions later in life — but she knows it won’t be easy.

“You have to be realistic about the fact that wherever they go, whether they’re going to see friends or grandparents or when they get older and make their own decisions, there’s going to be sweet stuff in front of them.”

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Chinese Scientist Responsible for Genetically Engineered Babies Gets 3 Years in Prison

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The international medical community was aghast last year when a Chinese scientists announced the first ever genetically engineered babies. He Jiankui and his team used the CRISPR/Cas9 gene editing tool to make two twin girls immune to HIV infection but did so without authorization from medical authorities. Now, Chinese state media reports that He Jiankui has been sentenced to three years in prison following a secret trial

He Jiankui dropped off the radar shortly after the announcement. Many speculated that he had been arrested by the Chinese government, and now we know what became of him. He Jiankui has been convicted of “illegal medical practice” and sentenced to three years in prison along with 3 million yuan ($ 429,000) fine. He’s also banned from working in reproductive medicine for life. Two co-authors of the paper have also been sentenced in the case. Zhang Renli will spend two years in prison, and Qin Jinzhou has been sentenced to 18 months. 

The CRISPR/Cas9 system has been heralded as a groundbreaking tool for editing DNA. The system comes from bacterial cells, allowing scientists to make precise cuts in DNA. Cas9 is a restriction enzyme — a protein that can cut DNA. Scientists can guide Cas9 to the right part of a genome using CRISPR DNA sequences. Researchers have used CRISPR in the lab to neuter disease-carrying mosquitoes, halt HIV replication inside cells, and engineer bacteria that can eat plastic. Editing the human genome with the intention of producing living, breathing people is regarded as irresponsible by most of the medical community when there is still so much we don’t know about the possible side effects. 

That didn’t stop He Jiankui, who published his paper last year along with 10 co-authors. The team introduced mutations into the CCR5 gene, which codes for a protein (also called CCR5) on the surface of white blood cells. This protein is important in immune system signaling, but it’s also the route by which HIV infects cells. There are millions of people with CCR5 mutations that make them immune to HIV, and He Jiankui introduced that mitation into embryos. The twin girls born in 2018 are allegedly healthy and have no other genetic abnormalities. 

The announcement of the sentence is also the first time Chinese authorities have confirmed the existence of a third gene-edited baby. He Jiankui claimed shortly after the initial announcement that another woman was due to deliver another designer baby in the coming months. So, there are now three genetically engineered people growing up in China, and the consequences of that are still unclear.

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China convicts researcher who claimed to create world’s first gene-edited babies

A Chinese scientist who set off an ethical debate with claims that he had made the world’s first genetically edited babies was sentenced Monday to three years in prison because of his research, state media said.

He Jiankui, who was convicted of practicing medicine without a license, was also fined 3 million yuan ($ 560,000 Cdn) by a court in the southern Chinese city of Shenzhen, China’s official Xinhua News Agency said.

Two other researchers involved in the project received lesser sentences and fines. Zhang Renli was sentenced to two years in prison and fined 1 million yuan. Qin Jinzhou received an 18-month sentence, but with a two-year reprieve, and a 500,000 yuan ($ 93,000 Cdn) fine.

He, the lead researcher, shocked the scientific world when he announced in November 2018 that he had altered the embryos of twin girls who had been born the same month. He described his work in exclusive interviews with The Associated Press.

The announcement sparked a global debate over the ethics of gene editing. He said he had used the gene-editing tool known as CRISPR to try to disable a gene that allows the AIDS virus to enter a cell, in a bid to give the girls the ability to resist the infection. The identity of the girls has not been released, and it isn’t clear if the experiment succeeded.


A lab technician demonstrates gene-editing software at a Chinese biotech company laboratory. (Thomas Peter/Reuters)

The CRISPR tool has been tested elsewhere in adults to treat diseases, but many in the scientific community denounced He’s work as medically unnecessary and unethical, because any genetic changes could be passed down to future generations. The U.S. forbids editing embryos except for lab research.

He told the Associated Press in 2018 that he felt a strong responsibility to make an example, and that society would decide whether to allow the practice to go forward. He disappeared from public view shortly after he announced his research at a conference in Hong Kong 13 months ago, apparently detained by authorities initially in an apartment in Shenzhen.

