Baby Reflux, Wilderness Therapy, Military Deployment – PediaCast 250

Join Dr Mike in the Pediacast Studio for another News Parents Can Use edition of our program. Topics this week include Autism Speaks, baby reflux, robot therapy, wilderness therapy, military deployment, and prevention of alcohol abuse in middle school through college.

Topics

  • Autism Speaks

  • Baby Reflux

  • Robot Therapy

  • Wilderness Therapy

  • Military Deployment

  • College Kids & Alcohol

Links

Transcription

Announcer : This is PediaCast.

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

Dr. Mike : Hello, everyone. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital in Columbus, Ohio. I'd like to welcome everyone to the program. This is episode 250 for April 24th, 2013. We're calling this one "Baby Reflux, Wilderness Therapy and Military Deployment". I'd like to welcome everybody to the show. A lots coming to your way this week. More than I just mentioned in the introduction. And, has as always, and we'll get to the complete line up in a moment.

0:01:03.8

First, I do want to give you a heads up on a conference that is coming to Columbus this summer. For those of you out there dealing with autism, in one form or another. It is the "Autism Speaks 2013 National Conference for Families and Professionals". It's happening Friday, July 26th and Saturday, July 27th. At the Hilton at Easton, here in Columbus, Ohio. The conference is sponsored by Autism Speaks, along with Nationwide Children's Hospital in the Ohio State University, Wexner Medical Center. Also the American Academy of Pediatrics is on board this year. And as the name of the conference suggests, it's aimed families and professionals with great information and education aimed at both groups.

This years' focus is treating the whole person with autism. Care across the life span. And it will feature sessions and workshops. Focused on the most current guidelines for addressing medical issues. Developing approaches to care that integrates behavioral and medical approaches across the lifespan.

0:02:01.9

And helping children and adolescent with autism spectrum disorder, have happy, healthy and successful lives. A couple with great key note speakers this year. Dr. Paul Carbone. Is an associate Professor of Pediatrics at the University of Utah. He'll be speaking on understanding medical issues from childhood to young adulthood. And then, Dr. Stephen Shore, and educator and author. Also Assistant Professor of Education at Adelphi University in Garden City, New York. He'll be speaking in creating a fulfilling life.

So, if you're dealing with autism at home, or elsewhere in the family, maybe the extended family, or in the classroom or if you're a clinician or scientist interested in learning more about autism. I do give a strong vote of confidence for this conference. Autism Speaks held this annual event in Columbus last year and there's a reason they're returning to Columbus in 2013. So, definitely give us some thought. Make it part of your summer plans. And I'll put a handy link in the show notes for this episode 250 over at pediacast.org.

0:03:01.3

That link will take you to the conference home page. You'll find lot's of more information about the conference and a convenient registration page.

So, again the "Autism Speaks 2013 National Conference for Families and Professionals". Friday, July 26th and Saturday, July 27th over here in Columbus, Ohio. It's coming your way.

All right, speaking of coming your way, what are we talking about for this episode? I gave you a little of a hint in the show title. But of course we have much more than that. Baby reflux, is it really a disease? Shouldn't we be treating it with medication? Or is baby reflux a variant abnormal. And medication worthless and needless expenses. Well, as it turns out, pediatricians can't quite agree on that answer. So we'll take a look at the debate.

Also, robot therapy. We've all heard about companion dogs and pet therapy for sick and injured kids. But, what about robots? Could they become a practical substitute for warm, furry creatures? We'll let you know.

0:04:01.9

And then we're going to move on to a different kind of therapy, wilderness therapy. These are programs for many troubled youths. Those battling addiction and depression and criminal records. Where they head into the woods and come out with a different outlook and lease on life. Question is, do they work and just as important, are they safe? And we'll consider both of those questions.

After that we'll take a look at the kids of parents who are deployed in the military. They are an important group. Nearly 2,000,000 of them to be exact. And the numbers surrounding the use of drugs and alcohol by these kids is not so good. So, we will take a look at the numbers and consider how we can help these kids cope with stress, and anxiety, and anger, and depression in a safer and healthier way. So, that's coming up.

And then finally, how to successfully prepare your older high school kid through the dangers of alcohol on college campuses. We hear stories in the news, and stories from friend and family of college students who turn of into a ditch, resulting in poor academic performance, and dropping out.

