It’s a tragic sign of spring: Two young children have died this month in Texas and Missouri after their parents accidentally left them all day in hot vehicles.

Although such deaths occur in nearly every month of the year, records show that warmer weather typically heralds a seasonal spike in fatalities from hyperthermia, or heat stroke, among children left in cars and trucks.

Worse, experts add, such calamities don’t have to happen.

“It’s a totally preventable occurrence,” said Kate Carr, president and chief executive of Safe Kids Worldwide, which recently launched a new campaign to raise awareness about the problem. “Our hearts go out to the parents and families of these children.”

In the most recent cases, a 7-month-old boy from the Sugar Land area of Houston died May 3 after the child’s father, Leland Jacobson, 41, left the baby for hours in the backseat of a pickup truck in 89-degree weather. Jacobson wasn't normally the parent who took his children to day care and became distracted after dropping off the older kids, police said.

On the same day, a 13-month-old boy from Lee’s Summit, Mo., died after his mother, a teacher, mistakenly believed she’d already left the child at day care that morning. Temperatures reached 83 degrees that afternoon.

“The investigation has revealed no signs of foul play and at this time it appears that the death was a tragic accident,” said Sgt. Chris Depue, spokesman for the Lee’s Summit Police Department.

That’s true of most cases in which children die after being left in hot vehicles. At least 529 such deaths have been recorded since 1998, including the two logged in the past week, according to figures from the Department of Geosciences at San Francisco State University, which tracks reports.

On average, 38 children die each year in hot cars, reports show. The numbers typically begin to climb in May, with an average of three deaths per month. They spike in July and August, when nine deaths, on average, are recorded, the figures show.

Overall, more than half of the deaths -- 52 percent -- occur when a child is mistakenly left in a vehicle, typically by a parent or caregiver who is rushed or stressed, said Carr.

“That’s a story we’ve heard first-hand,” she said. “The baby falls asleep in the back and mom or dad gets distracted. You can get in the car headed to work and absolutely forget.”

More precisely, a distracted brain can get stuck on autopilot, allowing parents to believe they actually have left the child, said Janette E. Fennell, founder and president of KidsAndCars.org,which has been focused on the problem for a dozen years. Her agency has counted 620 child deaths from hyperthermia since 1990.

Frequently, the accidents occur when there’s a deviation from the normal routine. Dad is handling the drop-off instead of mom, or there’s been some other change in schedule.

"The parents are absolutely certain that their children are in a verysafe place," Fennell added. It's only later, at the end of the work day, for instance, that they realize what's happened. 

About 30 percent of the deaths occur when a child is playing in an unattended vehicle and becomes trapped inside -- or in the trunk, reports show. Another 17 percent of deaths occur when a child is intentionally left alone, for instance, when a parent went shopping.

Once inside, the babies and children face temperatures that soar quickly to lethal heights. It takes only 10 minutes for the temperature to jump 20 degrees; within 30 minutes, it can climb by 34 degrees, according to a vehicle heat study sponsored by General Motors, which helps fund Safe Kids Worldwide.

Under that scenario, even a mild day -- 70 degrees -- can quickly become deadly.

“Cracking the window doesn’t help,” Carr said. “If you’ve ever been in a hot car that’s parked on an asphalt parking lot, you know how quickly that car heats up, even if your windows are down.”

Child's body heats five times faster
Regardless of how or why a child is left behind, the effect is swift and devastating, said Dr. Leticia Ryan, researcher and clinician at Children’s National Medical Center in Washington D.C.

“The child’s body heats up three to five times faster than an adult’s,” she said. “Their internal systems are not fully developed.”

Kids don’t sweat as efficiently as adults and their bodies absorb heat faster. It can take as little as 15 minutes in an overheated vehicle for a child to begin to suffer life-threatening brain or kidney injuries. When body temperature reaches 104 degrees, internal organs begin to shut down. At 107 degrees, children die. 

“It’s the double whammy of being more vulnerable to the heat illness in a short amount of time,” said Ryan, a pediatric emergency medicine expert who has seen many young victims of heat stroke. “In most cases, they’re usually too young to get themselves out of the car seat or to alert people outside of the car to their predicament.”

