Babbling Babies, Veggie Rewards, Raw Milk – PediaCast 277

Join Dr Mike in the PediaCast Studio for more news parents can use. This week’s topics include baby talk, the cost of ear infections, veggie rewards, bullying, raw milk, and conjunctivitis.

Topics

  • Baby Talk

  • The Cost of Ear Infections

  • Veggie Rewards

  • Bullying

  • Raw Milk

  • Conjunctivitis / Pink Eye

Links

Transcription

Announcer1: This is PediaCast.

[Music]

Announcer2: Welcome to PediaCast a pediatric podcast for parents.  And now direct from the campus of Nationwide Children's, here is your host Dr. Mike.

Dr. Mike: Hello everyone and welcome once again to PediaCast.  We are a pediatric podcast for moms and dads coming to you from the campus of Nationwide Children's Hospital in Columbus, Ohio.  It is January 29, 2014 episode 277 and I'm calling this one Babbling Babies, Vegetable Rewards, and Raw Milk.  It's a News Parents Can Use edition of the program, lots more coming your way and I'll break down the entire line up here in just a minute.

0:01:02.0

First I just have to say it's this time of the year that I do miss living in Florida and those of you who have followed the program for quite a while now know we started in Ohio, moved to Florida for a few years and because of our affiliation with Nationwide Children's, moved back up to Ohio and absolutely great being here, we've have a lovely studio, resources of a fantastic world class pediatric hospital.  But the weather this time of the year is not that great it's just been cold and snowy which I guess that's what you expect in the winter.  But I'm really ready for spring, truly am and I know that many of you in areas north probably feel the same way.  We did join a gym, we talk New Year's resolutions last year and we joined.  Co-worker told me about this great deal at a gym and we have been going whether we'll stick with that, I don't know. 

0:02:03.4

I just wanted to be spring so I can get outside and do some outdoor activities but in the meantime we go to the gym and try to increase our calories out and that's the thing, you hear about fancy diets and ways to lose weight and there's billions of dollars spent by people trying to do that.  What it boils down to is decrease you calories in and increase your calories out and the way to that is through exercise.  There's no easy way, just got to do it, you've got to find time for it.  So that's where we are.  What else is new in our house?  You know we try to limit screen time as we've talked about but there is one show we've been kind of watching here and there as a family and my British listeners will appreciate this.  We've kind of become Who-vient in our house, we have been watching a lot of Dr. Who and that's a good show, it's fun to watch with the kids, nothing really inappropriate and so that's been good.  

0:03:03.1

Not too much out school, I mean we're just kind of in a winter blahs here, the holidays are over and we're just trying to find that routine I guess that we talked about last week.  Alright what are we talking about this week in our News Parents Can Use edition of the program?  First up is babbling babies, you know we've all heard baby talk and you know what I mean, you lean over the crib and you say, "Oh what a cute little baby."  Some parents do it constantly, other cringe at the very thought but what about your baby's language development?  Does baby talk help or hurt?  The answer's coming your way.  Then we have the cause of ear infections.  We actually have a number to report, now I'll give you a hint, it's in the billions.  So what?  What it does mean?  How could the answer affect your child's health?  And how could it affect your grandfather's health?  That's coming up.  And then a vegetable reward, how can you get your child on board the fruit and vegetable train?

0:04:00.0

Some schools are experimenting with a controversial method, is it one you could apply at home?  I'll let you know.  And then bullying, the long term effect of bullying can last a lifetime.  It's not just the victims who pay a price the bullies themselves take mental illness with them into adulthood, and what about those who play both roles, bully and victim?  New study looks at the long term mental health outcomes and adult survivors of childhood bullying and we aren't talking anxiety or depression here.  Bullying can result in some serious conditions that are difficult to treat and I'll have the details a bit later in the show.  And then raw milk, it's becoming popular for parents to seek out local farmer, the place looks clean, the cow's look healthy, they're grass fed, there's no hormones, no antibiotics, and no pasteurization, but is that really a good idea?  We'll talk it through.  And by the way I have no agenda here folks, I just want you get the truth into your hand so you can make decisions that are educated on your own, so that's coming your way in a bit.

