Family Health and Nutrition

A new study conducted by researchers from the University of Georgia is exploring the long-term health benefits associated with paid maternity leave. 

Their study compared health outcomes from Norwegian women who had given birth prior to and following national regulations that mandated paid maternity leave. According to their findings, women who had more time at home after giving birth -- and were paid during that time -- were healthier at middle age than women who had to go back to work sooner after childbirth. 

“We know that women are healthier at 40, but we don’t know exactly why,” said researcher Meghan Skira. “We did not find significant changes in income or employment among the women who had access to the reform, so the health improvements are unlikely due to income effects. We speculate that a reduction in stress, more time to recover from childbirth, and perhaps breastfeeding play a role. More research on exactly why maternal health improved would be valuable.” 

Seeing improvements in middle age

Using the July 1977 paid maternity leave legislation in Norway as a starting point, the researchers compared middle-aged health outcomes of women who gave birth both before and after those regulations were implemented. The team analyzed differences in metrics like pain levels, cholesterol, exercise routines, and mental health, among several others. 

“In a typical observational study, you would be worried that those who take more leave are different in ways that might make their health better or worse,” said Skira. “Those who take longer leave may be wealthier or have more family support. On the other hand, those who have more postpartum health problems may take more leave. But here, because there is this sharp change in access to paid leave for everyone, the concerns about selection into leave-taking are minimized.” 

After looking at the data, it was clear that the women who had gotten longer paid maternity leave had better health outcomes by the time they reached age 40. They were 20 percent more likely to exercise, had nearly 4 percent lower body mass indices (BMIs), and were 18 percent less likely to smoke than the women who had given birth prior to this legislation. 

While all of the women benefited from these policies, the researchers explained that women in lower-income households saw the greatest changes. Prior to this legislation, the need for a consistent paycheck would’ve forced many women back to work earlier after childbirth; however, having this kind of security made a serious difference in their long-term health. 

“This sharp change in who was eligible for paid maternity leave provides a nice natural experiment,” said Skira. “Our findings show that having access to paid leave leads to important health benefits for mothers around age 40.” 

Broadening the scope of these policies

Though these findings focus on Norwegian health care mandates, the researchers hope that both consumers and legislators around the world recognize just how powerful policies like this can be for the long-term health and wellness of all women. 

“While things have changed since the 1970s, understanding the effects of this policy change is important since it extended leave benefits from a level similar to what the U.S. offers today under the Family and Medical Leave Act,” Skira said. “Our results, therefore, may inform the current debate over family leave policy.” 

The importance of sleep cannot be understated for any consumer, but researchers from the University of Warwick say that it’s especially important for developing children.

In a recent study, the team linked several negative mental health issues and cognitive problems with lack of sleep, including increased anxiety and depression. They say that getting adequate amounts of rest is especially important for children between the ages of 6 and 12 because their brains are still developing. However, there are some hurdles that parents will need to address to make sure their young ones are getting enough sleep.

"The recommended amount of sleep for children 6 to 12 years of age is 9-12 hours. However, sleep disturbances are common among children and adolescents around the world due to the increasing demand on their time from school, increased screen time use, and sports and social activities,” said University of Warwick professor Jianfeng Feng.

Parents can help by being proactive

Previous studies have gone into depth about children’s need for sleep, but the researchers reaffirmed those findings by analyzing data from over 11,000 children. They found that shorter sleep durations were strongly linked to negative health and behavioral outcomes.

"Our findings showed that the behaviour problems total score for children with less than 7 hours sleep was 53% higher on average and the cognitive total score was 7.8% lower on average than for children with 9-11 hours of sleep. It highlights the importance of enough sleep in both cognition and mental health in children," said Feng. 

The team notes that more research needs to be conducted to find the underlying issues connected between mental health and sleep, but parents can be proactive by setting stricter curfews and limiting technology before bedtime. This is true even for older children and teens.

“Even though adolescents start gaining self-sufficiency and independence, they still need sleep and might not prioritize that if left to their own devices,” said Ronald Rogge, a researcher and professor at the University of Rochester. 

Exposing children to a variety of healthy foods–starting as early as possible–can help promote healthy eating habits into adulthood, new research shows.

Following a review of data gathered from more than 40 peer-reviewed studies on how infants and young children develop preferences for healthy foods, researchers concluded that familiarizing kids with a variety of healthy foods starting very early helps to lay a foundation for healthy eating habits later in life. 

