Booster Seats, Pinworms, Pink Slime – PediaCast 214

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This week on PediaCast… Join us in the studio as Dr Mike takes questions from listeners. Topics include pinworms, shingles, and scoliosis. We also discuss carpooling, booster seats, and Pink Slime!

Topics

  • Carpooling
  • Booster Seats
  • Pinworms
  • Shingles
  • Scoliosis
  • Pink Slime

Links

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now, direct from the campus of Nationwide Children's, here is your host, Dr. Mike!

Mike Patrick: Hello everyone! And welcome one again to PediaCast, a pediatric podcast for moms and dads. This is Dr. Mike, as always coming to you from the the campus of Nationwide Children's Hospital. I'd like to welcome everyone to the program. It is episode 214, 2-1-4 for June 6th, 2012. And we're calling this, 'Booster Seats, Pinworms and Pink Slime." Yes you heard it right pink slime. That's made the news recently -a few months ago.

01:01

It's been kind of a continuing news story. And I haven't weigh in on it, and it was time to weigh in on pink slime. And if you're not sure what exactly that's all about or you kind of heard about it with regard to hamburgers, and McDonalds, and school lunches.

I'm going to let you know what I think about pink slime, that's coming up. Before we get started with the actual meat of the show, speaking of pink slime. Is it meat or is it not meat? We're kind of discuss it. I did want and we'll get to the rest of the lineup here because as you know we always cover more than just what's in the title.

But before we get to that I want to let you know if you're in Central Ohio, you want to mark down and you don't have anything planned -I should have told you this like a while ago. But if you don't have anything planned for this Sunday, June 10th, from 11:00AM to 4:00PM.

02:00

You may want to consider coming on down to the hospital because we're going to have a community celebration day. Now those of you who are regular listeners know that our new hospital opens June 20th, but we're going to have a sneak preview for the community and it's absolutely free.

You get behind the scenes tours of the new hospital. You can actually go inside and see the new emergency department, kind of wander around before patients get in there, we're going to let you do that. We're also going to have interactive education stations for kids out in the park and you can take part in a live version of the Columbus wishing tree project with the real trees.

Last week I told you about the virtual wishing tree project that regardless of where you live, you can be a part of that. And if you want more information on the virtual wishing tree, just listen to last week's show. But we're also having a live wishing tree project that's kind of move around town, and it will be at the community celebration this Sunday on the campus here at the hospital.

03:01

Of course fun activities for all ages. You'll be able to see our collection of giant animal friends. These are basically giant wood carvings of animals such turtles and bunnies, snails, you name it there's a bunch of different animal friends that are incorporated in the design of the new hospital.

And they're hand carved by artisans at the Carousel Works in Mansfield, Ohio. So really excited to share those with you as well. And I have to mention this too, this is a must do for everybody out there you got to do this. It won't take you long, you have to see what the new hospital looks like all lit up at night.

And if you go to nationwidechildrens.org there's a picture of it on the front page in the carousel. So the image is kind of slide by one of those images is the new hospital at night.

And then also on our grand opening page and I have a link to that in the show notes for you. But i if you go to nationwidechildrens.org/grandopening all one word you get to it that way.

04:02

And the reason you have to see this is because the kids in the hospital -in the new hospital, again I've mentioned this before; 12 stories tall, each floor the size of a football field. So this enormous building, but definitely it's big, but it's not impersonal.

And one of the things that's really cool is that the kids, when they're in the hospital of course they get private rooms, all rooms with the window view. And inside the room they get to pick what color their light to be -their lighting in the room. Now obviously if a doctor is examining a kiddo or a nurse is trying to put in an IV, or there's some other procedure being done, you got to have white light.

But most of the time when the kids are in their rooms hanging out, you know, those things aren't going on, and so they can sort of pick some moonlighting. And they can choose from blue, orange, pink, purple, green, yellow, so they get to pick what color they want the lighting in their room to be.

05:02

So obviously each kid is going to pick a different color, so when you look at the hospital from the outside, each room lit up with a different color. So you got these blocks of different colors almost like a quilt, and you got to see it to appreciate what I'm talking about, but it's really cool. You can tell I'm excited about it kids. Yeah, that really is.

And no one here twisted my arm and said, "Hey, talk up the outside of the hospital. We want people to go to the website and see what it looks like." There was none of that, I'm just really excited about it. All right. One of the thing I want to share with you and that is the My Children's app and this is a great way to connect with Nationwide Children's Hospital.

Now we have an old App, this is a brand new one, just released this month in coordination with our opening. And this app is really cool. Directions to main campus and all of our close to home centers, emergency information, urgent care locations, directions and hours, physician profiles, and contact information.

06:04

Helpful hints if your child is coming to the hospital, what to expect, what to bring. Great resource for educational materials and instant hookups with all of our social media outlets including Facebook, Twitter, You Tube, Pinterest, and of course PediaCast as well as other Nationwide Children's Hospital, podcast production and it's available for iPhones, iPads, and Android devices.