Norman Collins Sr.

Three-month-old "Bishop" Collins died on May 29, 2011 after he was accidentally left in a car in a church parking lot in Clarksdale, Miss., on a 93-degree day. His grandfather, Norman Lee Van Collins Sr., has become an advocate for car safety.

Such deaths leave the families devastated, too. The shock, grief and guilt are overwhelming, said Norman Van Lee Collins Sr., whose 3-month-old grandson, Norman Van Lee Collins III, known as “Bishop,” died last May 29 a hot car in a Mississippi church parking lot.

The child was accidentally left behind as his family hurried into a church service. The child’s father was the minister of music, so he was retrieving his keyboard from the car. He asked another church member to get the baby and take him to the nursery. But the church member didn’t hear him.

“There was just this miscommunication,” the grandfather recalled sadly. “I lost my grandson.”

To compound the tragedy, when Norman Collins Jr. reported the accident to the police, he was arrested for negligent manslaughter.

Nineteen states have laws that address leaving a child unattended in a vehicle. Thirty-one states have no specific laws, according to San Francisco State reports. An Associated Press investigation in 2007 found that charges were filed in about half of cases in which children died of heat stroke in vehicles; more than 80 percent were convicted.

In Collins’ case, the grand jury didn’t choose to indict him. “I did not even explore why,” the senior Collins said. “I was just so glad they didn’t.”

The bereaved grandfather now speaks publicly about Bishop's death in order to warn other families about the danger.

Airbags put babies in backseat
In one of the ironies of vehicle safety, the number of hyperthermia deaths in cars has skyrocketed since the early 1990s, when the advent of airbags led to directives that young children be placed in the back seats of cars and in rear-facing car seats for infants.

That position makes it easier to overlook babies, even for the most conscientious parent, said Carr, who recalled nearly forgetting to drop her own 2-year-old at day care -- until the child spoke up.

“Thankfully, my daughter was not a small baby who fell asleep,” she said. “From my own personal place in my heart, I have a great deal of empathy for these parents.”

Safety advocates such as Fennell, of KidsAndCars.org, have lobbied for years for technical solutions to the problem of leaving babies behind. Some private firms have come up with various devices, monitors and other alerts that can be purchased online, but none is available off the shelf, Fennell said.

Better, she said, would be a required sensor that could alert drivers that someone is still in the vehicle when they’re locking the car.

“We feel this is a good strategy because we know that many people feel that this ‘could never happen to them’ and may not think they need to purchase aftermarket technology,” she added.

Meantime, KidsAndCars advises all parents to institute an “iron-clad” rule with day care providers to contact parents if a child has not arrived as scheduled.

Safe Kids also advises that parents put back-up systems in place to prevent tragedy: Set up a “peace of mind plan” in which it’s routine to call or text a partner or other caregivers so that everyone knows when a child has been dropped off.

Place a purse, briefcase, gym bag, cell phone or other object needed at the destination in the backseat with the child. Set an alarm on a cell phone or computer calendar as a reminder to drop a child at care.

Though the number of child deaths from hyperthermia in cars is small, the actual number of incidents in which kids are endangered is likely much larger.

In Palm Beach County, Fla., there were 500 near-misses last year in which kids were retrieved from cars before they were seriously hurt, Carr said. The actual number of close calls is unknown.

“Never leave a child alone, even for a minute,” she said.  “It can and it does and it might happen to you.”

Related stories: 

• Hurt on the stairs: A child is injured every 6 minutes on the stairs
• CDC: Kids' accidental deaths down 30 percent
• Bioethicist: Youth hockey borders on child abuse
• VIDEO: Stairs in the home pose a hazard to kids

Nacho Doce / Reuters

Rychard Barboso, 5, looks at his physical therapist during a session at the Association for the Aid of Disabled Children (AACD) in Sao Paulo on March 19. All images captured by Nacho Doce of Reuters.

A disabled girl embraces a doll during a session of physical therapy at the AACD on March 19.