Starts during pregnancy 

The road to getting kids to enjoy healthy foods can begin even before the child is born, researchers say. 

Women who stick to a healthy diet while pregnant expose the child in utero to the flavors of healthy foods via amniotic fluid. Once the child is born, moms who breastfeed pass on the flavors of the healthy foods they eat through their breast milk. 

In addition to helping familiarize the baby with specific flavors, these early exposures can help infants become accustomed to the experience of variety. Familiarizing infants’ palates with the flavors of various healthy foods can help set the stage for when they’re ready to graduate to solid foods.

Early exposure is important

When children are slightly older, it’s just as important to continue exposing them to a variety of healthy foods like vegetables and fruits. 

In an interview with ConsumerAffairs, lead author Stephanie Anzman-Frasca, assistant professor in the pediatrics department at  the University at Buffalo Jacobs School of Medicine and Biomedical Sciences, explained that “neophobia” -- or a fear of new foods -- is a normal part of children’s development.

Kids’ reticence to try new foods changes over time, she said, adding that neophobia is lower during infancy and increases from there, making early life a great opportunity to promote the acceptance of new foods.

Persistence is key

While taking advantage of periods of low neophobia is easier on parents and likely to yield better results, Anzman-Frasca says it’s not too late to expose children to new foods in early childhood and beyond.

Cajoling kids into eating healthy foods they initially rejected can be a challenge for many parents and caregivers. However, given the critical importance of healthy eating behaviors later in your child’s life, the authors encourage parents not to give up–especially on an entire category of healthy foods, like vegetables.

“As they develop, children may go through phases where they suddenly like foods they previously wouldn’t touch, or don’t like foods that used to be their favorites,” Anzman-Frasca said. “So, we would recommend continuing to make a variety of healthy foods available and continuing to test out these different strategies that are supported by research.” 

Getting kids to eat healthy foods

Repeated exposure is generally an effective strategy for getting kids to eat specific healthy foods, she says, but there are other strategies parents can try in challenging circumstances. 

Anzman-Frasca and her colleagues recommend the following strategies: 

• Flavor pairings. New foods are paired with an already-liked food over multiple occasions to increase the taste for the new food on its own.
• Modeling. Children can eventually learn to like new foods after watching parents, siblings, or peers enjoying them. 
• Small tastes. Setting up a low-pressure environment can help too. Encourage the child to take a small taste of the food as opposed to pressuring him or her to finish a whole portion. “In this kind of setting, a child might just decide that today is the day to taste and like a green bean,” said Anzman-Frasca.

The study has been published in the journal Obesity Reviews.

Convincing kids to try new foods or eat more fruits and veggies can be a struggle, but a new study suggests there’s a way to get preschoolers to eat healthier -- and it doesn’t involve bargaining or pleading.

Simply making mealtimes a positive experience can prompt little ones to make healthier food choices, according to a study from the University of Illinois.

Researchers say a happier emotional climate during meals allows kids to become more receptive to the idea of trying healthy fare they may not have tried before.

Role of positive emotions

For the study, 74 parents of preschool-aged children answered two questionnaires about mealtimes over the course of two years. The researchers also conducted a home visit to observe the family’s mealtime behavior, looking closely at the positive and negative emotions expressed by both parents and their children.

Ultimately, it was discovered that a more pleasant mealtime atmosphere had a positive effect on what children ate. Children whose families expressed more positive emotions at mealtime ate about one serving more of healthy food (fruits, vegetables, and soy-protein products).

"Having more positive mealtimes, where people are enjoying themselves, where there's mutual warmth and engagement, makes it a little bit easier for children to approach healthy foods," said lead author Jaclyn Saltzman, a doctoral candidate in the department of human development and family studies at the University of Illinois.

Impact of negativity

On the other hand, the researchers found that negative emotions tended to put a damper on kids’ willingness to try new things.

"When you have a negative family mealtime, you don't want to sit there and try a new thing, enjoy a new texture, or cajole your child into trying something new. You just want to get through it," Saltzman explained.

But what if parents aren’t in the mood to put on a happy face at mealtime? There are still a few ways to generate positive emotions, say the study authors.