0:05:01.0

And sometimes deadly consequences because of alcohol use. There is a new study that look at how you the parent, can equip your high school graduate with knowledge and tools to fight the temptation. And in fact, we'll point you to an incredibly helpful handbook to guide you through the process. There's another version of the handbook compiled by MAD, Mothers Against Drunk Driving, which will help you approach the topic with alcohol with middle school and other high school students who aren't necessarily heading off to college quite yet. So, we'll get you connected with that handbook as well.

So, we have a big news parents, new show coming your way. And we'll get all the stories in a moment. I do want to remind you, if there is topic that you'd like us to discuss here in PediaCast. Or you have a question for the program. It's easy to get in touch with me. Just head over to pediacast.org, and click on the contact link. And there is a handy form there. You can submit a question and we'll try to get it answered on the program for you.

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Also, I want to remind you, the information presented in every episode in PediaCast is for general, educational, purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. 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 term of use agreement. Which you can find at pediacast.org.

All right, let's take a quick break. And I'll be back with "News Parents Can Use", right after this.

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All right. We are back. And first up, gastro esophageal reflux disease, also known as GERD, is overdiagnosed in babies. And calling it a disease leads to increased use of needless medication. These provocative statement comes from researchers at the University of Michigan and the University of Missouri, in an article called, "The Hazards of Medicalizing Variance of Normal", love that, which appeared in the April 2013 edition of the journal "Pediatrics". Medications used to treat reflux are some of the most widely used drugs in children less than one year of age. Now, I'm sure many moms and dads out there, you're shaking your heads right now, and yeah, my baby has reflux. And their taking medicine for it. After hearing this news story, your next thought would likely be, should we be using it? Ultimately that' a decision between you and your baby's doctor. But, moms and dads should know this. All pediatricians do not agree on labeling fuzzy babies who spit up as having a disease. And all do not agree on treating it of medication.

0:07:57.7

Dr. Beth Tarini, an Assistant Professor of Pediatrics at the University of Michigan, CS Children's Hospital, and senior author of this study, says "the opinion of an individual pediatrician on this matter, and words that pediatricians uses has an impact whether medication is ultimately prescribed". She says, "as doctors, we need to appreciate that the words we use when talking with patients and parents have power. The power to make a normal process seem like a disease. And as pediatricians, our jog is to make sick children healthy. Not to make healthy children sick".

For the study, researchers surveyed the parents coming in to a pediatric clinic. They gave each mom and dad a hypothetical situation in which they're the parents of the baby who cries and spits out excessively, unless otherwise healthy. Researchers randomly assigned these parents to one or two groups. For one group, they provided a label for their baby's hypothetical condition, gastro esophageal reflux disease. For the other group they did not use a disease label.

0:08:55.7

Researchers told half the parents in each group that existing medications are probably ineffective for fuzzy, spitty babies. But, they did not repeat this bit of information to the remaining half of each group.

So what did they find? Well, parents who heard of a label of gastro esophageal reflux disease, we're interested in giving their baby medication. Even when researchers told them that the medicine is likely ineffective. Parents who did not hear a disease label, they were interested in a prescription, only when the researchers skipped the discussion on medication effectiveness. So, which parents were least likely to request a prescription? Those who did not hear a disease label and were told that medication for fuzzy, spitty babies is likely ineffective.

Dr. Laura Sure, an Assistant Professor of Psychological Science at the University of Missouri, and lead author of the project, says "the growing digestive systems of an infant can be finicky and cause the child to regurgitate. A discomfort can cause the infant to cry. But t is not necessarily a disease. Parents can learn from this study that a disease label can make them want medication for their child regardless of whether the drugs are effective or not".

0:10:00.3

"Parents should follow doctors advice, which sometimes means accepting a doctor's explanation of why an infant's crying and vomiting maybe normal". She goes on to say, "unnecessary use of medication is costly, especially for families without insurance and the over use of medication can be a needless expense. In addition, the long term side effects of reflux medications, have not been fully studied, although they have been correlated to slightly higher rates of pneumonia".

OK. So, I have mixed feelings about this study, which I think as we talked through them will help some parents out there, who maybe asking the question I post at the beginning of the story, should my child be on reflux medications? It's true that many babies spit up. And it's also true that many babies are fuzzy when they spit up. We've talked about this in great detail in a previous episode of PediaCast. But, sort of in a nutshell it again, the bowel on top of the stomach is loose in many babies. So, it pops open when the stomach squeezes, and up comes some of the stomach contents.

