Click the button below to submit a comment on the proposed guidelines:

Consumers with celiac disease must avoid gluten—proteins found in baked goods made with wheat and some other grains. For people not sensitive to gluten, there is no health benefit to a gluten-free diet.

Some foods are naturally free of gluten. Here are some examples:

milk not flavored with ingredients that contain gluten, such as malt100 percent fruit or vegetable juicesfresh fruits and vegetablesbuttereggslentilspeanutsseeds, such as flaxtree nuts, such as almondsnon-gluten-containing grains, such as cornfresh fish, such as codfresh shellfish, such as clamshoneywater, including bottled, distilled, and spring

Get Consumer Updates by E-mail

Consumer Updates RSS Feed

Share copies of this article (918 KB)

On This Page:

Whether as muffins, rolls, or loaves, wheat bread is found in most households. But few consumers may appreciate the substance that helps the dough rise, keeps the bread from falling apart, makes it chewy, and adds to its flavor.

That substance is gluten. Breads, cakes, cereals, pastas, and many other foods are made with wheat or added wheat gluten to improve their baking quality and texture.

Technically, gluten represents specific proteins that occur naturally in wheat. However, the term “gluten” is commonly used to refer to certain proteins that occur naturally not only in wheat, but also in rye, barley, and crossbreeds of these grains and that can harm people who have celiac disease. The only treatment for this disorder is a life-long gluten-free diet.

Eating gluten doesn’t bother most consumers, but some people with celiac disease have health-threatening reactions, says Stefano Luccioli, M.D., a Food and Drug Administration (FDA) allergist and immunologist. They need to know whether a food contains gluten.

FDA has been working to define “gluten-free” to:

eliminate uncertainty about how food producers may label their products.assure consumers who must avoid gluten that foods labeled “gluten-free” meet a clear standard established and enforced by FDA.

FDA’s actions on Aug. 2 bring the agency one step closer to a standard definition of “gluten-free.” On this date:

FDA reopens the public comment period on its proposed gluten-free labeling rule published on Jan. 23, 2007.FDA makes available, and seeks comments on, a report on the health effects of gluten in people with celiac disease. The report includes a safety assessment on levels of gluten sensitivity in people with the disease.

According to the National Institutes of Health, celiac disease affects as many as 1 percent of the U.S. population.

The disease occurs when the body’s natural defense system reacts to gluten by attacking the lining of the small intestine. Without a healthy intestinal lining, the body cannot absorb the nutrients it needs. Delayed growth and nutrient deficiencies can result and may lead to conditions such as anemia and osteoporosis. Other serious health problems may include diabetes, autoimmune diseases, and intestinal cancers.

“Some people don’t get immediate symptoms, but when they do, they are typically gastrointestinal-related, such as abdominal pain, bloating, and diarrhea,” says Luccioli. “In infants, there may be a lot of vomiting, and they don’t grow and thrive.” And some people do not have any symptoms at all, adds Luccioli, but still may have intestinal damage and risk for long-term complications. It is important for individuals with celiac disease, who may vary in their sensitivity to gluten, to discuss their dietary needs with their health care professional.

Grocery shopping is challenging for people with this disease, says Andrea Levario, J.D., executive director of the American Celiac Disease Alliance. “When they find a product labeled ‘gluten-free,’ they don’t necessarily know what that means because today there is no federal standard for the use of this term.”

Having a federal definition of “gluten-free” is critically important, says Levario. “If we have one national standard, the individual will know that all products labeled ‘gluten-free’ will have no more than a minimal amount of gluten.”

back to top

“Eating gluten-free is not meant to be a diet craze,” says Rhonda Kane, a registered dietitian and consumer safety officer at FDA. “It’s a medical necessity for those who have celiac disease.” 

“There are no nutritional advantages for a person not sensitive to gluten to be on a gluten-free diet,” she adds. “Those who are not sensitive to gluten have more flexibility and can choose from a greater variety of foods to achieve a balanced diet.”

