The Most Popular Long Baby Names – N


Long baby names have traditionally not been very popular. In the past 100 years, no name longer than seven characters has ever been the most popular boy name.

However, there are benefits to giving your child a longer name. Longer baby names, such as Elizabeth, Margaret and Theodore, often have multiple nicknames associated with them, allowing children the flexibility to choose the name which best suits them as they grow older.

With this in mind, the experts at MooseRoots, a genealogy research site powered by Graphiq, used data from the Social Security Administration to determine the 25 most popular long names for both boys and girls in 2015.

The ranking goes from least popular name to most popular name for each gender, meaning the most popular boy and girl names both take the No. 1 spot. A name’s popularity is based on its frequency per million newborn boys or girls in 2015. To make this ranking, a name had to be eight characters long or more.

Since 1989, the average length of baby names has actually gotten shorter. While the top 100 baby names for boys and girls in 1989 averaged 6.14 characters, the top 100 names from 2015 averaged only 5.87 characters.

Read on to find the best long name for your baby. We only suggest that you don’t make your baby’s name too long – in some states, such as Massachusetts, there is a restriction on how long your baby’s name can be.

Note: Numbers showing how many boys and girls of every million were born with a given name in 2015 have been rounded to the nearest whole number.

Children Who Get Zika After Birth Tend Not to Fall Seriously Ill, Study Finds


Serious complications are rare among children infected with the Zika virus after birth, federal health researchers concluded in a study published on Friday — a rare bright spot in the unfolding story of the epidemic.

About 160 teenagers and toddlers infected with Zika virus have been reported to the Centers for Disease Control and Prevention since 2015. The agency’s new study marks the largest survey yet of laboratory-confirmed cases in children.

All of the infections were the result of travel, most commonly to the Dominican Republic and Puerto Rico. About 100 of the cases occurred in June and July alone. The report represents just a fraction of the actual number of children in the continental United States infected with Zika.

The children, aged 1 month to 17 years, were initially identified because they had symptoms of infection; only those who became ill were included in the research. Yet most people who are infected have no symptoms at all.

The virus can profoundly injure developing fetuses, leading to a range of birth defects including irreparable brain damage, hearing loss and eye defects. But the C.D.C. researchers, reassuringly, found no serious injury among infected children.

Typically, these children got only mildly ill: 129 had a rash, C.D.C. researchers found, while half were feverish and a quarter had red eyes or joint pain. One hundred and eleven had two or more of the four main symptoms.

Five teenagers, ages 16 and 17, were pregnant when they developed symptoms, highlighting the need for sexually active teenagers to protect themselves from Zika, especially after travel to affected places.

None of these children developed a kind of temporary paralysis called Guillain-Barré syndrome, which may be triggered by Zika infection.

Older adults are generally thought to be at higher risk for Guillain-Barré. But at the height of the Zika epidemic in Brazil, officials reported that a few children had developed the paralysis, as well as meningoencephalitis, a dangerous inflammation of the brain and spinal cord.

Still, the C.D.C. urged health care providers to test children with suspected Zika infection, to notify state health departments of all cases, and to remain vigilant for neurological complications even in the very young.

No child died in the C.D.C. study, but two were hospitalized. A four-year-old with a fever, a cough, and trouble eating or drinking spent three days under observation. A one-year-old with a cough and rash spent a night in a hospital.

Also on Friday, the C.D.C. announced that men who have visited areas in which the Zika is circulating should wait six months before having unprotected sex in order to avoid transmitting the virus, even if they have not had symptoms.

The C.D.C. had recommended that men refrain for six months if they had experienced symptoms of Zika infection, but only eight weeks if they had not. The change brings the C.D.C.’s advice in line with guidelines from the World Health Organization.

The new guidelines also suggest that both women and men in couples planning a pregnancy in the near future consider avoiding travel to areas where Zika is being transmitted, and that they use condoms or abstain from sex for at least six months after travel before trying to conceive.

The Zika virus lingers in semen, the reproductive fluid that contains sperm. On Thursday, French researchers reported that the virus can penetrate individual spermatozoa.

The study, published in The Lancet Infectious Diseases, found the virus in about 4 percent of the spermatozoa of a 32-year-old man who had had Zika symptoms more than four months earlier.