Creating a pleasant climate

"First of all, I wouldn't tell parents to just be more positive, to just slap a smile on your face, because in the face of a picky-eating preschooler or any other mealtime challenge, that's just not going to work," Saltzman said. "But there are several things parents can do."

Here are a few ways parents can improve the mealtime climate:

• Be clear about expectations. Make sure your kids know what is expected during meals by engaging in clear and direct communication about what is and isn’t appropriate mealtime behavior.

• Don’t force food introductions. While establishing healthy eating behaviors early on can pave the way for healthy eating habits later in life, Saltzman says parents shouldn’t force it. Encourage your kids to try new foods, but know that if they still don’t like it after several exposures it may be time to move on.

• Remind kids to use their words. Screaming doesn’t exactly lend itself to a positive mealtime atmosphere. Encourage your children to express themselves with words rather than screaming when they are upset.

• Stay calm. Breathing exercises, like mentally counting to 10, can help moms and dads keep their own emotions in check.

• Establish a routine. Parents should try to have meals in the same place and at the same time each day (when possible) to establish a routine.

• Get kids involved. Give children age-appropriate jobs, such as having an elementary-aged child set the table. The study also found that having kids participate in the meal planning and preparation process translated to more positive emotions during meals.

The study was published in the Journal of Pediatric Psychology.

Eating a healthy breakfast has been associated with everything from maintaining a healthy weight to improved academic performance. Yet, nearly half of all families in the U.S. regularly skip breakfast, according to the American Academy of Pediatrics.

When morning meals get lost in the shuffle, children may miss out on vital nutrients that can keep them going strong throughout the day. A healthy breakfast is essential for kids, says Carole Adler, a dietician at the Food and Drug Administration (FDA).

“Growing bodies and developing brains need regular, healthy meals,” she says.

But between rushed mornings and picky palates, creating healthy breakfasts can be a challenge. To help parents strike a healthy balance of fruits and vegetables, proteins, grains and dairy at breakfast time, consider implementing the following tips.

Tips to start the day off right

• Think outside the box. Breakfast doesn’t have to be comprised of traditional breakfast foods, says Adler. From last night’s leftovers to tuna fish with celery on a whole wheat English muffin, anything goes as long as you maintain a healthy balance.

• Cater to your child’s likes. Take a food your child loves and dial up its nutritional value. Pizza can be made using a whole-grain crust and topped with veggies; muffins can be made with zucchini and carrots and topped with peanut butter for protein; and a small amount of your child’s favorite sugary cereal can be mixed with a healthier brand of cereal.

• Maintain nutritional balance. Make sure your child doesn’t end the day lacking in one particular food group. If their breakfast doesn’t contain enough vegetables, consider preparing an afternoon snack that will have plenty (such as carrot, celery, and broccoli sticks with hummus dip).

• Fuel growth and activity. Growth and activity levels should be taken into account when preparing breakfast. To help growing kids stay full and focused until lunch, give them a breakfast that contains protein, fat, and carbohydrates. Protein choices might include an egg, some nuts, a slice of deli meat or cheese, or yogurt.

• Prepare a healthy snack. If there is no time for a sit-down breakfast, hand your kids something healthy to eat on-the-go as they head out the door. Adler recommends trail mix, a fruit-filled shake with milk or yogurt, or a whole-wheat tortilla spread with peanut butter or almond butter and a carton of milk.

• Prep the night before. Taking a few minutes at night to prepare the next day’s breakfast can help make a busy morning less rushed. Preparatory efforts can include chopping up fruit to layer in a yogurt parfait or add to cereal, cutting up vegetables for an omelet, or mixing up muffin or whole-grain waffle batter to put in the fridge.

The combination of warm weather and children heading back to school creates a perfect environment for lice outbreaks, and common misconceptions about head lice may put more kids at risk.

Dr. Patricia Brown, a dermatologist at the FDA, says the number of lice cases seems to peak when kids go back to school in the fall and again in January. When children play closely together, scalp-dwelling lice are given ample opportunities to move from one child to the next.

Regular head-to-head contact means the threat of head lice is much greater -- and contrary to myth, lice don’t prefer hosts with poor hygiene. In fact, lice are attracted to clean, healthy hair.

Identifying lice

While you might think itching is a tell-tale sign your child has lice, experts say only about 30 percent of people itch when they have lice. The best way to identify lice is to conduct regular checks.

