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Black Cohosh |
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Black Cohosh |
By Lennard J. Davis
Many common childhood ills—like ear infections, head colds, and stomachaches—can he treated safely and effectively with natural alternatives to conventional medicine. Here's what you'll need to know to keep your kids healthy, naturally.
As advocates of natural healthcare and the parents of two children, my wife and I have faced a health-care dilemma over the years. Bella and I maintain our own health and treat our own discomforts using a combination of good nutrition, herbs, and other natural remedies. But what about our kids? Should we use the same methods with them? Or should we turn to conventional medicine, including antibiotics, decongestants and other drugs?
The answer is a case-by-case integration of alternative and conventional medicines. For example, when our baby daughter woke up one morning with a temperature of 101.8 degrees, we called our pediatrician. He told us to bring Francesca to the hospital immediately for what seemed to us a frightening set of procedures: a spinal tap, three days of intravenous antibiotics, and a battery of blood tests and X rays. These procedures were necessary, the doctor said, because a baby exhibiting Francesca's symptoms was in danger of developing sepsis, a potentially life-threatening bacterial infection.
After much soul-searching and a lengthy discussion with the doctor, we decided to follow his advice. The way we saw it, we simply had no choice. But we did negotiate with him to spare the X rays and to allow our baby to leave the hospital a day early. And although most cases are not as dramatic as ours, each day thousands of parents must make similar decisions. Fortunately, there are reliable and effective natural remedies for many of the common illnesses of childhood. The key to using them is to read your child's symptoms accurately, to know about the uses of various remedies, and, most important, to communicate effectively with your child's doctor.
Henry Hochberg, M.D., a holistic family physician in Edmonds, Washington, suggests that parents interested in using natural remedies should examine their own belief systems before seeking treatment for their children. "Parents get into trouble when they have a rigid mind-set, either demanding antibiotics for every childhood ill- ness or categorically refusing them." Instead, he says, parents should keep an open mind about treatment options, which will open communication and build a relationship of trust with their child's doctor.
When planning a healthcare strategy, Hochberg advises parents who take their children to an alternative healthcare provider to also engage a pediatrician. This allows parents to handle most of their child's care naturally, but also provides a necessary measure of insurance. "What is dangerous," says Hochberg, "is [using] an alternative practitioner who does not know how to recognize serious pathology."
Janet Zand, LAc., O.M.D., one of the primary authors of Smart Medicine For A Healthier Child (Avery Publishing Group, 1994), also advocates a complementary approach to children's healthcare. Natural healing therapies and conventional medical treatment, she contends, "can—and should—work together."
Each approach to healing, Zand explains, has its place: "Conventional medicine generally works with drugs or surgery to suppress or correct a specific condition. And sometimes, that is exactly what is needed. At other times, however, a natural approach makes more sense."
Natural medicine works by supporting the child's body in healing itself, and thus addresses the whole body, not just the symptoms it's exhibiting. For instance, while antibiotics fight an infection by killing harmful bacteria, many alternative remedies boost the immune system so that the child is better able to resist infection furthermore, Zand says, while over-the-counter (OTC) or prescription medicines can make you feel better—suppressing a cough or relieving congestion, for example—they can produce side effects, such as restlessness or insomnia.
Most childhood illnesses are not life threatening, and will run their natural course without causing any lasting problems. And in most cases, parents can help their children through these illnesses with natural remedies, both safely and easily.
However, parents must remain alert to the signs that a child's illness requires more serious intervention (see box below). Here are some tips for handling five childhood illnesses naturally.
Colds and Flu
No childhood would be complete without runny noses, coughs, aches and pains. Experts estimate that kids under six, with their immature immune systems and frequent contact with other children, catch roughly seven colds a year. A typical bout with the common cold lasts two to five days, and is marked by symptoms like a stuffy or runny nose, coughing, sore throat and sneezing. Symptoms of influenza include chills, headache, fever, exhaustion, and loss of appetite. A child whose symptoms come on suddenly and who has a temperature above 102 degrees probably has the flu. Typically, a bout with the flu lasts three to four days.
Despite the many advances of modern science, no one has yet found a way to cure these ailments—or to prevent them completely. All that a traditional medical practitioner can do is treat symptoms and wait for the infection to run its course, says Kenneth Jaffe, M.D., a family practitioner in Brooklyn, New York, "In many cases," he says, "we're really treating the parent—because often the parent doesn't like the fact that the kid's nose is stuffed, even if the kid might not mind."