0:05:03.6

And then I'll wind up the show with a final word, I'm going to try something little bit different for this segment in 2014 starting with today's episode, just a little off the cough examination room advice, what in the world that does mean?  All I can say is stick around at the end of the show and find out in the Final Word segment.  Don't forget if there's a topic you'd like us to talk about, or you have a question for me it's easy to get in touch, just head over to pediacast.org and click on the contact link.  Also I want to remind you the information presented in PediaCast is for general educational purposes only, we do not diagnose medical conditions or formulate treatment plans for specific individuals.  So if you do have a concern about your child's health make sure you call your doctor and arrange a face to face interview and hands on physical examination.  Also your use of this audio program is subject to the PediaCast terms of use agreement which you can find at pediacast.org.  So let's take a quick break and I will be back with News Parents Can Use right after this.

0:06:01.3

[Music]

Dr. Mike: Common advice for new parents is this, the more words babies hear, the faster their vocabularies grow.  However new findings show early language development isn't so much spurred on by the quantity or number of words but rather the style of speech and the social contacts in which that speech occurs.  Researchers at the University of Washington and University of Connecticut examined thousands of 30 second snippets of verbal exchanges between parents and babies.  They measured parent's use of a regular speaking voice versus an exaggerated, animated baby talk style, and whether speech occurred one on one between parent and child or in a group setting.  

0:07:08.8

Dr. Patricia Khul co-author of the study and co-director of the University of Washington's Institute for Learning and Brain Sciences says, "What our analysis shows is that the prevalence of baby talk in one-on-one conversations with children is linked to better language development, both now and in future…. The more parents exaggerated vowels, for example, "How are youuuuu?… and raised the pitch of their voices, the more the one year olds babbled, which is a forerunner of word production. Baby talk was most effective when a parent spoke with a child individually, without other adults or children around.  Dr. Khul adds, "The fact that the infant's babbling itself plays a role in future language development shows how important the interchange between parent and child is….  The study published in the journal Developmental Science examined 26 babies each round one year of age who wore vest containing audio recorders which collected sounds from each child's auditory environment eight hours a day for four days. 

0:08:09.2

Researches then use language analysis software to examine over 4,000, 30 second intervals of recorded speech.  Within those segments investigators identified who is talking, how many people were present, and whether care givers used baby talk or regular speech.  Finally when the children were two years old parents filled out a questionnaire measuring how many words each child knew.  So what did they found out?  Well infants who heard more baby talk knew more words at age two.  But just how big was the difference?  Well these results may actually surprise you, two year olds and families who spoke the most baby talk in one-on-one social contacts, these kids knew an average of 433 words.  But those two year olds and families who used the least amount of baby talk in one-on-one situations they only knew an average of 169 words.  

0:09:00.3

In this relationship held through across socio-economic levels despite their being only 26 families in the study.  Dr. Nairan Ramirez-Esparza lead author of the study and an assistant professor of psychology at the University of Connecticut says, "Some parents produce baby talk naturally and they don't realize they're benefitting their children.  Other families are more quiet, not talking all the time but it does help to make an effort to talk more."  Previous studies have focused on the amount of language babies hear without considering the social context.  The new study shows that quality, not quantity is what matters.  As it turns out baby talk is much better at developing language than regular speech and even better if it occurs in a one-on-one interaction. Parents can use baby talk when going about everyday activities saying things like, "Where are your shoooes?,"  And, "Let's change your diiiiaper,…or, "Oh, this tastes goooood!,… emphasizing important words and speaking slowly using a happy tone of voice.  