0:10:58.9

But, the good news is it only last for a few months, for most babies. And the bowel matures. And the reflux goes away usually before the first birthday. Now, when these babies spit up, you have to remember, there was already fluid in the stomach. So, what comes up, always looks like a lot. But as long as your baby is growing well and staying well hydrated. Those are things that can help you determine. Then even if it seems like all the formula or all the breast milk comes up, you can be assured that no, it's not really all coming up. And yes, enough is staying down.

But what about the fuzziness? Well here is where things get tricky. And as you guys know, I take a practical approach. I absolutely appreciate evidence based medicine, very much. But, research studies are not perfect. And we can't approach medicine in a cookie cutter fashion. So, let me explain. When babies vomit, stomach contents comes up. And stomach acid comes with it. And as older children, teens, and adults with symptomatic reflux will you, it can hurt all the time.

0:11:59.8

Heartburn isn't fun. Long after the actual reflux episode, you can have a burning sensation, it's uncomfortable. But on the other hand, not everyone with reflux has these prolonged and severe symptoms of heartburn. So, how can you tell if a baby does or doesn't, since they can't talk to you and tell you. Well here is where the researchers make a valid point on medication effectiveness. If a baby cries immediately after spitting up, but then they console easily. They're probably aren't having long lasting severe pain. They're probably crying because they just threw up. Some comfortable, they don't like it. You know, vomiting makes me want to cry. Not because of long lasting pain, I just don't like doing it. So, for these babies, reflux medications aimed at decreasing stomach acid. Things like Zantac, also known as Ranitidine. Or Prilosec, also known as Omeprazole, or Prevacid is another one. These medications aren't going to help. They don't stop vomiting. And they don't make babies like vomiting any better.

0:13:00.9

Now, having said that, I believe there are babies with long lasting and severe symptoms of heartburn associated with their reflux, why shouldn't there be? We know long lasting reflux can hurt. We hear this from kids who have it. Who are old enough to talk to us and tell us it hurts. And we know there are babies with reflux who are fuzzy all the time, not just after spitting up. Who get started on reflux medication, aimed at decreasing stomach acid and their fuzziness improves. And if mom and dad forget to give their medicine for few days, guess what? The fuzziness comes back. Or they may grow larger, and so, they sort of outgrow their dose. They start to get fuzzy again. But when you up the dose to match their growth, or if it's a parent who forgot to give the medicine for a few days. When they start to give it again, the fuzziness improves again.

So, for these babies, I would say, and I think parents would agree, the medication is helping. Now, the next question is, is that fuzziness something we must treat? Are there long lasting consequences of untreated baby reflux?

0:14:03.3

Usually, there aren't. Are there long lasting consequences of using the acid reducing medication? Now, despite the researchers use of the phrase "unknown long term effect" in scare quotes, I would say usually, there aren't.

Look folks, we've been using Zantac in babies for more than 20 years. Now, does that mean it's absolutely safe, no. But 20 years of use without any concrete adverse effects, that makes me personally feel pretty good about it. So, really we're back to our old friend, the benefit versus risk meter. And for me here's how that looks. Now your mileage may differ. But if my child is spitting up and fuzzy all the time. So much so that family life is disrupted, and my kids, uncomfortable, I'd say the potential benefit outweighs the risk. So, I try it. If it doesn't helped, I stopped giving it. You know, maybe the fuzziness isn't reflux. Maybe it's colic, and will get better on it's own in a few weeks.

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On the other hand, if my baby only cries immediately after spitting up, and they console easily. Then the risk of the medication remote as it is, outweighs the benefit. Because the benefit in this case is likely zero. These kids are still going to cry after they spit up, 'cause they don't like spitting up.

So, that's how the analysis plays out for me. You definitely want to talk about your child's situation with your doctor. It is also important to point out, not all vomiting and fuzziness are caused by reflux. There are other possible causes of these symptoms. Some of them life threatening, so it's important to travel down this road with your child's doctor. So, while I agree with the researchers in a general sense. Too many kids are labeled with disease, too many kids are on needless medication. We also don't want to throw the baby out with the bath water. If your baby is spitting out and fuzzy, you need to see your doctor to get the right diagnosis. You need to talk to your doctor about treatment options. Keep in mind that there might not be an effective treatment. You might just have to wait this one out. On the other hand, there might be a benefit of giving reflux medication in your child.