The Association for the Aid of Disabled Children (AACD) in Sao Paulo is a non-profit organization that began in 1950 with just 14 patients. It now works with some 8,000 young victims of disabling conditions and diseases such as cerebral palsy, and most of the patients come from impoverished or broken homes.

Reuters photographer Nacho Doce became aware of the clinic through a close friend and was astonished at the range of disabilities the children faced and was impressed with their determination and resilience.

It was the children’s smiles and willpower that drew me to them from the start, as much to those who couldn’t move as to those who couldn’t speak or sense. The parents and even the therapists also showed incredible strength.

-- Nacho Doce

All photos were shot by Nacho Doce in March and April, and were made available to msnbc.com today.

A girl wearing a brace on her leg is assisted by a physical therapist during a hydrotherapy session at the AACD on April 3.

A physical therapist supports Luiza Ezaledo, 2, during a hydrotherapy session on April 2.

Luara Crystal, 5, who suffers from brittle bone disease, lifts a weight next to her physical therapist during a session at the AACD.

Ivan Bevenuto, 4, sits next to his skateboard after taking part in a Capoeira therapy session at the AACD on March 21.

Yara Santos, 9, talks with her mother before a session of physical therapy on March 21.

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Attention, germaphobes. Exposure to the microscopic bugs is crucial for keeping kids healthy, according to new research in the prestigious journal Science. The study strongly supports a growing body of evidence that you need to put away the disinfectant and expose children to the real world of germs and microbes. 

Getty Images stock

We're meant to encounter some microbes and dirt when we're young. It's how we build our immune systems.

Scientists Richard S. Blumberg and Dennis L. Kasper and a team of researchers at Harvard Medical School showed that in mice exposure to germs in early life helped reduce the body’s inventory of invariant natural killer T (iNKT) cells. These cells help protect us against diseases like inflammatory bowel disease and asthma. But, if there are too many of them with too much time on their hands, they can actually cause these conditions. By exposing young mice to common microbes the scientists saw that the animals were protected from accumulating T cells -- and were healthier than those who were not.  

The scientists reached an admittedly geeky conclusion: “These results indicate that age-sensitive contact with commensal microbes is critical for establishing mucosal iNKT cell tolerance to later environmental exposures,” they wrote in the journal Science. In other words, exposing baby mice to common germs got their immune systems appropriately busy and able to not over-react when encountering nasty bugs and other biological stuff later in life.

This is a big deal.

The rapid rise in food allergies, asthma and other immunological diseases is due, at least in part, to our modern obsession with cleanliness, scientists increasingly believe. The 'hygiene hypothesis', first advanced in 1989 by the British epidemiologist David Strachan, contends that these diseases are becoming more common because young children are not exposed to them at an early age. We spend so effort trying to prevent exposure to germs with antibiotics, antibacterials and soaps that letting kids get dirty seems like a violation of basic parental duty.

Parents are constantly being told to make their kitchens spotless, to kill 99.9 per cent of the germs lurking in their bathrooms and to wash themselves and their babies all the time.

This world of purity sounds good but it does not fit how we are designed. We are meant to encounter some microbes and dirt when we are young. It is how we built our immune systems. We need a certain amount of grunginess as kids to be healthy adults. 

As the Harvard study shows, filth can be good -- at least in tiny amounts when you are very young.

Arthur Caplan, Ph.D., is a Professor in the Department of Medical Ethics and Health Policy at the University of Pennsylvania

Ifp / featurepics.com

About 45 percent of parents give their children bottled water instead of tap water, a study found, which dentists say may leave them lacking fluoride that can prevent tooth decay.

When the dentist had to fill six cavities in her 4-year-old son’s baby teeth, Amy Wilson was shocked.

The New York City mother of three scanned her family’s habits, trying to figure how Seamus, now 7, could have developed such tooth decay so early.

“We said, 'No, no, no, they don’t have candy or gum or soda regularly,'” recalled Wilson, 42, an actress, author and blogger. For a while, she was stumped.

But then, at a party, a dentist friend posed a surprising question: Did Wilson’s children drink bottled water?