0:10:00.9     

Dr. Khul adds, "It's not just talk at the child, it's more important to work toward interaction and engagement around language.  You want to engage the infant and get the baby to babble back.  The more you get that serve and volley going the more language advances."  There you have it and I think it's the dads who really need to pay the most attention to this.  Call me sexist but I do think baby talk just comes more naturally for moms.  So dads don't criticize mothers for doing it, just go ahead jump on board the band wagon and give baby talk a try.  Your child will thank you by using more words down the line.  Acute otitis media or ear infections are the most common ailment among kids of pre-school age and younger in the United States primarily because these children have immature middle ear drainage systems, higher exposure to respiratory illnesses, and under developed immune systems.  And because it's also the most common reason for antibiotic use among children, the cause associated with acute otitis media are under more scrutiny than ever by healthcare in government administrators especially given today's political and economic climate, strained healthcare resources, and cost containment efforts.  

0:11:13.8

While estimates of the economic impact of acute otitis media have been formulated in the past, a new study by UCLA and Harvard University researchers is the first to use a national population data base that gives a direct head to head comparison of expenditures for pediatric patients diagnose with ear infections and similar patients without ear infections.  The study findings recently published in the journal Laryngoscope showed that acute otitis media is associated with significant increases in direct cause incurred by consumers in the healthcare system.  With its high prevalent across the United States, pediatric ear infections account for approximately $2.88 billion in added healthcare expenses annually and is a significant healthcare utilization concern.

0:12:00.9

Dr. Nina Shapiro co-author of the study and director of Pediatric Otolaryngology at Mattel Children's Hospital UCLA and I might add Dr. Shapiro's a former PediaCast guest a few years ago.  She says, "Although the annual incidents of ear infections maybe declining in the United States, the number of kids affected remains high and the public health implications of acute otitis media are substantial as our healthcare system continues to be vigorously discussed around the nation.  Efforts to control cost and allocate resources appropriately are of prime importance….  For this study researchers examined records of pediatric patients under the age of 18 obtained from the 2009 medical expenditure panel survey, a national survey conducted by the agency for health research and quality which serves a benchmark data set specifically designed for the assessment of healthcare cost.  Researchers sample the records of 81.5 million children and found 8.7 million of them had received care for ear infections.

0:13:01.5

The cost of visiting the doctor's office, filling prescription medication and other associated healthcare expenditures was then compared with children who had not been diagnosed with ear infections with rates adjusted for age, sex, region of the country, race, ethnicity, insurance status, and the presence of multiple illnesses at the same time.  So what did they find?  Well researchers say, "Children with ear infections had an average of two additional out-patient visits, 0.2 additional emergency department visits, and 1.6 additional prescriptions filled compared to those without ear infections."  So what did does mean in terms of dollars spent?  Well ear infections were associated with an increase of $314 per child annually for outpatient healthcare and an average of $17 an additional cost for medications.  This resulted in an overall increase across the whole United States of $2.88 billion spent each year for pediatric ear infections.

0:14:00.3

Dr. Shapiro says, "Although certain immunizations that target infection causing bacteria may play a role and slightly reducing the overall rate of your infections, millions of kids will still have them….  The take home message is that the common ear infection is an extremely costly entity with significant financial burdens on the healthcare system.  Future studies on the healthcare cost associated with acute otitis media may include analyzing the indirect cost such as work and school days missed, gasoline cost and parking charges for outpatients visits.  Here we go folks, welcome to our new healthcare system as we talk about utilization of resources.  And this is important because in the article the researchers don't mentioned this but this is the next step, why are they doing this kind of research to find out how much we spent on otitis media or ear infections.  The reason is because and we've talked about this before on PediaCast, the majority of ear infections will get better on their own without the need to see a doctor and without the need for antibiotics.