0:16:00.1

Benefit that outweighs the risk. And with all of this nuances, that's why we still need caring community doctors, who will sit down with you and walk with you down that road of decision making. You can't replace those encounters with inexperienced mid level providers in grocery store clinics. Using rigid protocols. You just can't do it.

All right, let's move on. This one is a fun story. Pet therapy can help patients cope with the pain, stress and physical effects of a serious illness, we know this. It's been studied before. But access to companion animals is not always possible. Sometimes they aren't available in the community, sometimes they aren't allowed in the physical space in which your sick or injured child resides. So, what about robotic animals? Could they offer the same benefit. These were the questions before researchers at Columbia University has published in the 'Pier Reviewed Journal, Cyber Psychology, Behavior and Social Networking". Dr. Sandra Okita, lead investigator of the project, says "robot therapy works. Significantly reducing pain ratings during a child's interaction with the robot".

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"But, this finding only holds true in the presence of a parent. When the child interacts with the robotic animal alone, without the parent present, there is no reduction in the pain scale". Researchers made another interesting observation, when parent, child and robot interact together, as the parents anxiety level in the perception of their child's pain diminishes, the child's self reported pain ratings improved in likewise fashion.

The authors describe this finding as parental modeling, a coping mechanism, by which children observe the emotional state of a parent and respond in a similar manner. Dr. Brenda Wiederhold, Editor In Chief of Cyber Psychology, Behavior and Social Networking, says "it will be useful to explore and in future studies, whether the benefit of parental modeling exhibited during the interactions is maintained long term. It will also be important to understand how we may lower the pain and anxiety in children without the presence of their parents, which is of course not easily feasible in a hospital setting".

0:18:00.5

So, this is an interesting study on several levels. First, it introduced me to the peer review journal "Cyber Psychology, Behavior and Social Networking". Got to love that. And it will be interesting to follow them for future articles. Second, robotic animals. I mean, what's not to love there. There clean, safe, predictable, no mess. OK, it doesn't mean as much when they lick your face or cuddle in your lap, but they can take the form of animals you couldn't really have in your hospital room. Like in the case of this study, an extremely cute robotic seal name "Paro". You can't bring a real seal into a hospital, not our hospital, maybe yours. Don't know for sure. But I kind of doubt it. By the way if you like to see Paro, you can judge for yourself, his cuteness, or if you'd like to read the entire article for yourself and be introduce to the journal, Cyber Psychology, Behavior and Social Networking, I'll put a link to it in the show notes for episode 250 over at pediacast.org.

0:18:58.3

So, my third point, and I save the best for last, is this whole concept of parental modeling. Where by kids take cues from mom or dad. And respond in like fashion. Look folks, this is something we see all the time in pediatric medicine. I can't tell you how many instances where I've seen an ill or injured child, who is really scared and upset, but whose parents is more upset than the kid. And if we can put the parent at ease, it's amazing how fast the child response. In fact, it's often better than pain medicine. And I'm sure many doctors and nurses in the audience right now, you're shaking your head in agreement. You know exactly what I'm talking about. So, moms and dads, I know, when your child is very sick or injured, it's natural to be anxious, I get that. But keep in mind who is watching and modeling your behavior, it's your sick or injured child. So, be strong for your kids even when it's difficult for you. And doctors and nurse in the crowd, we have to remember soothing the parent, maybe is important as soothing the child.

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Because as we soothe the parent, the child is likewise soothe. Important stuff for all of us to keep in mind.

All right, let's move on to another type of therapy. Teen ages participating in wilderness and adventure therapy programs are at significantly less risk of injuries than those of playing football. And are three times less likely to visit the emergency department for an injury than if they were at home. That's according to a new study from the University of New Hampshire and reported in "The Journal of Therapeutic Schools and Programs", Dr. Michael Gas, senior researcher on the project and Professor of Outdoor Education at the University of New Hampshire says, "After does this program work, the questions most asked by parents consider the adventure therapy, is will my child be safe? And when no one can guarantee the unconditional safety of any child, we can now show the relative risk levels for teen agers". And the study shows there is less risk to participants in Wilderness Therapy Programs when they are conducted correctly. Then the teen agers and their normal everyday life. So, what is adventure therapy?