“I had a dentist tell me to make sure to give my kids tap water and not bottled because the latter isn’t fluoridated, and he’s seeing kids with more cavities,” said Wilson, who posted on the popular blog, Type A Parent. 

It turns out that many dentists and government health officials suspect that the practice of skipping tap water in favor of bottled water may be contributing to rising rates of tooth decay in young children.

Courtesy Amy Wilson

Amy Wilson, 42, of New York, was shocked when Seamus, far left, had to have six cavities filled at age 4. She now makes sure Seamus, now 7, as well as Connor, 9, and Maggie, 4, drink fluoridated filtered water from the family tap.

“You should brush twice a day with a fluoride toothpaste, see the dentist twice a year for fluoride treatment and get fluoride in your drinking water,” said Jonathan D. Shenkin, spokesman on pediatric dentistry for the American Dental Association. “If you’re not getting it in your drinking water, that takes out a component of the effectiveness of that triad.”

The Centers for Disease Control and Prevention, too, warns that “bottled water may not have a sufficient amount of fluoride, which is important for preventing tooth decay and promoting oral health.”

No question, many kids do drink bottled water. One recent study in the Archives of Pediatrics found that about 45 percent of parents give their kids only or primarily bottled water, while another in the journal Pediatric Dentistry found that nearly 70 percent of parents gave bottled water either alone or with tap water.

More than 65 percent of parents using bottled water did not know what levels of fluoride it contained, that study showed.

At the same time, tooth decay appears to affect a huge swath of the nation’s young children. About 42 percent of children ages 2 to 11 in the U.S. had cavities in their baby teeth, according to a 2007 prevalence study, the most recent data from the Centers for Disease Control and Prevention.

The study tracked rising decay from 1988 to 1994 and then from 1999 to 2004, when it was up overall about 2 percent. The data showed that decay affected not only more than half of children at the lowest income levels, but also nearly a third of kids in higher-income families.

That supports additional research by Bruce Dye, a dental epidemiology officer with the National Center for Health Statistics, which actually found that boys in higher income families had the greatest prevalence of decay. Whether that's because it's harder to get those boys to brush, or because parents in higher-income families are more likely to provide more beverages, such as juice, sports drinks -- and bottled water -- isn't clear.

“I look at that as choices being made,” Dye said. “Gatorade or bottled water could be part of that.”

To be clear, there are no studies to date that document a clear tie between bottled water and tooth decay. And the International Bottled Water Association, an industry trade group, notes that at least 20 of its roughly 125 bottlers do offer fluoridated bottled water -- and that water is a healthier option than other beverages.

“In fact, bottled water does not contain ingredients that cause cavities, such as sugar,” the IBWA said in a statement responding to a recent New York Times story about a rise in dental surgeries among tots.

But Shenkin and other dental experts say it’s actually not clear whether there’s a link between bottled water and tooth decay, mostly because the issue hasn’t been studied because of a lack of funding for oral health research. 

They contend that the continued popularity of bottled water in the U.S. -- about 8.4 million gallons a year or about 27.6 gallons per person in 2009, according to the Beverage Marketing Corp. -- fuels concern about kids’ consumption.

“I look at it as parents trying to do the right thing, trying to be healthy, but being healthy doesn’t prevent [cavities],” said Dye.

Fluoridation of public water supplies has been hailed as a public health victory, but in recent years, many U.S. communities have voted to stop adding it to local drinking water. Fluoride protects against tooth decay, but it also can cause tooth discoloration and bone weakness if ingested at too high levels for many years, experts agree. 

Federal regulators last year proposed setting recommended fluoride levels in drinking water to the lowest end of a range that permits between 0.7 and 1.2 milligrams of fluoride per liter of water, but officials are still wrestling with finding a balance between preventing decay without harming teeth and health.

Meanwhile, inadequate brushing habits, delayed dental visits, poor choices of foods and snacks and bad beverage selection -- in addition to spotty consumption of fluoride -- all likely contribute to tooth decay, Dye said.

No matter what causes it, the problem with decay that starts early is that it often gets worse.