Brown recommends checking for head lice or nits by parting the hair in several spots. To help spot the sesame-sized critters, you can use a magnifying glass and a bright light. Nits (lice eggs) tend to be easier to spot and typically look like dandruff stuck to hair follicles, Brown explained.

If nits or lice are spotted, the next step is to begin the treatment process. The FDA advises against using insecticide sprays or fogs, stating “they are not necessary to control head lice and can be toxic if inhaled or absorbed through the skin.”

FDA-approved treatments for head lice include both over-the-counter and prescription drugs, such as Nix and Rid -- but be sure to read the label before purchasing head lice products to treat a very young child, since many are not for use in children under the age of 2.

Prevention tips

Head lice are the second highest cause of school attendance issues in the United States – between 6 and 12 million U.S. kids get head lice each year. To prevent a lice outbreak, it’s important to teach kids how to avoid coming into contact with them in the first place.

Teach children to avoid head-to-head contact during play and other activities at home, school, and elsewhere (sports activities, playgrounds, slumber parties, and camps) and not to share clothing, hats, hair accessories, helmets, headphones, and other supplies.

If a lice outbreak does occur, the FDA recommends taking the following steps to help control the spread of lice:

• Disinfect combs and brushes used by a person with head lice by soaking them in hot water for 5 to 10 minutes.

• Do not lie on beds, couches, pillows, carpets, or stuffed animals that have recently been in contact with a person with head lice.

• Machine wash and dry clothing, bed linens, and other items used by the person with lice using hot water and a high heat drying cycle. Clothing and items that are not washable can be dry-cleaned or sealed in a plastic bag and stored for two weeks.

• Vacuum the floor and furniture, particularly where the person with lice was sitting or lying down.

• After finishing treatment with lice medication, check everyone in your family for lice after one week. If live lice are found, contact your health care professional.

Your child’s health is in your hands when they’re under your roof, but the torch gets passed when they head off to school. For this reason, it’s crucial to make sure your child’s school environment has all the elements needed to help them thrive.

"Children spend a significant part of their day in school, and so the school environment is really important to their overall health," said Dr. Sandra Hassink, medical director of the American Academy of Pediatrics (AAP) Institute for Healthy Childhood Weight.

To pave the way for learning and growth, every child needs a nutritious diet, enough exercise, sleep, protection from illness, and security in the fact that their environment is a safe place.

You may be confident in your ability to provide these elements at home, but it’s also important to make sure your child’s school is up to the task of creating a healthy, nurturing environment for learning.

Elements to look for

The AAP recommends giving your child’s school a check-up to make sure it has the following elements:

• Healthy food. Kids consume between 35 to 40 percent of their daily calories while at school. And while most schools serve healthy, balanced lunches under the Healthy, Hunger-Free Kids Act passed in 2010, it’s important to make sure your child’s school doesn’t veer into unhealthy territory with regard to informal snacks, beverages, and treats.
• Daily recess. Designated time for unstructured play is fundamental for children’s social, emotional, physical, and cognitive development, says the AAP. Make sure your child’s school allots daily time for play and physical activity.
• Safe routes to school. Your child should be safe whether they travel to school by foot or on wheels. If your child walks to school, make sure the route has crossing guards at every intersection. If they ride the bus, ensure the bus has safety restraints.
• Reasonable start times. A brain that is well-rested will be much better at absorbing new information. To make sure kids (especially teens) are able to get enough sleep, the AAP recommends that middle and high schools start no earlier than 8:30 AM.
• Protection from disease. Ensure your child’s school has achieved “community immunity” by having a high percentage of immunized people. This can help prevent your child from catching a contagious disease like measles, chickenpox, or whooping cough.
• A school nurse. Make sure your child’s school employs a full-time professional school nurse, especially if your child has a chronic health issue like ADHD, allergies, or asthma that requires management.
• Freedom from bullying and teasing. Your child shouldn’t have to fear being bullied or teased when they step onto the school bus or walk through the doors of their school. To make sure your child’s school environment is a safe space, the AAP recommends making sure it has a firm policy against bullying and teasing.

Mild, short-term “baby blues” are considered normal in the first week or two after giving birth. In fact, it is thought that around 75% of newly minted moms experience feelings of anxiety and moodiness after childbirth.

However, women who suffer from severe postpartum blues are the most likely to go on to have full-blown postnatal depression. Now, researchers say a special supplementation regimen may help banish temporary baby blues and lower the risk of longer-lasting postpartum depression.