Gluten-free is not synonymous with low fat, low sugar, or low sodium. For people who must be on a gluten-free diet, Kane says it's important to check the ingredients list and Nutrition Facts information on food labels to find the most nutritious options.

back to top

In 2007, FDA proposed to allow manufacturers to label a food “gluten-free” if the food does not contain any of the following:

an ingredient that is any type of wheat, rye, barley, or crossbreeds of these grainsan ingredient derived from these grains and that has not been processed to remove glutenan ingredient derived from these grains and that has been processed to remove gluten, if it results in the food containing 20 or more parts per million (ppm) gluten20 ppm or more gluten

In the notice reopening the comment period, FDA states that it continues to believe the proposed definition of “gluten-free” is the correct one.

FDA’s notice also describes current analytical methods that can reliably and consistently detect gluten at levels of 20 ppm or more in a variety of foods. 

The agency is interested in hearing from the public and industry. The public comment period on the proposed rule will officially open after noon on Aug. 3, 2011, and will remain open for 60 days. To submit comments electronically, go to www.regulations.gov and

choose “Submit a Comment” from the top task barenter the docket number FDA-2005-N-0404 in the “Keyword” spaceselect “Search”

After FDA reviews and considers the comments, the agency will issue a final rule that defines “gluten-free” for labeling food products, including dietary supplements.

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

Aug. 2, 2011

back to top 

 

When flu season arrives this fall, a liquid form of Tamiflu—the most widely used anti-viral flu medication—will be available in a new, lower concentration to reduce the possibility of medication errors.

The change applies to the oral suspension form of Tamiflu and not the capsule. Oral suspension is a powder form of the prescription medication that a pharmacist mixes with water to make a liquid treatment easier to take by children or adults who are unable to swallow a Tamiflu capsule.

The Tamiflu packaging of its oral suspension product says “new strength” because the concentration of medicine in the liquid has been changed from 12 mg/mL (milligrams per milliliter) to 6 mg/mL. This change in concentration means that the amount of medicine that must be taken has also changed.  If taken as directed, the medicine is still as effective as it was before.

The Food and Drug Administration worked with Genentech Inc, manufacturer of Tamiflu, to create the new 6 mg/mL medication to reduce the possibility of errors in getting the correct dose. It will replace the 12 mg/mL concentration, which will no longer be manufactured but will be available until expiration.

Tamiflu is FDA-approved to treat adults and children older than 1 year who have had influenza symptoms for two days or less. Tamiflu stops the virus from spreading in the body and can help shorten the duration of such symptoms as a stuffy or runny nose, sore throat, cough and muscle aches.

Linda Lewis, medical team leader in FDA’s Division of Antiviral Products, explains that there have been no reported cases of serious side effects related to medication errors involving oral suspension Tamiflu. But there were many reports of confusion about prescribing and taking the right dose during the influenza pandemic in 2009, Lewis says.

That’s because when mixed as directed, the 12 mg/mL concentration gets frothy and bubbly and it can be difficult to get the right amount. “We were concerned that the measurement of the dose was not very reliable,” Lewis says. She adds that the mixture is not frothy when the concentration is lower.

Containers of the low-concentration medication will come with new dosing instructions based on body weight.

In addition, the dosing device has been changed to a 10-milliliter oral syringe, which will make it easier to accurately measure the correct dose. The dosing device originally packaged with the 12 mg/mL suspension was marked in 30 and 45 mg, which caused confusion in measuring the liquid medication.

Because there are no quality issues with the 12 mg/mL concentration Tamiflu, it will remain on the market until supplies run out and can be used until its expiration date.

With both dose concentrations being available during the flu season this fall, Kendall Marcus, safety deputy in FDA’s Division of Antiviral Products, cautions that pharmacists and physicians will have to be particularly careful in prescribing and dispensing the medication.

After the next flu season, only the 6 mg/mL concentration will be available.