“When you have tooth decay in your baby teeth, you will have tooth decay in your permanent teeth,” said Dye.

The problem may be particularly worrisome in minority families, who were three times more likely than others to give their kids only bottled water, usually because of concerns about the safety or taste of their home tap water.

Kids in minority families also are more likely to have tooth decay. The CDC data showed that 55 percent of Mexican-American kids ages 2 to 11 and 43 percent of black children had cavities in their baby teeth. For white youngsters, the figure was about 37 percent.

For all families, the key is to make dental health a priority, Shenkin said. Babies should see a dentist by age 1 and brushing twice a day with a fluoride-containing toothpaste should start at age 2.

“As soon as that first tooth comes through in the mouth, it’s susceptible to decay,” he said. “If you wait until kids are 3 or 4 years of age, it’s already happened.”

For Wilson, who admits tooth brushing is a struggle with kids now aged 4, 7 and 9, awareness has been a big part of changing her family’s habits.

“We live in New York City where the tap water tastes fine,” she said.

Related stories:

Got water? Schools scramble to provide kids most basic supply

Spanking linked to more aggression in kids

By Linda Thrasybule
MyHealthNewsDaily

The next time your little angel yells, "Mine!" or refuses to share, it might help to know that the reason young children behave selfishly could be that a region of their brains remains immature, a new study suggests.

Researchers studied the behavior and brain scan images of children as they played games that involved sharing a reward with another child.

They found that even though young children understood how sharing benefited the other child, they were unable to resist the temptation to make the "selfish" decision to keep much of the reward for themselves. Brain scans revealed a region that matures along with children's greater ability to make less selfish decisions.

The findings will help researchers better understand how social behavior develops, said study author Nikolaus Steinbeis, a researcher at the Max-Planck Institute for Cognitive and Brain Sciences in Germany.

The study is published in tomorrow's (March 8) issue of the journal Neuron.

Bargaining behavior improves with age
Experts believe that as children grow older, they become less selfish and increasingly focus on how their behavior may affect or benefit others. But it remains unclear why and how this shift toward "strategic social behavior " happens.

In the study, 146 children participated in two games, played in pairs. In the “Dictator Game,” one child offered to share a reward, and another child could only accept what was offered.

In the “Ultimatum Game,” one child could propose sharing the reward, but the other child could accept or reject the offer. If the child rejected the offer, neither child received a reward.

The findings showed that older children were better at sharing and negotiating with others. The researchers said these abilities grew as children improved control over their impulses.

A maturing brain
In the brain scan study, only children who made offers to share during both games were selected. To test whether the same brain regions involved in the children's behavior continued to play a role in adulthood, researchers looked at 14 adults who also participated in both games.

When comparing children and adults, the brain scans showed that a region called dorsolateral prefrontal cortex, located in the left side of the brain, toward the front, was more developed in adults. The area is considered to be involved with impulse control.

Researchers also noticed that younger children were more willing to accept unfair offers than older children.

The results suggest that selfish behavior in children may not be due to their inability to know "fair" from "unfair," but rather an immature part of the brain that doesn’t support selfless behavior when tempted to act selfishly.

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Sweetened cereals likely contribute to the extra sugars American kids consume at home, researchers say.

America’s intake of sugary foods and drinks has dropped in recent years, but U.S. kids are still consuming too much, government researchers say.

Contrary to popular belief, most of that sweet fare is coming from home, not from school or other settings, the researchers reported in a new study released by the National Center for Health Statistics.

For parents, that means that it’s even more important to monitor added sugars in kids’ diets, even those that aren’t so obvious.

“Added sugars are in sugar sweetened cereals, muffins -- even pasta sauce,” said Cynthia Ogden, the study’s co-author and an epidemiologist with the Centers for Disease Control and Prevention. “You can see it if you read the food labels.”

The report, which tracked consumption of added sugars by children and teens from 2005 to 2008, offered other unexpected findings, said Ogden.

Researchers also found that family income made no difference in children’s sugary diets.

“We found that all kids are eating a lot of added sugars,” she said.