Conventional medical treatment of colds and flu typically involves the following medications:
 | Cough suppressants, which repress the cough reflex by which the body brings up the mucus produced in the lungs in response to infection |
| Decongestants, which narrow the blood vessels in the sinuses and nasal membranes to reduce swelling and inflammation and decrease the amount of mucus produced in the nasal lining |
| Antihistamines, which dry out the nasal membranes and stop the secretion of mucus in the respiratory tract |
| Analgesics (like acetaminophen, the drug found in Tylenol, and ibuprofen, found in Advil), which reduce pain and lower fever. |
But these remedies can cause side effects and in some cases may even inhibit the body's ability to fight off a cold or flu. A cough that is productive—meaning it produces phlegm—is helping to rid the body of virus-containing mucus. Repressing a productive cough simply leaves this mucus where it is.
Natural medicine for colds and flu involves a different approach, using herbs, vitamins, and other nature-based remedies to help the body rid itself of the offending virus and soothe some symptoms. "Commercial antihistamines and decongestants are worthless against colds and flu," says Bob Rountree, M D., a family practitioner in Boulder, Colorado, and one of the authors of Smart Medicine for a Healthier Child. "I caution parents against using them. Antihistamines sedate kids, and over-the-counter remedies can perpetuate symptoms and interfere with healing."
Instead, Rountree recommends giving children a combination of herbs and vitamins, which will boost the immune system and make the child more comfortable for the duration of the infection. Here are some of his natural cold and flu remedies:
| Give your child lots of fluids to keep her from becoming dehydrated and to aid in the elimination of mucus; several herbal teas provide needed liquids as well as other benefits. |
Chamomile tea is relaxing (give one cup every few hours). Ginger tea helps to cleanse the body by
increasing perspiration (give a cup every four hours during the acute phase of a cold). Sage tea
will bring down a fever and help break up congestion (give one cup, up to three times a day, for
three to five days). Avoid giving your child dairy products, which can increase and thicken
mucus.
When to Call The Doctor
Following is a list of situations in which parents should seek immediate conventional
treatment for a child. Please note that this is not a comprehensive listing; talk with your
healthcare provider about your child's specific needs. Call the doctor:
If your child is between six months and three years old and is
running a fever of 102 degrees or higher If a child of any age has a fever and is unusually uncomfortable,
is in pain, complains of a stiff neck or headache, is sensitive to light, has difficulty
breathing, shows signs of dehydration (has bright yellow urine, sunken eyes, sheds fewer tears
when cry- ing), is listless, lethargic, or unusually sleepy If the thick nasal discharge of a head cold does not improve
after a few days If your child shows signs of respiratory distress (rapid breath-
ing, gasping, or bluish skin) in conjunction with a cold If your child is over three and is running a fever of 1 or 3 de-
grees or higher that does not respond within four hours to nor- mal fever control methods (for
example, analgesics, immer- sion in a tepid bath) If a child suffering from the flu develops a very high fever, has
a seizure, or shows changes in her level of consciousness or mental function If your child has violent, projectile vomiting If your child's vomit contains blood or if his vomiting lasts
more than a few hours and/or is accompanied by severe pain If your child has a bout of diarrhea that lasts longer than two
days (or persists intermittently for more than two weeks), has diarrhea that's accompanied by
severe or persistent abdominal pain, or if he has blood in his stool If your child has a strep infection (or has recently recovered
from one) and develops any of these symptoms: renewed f
ever, joint pain or swelling, muscle spasms, or a red, slightly raised rash on his neck, arms,
or legs If your child experiences sudden, severe pain in an infected ear,
accompanied by drainage from the ear If your child experiences fever, chills, dizziness, or serious
hearing loss in conjunction with an ear infection
If your child is under six months old and is running any fever or develops diarrhea (an
increase in stools or stools that are especially loose, yellow or green in color, or
foul-smelling)
| Zinc available either in lozenge or chewable tablet form_helps a child's immune system. Give her one dose a day for the first three days of a cold. Be careful not to exceed recommended doses; too much zinc can cause nausea and vomiting. |
| Give your child a dose of beta-carotene_ which will increase vi- tamin A production to help heal mucous membranes_twice a day for five to seven days. |
| Vitamin C, with its anti-inflammatory properties, is well-known for its ability to fight colds; give your child one dose, three times a day, for three days. |
| To give her immune system a boost, give your child one dose of echinacea (an antiviral herb) and goldenseal (an antibacterial that also soothes irritated mucous membranes), three times a day, for five to seven days. |
| Garlic has antibacterial properties and helps to detoxify the body. Give your child one capsule three times a day for a week. |
Fever
A fever is defined as a body temperature at least one degree above normal. A child typically will have a body temperature that fluctuates as much as two degrees, depending on things like his level of activity, the amount of clothing he's wearing, his stress level, and the time of day. A child's temperature, when taken orally, typically ranges between 96.8 and 99.4 degrees. Fever can be caused by many things: an allergic or toxic reaction (to a food or a bee sting, for instance), overexertion, or, most often, a bacterial or viral infection.
