Lying in your arms, the squalling bundle quiets. The odd-colored eyes fasten upon your bleary ones and the connection is made. As you exchange that long speculative look with your new child, a series of random thoughts percolate through your exhaustion. The first one (how funny-looking the infant is, wrinkled, lopsided, and red, almost ugly but, you add quickly, no doubt will improve with time) is gradually replaced by the initial urges to protect this helpless creature from the ills of our world.

Some of the dangers are too great. What can a parent do against terrorism, global warming, and nuclear threats? Some are inexplicable. What is the cause or cure for violence in the schools, racial unrest, economic uncertainty, or political shenanigans? Some things we leave to God's will or the roll of genetic dice. What good is it to worry about cancers, diabetes, or cystic fibrosis? These things, over which parents have no control, we can only hope to deal with if, heaven forbid, they happen.

So we protect in the ways we can. We teach them to look both ways before crossing, not take candy from strangers, and wash their hands before eating. We screen our caregivers, research the best pediatricians, avoid stray dogs, and keep our children well nourished, adequately housed, and clean. Parents do these things with the admirable intention of raising healthy happy kids to become healthy, independent adults.

Since WWII, the public has demanded answers from medicine, manifesting a better destiny for our children. In our lifetimes, infant mortality has dropped and families no longer expect to lose a child or two from childhood maladies. Vaccines, antibiotics, and other advancements in pre- and neonatal care have eliminated so many of the killers of yesteryear.

Why then are we losing the battle with asthma? The incidence of this disease is at levels never before seen - and rising.

Fifteen million Americans suffer from asthma, nearly half of them children. About 5000 die annually. In some Bronx neighborhoods up to twenty percent of the residents may be affected. In Australia one in four children have symptoms. Other industrialized regions, Western Europe, New Zealand, Hong Kong, South Africa, Singapore, and parts of South America, are struggling with similar epidemics. The number of afflicted has doubled in the past thirty years.

Asthma is a severe allergic reaction that causes wheezing, bronchial inflammation, and increased mucus production. The disorder is chronic, requiring constant vigilance and a pharmacopoeia of drugs, sprays, and paraphernalia. Frequent hospitalizations and prolonged periods of acute illness requiring bed rest interfere with the most basic aspects of normal life. Often the medicine leaves the patient feeling tired, disoriented, and detached. Though varying in severity, the disease's effects wear people down emotionally and physically. Lost school days, absenteeism from work, and limited abilities to engage in recreational pastimes contribute to a fatalism in the victims and their families, which increases noncompliance. If the disease fails to separate, debilitate, or isolate, the constant treatment does.

The unexpected onslaught of symptoms in otherwise healthy children generates the questions of 'How?' and 'Why?' as parents struggle to understand this disease.

Some grassroots organizations blame the disease on childhood immunizations, but this ignores the greater danger of the diseases vaccinated against. Others cite manufacturing pollutants, however many industrialized regions have low rates of asthma.

Researchers are discovering that, like the mysterious malady itself, the etiology is complex. A hundred years ago only the children of the wealthy exhibited symptoms that could be the forerunner of today's asthma. What do the privileged of the 1900's have in common with the sufferers of today?

Cleanliness. With the advent of suburbs, more children have been sequestered from the normal dirt of country living. As our children spend more time indoors, they are underexposed to allergens, bacterial endotoxins, and airborne viruses.

As with the children of the wealthy at the beginning of the 20th century, ours are not encouraged to engage in strenuous outdoor play. This exertion resulted in deep breathing that, in addition to stimulating the lungs and expelling excess mucus, drew in multitudes of nonpathogenic microbes. These harmless germs taught the budding immune system how to fight, while not causing more than sniffles.

In recent years, antibacterial soaps, lotions, and detergents have rid our homes of the last vestiges of these beneficial microorganisms. Overuse of antibiotics has robbed fledgling immunities from even the slightest challenges. Instead of developing the Th1 response to invading specks, which is a specific antibody tailor-made for the germ, the body relies on the Th2 cascade of biochemical-warfare, histamines and inflammation. This protection, though useful for expelling parasites, causes the symptoms most commonly associated with asthma.

Affluence. Our homes are snug against drafts, which would cleanse the air and allow those friendly microbes easier access to our lungs. The carpets, closets full of clothing, beds piled with blankets or quilts, the upholstered furniture, and abundant food, while making our lives more comfortable, also harbor dust mites and cockroaches. These long-time companions of civilization are responsible for a number the allergens that trigger asthma in the modern home.

Genetics. Certain ethnic groups develop the symptoms earlier and with increased severity. The Black and Hispanic populations in the US demonstrate a gene that researchers believe may be responsible for a predisposition to asthma. Boys and premature babies are at increased risk.

Can we protect our children from asthma?

Yes. Although a cure is not in sight, prevention is possible.

Nearly all members of the Hutterite religious sect possess the 'asthma' gene but only a few suffer from even mild symptoms. Lessons from their lifestyle may provide the answer to the greater problem.

Socio-economic profiles in city settings indicate that the ethnic groups at the greatest genetic risk of developing full-blown symptoms are the ones most likely to give newborns formula or cow's milk, unlike the Hutterites who breastfeed. Nursing infants for a minimum of four months supplements the natal immune system with immunoglobulins. Complete avoidance of solid foods, especially cow's milk, during this period will help prevent exposure to common food allergens.

Though the Hutterites don't forbid modern medicine, they rarely seek it for mild illnesses and allow simple fevers to run the course without oral antibiotics. Though it is contrary to our instincts to let our children be sick without seeking a quicker cure, those minor discomforts are stepping-stones to long-term immunologic health.

Hutterite children are farm kids. They work beside their parents, play strenuous games, and are stimulated from birth with dirt- and airborne non-pathogenic organisms. Our kids must experience the outdoors, in preferably rural settings, and be encouraged to higher levels of activity that will expand their lungs. The Hutterites spend time in large family gatherings, putting children with other children, trading germs. In this instance, daycare may actually be a beneficial situation for the city-bred child. A recent study in Germany supports this, citing far lower rates of asthma in children who attended daycare at an early age. A similar survey in the US indicates that those children with older siblings, and those who were placed in group-care settings were 40 percent less likely to experience wheezing than ones who didn't.

The sect rejects the trappings of affluence and embraces a simpler, spartan decor. Decreasing clutter in our homes by removing carpets, choosing laminate flooring, and discarding unused clothing, will reduce the habitat for insects, dust, and molds.

The examples are there, waiting for us to embrace the model.

In our quest for the cleanliness of brick and concrete, we've abandoned the soil beneath it. In our search for the best and most convenient, we've forgotten the basics. Though we all can't go back to farming, nor can everyone live in the country, we should stay in touch with our beginnings. Asthma is the reminder of where our roots need to be.

Children can't be Scotch-guarded or raised in hydroponics.

Let them get dirty.

1. Breastfeeding May Prevent Asthma, BBC
2. Dirt Could Be Good for You, BBC
3. Bacteria By-products May Protect Infants, Lung Line, National Jewish Medical and Research Center
4. Too Clean for Our Own Good?, Thought You Should Know Network
5. Does Civilization Cause Asthma? The Atlantic
6. Daycare Could Be Good for Children's Health, HealthCentral.com
7. Asthma in Children, Mother Spirit
8. Child's Plague, The Sierra Club