The discovery did not change the likelihood that the man could pass on the virus through sex, since he also had virus in his semen, the researchers from Toulouse University Hospital said. But the finding has implications for in vitro fertilization.

Sperm donations from men with some viruses, including H.I.V., can be “washed” by removing the seminal fluid, since the virus does not penetrate the sperm.

Although it is unknown whether the Zika virus inside the man’s sperm is infectious, the researchers said, the discovery suggests that fertility centers will need to screen donations carefully for the virus.

Another brief report in The Lancet by researchers in Madrid described a case in which a 53-year-old man who had a vasectomy in 2007 apparently infected his wife with Zika.

The case suggests that the virus penetrates the prostate, seminal vesicles or bulbourethral glands, which together produce pre-ejaculate and seminal fluid.

Medicaid Finds Opportune Time to Offer Birth Control: Right After Birth


COLUMBIA, S.C. — Last month, Akia Gayle gave birth to her third child. Sixteen hours later, while she was still in her hospital bed, a doctor implanted a matchstick-size plastic rod in her left arm because she did not want to have a fourth.

“To have it done right then and there — that’s good,” Ms. Gayle said. “I don’t want more kids.”

Ms. Gayle is one of thousands of women in South Carolina’s Medicaidprogram who have gotten long-acting contraception at an unusual moment — right after they give birth. The novel policy, which has since been adopted by at least 19 other states, covers long-acting contraception right after birth for women on Medicaid, the government health insurance for low-income Americans. It is intended to help answer one of the most vexing questions in public health: how to reduce unplanned pregnancy in the United States.

Nearly half of all pregnancies in the country are unplanned, and in a majority of those cases, the woman already has a child. Rates are at least twice as high for poor women. Yet contraceptive methods have never been better: Tiny implants and new, modern IUDs last for up to five years and are far more effective than condoms and the pill. The problem is that they are expensive and usually require several trips to the doctor, insurmountable hurdles for many low-income women.

be interacting with the health care system — at the birth of a child. It is also the moment she is most likely to be insured: Pregnant women who are poor and do not have insurance are put on Medicaid temporarily. Birth control is usually discussed in a checkup about six weeks after delivery, but a majority of women on Medicaid, which covers 57 percent of births in South Carolina, do not return, officials said. Nearly half of all births in the United States are covered by Medicaid.

The change seems to have done the unimaginable: connect large numbers of poor women with new methods of birth control that have the potential to give them a lot more say over when, and with whom, they have children. Since South Carolina started the policy in 2012, unplanned pregnancies have declined by 6 percent, and the state Medicaid office has saved $1.7 million.

Still, there are some who are leery of it, given the ugly history of forced sterilizations in the United States.

“I can’t put my finger on exactly why, but it makes me cringe,” said Dr. Joia Crear-Perry, an obstetrician in New Orleans who is the president of the National Birth Equity Collaborative, an advocacy group for black families. “It makes me think about control. Mistrust. The history of African-American women in this country.”

The policy is part of a broader set of changes transforming birth control in the United States. The pill has long been the most common, but it works only when women remember to take it. The new, long-acting methods, which include updated and less expensive intrauterine devicesand arm implants like Ms. Gayle’s, set the default to “not pregnant” until a doctor takes them out, a major change from the past and one that women have overwhelmingly chosen when offered the option for free in experiments in Missouri, Iowa and Colorado.

Taking note of the success that the South Carolina Medicaid office has had in boosting the use of long-acting contraceptives, the biggest private insurer in the state, Blue Cross Blue Shield, has started offering the same option to women who have just given birth. Nineteen other states — including Georgia, Iowa, Maryland, Massachusetts and Texas — have since made similar policy changes, according to the American Congress of Obstetricians and Gynecologists. This summer, the group recommended that other states do the same.

But last month, two women’s health groups, SisterSong and the National Women’s Health Network, published a statement urging caution: “Many of the same communities now aggressively targeted by public health officials for LARCs have also been subjected to a long history of sterilization abuse,” they said, speaking of long-acting reversible contraceptives.

Public health officials said they were working to address the concerns. “The words voluntary and reversible are very important,” said Dr. Lisa Waddell, the chief program officer of community health and prevention at the Association of State and Territorial Health Officials, which has been holding meetings and conference calls for states about long-acting contraception. “It’s important that women don’t feel coerced into something.”