Conventional medical treatment of fevers typically involves:
| Analgesics, including the OTC drugs acetaminophen and ibuprofen, which relieve aches and pains and reduce fever. |
However, some experts argue that fevers are not necessarily bad. An elevated temperature is less hospitable to microbes and increases the production and efficiency of white blood cells. Thus, many doctors now discourage parents from trying too hard to lower a child's fever in most cases.
"There is some controversy about fever reduction," says Rountree. "Some people think that aggressively lowering a temperature may prolong the illness. But it's hard to argue against lowering a fever if you have a kid who is really out of it." When a child is feverish, for example, he may not be interested in eating or drinking; a fever also can raise a child's metabolic rate, which can make him even more susceptible to dehydration.
In general, Rountree says, parents needn't worry about low-grade fevers—those below 102 degrees—unless the child is exhibiting other symptom or is under six months of age.
Here are some more suggestions for treating fevers naturally:
| Give a child with a fever plenty of liquids. If he's not fond of plain water, give him frozen fruit juice bars, herbal teas, soups, and diluted fruit juice. |
| Vitamin C can help reduce a fever; give one dose every two hours (for a total of four per day) while your child is feverish. |
| To help fight the underlying infection, give your child a combi- nation of echinacea and goldenseal. He should take one dose every two hours for the first day; for the next week give him one dose, three times a day. |
| To alleviate chills and increase perspiration, give your child a cup of herbal tea, brewed with equal parts of any of the follow- ing ingredients: lemon balm leaf, chamomile flower, peppermint leaf, licorice root, and elder flower. Or, brew up a batch of ginger tea. Your child can drink a half cup of tea, four times a day for one day. |
Ear Infections
Every year, about ten million children in the United States are treated for ear infections. In fact, ear infections are second only to upper respiratory infections (colds and flu) as the most common illnesses treated by pediatricians.
An infection of the middle ear, called otitis media, is most common among children between six months and three years. That's because the eustachian tube_the passageway linking the middle ear to the nasal cavity and throat_is more horizontal in infants than in older kids. This makes it difficult for excess secretions from the ear to drain. And when these secretions build up, pressure in the ear rises and infection often follows.
Traditional medical treatment for otitis media typically involves the following:
| Antibiotics are prescribed regularly for ear infections, and typi- cally will have a child feeling better within forty-eight hours. |
| For children who suffer from recurring ear infections and who have had a documented hearing loss as a result, surgery is often prescribed. The procedure involves the insertion of tiny plastic tubes into the child's middle ear. In almost every case, the tubes fall out on their own; in rare instances they must be removed surgically. |
The natural approach to ear infections is much different—and therefore often appealing to parents of children who have been repeatedly treated conventionally for ear infections, says Edward Chapman, M.D., a family practitioner who uses homeopathy in his practice in Newton Lower Falls, Massachusetts. "Many of the kids I see have been on multiple courses of antibiotics because they have recurring infections. We treat them [homeopathically], and in the majority of cases they end up having many fewer infections."
"Ear infections are a good example of the dramatic difference between conventional and alternative medicine," says Rountree. "In this case, conventional medicine is way off base. Kids who are treated more frequently with antibiotics have more infections. With antibiotics, the infections become self-repeating."
When parents think their child is in pain, most want to start the child on antibiotics right away, he says. "But unless a kid is really sick, I recommend foregoing antibiotics and doing things to make the ear feel better."