The Xinhua report, citing the court’s verdict, said the researchers were involved in the births of three gene-edited babies to two women, confirming reports of a third baby.

The court said the the three researchers had not obtained qualification as doctors to practice medicine, pursued fame and profits, deliberately violated Chinese regulations on scientific research and crossed an ethical line in both scientific research and medicine. It also said they had fabricated ethical review documents.

He studied in the U.S. before setting up a lab at the Southern University of Science and Technology of China in Shenzhen, a city in Guangdong province that borders Hong Kong. The verdict accused him of colluding with Zhang and Qin, who worked at medical institutes in the same province.

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Kylie Jenner ‘Can’t Wait to Have More Babies’ Following Travis Scott Split

Kylie Jenner Says She ‘Can’t Wait to Have More Babies’ Following Travis Scott Split | Entertainment Tonight

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‘It was powerful’: Cree babies are 1st to be born through Chisasibi midwifery program

Cayde and Ella Snowboy are the first two babies to be born under the Cree Board of Health and Social Services’ midwifery program.

They’re also cousins — their moms, Christina and Louisa Snowboy, are sisters.

They were pregnant at the same time, and signed up for midwifery care instead of the usual doctor’s visits during pregnancy and delivery.

“I was so happy that my family was there,” Christina said. “They supported me.”

The midwifery program, launched in September 2018, is part of efforts by the Cree health board to bring birthing back to the territory.

It gives Cree women with healthy pregnancies the choice to have their babies in Chisasibi, the largest Cree community in the region and the only one with a hospital, rather than down south.

“There were lots of people there while I was giving birth, lots of women,” said Christina.

“I was happy that I had lots of support.”

For Louisa, giving birth in Chisasibi meant being back in her own bed, with her healthy newborn and her older children, just four hours after giving birth — rather than having to stay for several weeks in a town almost 1,000 kilometres from home.

Louisa’s two older children were born in Val-d’Or. When midwifery services became available in her home community, she signed up right away.

Her positive experience helped convince her sister Christina, a first-time mom, to give birth in the community.
Cousins Cayde and Ella Snowboy were born in the spring. (CBHSSJB/T. Philiptchenko)

“[The birth] was indescribable. It was ecstatic. It was powerful,” said Jessyka Boulanger, the midwife who assisted Louisa.

“It was really like a circle of women supporting that life coming. It was so beautiful.”

Choosing where to give birth

Boulanger is one of four midwives in Chisasibi, and is also the head of midwifery services for the Cree Health Board. She travels by plane a lot, and often witnesses the moment when a mom steps off of a flight from the south and introduces her newborn to family for the first time, in an airport.

She says having the choice to give birth at home, with family close by, can be healing.

“The Cree, like many Indigenous communities, experienced trauma from residential schools, from colonization, separation of families. The systematic evacuation of women during pregnancy can re-open those traumas,” said Boulanger.

“Now, you can make that decision for yourself. You can decide where you feel the most secure, what has meaning for you, where you should be, and with whom. We’re able to give back that choice.”

When Louisa was pregnant, she and her family decided that her mom, Annie Sam, would be the one to welcome the baby. She says that having her mom catch the baby was deeply important to her.

“It’s wonderful that my two grandchildren were born here in our town,” said Annie Sam. “I wish more women would try to give birth here.”
Annie Sam, Louisa’s mother, Louisa and Jessyka Boulanger, head of midwifery services in Chisasibi, gaze at Ella. (CBHSSJB/T. Philiptchenko)

Traditional Cree birthing knowledge and practices are integral to the midwifery program. During pregnancy, women can learn from elders about naming rituals, ways of wrapping a baby, and how to treat rashes using traditional remedies.

The program is in high demand, with midwives now caring for almost half of Chisasibi pregnancies, or about 25 women. The community’s population is about 5,000 and growing quickly.

What was lost for so many years is coming back, said Boulanger.

“To be able to share that celebration of life, bring it back to the community, to the family, instead of [birth] being a separation or stress or worry. That it can be, once again, a joyful event.”