0:15:02.8

So the next logical step here is to say why are we treating all these ear infections?  Why are we spending all of this money on something that's going to get better on its own?  Now we've been down this path before and there is some difficulty convincing both parents and doctors to do this.  It's hard when you're the parent and your child is up crying two nights in a row with ear pain, you want them to get an antibiotic,  it's just drilled into you.  Sure I want to cut cost but not one that affects my child.  It's also difficult when you're the doctor, you want to make things all better faster and you want to please the parent.  It's easier to write for antibiotic, leave the room then to go into detailed explanation of the natural course and additional cost of using an unnecessary antibiotic.  The pediatric community has tried to rain this in, in the form of a plea for antibiotic stewardship.  It goes something like this, antibiotic overuse leads to the emergence of resistant bacteria which means there may come a day when antibiotics no longer work.

0:16:05.2

And since the majority of ear infections will improve on their own if we give them a few days then how about this for a plan, young babies will still use antibiotics since they're at the highest risk for complications like mastoiditis and meningitis.  But older kids with ear pain and fever, let's give it a few days and see if it gets better on its own, if it does which most of the time it will, then great.  If not then we'll prescribe an antibiotic a few days later or we'll give the parents the prescription now but tell them to wait a few days before filling it to give some time for the infection to clear on its own.  Sounds like a good plan right?  And it's supported by the American Academy of Pediatrics to boot but here's the problem, it's not really working, why?  Because parents usually demand an antibiotic when their kid is up crying all night and if doctor A won't give it to them then they'll hunt down doctor B and get the antibiotic from them.  And because it's easier for doctors to prescribe than to explain especially when explaining takes a long time and the reimbursements that primary care doctors receive necessitate high patient volumes in order to meet expenses and that just doesn't leave enough time for explaining, it's easier to write the prescription.

0:17:16.8

Since the antibiotic stewardship argument is failing now we're going to examine the cost of treating something that usually goes away on its own and as healthcare slowly marches from the private sector to the public sector with finite dollars to support it choices must be made.  Will the dollar be spent on treating your child's ear infection which will probably go away on its own if you didn't or on grandpas cardiac cath?  Now don't get me wrong, this isn't necessarily a bad thing because I personally believe that parents make unreasonable treatment demands based on the lack of understanding and doctors make unreasonable treatment decisions based on pressure from parents and the thread legal liability hanging over our heads.

0:17:59.8

So I'm fine with examining this sort of thing, it's really something we should've been doing long ago to control unnecessary cost it's just sort of sad that it takes the government stepping in to do a doctors should've been doing all along.  Now don't get me wrong I'm far from a total champion of government control over the healthcare system.  But it's more individual topics come up like this one I do want to communicate truth with you at least as I see it.  But you know it is what it is and it's a discussion that we need to have and not just behind closed doors in Washington.  Research suggest that a new federal rule has prompted the nation's schools to serve an extra $5.4 million worth of fruits and vegetables each day in school lunches, sounds like good news right?  Well there's some bad news too which isn't too surprising.  Turns out that of the $5.4 million worth of fruits and vegetables served each day $3.8 million of it winds up in the garbage can thrown away by children who didn't want it on their plates in the first place.  

0:19:00.6

These numbers published in the journal Public Health Nutrition come from researchers at Brigham Young University in Cornell, investigators observed three schools adjust to new school lunch standards that require serving a fruits or vegetables on every students tray whether the child intends to eat them or not.  Dr. Jill Price a professor of economics at BYU says, "We saw a minor increase in kids eating the items but there are other ways to achieve the same goal that are much cheaper.  Strange as it sounds directly paying a student to eat a fruit or vegetable is less expensive and gets better results."  Researchers conducted a second study to measure the effect of small rewards in the lunch room, the week-long experiment took on different twist in the 15 different schools, some could earn a nickel, others a quarter, others a raffle ticket for a larger prize but the results are generally the same.