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Well, it's the prescriptive use of wilderness adventure experiences to improve the mental health of clients, it primarily serves adolescents. And it is often seen as a treatment of last resort for youth, who typically present with three or more dysfunctional behaviors such as depression, substance abuse and suicidal thoughts. Dr. Gass, a leading expert in the field, estimates there are more than 200 such programs nationwide, raging from multi million dollars set ups, to individual counselors who may informally take a group or class into the woods. For this study, Dr. Gass, along with Steven Javorski, a doctoral student and lead author of the paper, look at incident data collected by the 12 adventure therapy which were members of the Outdoor Behavioral Health Industry Council in 2011. They analyzed injuries that resulted in the removal of clients from regular programming for more than 24 hours. Including injuries treated in the field, as well as those requiring evacuations to a medical facility.

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So what did they find? Well, the adventure therapy programs had an injury rate of just 0.11 injuries per 1,000 days in 2011. Or one injury for every 9,091 client days. So, for every client who was there, for each day that a client was there, if you took 9,091 of those days, you only have one injury. So that's pretty good. The estimated national average rate of injuries for adolescent treated in US emergency department nationwide, was three times that rate. The adventure therapy program posts even stronger records when compared to other common activities of teen ages. Injuries during high school football game are more than 140 times greater than those in the adventure therapy programs. And injury rates are also higher for snowboarding, down hill skiing, mountain biking, back packing and football practice. Researcher say they are hopeful their data will counter the public perception that these programs are dangerous.

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They say well managed programs are not dangerous and are not exposing kids to undue risks. So, why are these programs so safe compared to other teen age activities? Dr. Gass offers an explanation. He says, " as the field has developed, risks management standards have improved. And when it comes to implementing this standards, programs in the outdoor behavioral industry council have been leaders in the field". He adds, "perception of risk colors how we view everyday activities. Driving a car is actually more dangerous than hiking in the wilderness, particularly with well trained staff. These programs remove teens from other accepted yet higher risks situations like driving. Plus the effectiveness of these programs makes them not just safe, but saviors to parents of their very troubled adolescent clients. Many parents say this is the one thing that saved my child". Dr. Gass and colleagues are researching how and why adventure therapy works. But he is confident that their potency lies at the intersection of adventure programming and traditional therapy. He says, "the pill we are offering is the positive use of stress coated with appropriate level of care and support".

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In response to growth in the wilderness therapy field, the University of New Hampshire launched the nations first duo social work outdoor education degree in 2009. The 2 1/2 year program awards a Master Degree in Social Work and a Master Degree in Outdoor Education. Graduates of the program are working hard to expand the field of adventure therapy.

So, pretty cool stuff and life changing for many teen agers. If you are interested in learning more about the duo degree master's program in Social Work and Adventure Therapy at the University of New Hampshire, that sounds really interesting. I'll put a link to that program in the show notes for episode 250, go for app pediacast.org.

From robotic and adventure therapy, we move to military kids with deployed parents. In 2010, almost 2,000,000 American children, had at least one parent in active military duty. And when that parent is deployed, these kids have an increased risk of drinking alcohol and using drugs.

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That's according to a new study from the University of Iowa. This one really is from Iowa, not Illinois, I double checked. The research finding are published online in the journal "Addiction". Investigators used data from a state wide of 6th, 8th and 11th graders in Iowa, and focus, or they found an increased in alcohol use, binge drinking, marijuana and other illegal drugs. Along with an increased misused of prescription drugs among children of deployed parents compared to kids in non military families. Dr. Steven Arnt, senior study author, and a Professor of Biostatistics at the University of Iowa, says " we worry a lot about the service men and women, and we sometimes forget, they're not the only ones put in the harms way by deployment. Their families are affected too. And our finding suggests, we need to provide this families with more community support". He says "looking at the Iowa youth survey, we discovered we were right in regard to our idea that parental deployment would increase the risk for substance use behaviors in children. In fact, the number suggested we are a lot more right than we wanted to be".

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"For example, six graders in non military families, had binge drinking rates of about 2%, that jumps up to 7% for the children of deployed parents". 6th graders, binger drinking, seriously, 7% of those with deployed parents. That's crazy. The study showed the rates for drinking alcohol in the previous 30 days was 7 to 9 % higher for children of deployed parents. While rates for binge drinking, defined as five or more alcoholic drinks in a row. Were 5 to 8% higher. And this increase was seen at all grade levels.