Women’s health advocates argue that the methods empower women. Using them means women become parents only if they want to. And since single parenthood is a big driver of poverty, long-acting methods are a powerful tool to prevent it, according to Isabel Sawhill, a senior fellow at the Brookings Institution. Women covered by Medicaid are disproportionately more likely to be single parents, compared with women on private insurance, according to the Kaiser Family Foundation.

In South Carolina, doctors discuss the options for birth control long before the birth, during a prenatal visit. Which method, if any, is entirely up to the woman, state health officials say.

On a recent Tuesday, Dr. Chandler Finney, an obstetrician-gynecologist resident at Palmetto Health Richland, a large hospital in Columbia, was ticking off the long list of methods to Tiffany Hampton, 19, who recently found out she was pregnant.

“People your age tend to like this one,” she said, pulling a plastic model of a uterus with an IUD off a shelf. She pointed out that it was safe to use while breast-feeding. “It’s easy,” she added. “You don’t have to deal with it.”

Ms. Hampton, sitting in jeans and a T-shirt on an examining table, looked at it.

“I want to get one — I just have to choose which one,” she said.

Even though birth control was supposed to be free for women under the Affordable Care Act, many hurdles remain, and use has remained relatively low, compared with the pill.

That is changing. Recent legislation in California, Vermont, Maryland and Illinois requires long-acting methods to be included in contraception offerings by health plans, according to Elizabeth Nash, a senior state issues associate at the Guttmacher Institute. Advocacy groups are teaching doctors how to insert the devices and their clinics how to bill for them, a critical obstacle.

“Things have shifted so dramatically,” said Greta Klingler, a public health official in Colorado. “Every single state is really making efforts to increase access. I’m hopeful we’ve hit the tipping point.”

Giving a woman a long-acting contraceptive at the time of birth may seem obvious, but before South Carolina started doing it in 2012, it was rarely done, mostly because payment systems were not set up to cover it that way.

“She’s there, she’s definitely not pregnant because she just delivered,” said Dr. Judith T. Burgis, the chairwoman of the department of obstetrics and gynecology at Palmetto Health University of South Carolina Medical Group, a medical practice in Columbia. “It’s easier to do right then and there, before she gets home and has a newborn to take care of.”

The state has also streamlined the process of obtaining contraceptive devices for the broader population of women on Medicaid — not just those who are pregnant. Now women can get the device almost immediately after asking for one in a doctor’s office, instead of waiting weeks and making multiple trips.

Ms. Gayle, 28, a home health aide who is originally from Brooklyn, appreciated having the option to get the implant right away. Coming back to the doctor to talk about birth control would have meant borrowing a car, bundling her new baby and two other daughters into it, and driving 40 minutes. That was unlikely to happen, she said. She also liked that she could have it done and then forget about it.

“This right here is good,” she said, touching her arm, bandaged where the rod had been inserted. “You don’t have to remember to take anything. It’s just there.”

How kids’ asthma could be kept in check with a cleaner home


Reducing indoor allergens and pollutants can help control children’s asthma, reducing their need for medication, according to a new report from the American Academy of Pediatrics.

Many things in the home contribute to asthma symptoms and attacks, said report co-author Dr. Elizabeth Matsui. Dust mites and mold top the list, along with furry pets, smoke, cockroaches and airborne fragrances and chemicals.

“By intervening, you can have a big impact on your child’s asthma,” said Matsui, a professor of pediatrics, epidemiology and environmental health sciences at Johns Hopkins Bloomberg School of Public Health in Baltimore.

As many as 1 in 10 American kids has asthma, a chronic lung condition that makes it hard to breathe, according to the academy. Their inflamed, narrowed airways lead to wheezing, tightening in the chest, shortness of breath and coughing.

The first step is to learn what’s causing your child’s asthma. Infections prompt symptoms in some kids, but this new report focuses on environmental triggers. Allergy testing — either a blood test or an allergist’s skin test — can provide some vital answers, the pediatrician’s group says.

“As the parent of a child with asthma, I can honestly say that knowing what the triggers of the asthma are is important for the overall health and quality of life of the child,” said Dr. Vivian Hernandez-Trujillo, chief of pediatric allergy and immunology at Nicklaus Children’s Hospital in Miami.

After identifying the environmental culprits, appropriate measures can be taken, she said.