0:19:58.3

Offering small rewards increased fruit and vegetable consumption by 80% and the amount of wasted food declined by 33% which begs the question is benevolent bribery a better way?  Dr. Price says, "Parents are often misguided about incentives because we feel a sense of dirtiness about a bribe but rewards can really be powerful if the activity creates a new skill or changes preferences."  The case against using bribes in parenting is perhaps best articulated in Alfie Kohn's 1999 book "Punished By Rewards" in many scenarios the use of rewards can crash internal motivation with healthy eating for example, some fear that prizes will prevent children from developing their own motivation to eat things that are good for them.  Another danger known as the boomerang effect is the possibility that some children would eat less fruits and vegetables when the rewards disappeared.  These concerns led the research team to measure fruits and vegetable consumption before and after the week long experiment when the week of prizes ended, students went back to the same level of fruit and vegetable consumption as before so no lasting effect but no boomerang effect either.

0:21:07.2

Now the researchers are studying whether extending the experiments over three to five week period might yield lasting change and so far things actually look promising which leads Dr. Price to say, "I don't think we should give incentives such a bad rap, they should be considered part of the set of tools we can use."  So paying children money to eat their fruit and vegetable, what is this world coming to?  I'll let you decide.  New research has shown that being exposed to bullying during childhood will lead to an increased risk of psychotic experiences in adulthood regardless of whether they are victims or perpetrators.  The study published in the journal Psychological Medicine assess the co-horde of children in the United Kingdom from birth to fully understand the extent of bullying on psychosis in later life.  Researchers from the University of Warwick and University of Bristol say, "Victims, perpetrators, and those who have played both roles are in an increased risk of developing psychotic experiences with some groups almost five times more likely to suffer from psychotic episodes at the age of 18."

0:22:11.2

"Even when controlling for external factors such as family history or pre-existing behavioral problems the study found that in addition to the children who are chronically bullied over a number of years, the bullies themselves were up to four and a half times more likely to suffer from psychotic experiences by the age of 18.  Equally concerning those children who only experienced bullying for brief periods were still at an increased risk for psychotic experiences."  What exactly is a psychotic experience?  The term psychotic experience covers a range symptom from hearing voices and seeing things to straight up paranoia.  These experiences if persistent are highly distressing and disruptive to everyday life and they can morph into a full blown psychotic disorder such as schizophrenia or they may come and go milder symptoms that are difficult to diagnose yet still quite impactful of an individual's life.

0:23:06.0

Dr. Dieter Wolke a professor at the University of Warwick says, ""We want to eradicate the myth that bullying at a young age could be viewed as a harmless rite of passage that everyone goes through… it casts a long shadow over a person's life and can have serious consequences for mental health….  He adds, "These numbers show exactly how much childhood bullying can impact on psychosis in adult life. It strengthens on the evidence base that reducing bullying in childhood could substantially reduce mental health problems. The benefit to society would be huge, but of course, the greatest benefit would be to the individual….  The research team had previously looked at the impact of bullying on psychotic symptoms in 12 year olds and there have been short term studies that confirm the relationship between being a victim of bullying and psychosis.  The study however is the first to report the long term impact of being involved in bullying during childhood whether victim, bully, or both on psychotic experiences in late adolescent or adulthood.

0:24:02.8

Dr. Wolke says, "The results show that interventions against bullying should start early, in primary school, to prevent long term serious effects on a child's mental health. This clearly isn't something that can wait until secondary school to be resolved; the damage may already have been done….  More evidence regarding the dangers of bullying not just for the victim but for those who do the bullying as well and let's face it there're lots of kids who play the bully in one relationship and the victim in another, they're affected as well.  And at the end of the day it's up to us as parents and educators to know what kinds of situations our children are involved with and to tackle the problems head on, enough already with looking the other way.  Pregnant women, infants, and young children should avoid raw or unpasteurized milk and milk products and only consume one's which have been pasteurized.  That's according to a new policy statement from the American Academy of Pediatrics which was recently published in the journal Pediatrics.