In a study, women who took a combination of fruit-based supplements containing amino acids and antioxidants experienced no drop in their mood on day five after giving birth, when postpartum blues peak. Those who didn’t take the supplements had showed a “robust” increase in their depression test scores.

Wards off temporary sadness

The supplements -- which contain blueberry juice with blueberry extract (antioxidants) and the amino acids tryptophan and tyrosine -- were designed to “address specific changes that temporarily occur in the brain,” said Dr. Jeffrey Meyer, co-author of the study.

Feelings of sadness in the earliest days of motherhood are thought to arise from a surge in levels of a brain protein called monoamine oxidase (MAO-A), the researchers explained. MAO-A is the brain protein responsible for breaking down mood-related brain chemicals, including the 'feel-good hormones' serotonin, norepinephrine, and dopamine.

“We believe this is the first study to show such a strong, beneficial effect of an intervention in reducing the baby blues at a time when postpartum sadness peaks,” Meyer said in a statement.

Further research needed

The key ingredients in the supplements were not shown to increase levels of tryptophan or tyrosine in breast milk. But while the initial trial may have produced promising results, Meyer stressed that “people should wait until the regimen is approved for general use rather than trying it themselves.”

Meyer and his colleagues at the Center for Addiction and Mental Health (CAMH) say the study’s results could have been thrown off by a “placebo” effect. 

The study of 41 women was published in the journal Proceedings of the National Academy of Sciences.

Childhood obesity rates have seen a dramatic increase over the past 30 years, and it’s not just genetics that may raise a child’s risk of becoming obese. Behavioral and environmental factors can also make a child more susceptible to developing excess body fat.

The food choices kids make can greatly impact their overall health. As kids get older, it becomes even more important for them to understand what’s in their food. That’s why the FDA wants to help kids learn how to read nutrition labels.

Information listed on Nutrition Facts labels can be difficult for kids to understand. But in teaching kids how to read food labels, parents can arm them with a better understanding of how their food may affect their health.

Label-reading tips

September is National Childhood Obesity Month. Here’s how parents and caregivers can help young people learn how to read food labels.

• Check the serving size. First, adults should teach kids that all information listed on Nutrition Facts labels is based on one serving of food. It’s important to note, however, that foods often contain more than one serving. Sticking to the serving size is a crucial element of keeping calorie intake in check.
• Look at the calories. Obesity is caused by caloric imbalance, or a failure to balance calories consumed with calories expended. Preventing an imbalance from occurring can be achieved by considering the calories in food. The FDA notes that 400 calories per serving in a single food item is too high; 100 calories is moderate.
• Watch out for certain nutrients. Not all nutrients should be consumed in large quantities. Saturated fat, sodium, and added sugars are on the list of nutrients kids should get less of. Teach kids to look for Percent Daily Values (%DV) of 5% or less of these nutrients. Anything over 20% DV is too high.

What's safe for babies? Not formaldehyde, which is known to cause cancer in humans. And yet, a new report alleges that formaldehyde is present in more than half of a line of cleaning products that's promoted as being safe for babies.

BabyGanics describes its products as “so safe that you can even drink them” and in a video posted online, a company spokesman drinks from a bottle of a BabyGanics cleaner.

The Environmental Working Group (EWG) says the stunt is "a dramatic illustration of why it is essential that makers of cleaning products fully disclose their ingredients on product labels."

In its Guide to Healthy Cleaning, EWG gave an "F" grade to a number of BabyGanics products because of potentially hazardous ingredients and poor labeling 

The BabyGanics line is sold by national retailers such as Babies R Us and Bed, Bath & Beyond.

After the company contacted EWG and protested its grades, it agreed to post a full ingredient list on its website. This list, in turn, revealed that more than half of its products contain a preservative called HHT (Hexahydro-1,3,5-tris(2-hydroxyethyl)-s-triazine), which releases formaldehyde during product use. As a result, those products will continue to be graded “F” on the EWG guide until their formulations are changed.

BabyGanics took issue with EWG's findings. "Scientific evidence shows that HHT is perfectly safe as it was used in the 6 BabyGanics cleaning products: it does not release formaldehyde," the company said in a statement to ConsumerAffairs

"Further, no BabyGanics product manufactured today contains HHT, and HHT has never been used in any of the 30 plus BabyGanics personal care products," BabyGanics said.  