Most of those sugars came from foods rather than beverages, another surprise, Ogden said.

Overall, about 16 percent of the calories in the average American child’s diet came from “added sugars” -- sweeteners used in the making of foods such as breads, cakes, soft drinks, jams, chocolates and ice cream.

What’s scary is that the sweets count didn’t include naturally occurring sugars in items such as fruit and fruit juice.

The good news is that in teens, at least, consumption of added sugars appears to have declined a bit, from 22 percent to 17 percent of total calories, Ogden said. 

Still, that’s higher than federal dietary guidelines, which recommend that the total intake of discretionary calories, including added sugars and solid fats, be limited to 5 percent to 15 percent of daily caloric intake.

Dr. Wendy Slusser, a weight control expert, suspects that some of the new study’s findings might be explained by successful campaigns to get sugary drinks out of schools.

 "Other studies have shown that a good proportion of added sugars are being consumed outside the home,” said Slusser, an associate clinical professor of medicine at the Mattel Children’s Hospital at the University of California, Los Angeles and medical director for the UCLA Fit for Healthy Weight Program at Mattel. “So we’re probably seeing a drop in consumption outside the home.”

That means the next focus for intervention may be helping parents to choose healthier options for their kids to eat at home, Slusser said.

“This is an opportunity for families,” Slusser said. “There are estimates now that we could shift children’s weights back to 1970s levels if we could just take 350 calories out of a kid’s diet each day.”

One place to look is beverages, Slusser said. Some of the biggest culprits are 10 percent fruit juice drinks and sports drinks.

“Parents think they’re doing what they’re supposed to when they give their kids sports drinks on a hot day,” she said. “If you substitute water for sugary drinks, that’s a huge step in the right direction.”

Another place to lower sugar levels is in breakfast cereals, Slusser said. “You might want to give them regular Cheerios instead of Honey Nut Cheerios,” she suggested.

Avoiding processed foods is another way to skip the added sugars, noted Ogden. Choosing fresh foods and carefully reading labels of packaged goods can help.

The best way to cut down on added sugars in a kid’s diet is to make healthy eating part of the family routine, Slusser said. Make sure to leave time for a good breakfast in the morning and plan ahead for healthy snacks after school and nutritious dinners at night.

“Once there’s a routine, parents can integrate healthier foods into their children’s diets,” she notes. “When you’re always eating on the fly, you end up eating too many processed foods.”

Related:

Gluten-free diet may be waste of money for some, new research suggests

Kids don't get enough sleep (and neither did their grandparents)

High levels of arsenic found in fruit juice

By Linda Thrasybule
MyHealthNewsDaily contributor

The rate of children hospitalized yearly due to drowning-related incidents has dropped by half since the early 1990s, a new report finds.

The biggest drop occurred in the southern U.S., where drowning-related incidents fell from seven yearly hospitalizations per 100,000 children to three annual hospitalizations per 100,000 children.

"The report shows that we're doing a good job," said lead author Stephen Bowman, an epidemiologist and professor at the Johns Hopkins Center for Injury Research and Policy.

"Trends are going in the right direction, but there's still about 1,000 deaths from drowning in children per year," Bowman said. "And that's too many."

This is the first study to look at trends in hospitalizations for drowning incidents in children.

The study is published in the latest issue of the journal Pediatrics.

Every day in the U.S, about 10 people die from accidental drowning. Of these, two are children aged 14 years or younger, according to the Centers for Disease Control and Prevention.

Drowning is the second leading cause of accidental death in children ages 1 to 19 in the U.S.

Among children, infants and toddlers are the highest risk group. In 2007, almost 30 percent of children who died from accidental injury  died from drowning.

Near drownings can cause brain damage, which can lead to long-term health complications such as memory problems, learning disabilities and permanent loss of basic functioning.

"Drowning is such a terrible, nasty injury because you're not getting enough oxygen," said Dr. Linda Quan, a pediatric emergency room physician at Seattle Children's Hospital.

"You can have a cardiac arrest, and with medical assistance, your heart might be able pump again," said Quan, who was not involved with the work.