Marcus says consumers need to know the following:

You could receive either the 6 mg/mL or the 12 mg/mL version at your local pharmacy during the next flu season. If you have any questions about how to use the product safely, speak to your pharmacist or other health care provider.If you have taken oral suspension Tamiflu in the past, the container and label will look different.The new oral dosing device is different and the volume (mL) of your dose may differ from past prescriptions.If you have any problems with the medication, report them to your health care provider and to FDA’s MedWatch program.

Marcus notes that pediatric strength Tamiflu capsules (30 mg and 45 mg) have not changed and are still available for children who can swallow capsules. Another option for parents is to open the capsule and mix its contents with a flavored food, like chocolate syrup.

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

Medicines are powerful. They can cure disease, relieve symptoms, and help you stay healthy. But they can also do a lot of damage if taken incorrectly, when not needed, or when prescribed inappropriately.

The Food and Drug Administration (FDA) believes that many medication-related risks can be prevented if everyone committed to the safe use of medicines works together. Acting on that belief, the agency launched the Safe Use Initiative in November 2009 to foster collaborations within the health care community that will help prevent medication errors, misuse, and abuse.

Studies estimate that up to 50 percent of harm from medication use could be prevented. According to the Institute of Medicine, this would translate into about 1.5 million preventable incidents each year.

The goal of the Safe Use Initiative is to

identify specific, preventable harm related to medication usedevelop methods (interventions or strategies) to reduce harmidentify ways to measure the success of these interventions

Tens of millions of people in the U.S. take prescription or over-the-counter (non-prescription) medicines each year, says Karen Weiss, M.D., director of the Safe Use Initiative. “If we can reduce injury that occurs because people are not prescribing or taking medications optimally, we can improve their individual health and the health of the public.”

In its regulatory role, FDA has always tried to prevent medication errors, says Weiss. “A lot of what we do at FDA to reduce medication errors is because we have the authority from Congress to regulate drugs, drug labeling, and drug manufacturing standards.”

But the Safe Use Initiative is different, says Weiss, because it involves collaborations with other parts of the health care industry and professions—besides drug manufacturers and distributors—to reduce harm in ways that do not require regulation. Potential collaborators include

physicians, nurses, and other health care professionals and their professional societiesstate and federal agenciespharmacies, hospitals, and other health care facilitieshealth insurerspatients, caregivers, consumers, and groups representing their interests

FDA continues to add opportunities for collaboration to its growing list of projects that could reduce preventable harm from medicines. Two such opportunities are

to support and assist in the removal of abbreviations on prescription container labelsto support efforts to educate patients about the misuse and abuse of prescription drugs

Although FDA regulates prescription drug labeling—the printed material that accompanies such drugs—individual states regulate the label that the pharmacist attaches to the pill bottle. FDA is working with pharmacies, medical standards organizations, and others to set standards for this bottle label, such as spelling out the full name of a prescription drug instead of using an abbreviation that consumers may not understand.

For example, the prescription form of acetaminophen is often abbreviated “APAP” on the label of the bottle the consumer is given at the pharmacy. If consumers don’t know that “APAP” and “acetaminophen” are the same and are already taking an over-the-counter acetaminophen product (such as Tylenol or another brand), they could be taking too much acetaminophen and accidentally overdose. Too much acetaminophen can cause liver damage.

The Safe Use Initiative team is also working to make consumers aware of the importance of checking drug labels in general because many have the same ingredient—like acetaminophen, which can be found in more than 600 medications.

Another Safe Use Initiative project addresses the taking of prescription drugs when not needed. “About 55 percent of people who misuse or abuse prescription drugs get them from friends and family,” says Dale Slavin, Ph.D., associate director of the Safe Use Initiative.

“We need to create opportunities for discussion between the patient and the doctor,” Slavin says. “We, through collaborative efforts, want to provide tools that the doctor can use to have frank conversations with patients, and tools that the patient can use to understand the benefits, risks, and limitations of their treatment.”