You can look for in the iTunes store and Google Play. And again the app name -absolutely free is My Children's, so you want to check that out. All right. What we'll be talking about today in the program, we have lots coming your way. We have a new story on booster seats, this is what's interesting -parents have a little bit of a double standard on use of booster seats depending on if it's their child or someone else's child.

So we're going to talk about that. We're also going to answer your questions, in this program, we're going to talk about pinworms, shingles, and scoliosis.

07:00

And particular questions that you folks have about those issues, so answers to those are coming your way. And then we're going to wrap things up with the brief and somewhat opinionated discussion just to warn you on pink slime because I haven't weighed on that yet. And as I mentioned the time had come.

Also want to remind you if there's a topic that you would like us to discuss, just head over to PediaCast.org and click on the contact link. You can also email PediaCast@gmail.com, or call the voice line at 347-404-KIDS, that's 347-404-K-I-D-S, or 5437 if you can't spell that out. Also 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 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 over at PediaCast.org.

08:05

All right. Before we get to your questions, I want to cover an important news item for carpooling parents. And this is brought to you as always from our news partner Medical News Today -the largest independent health and medical news website. You can visit them online, and I encourage you to do so at medicalnewstoday.com.

Child health expert who conducted a national survey in the US, found that although most parents make sure their children use a life saving booster seat in the family car, they tend to forego booster seats when car pooling. Researchers at the University of Michigan's C.S. Mott's Children's Hospital in the Ann Arbor, suggests shortage of space in cars and the difficulty of making arrangements with other drivers, are the main reasons parents relax their use of booster seats while car pooling.

Their article published in the Journal of Pediatrics points out that previous studies have found booster seat amongst school children is consistently lower than national goals. With this in mind, Dr. Michelle Macy and colleagues set about exploring the link between booster seat use and car pooling.

09:06

Dr. Macy a clinical lecturer of emergency medicine at U of M and and a pediatrician at C. S. Mott Children's Hospital, reports most parents surveyed said, "their children used the safety seat when traveling with the family car. But more that 30% of the parents revealed that they do not enforce this rule when their children ride with other drivers.

For those study, researchers examine the responses to a web based cross sectional survey of a nationally representative sample of U.S. parents in January 2010. Respondents were parents of four to eight year olds who answered 12 questions regarding the use of booster seat ad car pooling. Six hundred and eighty one parents responded, 76% reported their child use the safety seat when riding in the family car, so that's good.

Parents were more likely -of course we'd like that to be a little closer to 100%, but 76% I guess was I don't know, it's a little higher than I thought especially when you're talking older kids and booster seats.

10:02

You know, we're talking kids up to eight years of age who should be in booster seats, but you know, when you're out and about on the road, you definitely see kids who aren't. So 76% reported their child use the safety seat for their four to eight year olds when riding in the family car. Parents were more likely to report child safety use if the child was younger, and on the younger end of that, for to eight year old frame.

And if there was a state law enforcing the use of booster seats, then they were also more likely to use them. However, parents were not so good at residing the content of state booster seat laws with half of them unsure of the required age range for booster seat use in their state and another 20% guessing the age range by getting it incorrect.

Among parents who car pool and whose children use a safety seat in their own car, 79% said they would always ensure their own child was in a booster seat when sending them off with another driver, but only 55% said they would always put a friend's child in the booster seat when they were doing the driving.

11:04

The authors conclude booster seat uses inconsistent during car pooling which is a common real world situation. They also say convenience as well as driving skill confidence are likely influential factors. So I want my kid in a booster seat if you're driving, but your kid is fine without one as long as I'm the one behind the wheel, that's basically what they're saying.

Clinicians who care for children should increase efforts to convey the importance of using the size appropriate restraint for every child for every trip regardless of whose child, and regardless of who's driving. OK. That's according to the researchers and so I just pass that onto you because I do believe that's true. The research team also notes practical barriers such as lack of space in the vehicle and difficulties making arrangements with other drivers lead parents to forego safety seats when car pooling.

Dr. Macy says, since many parents are unaware of current booster seat recommendations, pediatricians should tell them what it is as a matter of priority.

12:05

In most U.S. states laws requires all children up to age eight to be restrained in an appropriately sized car or booster seat. The American Academy of Pediatrics however recommends parents use booster seats until children reach a height of 57 inches which is four foot nine inches, and the average height of an 11 year old.

Considerably later that the age sighted in most state laws. If a child starts using an adult seat belt too early it can be dangerous because the shoulder and lap belt won't fit properly, and an ill fitting seat belt may not save your child's life, in fact it may cause injury. Dr. Macy concludes by saying parents need to understand the importance of using a booster seat for every child who does not fit properly in an adult seat belt on every trip, and every car regardless of who is driving.