Marijuana use was also higher for children of deployed parents. 2% higher for 6t graders and 5% higher for 11th graders.

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As it turns out living arrangements also matter. Dr. Arnt says when at least one parent is deployed, there is a measurable percentage of children who are not living their natural parent. Some of these children go live with their relative. But some go outside of the family, and that change in living arrangement grossly affects the risk of binge drinking and marijuana use in this children. In fact, and this numbers are quite remarkable. Children of deployed parents who are not living with a parent or relative, are more likely to binge drink alcohol, by a factor of 42% when compared to children from non-military families. How about those living with the non-deployed natural parent? The numbers are better. But, they are still not great. They're more likely to binge alcohol by a factor of 8% compared to non-military families. Dr. Arnt says "deployment is going to be disruptive anyway, which is probably why we see the over all increased risk of substance abuse in these children. And then for those children where parental deployment means they end up living outside the family, it's a double whammy. Our results suggests that when a parent deploys, it may be preferable to place the child with a family member and try to minimize the disruption of the child's living arrangement.

0:28:04.1

He goes on to say "I think our finding suggest, first that people need to be aware. That for service members and their families, this is a real phenomenon. And one should receive close attention. I would also think that schools should have a heighten awareness that children with deployed parents may need extra help.

So, these are great points all around from the University of Iowa. Incidentally, Iowa, along with Vermont, Wisconsin and Minnesota, has the largest portion of military moms and dads deployed with reserved and national guard units. So, it's a hard hit state. And, well the numbers in the study comes from children in Iowa, I think we can expect the same stresses and probably the same substance abuse patterns. Really for kids in any state with the parent deployed in the military. And really, substance abuse is simply one measurable outcome. Think about the anxiety this kids face, and the fear, uncertainty, depression. So, my prayer certainly go out for this kids.

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And, I agree as extended families, we need to care for this children. You know, our extended loved ones, brave men and women who are far away, but not far from our hearts, we need to care for their kids, like they're our kids. So, if you are an extended relative of a child whose mom and dad is deployed, even if that child is not living with you, dig into their lives. You know, have them over for dinner, engage them in conversation, help them with their homework, take them to a ball, go outside and play ball. You get the picture. And to do it on a regular basis, because you really do have the opportunity to make a difference in that child's life.

All right, lets move on to our final news story this week. We're going to head back to college. I told you, more college stories. But I think these are important ones. Teen age college students are significantly more likely to abstain from drinking alcohol or to drink only minimally when their parents talked to them before they start college. That's according to Dr. Robert Teresi, a Professor of Bio Behavioral Health at Penn State, as reported in "The Journal of Studies on Alcohol and Drugs".

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He said "Over 90% of teens try alcohol outside the home before they graduate from high school. And it is well known that fewer problems develop for every year heavy drinking is delayed. Our research over the past decades shows parents can play a powerful role in minimizing their teens drinking during college, when they talk to their teens about alcohol before they enter college".

Researchers recruited over 1,900 study participants by randomly selecting incoming freshman to a large public university in the Northeastern portion of the United States. Gee, do you think it could be, I don't know, Penn State? Since that's where the research comes from. Investigators, I don't know why they're so cryptic in that. Anyway, maybe it's a different school they used, I don't know. Maybe they travelled to get their research, don't know.

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Investigators placed each participant into one of four groups, based on their level of alcohol consumption. They were put into one of four groups. Either they were non-drinkers, weekend light drinkers, weekend heavy drinkers and all the time heavy drinkers. And by the way, these people, they're all under the legal limit of being able to drink alcohol. But that's beside the point. Then the team mailed a 22 page handbook to the parents of these students prior to the start of freshman year. The handbook contained an over view of college student drinking. Also, included strategies and techniques in communicating effectively. Ways to help teens develop assertiveness and resist peer pressure. And in depth information on how alcohol affects the body. The parents were asked to read the handbook and talk to their teens about the contents, but not necessarily right away. Researchers asked one-third of the parents to go ahead and talk about it during the summer before the college. And again during the fall semester. And they asked the final one-third to wait until after school starts, and go over the handbook for the first time during fall semester.