This is especially important for opioid drugs, says Slavin, “where the abuse potential is there, the dependence potential is there, and the potential for others to steal or misuse their drugs is there.”

FDA invites comments and suggestions on drug safety issues and how to prevent harm at cdersafeuseinitia@fda.hhs.gov.

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

 

Get Consumer Updates by E-mail

Consumer Updates RSS Feed

Share copies of this article (2 MB)

On This Page:

As headlines from Europe implicate tainted vegetable sprouts in more than 4,000 illnesses and dozens of deaths, American consumers may wonder, “Could that happen here?”

The U.S. has had its own headline-grabbing outbreaks from contaminated vegetables—such as lettuce in 2010, peppers in 2008, and spinach in 2006—but a new law has set in motion sweeping improvements to the safety of our food supply.

President Obama signed the FDA Food Safety Modernization Act into law on Jan. 4, 2011, but the year before, the Food and Drug Administration was already gearing up for important work that was mandated by the act: the Produce Safety Regulation.

This regulation will establish mandatory, science-based, minimum standards for the safe growing, harvesting, sorting, packing, and storage of fresh fruits and vegetables. “This will be a monumental shift in food safety,” says James R. Gorny, Ph.D., FDA’s senior advisor for produce safety.

Since 1998, produce growers have had available the “Good Agricultural Practices” issued by FDA and the U.S. Department of Agriculture (USDA). But this guidance is not an enforceable regulation like the Produce Safety Regulation will be, says Gorny.

back to top

"This will be a monumental shift in food safety."

As part of the regulatory process, FDA publishes a “proposed rule” and then invites comments to the proposed rule “docket” (public record) online or by mail.  Anyone can comment on a proposed rule, and the agency considers all comments submitted to the docket before drawing up the final rule, or regulation. FDA also intends to hold public meetings about the proposed Produce Safety rule after it is published, to provide additional opportunities for the public to comment. The agency expects to publish a proposed Produce Safety rule by spring 2012.

Due to the diversity of produce farms throughout the country—ranging from a few acres to thousands of acres, and growing from a few crops to dozens of vegetable varieties—FDA decided to reach out to growers before drafting the proposed rule.

In 2010, technical experts, scientists, and other staff from FDA and USDA went on the road to meet with growers as well as produce industry groups, public policy groups, state agricultural departments, and public health departments in 13 states. They toured farms—both big and small—and talked to the owners. Some of the farm tours were attended by FDA leadership, including FDA Commissioner Margaret A. Hamburg, M.D., and Deputy Commissioner for Foods Michael R. Taylor, J.D. At the invitation of FDA, USDA Deputy Under Secretary for Marketing and Regulatory Programs Ann Wright joined several of the tours as did a number of state commissioners of agriculture. 

“Before we put pen to paper, we wanted to find out what growers are doing now and the food safety challenges they face,” says Gorny.

“It was a very refreshing change in the process that was welcomed by the growers and that allowed them to be a part of the process,” says Bob Jones, Jr., co-owner and production manager of the Chef’s Garden, a 300-acre farm in Huron, Ohio.

“The Ohio growers, in general, have a great appreciation and understanding of the necessity of good food safety,” says Jones, who also serves on the board of several agricultural associations in the state. “We have a social responsibility to consumers who purchase and consume the food we grow.”

Several themes emerged from the visits, says Gorny. Many growers commented that produce safety standards should

be appropriate and flexiblebe science-based and risk-basedbe practical—not overly burdensomeapply to both imported produce and domestic producebe accompanied by a strong education and outreach program

The agency is working to create a regulation that will be flexible and appropriate for both large-farm operators and smaller farmers—including sustainable, organic, and Amish farmers FDA met when touring the country.

back to top

“One of the themes we heard over and over is ‘educate before you regulate,’” says Gorny.