The Cree Health Board is planning to expand midwifery services to other communities in Eeyou Istchee, and to train Cree midwives. Birthing homes will be built in Waskaganish, Mistissini, and Chisasibi over the next few years.

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Fisher-Price recalls Rock ‘n Play sleepers in U.S. after more than 30 babies die

Fisher-Price has recalled nearly five million infant sleepers in the United States after more than 30 babies died in them over a 10-year period.

The U.S. Consumer Product Safety Commission said anyone who bought a Fisher-Price Rock ‘n Play sleeper should stop using it right away and contact Fisher-Price for a refund or voucher. The sleepers, which are used to put babies to sleep, are soft-padded cradles that vibrate.

In announcing the recall on Friday, Fisher-Price and the CPSC said the deaths occurred after infants rolled over from their backs to their stomachs or sides while unrestrained, but did not specify how they died. In an article this week, Consumer Reports found that some of the infants died from suffocation.

A safety warning was issued last week, but the American Academy of Pediatrics urged Fisher-Price and the CPSC to recall the sleepers, calling them “deadly.”

Health Canada said Saturday that the Fisher Price Rock ‘N Play Sleeper is “not permitted for sale in Canada.”

“If Health Canada determines this product was made available in Canada, it will take appropriate action as necessary,” a spokesperson said in an email.

In a statement, Fisher-Price said that it stood by the safety of its products and said it issued the voluntary recall “due to reported incidents in which the product was used contrary to the safety warnings and instructions.”

The recall covers about 4.7 million sleepers, which sold for between $ 40 and $ 149 US since 2009.

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How tiny babies are revealing big clues of early life

A newborn's first few days of life is fragile and potentially dangerous, navigating a world full of viruses, infections and bacteria. Many around the world don't survive.

While doctors and researchers have traditionally had few clues about what is happening to a newborn during this critical time, a new international study involving the University of British Columbia (UBC) may provide doctors with a roadmap for better survival strategies.

"A large proportion of childhood mortality is newborn mortality and there's a lot we don't know about neonatal immunology," said Dr. Jeffrey Pernica, head of pediatric infectious disease at McMaster Children's Hospital in Hamilton.

The study, published in the journal Nature Communications, looked at two groups of newborns in different parts of the world: Papua New Guinea and Gambia.

The researchers compared two tiny blood samples — less than a quarter of a teaspoon from each newborn — with the first being taken at birth and the next taken later in the first week of life.

What they found was dramatic: Thousands of changes over that first week of life, including specific genes and immune cells being activated and proteins being produced.

Bob Hancock's team at UBC pioneered a blood work technique that yielded big data from less than a quarter of a teaspoon of blood. (CBC News)

"I don't think we knew how the infant's immunity changed over time," said Canadian microbiologist and study co-author Bob Hancock. "I don't think we appreciated the staggering number of changes that are occurring."

Hancock's lab at UBC performed the blood work on the tiny recruits. Up until now, the biggest challenge for scientists gathering data had been sourcing a large enough blood sample from a newborn to provide comprehensive information.

Hancock's team pioneered a technique using sophisticated software to get a huge amount of data from a tiny drop of blood.

"We saw a turn on of dedicated cells called neutrophils; neutrophils are the body's way of fighting infections. We saw a turn on of proteins called interferons, which is the major anti-viral or viral-fighting mechanism in the body. And we saw a turn on of a protein called complement — one of the most important ways of fighting bacteria," said Hancock.

"So in these ways, the infant was adapting to try to resist the challenges of the first week of life, recovering from the stress of birth."

Common developmental path

What also surprised Hancock and the global research team were the common biological threads between two sets of newborns born thousands of kilometres apart. It suggests that the molecular changes aren't random, but instead follow a specific developmental pathway.

The researchers say that finding could provide doctors with better opportunities to save more infants, particularly when it comes to immunization.

"This common trajectory is exciting, as it allows us to ask bigger questions about the differences between different populations and the impact of biomedical interventions, such as vaccines, on development," said Dr. Ofer Levy, one of the study's senior authors and a physician with Boston Children's Hospital.

In most of Canada and the developed world, infants are given their first vaccine at two to three months, for diphtheria, pertussis, tetanus and polio. Some provinces also offer vaccines for influenza type B and hepatitis B. The schedule is a bit different in Canada's North, where newborns and infants in Nunavut also get a vaccination for tuberculosis because of a high prevalence of the disease.