So as to an honesty check here moms and dads, how many of you go a little lax on the rules when your child car pools with another family or when you drive around someone else's kid?

13:05

I'll admit that we have done that before in the past and I'm not proud of that and won't do it again. Of course my kids both on adult car seats now or adult seat belts now. So isn't that convenient? Yeah. I'm not going to make that mistake. Many of you I'm sure in the same boat with younger kids right now though who don't fit properly with an adult seat belt

Again, that could up to age 11. So really we got to knock this off, the risks are the same regardless of the identity of the car and driver. So make sure your kid or your friend's kid always travel with their booster seat if the adult seat belt does not fit properly.

So I've included this link before, but I'm going to put again, and that's the official 2012 car and booster seat recommendations in their entirety from healthychildren.org and the American Academy of Pediatrics. And you can find that link in the Show Notes over at PediaCast.org.

14:03

So if you want to know all the rules -so you want to dot all your Is, cross all your Ts when it comes to car seats and booster seats for the latest recommendations, the 2012 version, you can find at PediaCast.org in the Show Notes for episode 214 which is the one you are currently listening to.

All right. Let's take a quick break and we're going to comeback and answer your questions on pinworms, shingles, and scoliosis, plus still to come pink slime. We'll get started with the rest of the show right after this.

[Music]

15:04

OK. We are back and our first question, you're going to love this. It comes from anonymous in Berkeley, California. So folks in Berkeley apparently don't want their neighbors to know that your children have pin worms, which you shouldn't be too embarrassed about that because lots of kids have pinworms, you catch them at school. It's not a matter of your own hygiene.

So let's talk about pinworms, anonymous in Berkeley, California says, "Dear Dr. Mike, I love your show. Been listening for awhile, I have a quick question for you.

My son has been itching his bottom for a few weeks, and I think he must have pinworms. I will ask his doctor when we see her for the next well check up which is next week, but I would like to hear your thoughts on pinworms especially on treating pinworms with garlic or garlic oil, that was what my parents did for me when I was little, but I would like a doctor's opinion. Thanks so much for all you do." So thank you anonymous for the question.

16:00

I do sort of understand you when you want to remain anonymous on the pinworm issue. But again I want to reassure you, we see lots of kids with pinworms, so don't be embarrassed it's not your fault it happens, and we deal with it. So let's talk pinworms, believe it or not this is a PediaCast first. We have not covered pinworms before.

I was a little surprise at that, you know, I went back through the archives and did the search. Of course I have the text of the scripts and all my notes and for every show. And I really thought I was going to find something on pinworms, and it just sort of recap it again but I had to sort of research from scratch to make sure everything is up to date which I usually do that anyway even when I cover something before. But pinworms is new to the program, so what are they?

Pinworms really are worms, unlike ringworm which is not really a worm, it's a fungal infection. But pinworms really are worms, they live in the human intestine. Actually they only live in the human intestine, so you can't get it from a dog or a cat, or another animal, only human -human to human transmission.

17:04

They are thin and white, they measure about a quarter to a half inch in length. So think rice, maybe a little bit longer, little wiggling pieces of rice. And their life cycle goes something like this, let's start with pinworm birth. All right. Infected individuals consume pinworm eggs -when we finish out the life cycle we'll talk about how you can come into contact with pinworm eggs.

But the egg travels to the intestine, and boy and girl pinworms are born. Boy pinworm meets girl pinworm, they mate, and the females make their way to the end of the shoot, and they came out the anus. They typically do this while their host whether it be a child or an adult is sleeping because the host body is still quiet and dark. I shouldn't say that. I have no idea if pinworms have ears and eyes.

18:01

So I'm not sure that the quiet and the lack of light make any difference on when they come out. But I'm sure the pinworms can tell that the host is not moving around. I've never asked pinworm, but I suspect that's the case. So the pinworm wiggles around on the anus of the host and deposits thousands of microscopic eggs on the external rectal mucosa. Isn't that nice?

The wiggling worms and eggs cause some inflammation, some irritation because we're not supposed to be there, and the body's immune system recognizes that fact and that results in inflammation and intense itching. So what will happen to the host, the child scratches the itch, you know where that is. And they get microscopic eggs on their fingers and under their fingernails.

And then here she touches someone or something and deposits those little microscopic eggs in the process. And then person number two, host number two either is that someone or they touched something that has these eggs.

19:09

And again they're microscopic. You're not going to see them, and advertently consume the egg, and we're back to the part of the cycle where we began with the host ingesting the lovely pinworm eggs. And again notice that the pinworms only involve humans in this cycle, so you can't get pinworms from your pet and you cannot give pinworms to your pet, they're humans only. OK. So next stop, let's talk diagnosis. How do we know that your child has pinworms?