FDA doesn’t make produce safer, he adds. “We make the rules that must be followed to keep produce safe. So we need to assist growers with knowledge and training to comply with those rules.”

FDA is exploring partnerships with state agricultural departments and extension services, produce industry groups, and coalitions such as the Produce Safety Alliance—a collaboration between Cornell University, USDA, and FDA—to reach out to growers and provide them with training regarding on-farm produce safety.

Jones says everybody who handles food—growers, packers, transporters, processors, grocers, and consumers—has an important part to play in food safety. “You can educate growers on all they can do in the field—for instance, with water quality and worker hygiene—to lower the likelihood of microbial contamination,” he says. But it won’t be effective unless all the other food handlers practice food safety, too.

The bottom line, says Gorny, is that FDA wants American consumers to be able to buy healthful fruits and vegetables with the utmost confidence in their safety.

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

 

 

When the Food and Drug Administration allowed silicone gel-filled breast implants back on the market in November 2006, the agency required the manufacturers to conduct follow-up studies to learn more about the long-term performance and safety of the devices.

Today, FDA released a report that includes preliminary safety data from these studies, as well as other safety information from recent scientific publications and adverse events reported to FDA.

FDA approved silicone gel-filled breast implants for increasing breast size (augmentation) in women age 22 or older and for reconstruction (after breast cancer surgery or other medical issues) in all women. They are also approved for revision surgeries, which correct or improve the result of an original augmentation or reconstruction surgery.

Almost five years later, FDA’s report continues to support the safety and effectiveness of these implants when used as intended, but states that women should fully understand the risks before considering getting them.

Breast implants are not lifetime devices. The longer a woman has them, the more likely she is to have complications and need to have the implants removed or replaced. Women with breast implants will need to monitor their breasts for the rest of their lives.The most frequently observed complications and adverse outcomes are tightening of the area around the implant (capsular contracture), additional surgeries, and implant removal. Other complications include a tear or hole in the outer shell (implant rupture), wrinkling, uneven appearance (asymmetry), scarring, pain, and infection.Studies to date do not indicate that silicone gel-filled breast implants cause breast cancer, reproductive problems, or connective tissue disease, such as rheumatoid arthritis. However, no study has been large enough or long enough to completely rule out these and other rare complications.

FDA is working with the two manufacturers who make silicone gel-filled breast implants, Allergan and Mentor, to address the challenges in collecting follow-up data on the women who have received these implants.

“It is important that women with breast implants who experience any symptoms see their health care providers,” says Jeffrey Shuren, M.D., J.D., director of FDA’s Center for Devices and Radiological Health. “Women who have enrolled in clinical studies should continue to participate so that we can better understand the long-term performance of these implants and identify any potential problems.”

FDA also provided other information today on both silicone gel-filled and saline-filled breast implants:

FDA recommends that women with silicone gel-filled breast implants do the following:

Follow up. Continue to routinely follow up with your health care provider. Get routine MRIs to detect a rupture that you may not be aware of (silent rupture).  FDA recommends that women with silicone gel-filled breast implants get screenings for silent ruptures three years after they get implants and every two years after that.Be aware. Breast implants are not lifetime devices. The longer you have breast implants, the more likely you are to have complications. One in 5 patients who received implants for breast augmentation will need them removed within 10 years of implantation. For patients who received implants for breast reconstruction, as many as 1 in 2 will require removal within 10 years of implantation.Pay attention to changes. Notify your health care provider if you develop any unusual signs or symptoms. Report any serious side effects to the breast implant manufacturer and MedWatch, FDA’s safety information and adverse event reporting program. Report online at http://www.fda.gov/medwatch/index.html or by calling 800-332-1088.Stay in touch. If you’re enrolled in a manufacturer-sponsored study, continue to participate. These studies are the best way to collect information about the long-term rates of complications.

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products. 