Dust mite allergies, for example — a problem for as many as 6 out of 10 kids with asthma — can be helped by removing carpeting and stuffed toys, the report noted.

Vacuuming with a HEPA filter, encasing your child’s mattress and box spring in allergy-proof covers, and regularly washing bedding in hot water are also recommended for controlling dust mites, Matsui said.

However, if your child is allergic to cats — another common trigger — there’s really no option but to find the animal a new home, she said.

“The allergen that the pet produces is airborne and very sticky, and so even when you try to isolate the pet, you don’t really have any improvement in the child’s asthma,” Matsui explained.

Indoor pollutants can also trigger asthma in some kids.

Smoking is the major contributor to indoor pollution, Matsui said. Giving up smoking or at least banning it inside the house is key, she and Hernandez-Trujillo said.

“We, as adults, have control over this and should not underestimate the negative impact this has on the health of our children, especially those with respiratory conditions such as asthma,” Hernandez-Trujillo said.

Electronic cigarettes and marijuana also emit airborne particles that can trigger asthma, the report stated.

For any child using daily asthma medication or experiencing symptoms several times a week, parents should talk with their pediatrician about possible environmental triggers, Matsui said.

“This approach should be an integral part of asthma management,” she said. “If environmental exposures are targeted, the effects on the child’s asthma can be similar to that seen with medication,” Matsui said. At the very least, this approach may reduce the need for control medications, the report said.

But to succeed, you’ll need to tackle all the triggers, not just one or two, Matsui added.

Other highlights of the report, published online Oct. 31 in the journal Pediatrics:

  • Asthma rates are as high as 25 per cent in some communities, and studies have identified poverty as a major risk factor for the disease, according to the report.
  • The makeup of children’s airways may leave them especially vulnerable to environmental allergens and pollutants. Also, many kids spend time on the floor where allergens collect, the report authors noted.
  • Controlling your children’s asthma triggers will reduce their dangerous and uncomfortable symptoms, Hernandez-Trujillo said.

“In addition, this will ensure that kids are feeling well enough to attend school and allow them to thrive,” she said.

Need a snuggle? Vulnerable infants bond with volunteer cuddlers


Julia Gluck has a date with a special little guy. But today he’s running a bit late.

He’s preoccupied by other urgent matters, it appears, giving a good humoured nurse a rough time, by peeing — not once, but twice — in her general direction. And all she was trying to do was change his diaper.

Finally, little baby Zayn is delivered to the outstretched arms of Gluck. He’s wearing a navy blue shirt emblazoned with the words “Our little man” and a pair of matching pants. The wait was worth it.

“Here we go,” says Gluck, getting comfortable in a rocking chair. “You’re going to cuddle with me today.”

The 66-year old Toronto woman is a volunteer cuddler at St. Michael’s Hospital. The program was developed about a year ago to provide babies in the neonatal intensive care unit (NICU) with some extra tender loving care.

“Families can’t always be in the unit 24 hours a day, seven days a week,” says pediatrician Tony Barozzino. “Sometimes it’s just because of logistics … some of them have children at home that they’re caring for while they have a sick child in the hospital. Sometimes the mothers themselves will have their own physical issues after delivery that requires them to be either hospitalized, or resting at home.”

Gluck is a natural. An old Hebrew lullaby she sang to her own son when he was younger does the trick. Soon baby Zayn’s eyelids are closing

Oh, big yawn,” Gluck murmurs. “You’re a tired guy. It’s hard work growing up.”

Zayn had a rough start. (For privacy reasons, his mother prefers we not use his full name.) Born prematurely at 31 weeks, he’s been at the hospital’s NICU for about two months. His mother has two teenagers at home, so when volunteers like Gluck step in, it’s a lifesaver.

‘It’s like a second mother’

“When I go home, someone’s here cuddling him and loving him just as much as me,” she told CBC News. “It’s like a second mother.”

There are about 20 volunteer cuddlers at St. Michaels and just as many on a waiting list. The would-be cuddlers are thoroughly vetted, going through extensive medical and police background checks.

There are guidelines too for hospitals wanting to develop their own volunteer infant cuddling program, endorsed by the Canadian Association of Paediatric Health Centres.