"But other organs including the brain may not be able to sustain such an injury," she said.

Which may explain how even after resuscitation, a person can still die after being hospitalized.

Are efforts to reduce accidental drownings enough?

Researchers looked at hospital data over a 16-year period and found the rates of hospitalization from drowning-related incidents declined in children younger than 19 years old.

From 1993 to 2008, researchers found, the number of hospitalizations associated with drowning decreased from about five cases per 100,000 children, to two cases.

Researchers also observed a 40 percent drop in bathtub-related drowning hospitalizations in infants and toddlers.

Study authors noted boys maintained higher rates of drowning injuries than girls.

The reason for the overall decline may be due to "educational campaigns that have been put into place to reduce drowning," Bowman said.

"Efforts such as putting fences around pools and encouraging parents to have kids in a supervised setting, are some of the things we'd like to believe are yielding positive results in reducing drowning," he said.

But Quan said she isn't entirely sure such efforts are the only reason for the decline.

"It could mean that kids aren't going to the beach as often," she said. "Or maybe they're just sitting at home playing computer games. We don't really know for sure why there's a decline." She said there hasn't been enough attention given to water safety.

"We haven't had national focus, medical focus or family focus on preventing drowning," Quan said. "We haven't taken the same approach to preventing drowning like we have with motor vehicle accidents."

What is most important is that parents follow all the necessary steps to ensure their child is safe, she said.

"Every family needs to think about how to prepare and respond to any water related activity," Quan said.

Some of her suggestions included:

• Bring a lifejacket with you when visiting a beach.
• Swim only where there's a lifeguard.
• Keep active watch on your child if they're near or in the water.
• Have your kids take swimming lessons.
• Before engaging in a water-related activities, set expectations and rules with your kids.

Mark Ralston / AFP/Getty Images

A school cafeteria worker hands out fruit and drinks to school children at the Normandie Avenue Elementary School in South Central Los Angeles on Dec. 2, 2010, the same day Congress passed The Healthy Hungry-Free Kids Act.

It may not sound like much but there’s a new item on the school menu: water.

Across the country, administrators are scrambling to comply with a new federal requirement that free drinking water  be offered at lunch as part of an ongoing push to improve the health of the nation’s 49 million public school children.

The solution isn’t as simple as pointing kids toward the nearest water fountain. Just ask Brian Giles, food services senior administrator at the Houston Independent School District, the nation’s seventh-largest district, with more than 202,000 students and almost 300 campuses:

“The majority of our schools do not have drinking fountains or ready access to water in the lunchroom,” he said.

To comply, he’s spent $60,000 to buy 3.5-gallon water coolers for each school cafeteria. In the lunch line, students can choose milk or juice, or a cup for water.

“Every kid needs access to water,” he said. “It would have been nice if the feds allocated some money for it.”

The mandate comes as schools struggle with budget cuts amid growing concern with childhood hunger and obesity. In December, President Barack Obama signed The Healthy, Hunger- Free Kids Act, which includes the provision that schools make water available at no charge during lunch.

Experts say water is the ideal drink for kids already drinking too many high-calorie, sugary drinks.

Like Houston, schools in Atlanta are putting out water coolers and making cups available. Other districts have invested in costlier water stations where students can fill cups or bottles.

 “We’re looking at what is the most cost-effective, practical and environmentally –sustainable way to provide water to our students,” said Seattle Public Schools spokeswoman Teresa Wipple. For now, the district puts out pitchers and cups in the cafeterias of its 94 schools.

While bringing more water into schools is a good idea, researchers say it’s only part of the solution to combating obesity.

“It’s a step in the right direction but it’s going to take more than that,” said Lindsey Turner, a senior research specialist at the Institute for Health Research and Policy at the University of Illinois at Chicago.

As the lead author of a 2010 study, Turner found almost half the nation’s public elementary school students could purchase soda, sport drinks and higher-fat milk during the 2008-2009 school year from vending machines, school stores and a la carte lines.

Getting students to drink the water is another challenge.

“We’re not seeing a lot of demand for it,” Giles said.