 

The Food Safety Modernization Act (FSMA), signed into law by President Obama in January, has been called “historic” because it puts the focus of the Food and Drug Administration (FDA) on prevention—working to ensure that unsafe foods are not distributed in the first place.

FDA Commissioner Margaret A. Hamburg says the law directs the agency to oversee food safety in a way that applies “the best available science and good common sense to prevent the problems that can make people sick.”

What lends the new law additional importance is that it provides FDA with new enforcement and inspection authorities.

“These new authorities are critical for the law’s success,” said Michael R. Taylor, FDA’s deputy commissioner for foods. “They give the food companies strong additional incentives for keeping their products safe, and that helps us achieve the new law’s goal, which is to protect consumers from unsafe food.”

Foodborne outbreaks are a significant public health burden that increases the cost of the nation’s health care and, as Taylor has emphasized, many of them can be prevented. And keeping foodborne outbreaks from happening in the first place is what FDA intends to do by implementing the following key provisions:

back to top 

Expanded administrative detention: The law gives FDA more authority to prevent the release into the marketplace of adulterated or misbranded food, including potentially harmful food.

Food adulteration can be caused by many factors, including bacterial or chemical contamination, filth or decomposition, the presence of an unsafe food additive, being prepared, packed or held under insanitary conditions, and leaving valuable materials out of the product or substituting other, inferior materials.

Misbranding food can be caused by ways that include not declaring certain ingredients or major food allergens, and not complying with nutrition information content on labeling.

This tool allows FDA to effectively remove the food from distribution channels while the agency pursues legal or other enforcement actions.

Records inspection: The law expands FDA’s authority to gain access to records about potentially hazardous foods. In addition to examining the records tied to a particular food that could pose a health hazard, the agency can now inspect records related to any other food it believes is likely to be affected in a similar manner. Authority to deny entry: Under FSMA, if a food producer in another country does not permit FDA to inspect its facility, FDA can refuse to allow food from that facility into the United States.

back to top 

The new law also strengthens FDA’s enforcement tools in the event that potentially unsafe food has already entered the marketplace.

Suspension of registration: The law authorizes FDA to suspend the registration of a facility under certain circumstances if the food it manufactured, processed, packed, received or held presents a serious health hazard. A facility with a suspended registration will not be able to legally offer food for sale in the United States until FDA lifts the suspension.Mandatory recall: Before FSMA, FDA had to rely on a firm’s voluntary decision to remove food from the marketplace that could be hazardous to humans or animals. Under the new law, the agency can order a recall if the company does not cease distribution itself and recall its product. If there is reason to believe that the food is adulterated or misbranded and that use of the product could result in serious illness or death, FDA can order that distribution be halted and all implicated products recalled. Additionally, FDA has launched a new search engine where consumers can quickly and easily check on new and recent recalls.

FDA is also directed by the law to upgrade its ability to track both domestic and imported foods. To do this, FDA will establish pilot projects to test how to rapidly identify recipients of food—this is critical information FDA needs to rapidly find the source of a foodborne outbreak and to understand its scope.

“Product tracing doesn't prevent an outbreak, as it’s more about response,” says Bill Correll at FDA’s Center for Food Safety and Applied Nutrition.  “However, it can prevent further illnesses during an outbreak when FDA can determine the source, contain further exposure and get the product recalled and out of distribution and consumer households.”

back to top 

The new FDA authorities have been widely acclaimed by consumer advocates as well as industry.

Caroline Smith DeWaal, the veteran food safety director of the Center for Science in the Public Interest, has hailed FSMA as a far-reaching improvement over previous food safety laws.  "The bill contains important provisions for prevention, standard setting and enhanced enforcement.  It will significantly reinforce the FDA's food safety program," she predicts, "and help the agency advance in its public health mission."

Kathy Means, vice president of the Produce Marketing Association, said that members of her organization “regard FSMA as a law that takes a good, comprehensive look at food safety. It sets the expectations for food safety measures by the industry, and it sets the priorities for the FDA—all of which is important for keeping our food safe.”