Well the first clue is usually an itchy bottom. Irritability and restless sleeping is also common. Less common but possible, intermittent abdominal pain, nausea, occasionally vomiting and a decreased appetite. Weight loss is usually not an issue as usually these worms aren't big nutrition robbers like some other types of intestinal worms. However if your child has a massive infestation, a

20:02

However if your child has a massive infestation, malnutrition and more severe abdominal pain is a possibility, but most typically you're going to see itching, and irritability, and restless sleeping as the most common complaints. Incidentally some folks have no symptoms at all, they tolerate the worms well, their immune system sort of keeps them in check so you don't get too many of them.

You have no abdominal pain, no nausea and the child doesn't really form that much of an immune response to the worms or the eggs, so their bottoms don't itch. And these kids and grown ups are the ones that are most likely to not get treated because they don't know they have it and they spread the worms to others.

And it's not just in the home where they're spread, you can also pick them up -in fact a big place top pick them up is going to be at school. Work sites, restaurants, shopping malls, playgrounds, the YMCA, churches, day cares, you get the picture they can be anywhere.

21:01

The pinworm eggs can survive on surfaces for two to three weeks, so you know, if a kid itches their bottom and touches the doorknob, or shopping cart, or whatever else you want to imagine. The eggs can actually stay there for two to three weeks.

Hand hygiene goes along way to prevent the spread which is easy to understand why when you think about the worm's life cycle. So washing with soap and water or using a hand sanitizer is important for everyone after using the restroom, after playing, after contact with others, and before eating or putting your fingers in your mouth.

Of course good luck getting kids to follow this advice without fail which is why pinworms spread pretty easily. Even if you maintain a clean house and good hand hygiene is usually practiced, everyone is still at risk for getting pinworms. OK. So what do you do when this happens? When you get pinworms what do you do? Well, first if we expect pinworms based on the symptoms, we look for them.

22:02

And couple of ways to do that because there are other things that can cause rectal itching, you know, we have differential diagnosis here. And problems with sleeping and abdominal pain, and nausea, and vomiting -all the symptoms that we attributed to pinworms. There are other things that can cause it as well. So we like to actually see these worms.

So how do you do it? Well, a couple of hours after your child goes to bed, you sneak into their bedroom with a flashlight, pull down their drawer, shine the light, and you know, where you're shining the light. And you look for little pieces of wiggling rice maybe a little longer than rice, but they're thin, they're white, small, and they are wiggling.

If you don't see anything, you can place a piece of transparent tape in the anal region and wait few hours, and then check the tape for worms stuck to the surface little later on in the night. Now sometimes you get lucky and you'll see the pinworms on the toilet paper after wiping, or in the toilet water itself.

23:05

So look in those places too and you may not have to sneak in at night. And sometimes that's how kid -kids will say, "Hey mom, I have like little pieces of rice on my poop or on the toilet paper, and they were wiggling that will give you an idea that's probably pinworms. So once you established that you are dealing with pinworms, and by the way you don't need to collect them and take them to the doctor's office. Your doctor doesn't need to see them, OK?

Please, don't take them in. Just say, "Hey, I saw little white pieces of wiggling things that looked like rice", and your doctor is going to go, "Oh pinworms." And they don't want to see them in a zip lock baggy, folks -they don't. Well, OK. Maybe some of them do. Most don't, OK. At least most of the ones I know don't. All right.

So tell your doctor and then your doctors is going to say, "Oh, we're dealing with pinworms", and then how are you going to treat it? Well, generally we use an anti parasite medication that kill the pinworm.

24:00

And examples of this include things like Vermox, is a brand name of mebendazole, Albenza is another drug, and Pin-X which I think is a cute name for an anti pinworm medicine, Pin-X. That is pyrantel is the generic drug name.

So these are all medications that kill the pinworms. Generally you treat with one dose, and you clean the house well, sanitize surfaces, wash bed linens and clothes. You have to remember, you got to keep in mind the eggs are hardy and the re-infection is common. And so many of us will repeat the treatment in a week or two.

And sometimes more than two doses are required especially if the primary infection is outside of the home, at school or work so that you can keep getting re-infected unless you practice better hygiene and whoever it is that you're getting the infection from, figures out that they're infected and sop spreading it which that can be sometimes difficult.

25:02

So re-infection is common not just in the house, but at work and at school. And so this can become a nuisance at times. When one kid has it in the home, we often treat the entire family at the same time in case one member is an asymptomatic carriers, that way we get rid of it in the house all at the same time by treating everybody.

Now, this becomes a little bit of an issue, so if your pediatrician you seek with pinworms, you ant to treat everyone in the house, but not everyone in the house is your patient, and insurance companies get a little upset when a doctor is prescribing medicine for people who aren't their patient and actually pharmacy boards can get upset about that as well.