0:25:01.2

In issuing the statement the academy takes the same position as the American Medical Association, The American Veterinary Medical Association, The International Association for food protection, The National Environmental Health Association, US Food and Drug Administration, and The World Health Association.  Whether from cows, goats, or sheep raw milk and milk products are continuing source of bacterial infections that are especially dangerous to pregnant women, fetuses, the elderly, young children, and people with compromised immune systems .  The popularity of raw milk and raw milk products such as soft cheeses has been growing in recent years in part to the claims of health benefits, but those claims have not been backed up by science.  Studies have shown repeatedly that raw milk and pasteurized milk contain equivalent levels of nutrients such as proteins, carbohydrates, calcium, vitamins and enzymes.  Claims that raw milk is not associated with lactose intolerance have not been substantiated by independent studies.

0:26:02.0

Dr. Yvonne Maldonado lead author of the statement and a professor of pediatrics at the Stanford University School of Medicine says, "We have no scientific evidence that consuming raw milk provides any advantages over pasteurized milk and milk products.  But relative to the amount of raw-milk products on the market, we do see a disproportionately large number of diseases and illnesses from raw milk….  From 1998 through 2009, there were 93 recorded outbreaks of disease resulting from consumption of raw milk or raw-milk products, causing 1,837 illnesses, 195 hospitalizations and two deaths in the United States. Most of these illnesses were caused by contamination of the product with E. coli or with species of Salmonella or Campylobacter. Infections by such bacteria can cause diarrhea, fever, cramps, nausea and vomiting. Some infections can spread to the entire body and become life threatening.  A 2011 survey by the National Association of State Departments of Agriculture determined that raw milk and raw-milk products were legal to sell in 30 states, though only a few allowed sales in grocery stores.  

0:27:09.6

The FDA banned interstate shipment and sales of raw milk and some raw-milk products in 1987, but it has no jurisdiction over whether such products created in a state may be sold within that state's borders. An exemption in the FDA prohibition allows cheeses that have been aged at least 60 days to be transported across state lines for sale, provided the cheese is clearly labelled as unpasteurized. Before pasteurization was developed, one of the major causes of childhood disease and death was drinking milk because there was no way to decontaminate it. It was not uncommon for children to get tuberculosis from milk.  Some advocates of raw-milk consumption argue that cows are healthier now compared with the pre-pasteurization era, but Dr. Maldonado says, "That even in healthy herds, there are other organisms that can cause serious bacterial infections in children and pregnant women…. 

0:28:00.9

She adds, "There have been recent studies demonstrating that even healthy dairy animals in good facilities carry some of these organisms on their udders, or the organisms are somewhere in their environment, and the milk can be contaminated with them.  When these organisms are ingested, especially by young babies or pregnant women, they can cause severe illness….  The academy's policy statement endorses a nationwide ban on the sale of raw or unpasteurized milk and milk products, including raw-milk cheeses that have been aged for more than 60 days. In endorsing a raw-milk cheese ban, the statement cited scientific evidence that E. coli 0157, a pathogenic strain of the E. coli bacteria that can cause particularly severe symptoms and in some cases liver failure, can survive in raw-milk cheese even after 60 days of aging and has been linked to E. coli outbreaks.  The statement also encourages pediatricians to lobby their state representatives in support of a ban on raw-milk sales in the states where they live. 

0:28:59.9

The academy's statement contains a list of organisms detected in raw milk and raw-milk products. In addition to many species of bacteria, the list includes giardia, rabies and norovirus. According to the U.S. Centers of Disease Control and Prevention, norovirus is the most common cause of acute gastroenteritis or vomiting and diarrhea in the United States, causing 20 million illnesses and contributing to over 60,000 hospitalizations and over 700 deaths annually.  Dr. Maldonado says, "We invented pasteurization to prevent these horrible diseases, and there is really no good reason to drink unpasteurized milk….  So this has become a bit of a fad of late to a buy and drink raw milk and I get why people do it, I mean we hear stories about cows getting hormones and antibiotics and we see this sometimes filthy conditions of a large dairy farms on those net flick streaming high shock value documentaries, but raw milk is dangerous too even when it comes from the friendly clean neighborhood farm down the road from your house or in your own backyard. 