Here are some suggestions for treating ear infections naturally:
| Keep your child well hydrated, providing water, teas, and di- luted fruit juices. Avoid dairy products, which thicken and increase mucus, making it hard for an infected ear to drain. |
| While they are killing the infectious bacteria, antibiotics also can strip away necessary bacteria in the intestinal tract. You can re- place these "friendly" bacteria by giving your child lactobacillus acidophilus or bifidus. Give him either one-quarter teaspoon of powder, one teaspoon of liquid, or half the contents of a capsule once a day, two hours after he has been given an antibiotic. |
| Vitamin C and bioflavinoids both are mildly anti-inflammatory. Give your child one dose up to six times a day. |
| Echinacea and goldenseal stimulate the immune system. During an acute infection, give your child one dose every two hours. As the infection subsides, give him one dose three times a day for one week. |
| Garlic, an antibacterial, also helps clear up ear infections, and is available in odor-free capsules. Or heat a clove of fresh garlic in some olive oil (be sure the oil is only slightly warm, not hot). Then, with your child lying on his side, pour one or two drops of the warm oil into the infected ear. The oil also helps to relax and anesthetize the ear membrane, thus lessening the child's discom- fort. |
| You also can heat a bit of mullein oil, a traditional Native Ameri- can treatment for inflammation and swelling, and pour a few drops into your child's ear. (Again, be sure the oil is only warm, not hot.) |
Sore Throats
In most cases, a sore throat is caused by a viral infection and often is accompanied by a head cold, runny nose, or ear infection. However, about one-third of all childhood sore throats are caused by bacteria—the highly contagious streptococcus variety_and are called "strep throat."
Because strep is not always distinguishable from a plain old sore throat (symptoms of strep include a fever and red, swollen tonsils), a firm diagnosis can be made only through a throat culture performed in the doctor's office. If your child shows symptoms of strep, call your doctor. Left untreated, strep can lead to serious complications, including rheumatic fever and scarlet fever.
When a child has a sore throat, conventional medicine typically prescribes the following:
| If a sore throat is not caused by strep, a child will be given pain- and fever-reducing analgesics—ibuprofen or acetaminophen. |
| If a case of strep is confirmed, a child will be put on antibiotics (typically, a ten-day course of penicillin or erythromycin). |
Rountree argues that this conventional, antibiotics-automatically approach has its drawbacks, and instead recommends a three day waiting period after a strep diagnosis before starting a child on antibiotics. He cites research that found children who were given antibiotics at the initial diagnosis of strep throat suffered a higher rate of reinfection than children whose antibiotic treatment was delayed for three days. "Immediate treatment with antibiotics inhibits the immune system by slowing the production of antibodies," he says. "If the body is permitted to initiate healing on its own, it may be more able to mobilize the defenses required to heal itself."
Here are some natural alternatives to conventional sore throat treatment: .
| Keep your child well-hydrated by providing lots of fluids: clear soups, diluted fruit juices, and water. Try giving her a cup of soothing herbal tea, made with licorice root, hyssop, slippery elm bark and sage three times a day for a few days. (Your child also can gargle with this tea once it's cooled.) |
| Give your child sugar-free vitamin C and zinc lozenges to suck on (for a total of one dose per day of zinc and up to six doses a day of vitamin C. |
| Give grapefruit seed extract, mixed with water, as either a drink or a gargle. For a gargle, add five to ten drops of highly concen- trated extract to a glass of water and give it to your child as needed; for a drink, dilute three to five drops in six ounces of water and give it to your child three or four times a day for up to three days. |
Diarrhea, Constipation, and Stomachaches
Stomachaches and digestive discomfort are routine in childhood, and can range from the minor discomforts of indigestion to potentially life-threatening cases of diarrhea and food poisoning.
Stomach upset often begins with loss of appetite and progresses to nausea, pain_either constant or cramping_vomiting, and possibly diarrhea. Constipation is evident when a normally regular child goes two or three days without a bowel movement or has difficulty passing stools. Diarrhea is characterized by the passage of frequent, watery stools, and is often accompanied by cramping Most cases of diarrhea are not serious, but diarrhea that lasts more than a few days can leave a child's body dangerously dehydrated.