And we can understand if someone that's not your patient has an allergic reaction to it which is very unusual, but you know if they would have and adverse outcome base on the medicine, you don't really need to have document that you ever examined the person, that can be a problem. Some doctors you know, will prescribe more of the medicine in one kid's name, but again -so everybody in the house can have it.

26:06

But again that can be a problem with pharmacy boards and with insurance companies. So typically what we do is say, this is what I do anyway is just -I'm happy to see other kids in the house, but you have to come in and make an appointment so that we can generate a chart and we can examine the child and establish a patient-doctor relationship with each of those kids.

And then adults in the house probably got to call their doctor and just say, "Hey, my kid has pinworms, I need the same medicine and then sort off get it from each person in the house's doctor and then all take it at the same time. So that's generally how that works. So what about garlic? You know, you find tons of anecdotal reports of garlic successfully treating pinworms on the internet.

And many grandparents and great grandparents swear by it. I'm not going to say that that doesn't work, if it does work, we don't understand the mechanism by which garlic would work.

27:03

So we don't know like what dose you should use, we don't know depending on that dose of garlic, what are the side effects or issues that might be associated with the dose that you need to have the desired effect. And again, I'm not saying that there even is a desired effect. Just no one has really studied this.

There aren't any available studies to answer, you know, know one has pitted non treatment in one group, garlic in another group, and one of the commercially available anti pinworm medications in the their group. So there you go, if you are a resident or a pediatric fellow, and you want to research project, there's a good one to do. We do understand out though how the drugs that I mentioned . We do understand how those work, we do understand the required dose, we do know each medication safety profile.

So if I', a doctor and I have to choose between a remedy that I don't really understand, I don't know what the dose is, I don't know what untoward effects there might be versus something I do understand -I'm going to pick the one the sort of standard of care and what I do understand which would be the anti pinworm medications that we went through.

28:17

But again that's not to say that garlic doesn't work, we just don't really know because no one has really studied that. All right. So there you have it anonymous in Berkeley, California. Pinworms in a nutshell. All right.

Let's move on to Theresa up the West Coast in Vancouver, Washington. And Theresa says, "Hi Dr. Mike. My 11 year old was recently diagnosed with an outbreak of shingles, the rash has finally scabbed over and the pain is almost gone, but I have a few questions for you about shingles.

Number one; I read that shingles usually show up in older people or those with compromised immune systems. Why would a child get it who is otherwise healthy? Number two; the doctor said that sometime s the outbreak only happens once, sometimes multiple times.

29:01

Is there any indication of whether it will come back and is there anything you can do to prevent or shortened an outbreak? And number three; I read the likelihood of shingles is higher with the chicken pox vaccine that with an actual chicken pox exposure. Is there any research on this? Thanks for any resources and insight you can provide.

So thanks for the questions Theresa, they're good ones. And first let's do a quick primer on shingles. The chicken pox virus also known as varicella is the culprit here.

And what happens is this; the virus whether it's in the form of a natural disease or whether it's from a live attenuated vial vaccine, so we have a less infectious form of the various that is it is still live various, but it's being given as part of the chicken pox vaccine whether you come into contact with the virus that way with the vaccine, or whether you have the natural disease, the important thing to remember is that it is mostly killed by the immune system.

30:00

And so you form antibodies against it, that your body them remember so if that natural virus comes back or comes for the first time after you've had the vaccine, your body's immune system can attack it and fight it before you get sick. So notice I said that it's the natural virus or the virus from the vaccine, it gets mostly killed by the immune system, but mostly killed is not completely killed.

So a few virus particles survive and they line a sort of dormant state in nerve cell bodies. So your nerves have a cell body and for those of you who remember high school biology, you know you got the axon and the dendrites just kind of ringing the bell a little bit. And you have the derma cell body just where the nucleus of the cell lives.

And so the chicken pox virus stays in a dormant state in some of these nerve cell bodies. But the immune system kind of keeps them in check and keeps them dormant.

31:05

But sometime the virus wakes up and becomes active, and the immune system hiccups in its effort to stand watch. I'm simplifying this a little bit, but when that happens, the varicella virus when it wakes up and the immune system doesn't keep it in check. It can travel from the nerve cell body down the nerve, to the skin, and it infects the skin.

But only the skin supplied by the nerve -the sensory nerve that it was living in. So from the affected person's perspective, you'll often feel itching, or burning, or pain sensation in the distribution of the nerve that's in question.

And that will happen a day or two before the rash breaks out. And this is just the result of the virus waking up and now the immune system is kicking in and it's a little too late to prevent the process, but it does cause inflammation of that nerve, and so that's why when nerve inflammation results, the nerve fires because of the inflammation and the brain is fooled into thinking the skin is having a problem.

32:08

So you feel what the brain tells you to feel in response to that nerve being inflamed because of the virus being there. And so you feel itching, burning pain sensation to the skin that is distributed by the nerve that is in question. So hopefully that makes sense to you.