This article appears on FDA's Consumer Updates page, which features the latest on all FDA-regulated products.

August 10, 2011

 

Water, bugs, and the sun, are a few of the things kids experience more of in the summertime. For parents and others, extra vigilance is required to prevent injury and keep kids safe and healthy.

Water, bugs, and the sun, are a few of the things kids experience more of in the summertime. For parents and others, extra vigilance is required to prevent injury and keep kids safe and healthy. Here are a few tips to help parents practice prevention, for their children's health.

Keep kids' safe – home alone.
Every parent eventually faces the decision to leave their child home alone for the first time. Whether you are just running to the store for a few minutes or are working moms and dads, parents need to be sure their children have the skills and maturity to handle situations safely. Children face real risks when left unsupervised. Those risks, as well as a child's ability to deal with challenges, must be considered.

Prevent cyberbullying.
Youth can use electronic media to embarrass, harass or threaten their peers through email, a chat room, instant messaging, a website (through blogs), or text messaging. Increasing numbers of teens and pre-teens are becoming victims of this new form of violence. Like traditional forms of youth violence, electronic aggression is associated with emotional distress and conduct problems at school. Learn strategies for protecting children from this type of violence.

Keep your kids tobacco free.
Despite the impact of movies, music, and TV, parents can be the GREATEST INFLUENCE in their kids' lives. Talk directly to your child about the risks of tobacco use; if friends or relatives died from tobacco-related illnesses, let your kids know. If you use tobacco, you can still make a difference. Your best move, of course, is to try to quit. Meanwhile, don't use tobacco in your children's presence, don't offer it to them, and don't leave it where they can easily get it.

Talk early and often about alcohol and drugs.
Start having conversations about your values and expectations while your child is young. Your child will get used to sharing information and opinions with you. Knowing the facts will help your child make healthy choices.

Prevent teen dating violence
Did you know that in the past 12 months, one in 10 teens report being hit or physically hurt on purpose by a boyfriend or girlfriend at least once? And nearly half of all teens in relationships say they know friends who have been verbally abused.  Dating violence can have a negative effect on health throughout life. Victims of teen dating violence are more likely to do poorly in school, and report binge drinking, suicide attempts, physical fighting and current sexual activity. Before violence starts, a teen may experience controlling behavior and demands. That's why adults need to talk to teens now about the importance of developing healthy, respectful relationships.

Know asthma triggers [PDF - 2.15 MB].
An asthma attack is when you have trouble catching your breath. Many different asthma "triggers" can cause this to happen. Knowing some common triggers such as tobacco smoke, dirty air outside, bad weather, and hard exercise that makes you breathe fast can prevent asthma attacks. Speak with your health care provider about making a plan that can help control your child's asthma.

Develop a family disaster plan.
Meet with your family and discuss why you need to prepare for disaster. Explain the dangers of fire, severe weather, and earthquakes to children. Plan to share responsibilities and work together as a team. Discuss the types of disasters that are most likely to happen. Explain what to do in each case.

Water safety.
When most of us are enjoying time at the pool or beach, injuries aren't the first thing on our minds. Yet, drownings are the leading cause of injury death for young children ages 1 to 4, and three children die every day as a result of drowning. Parents can play a key role in protecting children from drowning.

Boat safely.
Recreational boating can be a wonderful way to spend time with family and friends. Making boating safety a priority can ensure that it stays fun. By wearing a life jacket, you can dramatically decrease your chances of drowning while boating.

Child Passenger Safety: Make sure the ones you love are safe and secure—all the time, on every trip.
In 2008, about 4 children ages 14 or younger were killed in motor vehicle crashes every day, and many more were injured. But parents and caregivers can make a lifesaving difference. Whenever you're on the road, make sure your child passengers are buckled into appropriate safety seats. The safest place for children of any age to ride is properly restrained in the back seat. Children ages 12 and younger should always be buckled up and seated in the rear seat of vehicles. Infants in rear-facing car seats should never ride in the front seat of vehicles with airbags. Learn all you can do to keep your most precious cargo safe and locate a car inspection station in your area.