0:30:02.0

Go with the grass fed, hormone free, antibiotic free, organic variety of milk if you must I'm all for that in fact that's what we drink in our home.  But seriously folks don't drink it raw, there's no evidence to suggest that raw milk or raw milk products are beneficial.  However there's plenty of evidence to suggest that they can be dangerous and sometimes deadly.  So when it comes to drinking raw milk, just say no, make sure it's pasteurized.  Alright that concludes our main new stories for this week's edition of PediaCast in our News Parents Can Use edition of the program.  Let's take a quick break and we're kind of going to change gears for 2014 with regard to the Final Words segment and I'll explain it all what the change means right after this.

[Music]

0:31:00.4

Dr. Mike: Alright we are back and then I mentioned there's going to be a little bit of a shift of focus with our final word this year. I'm going to start doing some pediatric nuggets that mom and dads should know, really unscripted, kind of the insider's scoop, what is your pediatrician wants you to know and we'll focus on seasonal diseases and injuries.  Not as much information as our nuts and bolts approach but rather just the five minute nugget, what do you really need to know?  What are the myths?  What's the truth?  That's going to be the aim and focus of my final words this year and we'll see how it goes.  PediaCast is a work in progress, if it works we'll stick with it, if not we'll reconsider.  Either way I would love to hear your feedback on this segment and just let me know if it's helpful and interesting.

0:32:11.9

So basically it's going to be what the most common questions I get in the exam room and the answers I give, just little nuggets.  And this week we're going to talk about conjunctivitis, I've been seeing that quite a bit and a lot's going to boil down with that, like I'm going to think about the last few times I've worked, and what am I seeing a lot of right now?   We are seeing a lot of conjunctivitis, so what is conjunctivitis and how is that related to pink eye?  What causes it?  By definition conjunctivitis just means that the conjunctiva which is the outer covering of the eye is inflamed.  Basically the white part of the eye becomes pink and you may or may not have some drainage associated with that redness of the eye and that drainage can be clear, or it could be purulent, or pussy, or have yellow or green color in it meaning that the immune system is sending in white blood cells to attack something and so we have some puss that's coming out of the eye.

0:33:17.3

So that's conjunctivitis, you may have heard pink eye.  Pink eye is a non-medical lay person's term for a severe usually viral conjunctivitis.  So just really inflamed conjunctive, maybe some clear drainage but not much and it's very contagious, so that's what a pink eye is.  But really pink eye is just a type of conjunctivitis.  So what causes conjunctivitis?  It can be an infectious agent like a virus or a bacteria, allergies can also result in conjunctivitis so you may have to treat those, and just chemical irritation, if you get soap or shampoo in your eye or a more harmful household chemical product.  

0:34:00.1

So just irritation of the eyes by things in the environment can also cause conjunctivitis and the way that the doctor tells the difference between those things is by the history, any known exposures, how long it's been going on, and then an examination of the eye itself and then we can come up by taking a history in the physical we can come up with what we think is going on whether it's a virus, or bacteria, or allergy, or from an irritant.  We also want to look at, are there any associated disorders?  You know a lot of times this time of the year you'll have conjunctivitis with an upper respiratory infections usually a viral upper respiratory infection.  And then ear infections can also go along with having conjunctivitis as well so we always get a good look in the ears.  In terms of treatment, the treatment is going to depend on what the cause is.  For a viral conjunctivitis there really is no treatment for that just the virus has to go away on its own, we want to make sure the kids aren't rubbing their eyes too much that they don't scratch their eyes or have a corneal abrasion because they're itching their eyes so that's one thing we want to worry about.