And so you got the nerve inflammation, now the virus actually gets into the skin that's supplied by that nerve and it will cause a rash, and it's a rash that looks kind of like a chicken pox rash, but it's only limited to the area of skin that nerve goes to. And we call that area or skin dermatome. So you have a breakout just in that dermatome in that section of the skin, and you get vesicles, little fluid filled blisters, they rupture, they scab.

33:02

They can become secondarily infected with skin bacteria just like chicken pox but only in that patch. The immune system finally wins, and the rash goes away, but that process can last a few weeks. OK.

So that's shingles in a nutshell. So now let's get to your specific questions Theresa. Number one; you said that you read that shingles usually show up in older people or those with compromised immune systems. Why would a child get it who is otherwise healthy? And answer to that question is because sometimes they do. Our immune systems aren't perfect, even in kids. And sometimes events that we really don't understand conspire against us.

So what exactly triggers the virus to wake up and what causes the immune system to hiccup and allow that virus to travel down the nerve? We don't really completely understand it. Some possibilities include illness, so if your immune system is working elsewhere, doing something else, that's something that could allow this to happen.

34:03

Certain medications like steroids for instance if you have a kid with asthma and they're on prednisone because their asthma – that suppresses the immune system so that could be an initiating factor. Also things that we don't understand on the skin -pressure points, so beneath bra straps, or elastic waistbands, it's a little bit more common that shingles can erupt in areas where there is pressure points to the skin.

And we don't really understand why that is. And there's probably factors involved here that just haven't been discovered yet. Now, if our immune system isn't perfect as kids, guess what? It gets worse as we age. And so the incidence and severity of shingles outbreaks does rise with age. But that doesn't mean that this process is absent in healthy children, it's not we see it and it happens.

Now I will say this if they happen frequently in childhood, or if they're particularly severe, then it is possible that your child has a contributing immune system problem and your doctor will want to know about this and will look into it.

35:11

So if your child gets shingles and they're otherwise healthy, and it happens occasionally, you know, happen once when they were four, it happens again once when they are seven, that sort of thing is not so worrisome.

But if it's happening three and four times a year then there could be a problem in their immune system and so it needs to be looked into. Now I use three or four times a year as an example when do you go from OK, if it happens once every few years that's OK, to a few times a year, that's not OK.

At what point do you go from it's OK to it's not OK, and that's where the art of medicine comes in, not just the science of medicine. So there's not all if it happens this often then it's a problem. You have to look at the whole picture, and that's why for your particular child we can't give you advice.

36:01

You have to see your regular doctor and let them make that call when it goes from being not a problem to being a problem in terms of how often or how severe shingles is happening. But the bottom line is, it does happen occasionally even in kids, even in healthy kids, so you're in good company for that.

By the way for those of you who have made the connection, so this is like you know, advance PediaCast here. There's another virus that behaves in this fashion, and that is the herpes virus. So you know, the herpes virus you can get cold sores on the lips, and that is reactivation of virus she had when you were a kid, when you had lots of sores inside the mouth.

And so it's the same kind of thing with the reactivation. In general herpes also can come and go for the course of your lifetime. Again, because a dormant virus wakes up, travels down the nerve, and affects the skin associated with that nerve, and so that happens with herpes viruses as well.

37:04

And as it turns out the chicken pox virus varicella belongs to the herpes family of viruses and in fact the medical term for an outbreak of shingles caused by the chicken pox virus is 'Herpes Zoster', but I digress. Let's – I just thought you'd find that interesting. Let's jump to Theresa's next question, she says, "The doctor said sometime s the outbreak only happens once, sometimes multiple times.

Is there any indication of whether it will come back, and is there anything you can do to prevent or shorten an outbreak? So another excellent question Theresa. Again, we don't know why it sometimes only happens once and sometimes it happens multiple times. And again sometimes you know it's difficult to know again when multiple times is too many.

So we don't really understand that, but it's just something that you have to see your doctor and look at how many times it's happening and then determine if that's an issue or not.

38:02

If it's something that you knew that your doctor needs to address or not. So what about prevention? Well if there is a known initiating factor like tight waistbands or bra straps, then you may be able to avoid the initiating event. It's difficult to avoid other infections, you know again since there's so much to this that we don't understand you can see why we aren't so good preventing it.

You know, steroid medications if that has caused outbreaks in the past, you might want to try to avoid steroid medicines, but that maybe difficult if you have severe asthma or there's some other reason that you're taking a steroid medicine and you need it. You know then you got to look at the risk versus benefit and it may still be that the benefit of the steroid medicine outweighs the risk that you're going to have an outbreak of shingles.

So again, there's something you just have to really discuss on a case by case basis with your physician. Now, there is a medicine called axyclovir that can kill the varicella virus and lessen the duration and severity of the outbreak.