Besides preemies, other babies at St. Michael’s Hospital face serious challenges. They are born to disadvantaged mothers with mental health and drug addiction issues, says Dr. Barozzino.

Out of 550 babies admitted to the unit, about 7 per cent suffer from narcotic withdrawal syndrome, he says.

Human touch improves outcomes for babies

But regardless of background, all vulnerable babies benefit from the healing powers of a touch.

“Human touch can lower your heart rate as a newborn,” says Dr. Barozzino. “It can improve your neonatal mental health. It can improve your weight gain. It can improve their ability to tolerate their environment because there’s less stress and stimulation.”

“Oh my word, was that a wink?” Awake from his nap, Gluck’s tiny charge is animated — much to her delight. “Did you wink at me?” Her cuddling time with baby Zayn is coming to an end.

“It’s like being in heaven,” she says. “I walk out of here so calm and so refreshed. It’s way easier than paying for therapy. I can tell you that!”

Zayn is returned to his nurse. Gluck takes off her hospital gown, and dons a baseball cap with the word “Bubbie,” yiddish for grandma. She’s expecting her second grandchild in the new year.

“It’s the most wonderful thing,’ she says about being a cuddler. “How to give back I think is a challenge to a lot of people. This is the almost perfect way of giving back.”

For Zayn’s family, there will be an unexpected addition at the Thanksgiving table. Baby Zayn — whose original due date was October 19 — was discharged just in time for the holiday.

Should You Intervene When a Parent Harshly Disciplines a Child in Public?


A woman in a Walmart in Texas last week who took photos of a man pushing a shopping cart with his daughter’s hair wrapped around its handle helped touch off a debate about when, or if, a bystander should intervene when a parent harshly disciplines a child in public.

The woman, Erika Burch, was with her husband, Robert, in the store in Cleveland, Tex., about 45 miles north of Houston on Sept. 19 when they spotted the girl walking extremely close to the cart. Her head was leaning at an odd angle as the man dragged her alongside the cart by her hair, Ms. Burch said in an interview.

Mr. Burch, 44, said the girl, who the police said was 5, was crying: “Please stop! I won’t do it again.” He added that she was “just begging the man to let her go.”

Ms. Burch, 25, intervened.

She said she spoke to the man three times to try to get him to stop, each time raising her voice. Ms. Burch said the man told her, “I grew up just fine,” and began cursing at her. She called 911, and a police officer who was in the store about a shoplifting case was there within minutes.

On its Facebook page, the Cleveland Police Department said a joint investigation was underway with Child Protective Services. Witnesses were interviewed and reports were taken, the police chief, Darrel Broussard, said in an email.

“We do not condone the father’s actions in this incident, but we must gather all the facts and evidence,” he wrote, adding that the father let go of the girl’s hair “pretty quickly.”

“There have been forensic interviews conducted with county child advocacy group, and digging into the past behavior and history of the family (none found),” the chief wrote..

No charges have been filed, and the man was not identified by the police. The chief said that “many intervention plans” were in place and that the child was “doing great,” adding that the family has “a very strong mother.”

Since Ms. Burch posted her story on Facebook, it has been shared more than 242,000 times and was reported by numerous news outlets. It was only after she intervened at the store, she said, that other shoppers thanked her. She said some people later sent her Facebook messages that the couple, who have four children, ages 2 to 7, should have minded their own business.

But Mr. Burch said the circumstances demanded action. “This is what is wrong with America today,” he said. “Everybody’s too scared to get involved anymore.”

So what should observers do in situations like this one? We asked the experts.

Is it my business to say something?

• Dan Duffy, president and chief executive of Prevent Child Abuse America, said his organization is a firm believer that “if you see something, say something.”

• Do not wait for the situation to deteriorate before getting involved, said Darleen Simmons, a public health educator with Saint Paul-Ramsey County Public Health in St. Paul, and the lead trainer for the Wakanheza Project, which teaches strategies to defuse stressful situations. (Wakanheza is the Dakota tribe word for child; its English translation is sacred being.)

“If you wait for something to get worse before doing anything, it definitely can get worse and then it becomes harder to connect and be of help,” she said.

• Folusho Otuyelu, an assistant professor of clinical social work at Touro College Graduate School of Social Work in Manhattan, said, “Others may not be brave enough to intervene but are thinking someone should get involved.”

The person intervening may feel alone but really is not, she said.