0:35:04.7

A lot of times we'll go ahead and prescribe some antibiotic eye drops even when we think it's a virus because kids just really have their hands and fingers in their mouth and another places and then they rub in their eyes and pretty soon you have skin bacteria and mouth bacteria that's starting to grow in the eyes and now your viral conjunctivitis has turned into a bacterial conjunctivitis.  So lots of times we will use antibiotic eye drops even if we think it's viral just to prevent it from becoming a bacteria although we may have to re-think that as we think about cause and is this something that would gone away on its own.  Anyway and should you wait until it is bacterial before you actually prescribe the drops so those are some controversies I guess that you could think of.  If they have an ear infection with it and it's an ear infection that we decide we're going to treat with antibiotic, and again we may be able to get away just using the oral antibiotics without having to use eye drops.

0:36:03.4

At the same time in other situations we may want to do both the oral antibiotic and the eye drop antibiotic.  That's kind of conjunctivitis in a nut shell if it's an allergic conjunctivitis there're different eye drops that you can use for that on a daily basis.  Of course figuring out what you're allergic to and trying to avoid exposure is also a good idea but there are medicines that can be used for an allergic conjunctivitis.  And then for an irritant if you're worried that the irritant is still there your eyes may need irrigated, if there's more damage than just inflammation an ophthalmologist or eye doctor may need to be called in to make sure that there's no deeper damage from whatever chemical what was present. So there're lot of different things to think about when we think about conjunctivitis and again this is why you can't have a robot practice medicine because there's just so many nuances and with the history, and the physical in making this kind of decisions. 

0:36:59.5

So that's the scoop on conjunctivitis and that's my final word.  Again we'll take a different disease process or injury that's appropriate for that time of year and we'll just go through some nuggets on it and share those with you.  So hopefully you find that helpful, if not let me know and we'll re-think it.  I want to thank all of you for taking time out of your day to make PediaCast a part of it.  Don't forget PediaCast and our single topic short format programs PediaBytes are both available on iHeart Radio Talk which you'll find on the web and the iHeart radio app for mobile devices.  Reviews and comments on iHeart Radio and on iTunes would be most helpful.  PediaCast is also available on the web, again at pediacast.org, in iTunes itself, we're also any place that put an RSS feed into their program.  There's lot of pod capturing type of apps out there, we're in all of those.  You'll also find us on Stitcher, lots of different places whatever you use to listen to music and talk, just search for us and we're probably there, if we're not let us know and we'll try to get on there for you.  

0:38:08.7

Also very helpful our links, mentions, shares, re-tweets, re-pens basically if you're on social media make sure you get connected with PediaCast, we are on Facebook, Twitter, Google Plus, and Pinterest.  If you think we ought to be somewhere else let me know.  Then what I'd really appreciate is all of our material when we do put out, hey we have a new one, if you could share that all that would be so helpful.  If you're connected to us on Facebook when I put out a Facebook message that hey there's a new program please share that with your social contacts and that would really help because we really don't have much of an advertising budget here for PediaCast, we really rely on you to help spread the word.  We also appreciate you telling your family, friends, neighbors, and co-workers about the program and most of all, be sure to tell your child's doctor.  So next time you're in for a well check-up or a sick office visit just say, "hey doc, got an evidence based pediatric podcast aimed at moms and dads hosted and produced by a board certified pediatrician and affiliated with a major pediatric facility of Nationwide Children's Hospital in Columbus," and let them know so that they can spread the word and let their other patients and families know about the program.

0:39:18.4

I really would appreciate you doing that, and posters are available under the resources tab at pediacast.org.  Once again if you want to get in touch with me it's easy to do, just head over to pediacast.org and click on the contact link and let me know your thoughts, your ideas, what you think about the new final words segment, ideas for show, topics this year, and any questions that you have that you'd like answered on the program and you'll find that again at pediacast.org, just click contact Dr. Mike and I read each and every one of those that come through.  And until next time which will be next week, this is Dr. Mike saying stay safe, stay healthy, and stay involve with your kids, so long everybody.

0:39:57.1

[Music]

Announcer2: This program is a production of Nationwide Children's, thank you for listening.  We'll see you next time on PediaCast.  

0:40:19.3

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