39:05

But the key with acyclovir is you have to start it early like on the first day that you feel the skin tingle, and before you actually have the rash. Once you've had the rash a couple of days, acyclovir is unlikely to help.

Now the exception of this is folks with known immune system problems or a history of frequent severe outbreaks of shingles,or folks who fit a high risk profile for getting a frequent or severe shingles. And in those cases you want to start acyclovir as soon as possible even if it isn't started early and you've had the rash for a couple of days you still started it.

But in folks in healthy individuals who have shingles then the rash has already been there a couple of days, the acyclovir is unlikely to be of much benefit for them. But again these are not blanket statements, each individuals case varies you really have to talk to your doctor about that. All right. And finally Theresa's third question; "I read the likelihood of shingles is higher with the chicken pox vaccine than with an actual chicken pox exposure, and is there any research on this?"

40:09

All right. So here's the deal with this, Theresa. You got to follow me, you got to use your thinking cap here. Initial studies did show a decreased incident of shingles with the varicella vaccine compared to natural chicken pox disease.

So when the chicken pox shot first was coming out, it looked like the incidents of shingles was not going to be as much. And that kind of made sense. And we'll talk about why here in a second, but a more recent study has showed the opposite that there's an increase in incidents of shingles with the chicken pox vaccine compared to natural chicken pox.

But let's not get too excited about this. Let's think about why this is? When the initial studies were done, the chicken pox vaccine hadn't been around for a very long time.

41:02

So you have two groups of kids, you have kids who have the vaccine, and you had kids with natural disease. And you're going to follow them along for the same length of time. Now, obviously the viral load is going to be a little bit different between these two groups.

So if you have the viral vaccine, your viral load, the amount of chicken pox in your body is less to begin with, than if you have the natural disease you just have a ton of the virus inside of you. so right there are two groups who are going to be a little bit different right out of the gate, in terms of how much chickenpox virus is in them to begin with and you think well, you have the vaccine, you have less of the virus, less of a viral load, less of a chance that some of that virus is going to go dormant, so you're going to have less of a chance of getting shingles that kind of make sense, right?

And now you're following them over a set five year period. So you're going to follow both groups for five years, one with a massive viral load at the beginning, and one with the very, very, very small viral load at the beginning of the five years.

42:02

So you follow both those groups for five years, which group do you think is more likely to have an outbreak of shingles. It's the natural disease group, right? With time being equal, the kids with more virus at the beginning are more likely have virus particles that evade the immune system and go dormant which means they have a greater chance of one of those may particles going active.

So this observation makes sense, natural disease equals more viral load, equals more shingles outbreak down the road. So why are studies now showing the opposite to be true? Let's think about this, the initial studies were prospective trial, so the start point was either you had the vaccine or you had natural disease, and the end point was five years.

The later trials aren't prospective studies, they're retrospective studies. So what that means is take kids with shingles and now we're going to look back and ask, OK. Do they have the vaccine or did they have natural disease? And in this case time is not equal.

43:01

So unless all the kids had natural chicken pox -the at chicken pox vaccine is typically given at 12 months of age, so unless all the kids had natural chicken pox at exactly 12 months of age which is not the case with these studies, then time is not equal here. So we're just looking at shingles and looking back and saying, "Did you have the shot or did you have natural disease?"

But the time it elapse between those two are not necessarily equal. So do you see why this is important? The vaccine group had been living with their virus since they were 12 months old. The natural disease kids have been living with the virus since they have the natural disease which in many cases is during the school age years,.

Let's say you take two 15 year olds, OK. One had them the vaccine at one year of age, and at 15 years of age they have their first episodes of shingles. The other let's say had natural chicken pox at 10 years of age, but they've not yet experienced the shingles outbreak.

44:04

The vaccine kid had fewer virus particles to begin with, but he's had 15 years in which his immune system could hiccup and one particle could go active, whereas the natural disease kid had more particles to begin with, more viral particles, but he's only been living with the virus for five years not 15 years, so he hasn't had 15 years for his immune system to hiccup only five.

So of course the vaccine kids are going to start having more cases of shingles as we get further away from their initial viral load, they simply have more time for their immune system to hiccup, and allow them to get shingles.

So the best study would take kids who have the vaccine at exactly 12 months and kids who have natural chicken pox at exactly 12 months and followed both groups prospectively and then see what the difference in shingle rates is moving forward from there. But no study has been conducted in that fashion. So I hope you see how these observations make sense.

45:00

It makes sense that more kids who had the shot are getting shingles as they get older because they've been living with that dormant virus for a longer period of time. You have to think about it a little bit, but it does makes sense.

Now are these kids who are having some frequent shingles outbreaks after following their chicken pox shots as we get years down the road. Are these kids having more severe outbreaks that those who had natural disease? No. Studies have not shown that. Are there kids alive today because they have the chicken pox shot?