Should I call the police?

• Chris Newlin, executive director of the National Children’s Advocacy Center, said people commonly call 911 if they see a fire or a crash, so why should cases of child endangerment be different?

“If someone is being abusive to a child in public, just imagine what happens behind closed doors,” he said in an email.

• Dr. Jeffrey Gardere,a clinical psychologist and a professor of behavioral science at Touro College of Osteopathic Medicine in Manhattan, said that if you believe the child is in “imminent danger,” you can make an anonymous call to the police.

“You may feel guilty that you may be getting that parent in trouble, or that you may be making a mistake and misinterpreting the situation,” he said. “However, think about how inaction can lead to the injury, danger or death to the child. Now think about that guilt.”

• Other experts cautioned that involving the authorities right away might cause the situation to escalate. The parent might be frustrated or having a bad day and not necessarily be abusive.

“You do need to acknowledge the right of parents to discipline their child within limits,” Dr. Lolita M. McDavid, medical director of child advocacy and protection at Rainbow Babies and Children’s Hospital, the pediatric hospital of University Hospitals Case Medical Center, in Cleveland, Ohio, said in a email.

If you believe a child is “truly being hurt or assaulted, you do need to step in and do something about it,” she said.

In that case, be very firm with the parent, but if that person confronts you, alert a security guard or the police immediately. “You have to be safe yourself,” Dr. McDavid said.

That is not an unfounded concern. In 2011, a mother on a Philadelphia bus who was angry at being criticized by a passenger for spanking her child made a phone call, and two accomplices arrived and fired on the bus with an assault rifle and a pistol right after she left, The Philadelphia Daily Newsreported. No one was hurt.

Ms. Burch said the thought crossed her mind that the man in Walmart might have a gun. She said that she watched closely for any sudden movements, but that she would not relent.

“He would have to shoot me right there,” she said.

Am I legally obligated to intervene?

Mandated reporters, such as teachers or doctors, are required to report suspected child abuse, but ordinary citizens are free of that obligation, said Randall M. Kessler, a former chairman of the American Bar Association’s Family Law Section, who has a law practice in Atlanta.

“While some might argue there’s a moral or ethical responsibility, we do not as a society criminalize a failure to report a crime,” he said in an email.

Some states have “good Samaritan laws” that protect those who intervene from civil claims if they acted in good faith.

How should I approach the situation?

• Avoid being angry, stern or confrontational, Professor Otuyelu said.

Be warm, friendly and concerned. Speak in an even and soft tone and ask politely if the person needs help. Gently but firmly point out that the child could get seriously hurt and that the person’s behavior needs to stop immediately.

• Collect yourself before you talk and withhold judgment, Ms. Simmons said.

“It really starts with no one as a parent wants to be told we’re doing something wrong or we’re a bad parent,” she said. “That’s a recipe for something to blow up in your face.”

What do I say?

• Professor Otuyelu suggested: “Hello, I don’t mean to get into your business or tell you how to parent, but I noticed that” and fill in the sentence with what you observed.

• Mr. Baker recommended: “I remember when my children were that age. They can be a handful. Do you need any help?”

• Dr. McDavid recalled a shrieking child and a screaming mother waiting to check out at a grocery store: “I said to them ‘Hey, are you O.K.?’ I said to the child, ‘Can you stand there quietly while we wait in line?’ They both calmed right down.”

• Ms. Simmons said sometimes you have to act in the moment. She recalled an airplane passenger seated near a child who was crying and acting out. The passenger made a hand puppet out of an airsickness bag to distract the child and it worked, she said.

“If you bring a genuine care and desire out of love and respect, people will get that,” she said.

How Much Is It Worth to Hold Your Newborn? $40, Apparently


After holding his newborn son for the first time at a Utah hospital last month, a man found a strange charge on his bill: $39.35.

The man, Ryan Grassley, thought the charge, which appeared to be for holding his baby to his wife’s chest, was a bit of a joke. (The charge was listed as “skin to skin after C-sec.”) So he didn’t take it too seriously when he posted a picture of the bill on Reddit.

But the story quickly gained steam: As of Wednesday, it had prompted over 11,600 comments from other users since being posted Monday evening and vaulted high up on the internet’s “front page,” (as Reddit calls itself) by more than 6,000 upvotes.