'A large proportion of childhood mortality is newborn mortality and there's a lot we don't know about neonatal immunology,' said McMaster University's Dr. Jeffrey Pernica. (Craig Chivers/CBC News)

This latest research could potentially change how all doctors think about the best time to vaccinate a baby.

"We'd really like to know more about whether we can actually start doing these vaccinations even earlier in the infants to give them a better chance of fighting off the devastating diseases that vaccines protect against," said Hancock.

For Pernica, the study offers other things to consider when looking at how to protect newborns in those early days, including whether more specific testing can be done at birth to determine which baby may get sick, as well as providing more information to new mothers.

"This study will add a lot to what scientists know in the future," he said.

The study's main limitation was its small sample size: Only 60 babies were involved. But the researchers say they plan to increase that number through subsequent research in the hopes of providing the world's most vulnerable with a fighting chance as early as possible.

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Over 2 dozen children including babies die from bitter cold in Syria camp, WHO says

At least 29 children and newborns have reportedly died in a teeming camp in northeastern Syria over the past eight weeks, mainly due to hypothermia, the World Health Organization (WHO) said on Thursday.

About 23,000 people who fled fighting in Deir al-Zor between the Islamic State in Iraq and Syria (ISIS) and the U.S.-backed Syrian Democratic Forces alliance have arrived at al-Hol camp, swelling its population, the UN agency said. The fighting is led by the Kurdish YPG militia 

"The situation in al-Hol camp is heartbreaking. Children are dying from hypothermia as their families flee to safety," Elizabeth Hoff, WHO representative in Syria, said in a statement.

The agency appealed for unhindered access to the camp, saying the situation has become "critical" for 33,000 people, mainly women and children, now living there in bitterly cold conditions.

Many displaced people had walked for days or travelled in open trucks, arriving malnourished and exhausted following "years of deprivation" living under ISIS control, it said.

"Thousands of new arrivals have been forced to spend several nights in the camp's open-air reception and screening areas, without tents, blankets or heating," the WHO added.

WHO-supported teams are working round the clock in the camp to screen new arrivals, support vaccination and refer severely malnourished children to a hospital in al-Hasakah, it said.

"Humanitarian access to the camp and surrounding roads is hampered by bureaucratic obstacles and security constraints," the agency added, appealing to all parties to provide unhindered access for life-saving aid.

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Canadian Paediatric Society updates food guide for babies at risk of allergies

New guidelines from the Canadian Paediatric Society recommend that babies at high risk of developing allergies be offered common allergenic foods at about six months of age.

Babies who are ready for food sooner can start as young as four months, but not earlier.

The recommendations follow a recent shift in global thinking on when to introduce potential allergens. The most common ones are cow's milk, egg, peanut, tree nuts, fish, shellfish, wheat and soy.

Babies are considered at high risk if they have a history of eczema, or a parent or sibling with allergies.

The society advises caregivers to offer potential allergens one at a time to gauge reaction. If the foods are tolerated well, offer them a few times a week to maintain tolerance. If there's an adverse reaction, consult a doctor about the next steps.

The society pointed to emerging evidence that offering allergenic solids before six months may help prevent development of an allergy in high-risk infants, especially to egg and peanut.

This is in contrast to the society's advice in 2013, when it urged six months of exclusive breast feeding for infants at high
risk for food allergy.

The new guidelines note Health Canada still recommends breastfeeding exclusively for six months. However, infants a few weeks younger can try solids if they are ready.

"We now know that, in high-risk kids, allergenic foods should be introduced at an early age," Dr. Elissa Abrams, chair of the CPS Allergy Section and a pediatric immunologist with the University of Manitoba, said Thursday in a release.

"For families with a history of allergies, these recommendations give them guidance on what they can do to help prevent the condition in their children."

Babies who are not considered high risk should start trying foods at about six months of age.

For young infants new to solids, the society recommends diluting smooth peanut butter with water, or mixing it with a previously tolerated pureed fruit or vegetable, or breast milk.

Older infants can try smooth peanut butter spread lightly on a piece of thin toast.

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