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Dr. Teresi explains, "We were trying to determine the best timing and dosage for delivering the parent intervention. For timing, we compared before school started to after school started. And for dosage, we compared one conversation to two". So, what were the results? Dr. Teresi says, "we know that, without an intervention, there is movement from each drinking level into higher drinking levels. For example, non-drinkers tend to become light drinkers. Light drinkers will become medium drinkers, and medium drinkers will become heavy drinkers. Our results shows, that if parents follow the recommendations suggested in the handbook. And talked to their teens before they enter college, their teens are more likely to remain in the non-drinking or light drinking groups".

But what if their teens were heavy drinkers in the first place? He says "In that case, data from the study suggest that heavy drinkers may transition out of the heavy drinking group, if their parents intervene before school starts".

0:33:01.8

And when is the best time for this conversation. Dr. Teresi says "Do it during the summer before college starts. Waiting after the semester starts may not work as well. In fact many families, in the wait until during the semester group, the talk made no difference at all in student drinking behavior". And which was better? One talk or two? He says " the second talk during the fall semester did not have additional benefit. So the key is one go through with the handbook but it should be done during the summer before school starts". So, can you, the PediaCast listener, can you download the handbook and use it before your teens heads off to college. And do they have a high school version for younger teens? And the answer to both questions is yes. The before you go to college version is called "A Parent Handbook for Talking with a College Student About Alcohol". And I'll put a link to it in the show notes for episode 250 over at pediacast.org.

0:34:00.7

The version for younger teens, so middle school and high school, again, compiled by MAD, Mother Against Drunk Driving. But still based on all the same information that was in this research study. It's called "The Parent Handbook for Talking with Teens About Alcohol", and I'll put a link to that one in the show notes for episode 250 as well again over at pediacast.org. So, moms and dads, if you have teen agers at home, this is definitely a time you do want to head over at pediacast.org. Find the show notes for episode 250, and you'll find the handbooks. One, for middle school and high school and then one for talking to your kids right before they leave for college. Really important here, a lot of kids fall into that trap of drinking in college. And it really to some degree, changes the course of their life unfortunately. So, I would encourage you to definitely check those out.

All right. That wraps up this weeks "News Parents Can Use". Let's take a quick break and I'll be back with a final word right after this.

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0:35:01.4

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All right. My final word today is really a follow up and an emphasis on a couple of our news stories today. You know, we've all heard, it takes a village to raise our kids. To which to be honest, when I hear the phrase, I usually kind of roll my eyes and say to myself, "No, I'll raise my kids. Thank you very much". But the news stories today really got me thinking about the responsibilities we have to kids who aren't necessarily our own kids, but who are in our sphere of influence.

0:36:03.0

And especially those kids who may be extended family. You know, when we think about an important time in their life, like graduations, and birthday parties, and school plays. But, who we really don't give a second thought about pretty much any other time. Now keep in mind, keep that in mind, and also think about your own kids and the important role that we as parents play in their lives. Nurturing them, loving them, guiding and directing them. Building relationships, investing in their lives. Those are our own kids. And it's easy for us to have that sort of influence when we are living under the same roof. But, what about those kids, who are again in our sphere of influence especially extended relatives. So, now I'm talking nephews, nieces, grandchildren, second cousins. There's probably a lot of those that you can think about, who don't have the kind of support at home, that I had mentioned of what we want to do with our kids. The nurturing, the loving, the guiding, the directing. All of that. And you think about those kids in your life and you know that they're not getting that kind of support at home.

0:37:06.9

Maybe it's a deployed parent, maybe it's a single parent who works lots of hours to financially support their child. And they really wanted to do all those things. They want to nurture him, and love, and guide, and direct. But they just don't have time or energy because their working so hard to financially support the child. Maybe, there's that kid you know, who is getting off to college and dad is an alcoholic. And mother isn't the type to talk about alcohol with the kids. You know, cultural and societal boundaries often keep us from getting involved. And really, those boundaries are probably why I myself roll my eyes when I hear the phrase "it takes a village". But something is got to give. And when I hear about kids living with non-relatives, whose parents deployed in the military. Who has a 48% greater risk of binge drinking as a middle schooler, I don't know, they just make me fell sick inside. And I hope it makes you feel sick inside too.