The Reddit post touched a nerve with people because it seemed to underscore a national frustration with unexpected hospital fees and arcane medical billing.

Mr. Grassley, 37, of Spanish Fork, Utah, wrote that his son was born on Sept. 4. While his wife, (whose name Mr. Grassley has not revealed) was delivering the baby, he was asked if they would like to hold their newborn after the procedure at Utah Valley Hospital in Provo.

Mr. Grassley held his son between his wife’s neck and chest, while a nurse took pictures. For this, the description on the bill seemed to suggest, he was charged the fee. (It’s about the price of a four-month subscription to Netflix.)

Janet Frank, a spokeswoman for Utah Valley Hospital, said in a statement, however, that the charge was not for skin-to-skin contact, a practice that hospitals use to increase bonding and breast-feeding, among other things.

Ms. Frank said that the charge was incurred because an extra nurse was needed in the operating room while Mr. Grassley and his wife held their newborn son and that the nurse was necessary to ensure that “both mom and baby remain safe.”

Only in the case of a C-section birth is an additional nurse brought into the operating room,” the statement said.

Once Mr. Grassley saw that the Reddit thread was gaining momentum, he clarified that he and his wife knew the cost for the delivery would be steep. The total charges listed on the bill, including the C-section, came to $13,280.49 before payments and adjustments.

“We knew what we were signing up for and have some money saved up,” he wrote, adding: “Everyone involved in the process was great, and we had a positive experience. We just got a chuckle out of seeing that on the bill.”

Of course, not everyone is financially prepared to deal with exorbitant costs, which helps explain why the post prompted such attention. The Reddit thread that Mr. Grassley started was filled with horror stories about medical fees and the comparative ease of paying them in other countries.

In a Time magazine cover story in 2013, Steven Brill wrote about how American hospitals can charge high fees for seemingly simple procedures. Though the article was filled with stories similar to Mr. Grassley’s, Mr. Brill also noted that American health care is not governed by a rate-setting system.

This means the federal government does not set rates for items like skin-to-skin contact or for summoning an additional nurse to the operating room after a C-section.

Prices for patients with private insurance or those paying out of pocket are generally set by the hospitals. Tom Hudachko, a spokesman for Utah’s department of health, said the state does not “have any rate-setting authority on any plans outside of Medicaid.”

Ms. Frank, the hospital spokeswoman, would not initially say whether the hospital itself had set the price for the nurse that Mr. Grassley was charged for.

But after repeated inquiries, Ms. Frank confirmed by email that the hospital did set the charge, which was determined as “a function of nursing time.”

“We are actively evaluating how better to define the service as it appears on a patient’s bill,” she said.

Unicef Cuts Cost of Vaccine That Protects Against 5 Diseases


The United Nations Children’s Fund has made a deal with six vaccine manufacturers that will cut in half the price of a shot that protects children against five diseases, the fund announced last week.

The deal will mean three years’ worth of vaccine at an average price of 84 cents a dose; buyers currently pay about $1.84, according to Unicef.

Unicef will buy about 450 million doses for 80 of the world’s poorest countries. Low- and middle-income countries purchasing vaccine for themselves can also qualify for the lower prices, Unicef said.

The vaccine protects against diphtheria, tetanus, whooping cough, hepatitis B and Haemophilus influenzae Type B (known as Hib). Gavi, the Vaccine Alliance, estimates that the shots will prevent more than five million deaths by the year 2020.

In 2001, only one company made the so-called pentavalent vaccine. As more companies have started offering it, Unicef has forced them to compete by holding several rounds of bidding for large contracts and publishing all of the prices that were offered.

Another advantage of an expanded market is that vaccine plants can develop sterility problems that force them to shut down for cleaning and repairs. Having multiple manufacturers ensures against shortages, which can be disastrous during epidemics.

Measles shots and doses of vitamin A are among the chief reasons t the number of children who die before reaching age 5 has dropped sharply. The number was about 10 million a year 10 years ago; it is now approaching five million a year.

But the diseases prevented by the pentavalent vaccine kill many of the youngest infants. Progress saving those lives has been slower. The Hib bacterium alone, for example, kills about 350,000 children a year.

The pentavalent shot is typically given to each baby three times — at 6 weeks, 10 weeks and 14 weeks. Measles vaccine and vitamin A are usually not given until about 9 months.