Stomach problems can be caused by a number of things: food poisoning, overeating, motion sickness, infection, allergies, and emotional upset, among others. If your child has a single episode of vomiting, it may be a reaction to something he's eaten. If the nausea is severe or persistent, he may have food poisoning or a viral or bacterial infection.
Conventional medical treatment for stomach distresses include:
| Antiemetics, which are prescribed to ease nausea and stop vomiting |
| OTC drugs, including bismuth subsalicylate (Pepto Bismol), which is helpful in controlling nausea and diarrhea; emetrol, a syrup that settles the stomach; loperamide (Imodium AD), which slows movement of the intestinal muscle to relieve diarrhea; and kaolin-pectin (Kaopectate), which acts to solidify substances in the intestines |
| Bulk-forming laxatives, including magnesium hydroxide (Milk of Magnesia), and stimulant laxatives like castor oil and bisacodyl (Ducolax), also available over the counter |
If you'd rather treat your child naturally, here are some suggestions for treating stomach problems with alternative medicine:
| To remedy constipation, increase the fiber in your child's diet. Give her a piece of fruit (like a banana or prune) an hour before her regular meal. Foods high in magnesium, like dark green, leafy vegetables, are also helpful in relieving constipation. |
| Lactobacillus acidophilus or bifidus are "friendly" bacteria that are helpful in relieving constipation, nausea, and diarrhea. For constipation, give your child one dose daily until her normal bowel movements return; for diarrhea, give one dose twice a day for five days; for nausea and stomachache caused by a viral or bacterial infection, give one dose three times a day for two to three weeks. |
| Herbal teas can be very useful in treating stomachaches. Try giving your child a cup of ginger tea (which helps combat nausea and vomiting), licorice root tea (which also aids in settling the stomach), or peppermint tea (a digestive aid), a few times through out the day. |
| Aloe vera juice can also be soothing to a child's irritated diges- tive tract (be sure to buy a product labeled for internal use). Give your child one tablespoon diluted in six ounces of water up to three times a day. |
Homeopathy for Kids
Janet Zand, Laco., M.D., a naturopathic physician, doctor of Oriental medicine, and an author of Smart Medicine for A Healthier Child (Avery Publishing Group, 1994), offers these suggestions for treating common childhood ailments homeopathically.
| Know your dosages. Homeopathic remedies are derived from naturally occurring plant, mineral, or chemical substances, and are available in different potencies. Remedies come in several forms: the mother tincture (an alcohol-based extract that most often is used topically), x potencies, and c potencies. Mother tinc tures are not recommended for kids because of their high alcohol content. |
| As in the Roman numeral system, x represents the number ten, and means that the mother tincture has been diluted to one part in ten. The number preceding the x indicates how many times the remedy has been diluted (a 6x remedy began as a mother tincture and was diluted to 10 percent of its original strength six times). C potencies have been diluted to one part in one hundred from their original mother tincture (a 3c potency has been diluted to one part in one hundred, three times). |
| Homeopathic remedies come in pellet, tablet, and liquid form, the first two of which are preferred for treating children. These remedies work best when taken within 30 minutes of a meal. Avoid touching the pellet or tablet with your fingers, as this can decrease its effectiveness. Instead, shake the tablet or pellet into a clean spoon and place it directly into your child's mouth. |
| For a cold or flu, give your child_at the first sign of a sniffle_a dose of Anas barbae three times a day for one day. Then, during the acute phase of the cold, give her one dose of a symptom- specific remedy three to four times a day for three days. For the child with a very runny nose and a lot of watery nasal discharge, give Allium cepa 12x or 6c. For a child who feels chilly, restless, and weak, give Arsenicum album 30x or 9c. If she complains of aching deep in her bones, give her Eupatorium 12x or 6c. And if she has a stuffy nose with thick yellow discharge, give her Pulsatilla 30x or 9c. |
| For a sore throat, give your child Phosphorus 30x or 9c, three times a day for up to two days. |
| Homeopathic fever remedies are useful if administered at the first onset of fever. If your child seems restless_rolling around in bed and agitated—you can give him one dose of Aconite 30x or 9c every two hours, for a total of three doses. If your child has chills and a flushed, heated face and body, give him a dose of Belladonna 30x, 15c, or 30c every hour for up to a total of three doses. |
| To treat an ear infection, try Kali muriaticum 12x or 6c. Give one dose, three times daily, for one or two days. If your child has had tubal implant surgery, try giving her one dose of Arnica 30x or 9c three or four times a day for two days. This will help reduce inflammation around the tubes. |
Recommended Dosages for Herbs and Supplements
Herbal Remedies When treating your child with herbs, it is important to base the dosage on your child's age, weight, and condition.