0:38:00.0

In that way we, you know, make a difference on those kids lives. We can't change the world, I get that. But here is what we can do. We can care for and affect change in our homes to our kids. And we can extend that care and change to kids we know, who need us. That's my final word.

All right, a big thank you to everyone who took time out of their day to listen to PediaCast, really appreciate it being part of the audience. I do want to remind you, iTunes reviews are helpful. If you have not reviewed PediaCast on iTunes before, I just ask you take 5 minutes of your time to free program, we're not really asking for much. Just five minutes of your time, head over to iTunes. Find the podcast directory, click Kids and Family. PediaCast is usually in the What's Hot portion of the Kids and Family section of the podcast directory within iTunes, or you can just go to the search bar and put in PediaCast and find us that way. And just take five minutes of your time to write a review for us.

0:39:01.7

Those reviews really help keep PediaCast up high in the podcast directory. And so, parents who come along looking for a podcast to try out, which I'm sure many of you out there that was your experience. You're looking, you find PediaCast, you decide to give it a try. That's how we really get a lot of our audience members. And so, those reviews on iTunes help to propel us up. And so as just those who came before you wrote a review. And kept us up there in the ratings. And so you are able to find us. If you could sort of continue that, and write a review of you own, which will help those who come after you, 'cause they're seeking for something worthwhile and useful within iTunes. So, if you've not written a review in iTunes, we'd really appreciate it.

We also appreciate links, mentions, shares, retweets, re-pins, all those good things on your web pages and blogs and social media sites. We are on Facebook, Twitter, Google Plus and Pinterest. And of course we always appreciate your telling your family, friends, neighbors and co-workers about the program.

0:40:03.2

And probably most important of all, tell your child's doctor. Even if you told him before, tell him again. Next time you head in for a well check up or a sick office visit, just say "Hey, I found this great evidence based podcast with trustworthy information aimed at moms and dads. And you can find it at pediacast.org. If they'd like a poster, to put up in their exam rooms or in their offices, we do have those available under the resources tab at pediacast.org.

And of course, those aren't for the exclusive use of doctors, out in the audience, those are also great for bulletin boards at a day care center and church nurseries, and really wherever parents congregate, we'd appreciate you helping us out and spreading the word. Also, I want to remind you that PediaCast is your program. If there is a topic you like us to talk about or have a specific question for me, just head over to pediacast.org. Click on the contact link. It's really easy to get in touch with me. And I do look at each and every one of those that come through. So, be sure to, even if you are just saying hi, that's fine. Just go to pediacast.org and click on the contact link.

0:41:07.3

We also have a new link in the show notes. If you head over to pediacast.org and click the show notes for episode 250, you'll find it in the link portion of the show notes. It simply says "connect now" with a pediatric specialist. And basically this is a direct line for PediaCast listeners to our community of specialist. So you just gives your name, and the best way to contact you, whether that be your email address or a cell phone, home phone. Even a physical address, if you want us to send something in the mail. And you just tell us what the issues is. What the question is, what you're problem is with your child. If you'd like a second opinion on something. If you would like your child seen by one of our specialist, you just let us know. And the hospital will get back in touch with you and to get something set up. So it's a really easy way, it's just a direct line for the PediaCast community to plug in to the specialist at Nationwide Children.

0:42:05.6

Now, in some cases, I don want to point, your insurance company may say "hey, we'll schedule you an appointment". Let's say your child has diabetes, let say, and you'd like our endocrinologist to take care of him, or to give you a second opinion that you are doing the right thing. The hospital may determine with your insurance company, that referral has to come through your regular doctor. That's possible. But, at least this will get the ball rolling and they'll let you know what it is you need to do to take the next step to have your child evaluated by one of our specialist. And if you are out of state, we have a lot of kids that are seen here in Nationwide Children's who are from out of state. We have a great Ronald McDonald house. And lots of supporting things to help you in terms of getting to Columbus and staying here while your child is being evaluated and treated. And we have a great community of social workers here at the hospital that can help arrange those kind of things and find out what sort of resources are available to help you out.

0:43:02.5

So, if you're thinking there is no way I can get there, give us a try. You don't know what we can arrange for you. So that's the Connect Now with a pediatric specialist. And that link is available in the show note over at pediacast.org.

All right. Once again, thanks all of you for stopping by. And until next time, this is Dr. Mike, saying stay safe, stay healthy and stay involved with your kids. So long everybody.

[Music]

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

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