The company said that, although "scientific evidence shows the ingredient is perfectly safe as it was used, BabyGanics had already moved before EWG’s comments to replace the preservative containing HHT in our surface-cleaning products."

The company said it replaced it with "an equally efficacious and safe preservative that may be more attractive to consumers."

Parents beware

“Consumers should be wary of products that release formaldehyde because it is a carcinogen that experts believe is unsafe even in small amounts,” said Johanna Congleton, a senior scientist at EWG. “It would be hard to find anyone, especially parents, who believe it’s acceptable for products marketed as safe to use around babies to contain a substance known to release a known human carcinogen.”

The BabyGanics revelation is a dramatic reminder that consumers cannot take companies’ labeling and marketing claims at face value.

“As a mother of two young children, I am shocked that companies don’t have to tell consumers what’s in their cleaning products,” said Heather White, EWG’s chief of staff and general counsel. “So many families buy these products because they think they are safe, when in fact they contain chemicals that could pose serious dangers, including cancer.

"My advice to consumers is simple – don’t buy products labeled only with generic terms like ‘surfactants’ or ‘preservatives.’ Companies need to tell us exactly what’s in the products they’re selling. We have a right to know what chemicals we’re bringing into our homes in the products we buy. And EWG’s Guide to Healthy Cleaning was created to help consumers exercise that right.”

EWG’s guide has highlighted how many cleaning products contain toxic chemicals and how difficult it is for even careful consumers to find out exactly what’s in them. Many companies use generic names like “surfactants” and “mineral salts” to describe some of their ingredients. Current federal law does not require disclosure of ingredients on the vast majority of cleaning products.

EWG’s rating system and the information provided by the guide is challenging other companies to reevaluate what they put in their products and to detail that information on their product labels and on their web sites.

"Today's landmark settlement is a success story showing how Proposition 65, California's premier right-to-know law, protects our families and communities from the health risks resulting from exposure to toxic chemicals in our environment," said California Attorney General Bill Lockyer.

"The power of the law is stimulating the costume jewelry industry to employ methods to reduce and eliminate lead from their products in order to avoid having to warn consumers about the health risks."

The settlement requires defendants to meet new standards for lead-free and low-lead jewelry and to meet those standards as quickly as possible, but no later than 2008. After that date, they are required to halt sales in California of any product not meeting these tough new standards for lead content.

Lockyer filed the lawsuit in June 2004, alleging defendant retailers violated Proposition 65 by failing to warn consumers about the health risks of exposure to the lead contained in certain jewelry. Proposition 65 requires such warnings when consumers are exposed to substances known by the state to cause cancer or reproductive harm.

In December 2004 the retailers agreed to mediate. A group of 38 jewelry distributors voluntarily joined the mediation and are joining the settlement.

The defendants have agreed to pay a total of $1.7 million, including $100,000 in civil penalties; $250,000 for a jewelry testing fund; $325,000 to educate consumers about the health risks from exposure to lead and other heavy metals; and the remainder in attorneys' fees. Other companies will have the ability to join in the stringent standards of the agreement in order to avoid potential liability.

Lockyer was joined in the settlement by the Center for Environmental Health and As You Sow, private parties that initially filed 60-day notices with the Attorney General's office notifying their intent to sue under Proposition 65.

Lead has been listed under Proposition 65 since 1987 as a chemical that can cause reproductive harm and birth defects, and has been on the list of chemicals known to cause cancer since 1992.

The state's testing found high levels of lead in both the metallic and non-metallic components of the jewelry targeted in the case. The amounts were well above the level that triggers the requirement to provide a Proposition 65 warning to consumers.

Exposure to lead occurs chiefly from ingestion, such as eating or putting objects into the mouth, putting young children particularly at risk. Teenagers also can suffer adverse effects, which include brain damage, kidney damage, hearing loss, and impaired growth.

Companies that entered the settlement include Burlington Coat Factory, CBI Distributing, Claire's Boutiques, Claire's Stores, Express, Federated Department Stores, J.C. Penney, KMart, Macy's West, Mervyn's, Nordstrom, Ross, Sears, Target and Toys R Us. Remaining as litigants are Wal-Mart, Jordache, Cornerstone Apparel (Papaya stores), the Gerson Company, and Royal Items.