| Newborn to two years: One dose equals three drops of tincture diluted in one-quarter cup water, formula, or breast milk or two to three teaspoons of tea brewed with the herb. A nursing mother may take an adult dose of the appropriate herbal treatment, as the herbs will be transmitted to her baby through her breast milk. |
| Two to six years: One dose equals six to ten drops of tincture diluted in one-quarter cup of water, or two to three teaspoons of herbal tea. |
| Six to twelve years: One dose equals ten to twenty drops of tinc- ture, a half cup of herbal tea, or one tablet or capsule. |
| Twelve years to adult: One dose equals twenty to forty drops of tincture, one cup of herbal tea, or two tablets or capsules. |
Nutritional Supplements Please note that these are therapeutic doses. They do not necessarily represent the amounts of these nutrients that your child needs on a daily basis, but rather the increased amounts that may be helpful for certain conditions, when taken for limited periods of time.
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| Witch Hazel |
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Recommended Dosages |
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| Vitamin A/ Beta Carotene | Vitamin C | Bioflavinoids | Zinc | |
| Birth to six months Six to twelve months |
2,000 IU 2,000 IU |
40 mg 60 mg |
40 mg 60 mg |
4 mg 6 mg |
| One to two years Three to four years |
2,500 IU 2,500 IU |
100 mg 150 mg |
100 mg 100 mg |
10 mg 10 mg |
| Five to six years Seven to eleven years |
3,000 IU 4,000 IU |
150 mg 200-500 mg |
150 mg 200-500 mg |
10 mg 15 mg |
| Twelve to fifteen years Sixteen to eighteen years |
5,000 IU 5,000 IU |
300-500 mg 300-500 mg |
300-500 mg 300-500 mg |
15 mg 15 mg |
A Sensible Solution
While alternative medicine is safe and effective for many common childhood aches and pains, what if your child has a major illness? "If you think that something serious is going on, I think you need to pursue very conventional lines," says Rountree. "Conventional medicine has a lot to offer in terms of diagnosing disease. And once you know where you're starting from, you're ready to make an informed decision about treatment."
Chapman agrees. "If I had a kid with a high fever, a headache, and sensitivity to light, I would suspect meningitis. And in that case, the kid would get a culture, a spinal tap, and antibiotics. Although I favor homeopathic remedies, I have no problem using antibiotics when they're needed."
In the final analysis, all parents must make their own decision regarding their children's care. "I implore people to share as much as possible with their conventional doctor," says Rountree. "Don't just listen to what your doctor says and then go home and start using herbal remedies on your own. Share with your doctor what you're doing and what you've found to be effective." This strategy, he says, will ensure that your child's care is as comprehensive and as effective as it can be.
The benefits of sharing information with your child's doctor go both ways, adds Hochberg. "You can make it easier for your doctor to understand what you are up to, and this may ignite his or her own interest in alternative medicine."
Parents who use alternative approaches can take comfort in the fact that they are really helping their children to get better. By doing more than just administering pills, mothers and fathers who brew teas, cook up cough medicines, bathe fevered children, and give hourly doses of herbal remedies are teaching their children time-honored lessons in healing and caring. These children are learning how to bring healing into the home through their own hands. And that knowledge, along with the simple benefit of just feeling better, will provide a legacy of natural health for the future.
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Ginger |
RESOURCES
The American Holistic Medical Association
4101 Lake Boone Trail, Suite 201
Raleigh, NC 27607
919-787-5181
The American Association of Naturopathic Physicians
2366 Eastlake Avenue East, Ste. 322
Seattle, WA 98102
The Herb Resource Foundation
1007 Pearl St., Ste 200
Boulder, CO 80302
303-449-2265
Homeopathic Education Services
2124 Kittredge St.
Berkeley, CA 94704
510-649-0294
Leonard J. Davis teaches at the State University of New York at Binghamton and writes frequently about health and parenting issues. He is the father of two.
Reprinted with permission from Natural Health, November/December 1995. For a trial issue of Natural Health, call 1-800-526-8440.