First Baby in Puerto Rico With Zika-Related Microcephaly Born


The first child in Puerto Rico with Zika-related microcephaly has been born, the territory’s secretary of health announced Friday.

The fetus’s abnormally small head was not detected until the mother was nearly eight months pregnant, according to The Associated Press, even though the mother was probably infected in her second month.

The mother did not get regular prenatal checkups, the AP quoted the health secretary, Dr. Ana Rius, as saying.

The baby, born within the last two weeks, is still hospitalized with severe birth defects, including vision and hearing problems.

The first case of Zika infection in Puerto Rico was reported last December, but the virus spread slowly for months before exploding into thousands of cases in early summer, when the Centers for Disease Control and Prevention estimated that as many as 50 women a day could be getting infected.

Puerto Rico’s policy is that pregnant women there with Zika symptoms should be seen by a doctor at least three times during a pregnancy, with fetal ultrasounds each time.

The C.D.C., which is underwriting much of the territory’s Zika-fighting efforts, said Friday that the child would be monitored until he or she was 3 under the Zika Active Pregnancy Surveillance System, as are all children born to mothers infected with Zika.

Sometimes babies infected in the womb with viruses like rubella or cytomegalovirus appear normal at birth, but later turn out to have serious problems with hearing, vision or learning, and officials want to know if Zika carries the same risks.

300 Million Children Breathe Highly Toxic Air, Unicef Reports


MUMBAI, India — About 300 million children in the world breathe highly toxic air, the United Nations Children’s Fund said in a report on Monday that used satellite imagery to illustrate the magnitude of the problem.

The vast majority of these children, about 220 million, live in South Asia, in places where air pollution is at least six times the level that the World Health Organization considers safe, Unicef said.

The agency said the children faced serious health risks as a result.

“Children are uniquely vulnerable because their lungs are still developing,” said Nicholas Rees, the author of the report.

“Early exposure to toxic air has lifelong consequences for them,” he said.

Among the most dangerous pollutants are air particles known as PM2.5, which are a small fraction of the width of a human hair.

They can be released from fossil fuel combustion and industry, and include natural sources like dust.

The ultrafine particles enter the bloodstream through the lungs, worsening cardiac disease and increasing the risk of stroke and heart failure, in addition to causing severe respiratory problems, like asthmaand pneumonia.

Early studies also suggest a possible link between pollution and children’s cognitive function, the Unicef report noted.

It also cited numerous studies connecting chronic exposure to high pollution with an increased risk of miscarriage and early labor in pregnant women, and low birth weight.

Globally, about seven million deaths are linked to air pollution, 600,000 of them children under 5, the Unicef report said, citing World Health Organization studies in 2012 and 2015.

Air pollution is linked to one in 10 deaths of children under 5, the W.H.O. has reported.

But in its report, Unicef also argued that the effects of toxic air go well beyond early mortality, in particular for children, on whom the lifelong effects are only now being understood.

Beyond the children living in the most toxic air, about two billion children in the world, constituting the vast majority, live in places where air pollution exceeds the level that the W.H.O. considers unhealthy, the report said.

And Unicef warned that children’s health could be increasingly at risk in the ensuing decades as the most populous countries rapidly industrialize, a factor that historically has been accompanied by rising rates of air pollution.

But the future doesn’t have to be that way, Ramanan Laxminarayan, a senior research scholar at the Princeton Environment Institute, argued in an interview.

He noted that China, where air pollution soared during industrialization, has radically changed course.

“China is investing significantly in clean-air technology on a scale unprecedented,” Mr. Laxminarayan said.

Air pollution is about as severe in India, he said, but the causes are in some ways more easily correctable, like the burning of paddy straw by northern Indian farmers after they harvest it.

“This is just gross stupidity,” Mr. Laxminarayan said, and alternative ways of disposing of the crop can easily be found without compromising India’s economic future.

Industry isn’t yet as big a source of air pollution in India, where development so far has come from less-polluting industries like pharmaceuticals, giving India a choice of whether to take a different route to future development, Mr. Laxminarayan said.

India has taken some steps toward charting a cleaner road to development but needs to be much bolder if it is to protect its children’s health, he said.

“India could have been a country to get rich without China’s type of industrial pollution,” he said. “It is throwing away that opportunity.”