Play it Safe. Prevent concussions.
There are things you can do to help lower the risks for concussion and other injuries. A concussion is a type of traumatic brain injury, or TBI, caused by a bump, blow, or jolt to the head that can change the way your brain normally works. Concussions can also occur from a fall or a blow to the body that causes the head and brain to move quickly back and forth. Concussions can occur in any sport or recreation activity. Learn concussion signs and symptoms and what to do if a concussion occurs.

Prevent falls.
Falls are the leading cause of non-fatal injuries for all children ages 0 to 19. Every day, approximately 8,000 children are treated in U.S. emergency rooms for fall-related injuries. This adds up to almost 2.8 million children each year. Many falls can be prevented, and parents and caregivers can play a key role in protecting children.

Prevent burns.
Every day, 435 children ages 0 to 19 are treated in emergency rooms for burn-related injuries and two children die as a result of being burned. Younger children are more likely to sustain injuries from scald burns that are caused by hot liquids or steam, while older children are more likely to sustain injuries from flame burns that are caused by direct contact with fire.
Thankfully, there are ways you can help protect children from burns.

Keep teen drivers safe.
Discuss your rules of the road with your teen. Talk about why they are important to follow, as well as consequences for breaking the rules. Work with your teen to draft and sign a parent-teen driving agreement. You may choose to hang yours on the refrigerator door to highlight the importance of safe driving. Let your teen know that following the rules and driving safely will result in greater driving privileges.

Prevent childhood lead poisoning.
Lead poisoning is entirely preventable. The key is stopping your child from coming into contact with lead and treating children who have been poisoned by lead. Lead-based paint and lead contaminated dust are the main sources of exposure for lead in U.S. children. Learn ways to reduce children's exposure to lead poisoning.

Prevent too much sun.
Just a few serious sunburns can increase your child's risk of skin cancer later in life. Kids don't have to be at the pool, beach, or on vacation to get too much sun. Their skin needs protection from the sun's harmful ultraviolet (UV) rays whenever they're outdoors.

Have a healthy home.
Stay smart around the house. Get smart tips on fire prevention, microwave use, and living with pets. Parents can also take many actions to protect their children's health and safety. At a very young age, children develop the habits and behaviors that will influence their lifelong health.

Keep cool in the heat.
Take steps to prevent heat-related illnesses, injuries, and deaths during hot weather. People who are at highest risk are the elderly, the very young, and people with mental illness and chronic diseases. But even young and healthy people can get sick from the heat if they participate in strenuous physical activities during hot weather. Never leave infants, children or pets in a parked car, even if the windows are cracked open.

Be active.
Youth gain physical and mental health benefits when they participate in regular physical activity. Regular physical activity in childhood and adolescence improves strength and endurance, helps build healthy bones and muscles, helps control weight, reduces anxiety and stress, increases self-esteem, and may improve blood pressure and cholesterol levels. Positive experiences with physical activity at a young age also help lay the basis for being physically active throughout life.

Eat healthy foods.
You can help children learn to be aware of what they eat by developing healthy eating habits, looking for ways to make favorite dishes healthier, and reducing calorie-rich temptations. To help your child maintain a healthy weight, balance the calories your child consumes from foods and beverages with the calories your child uses through physical activity and normal growth.

Get immunizations.
Vaccines aren't just for babies. As kids get older, the protection provided by some of the vaccines given during childhood can begin to wear off. Older kids can also develop risks for certain infections as they enter the preteen and teen years. The preteen and teen vaccines not only help protect them, but also their friends, community and family members. Also, make sure that children's vaccinations are up to date. When traveling with children, outside of the country and for recommendations for specific countries, don't forget to check the destinations  page for the region you are traveling to.