Yes. Absolutely. Absolutely there are kids alive today because they had the chicken pox shot. Natural chicken pox disease kills kids. It's not theoretical, it happens, I've seen it happened more that once. So even if we are seeing more kids with shingles because more kids have been living with the virus since they were 12 months old, the benefit of the chicken pox vaccine still far outweighs any risk. And that's not just my opinion, that's the filling of the scientist and other experts at the Center for Disease Control in the American Academy of Pediatrics.

46:06

Now will you see anti vaccine groups saying, "Hey look here, look here. Chicken pox vaccine means more kids are getting shingles." Yes there would be anti vaccine groups saying that, ad you can say big deal, that's expected it makes sense when you understand the pathophysiology of the varicella virus and feel free to ask them why this observation is true, and then you can explain it to them.

You an be helpful in that way to the anti viral folks that are out there. All right. Thanks for the question Theresa, it's always appreciated. Let's move on to our final listener question. And this one comes from Kimberly in Kentucky. Kimberly says, "Hi Dr. Mike. I'm a new listener and I'm so happy to have found this podcast, what a great resource, I'll certainly be bringing your flier to my son's day care provider and pediatrician."

Thanks Kimberly, we really appreciate that. My question is for my 10 year old niece, she was recently diagnosed with scoliosis and underwent surgery last week.

47:02

We do have a family history of scoliosis, and so it was not a total surprise, but we're little surprised to how early and how severe it was. The journey started few months ago when my niece began to complain about back pain. My sister took her to her pediatrician who said that they could see anything wrong.

The doctor said it was probably growing pains and instructed my sister to give ibuprofen, if my niece seemed to be in moderate discomfort. Two months later when the pain continued even with the ibuprofen, my sister returned to the pediatrician, this time she was told there was a curve in my niece's spine, and the pediatrician referred my niece to a pediatric orthopedic specialist, this doctor said the curve was severe, and immediate surgical intervention was necessary.

I am happy to report there were no complications with the surgery and my niece is now recovering at home. I have two concerns; could the scoliosis really have been undetectable during the first exam especially given our family history and my niece's sincere complain of pain and secondly what kind of follow up care or therapy is she going to require?

48:01

My sister and niece live in California, I live in Kentucky, and so all the information has been second hand. My sister told me she does know what to expect now except that there would be a six to nine month recovery time for the spine to heal and then my niece can return to most of her regular activities. She is beside herself with concern for her child along with guilt of not knowing what was happening sooner.

She's been focused on the surgery and she never even stopped to wonder what happens next. I searched for older podcast or scoliosis might have been mentioned, PediaCast number four, 27, 35, 40 all came up. I listened to the first of these and was excited to check out the website iscoliosis.com that you recommended, and I'll listen to the three show when time allows.

I just wondered if you have any new or additional information or resources that you might like to share on this topic. Thanks so much for the time and effort you invest in producing this podcast, I only wish I found it sooner. I cannot wait to share your podcast with other parents because it is such a great resource.

49:00

A friend of mine is a social worker who does early screening, education, and intervention with family, and I think she would be happy to learn about you as well. Please keep up your good work. I look forward to listening to many more PediaCast in the future. So thanks for your kind words Kimberly, I really do appreciate that.

So scoliosis, it's actually been awhile since we covered this in detail, the other ones were scoliosis was kind of mentioned, but the last time that we really did scoliosis was back in episode four. Episode four for crying out loud. In the tradition of our first two questions, let's nutshell typical scoliosis before we answer your specific concerns.

And I will point out your niece does not sound like she has typical scoliosis. And by the way iscoliosis.com is still around and kicking and it's still a great site with lots of information. And I'll put a link to it again in the Show Notes for this episode 214, so folks can find it easily.

50:00

So first let's define scoliosis, what is it? Well scoliosis is a sideways curve of the spine. And it's most commonly see in the thoracic portion of the spine, so that's going to be between the waste and the shoulder blades.

Actually that's not completely true is it? It's most commonly seen in the thoracic part portion, but that's going to be not from the waist I'm sorry, from the end of the ribs where the ribs and the back come into the vertebrae, into the -I want to say spinal cord, the ribs don't go into the spinal cord. The ribs go into the spine, the boney spine not the cord.

So where the ribs come into the spine at the very bottom, from there to the shoulders, that's the thoracic spine. And that's where you're going to see most cases of scoliosis.

51:01

But it can also happen in the lumbar portion of the spine which is that's between the bottom of the ribs and the waist, and the back. It's going to develop gradually, it's usually first noticeable around the onset of puberty and it often worsens and sometimes rapidly during adolescent growth spurts. It's seen in both sexes, male and female, but it is a little more common in females.

So what causes this? What causes scoliosis? Well, the most common form of is idiopathic which means that the cause is unknown, it just happens. And there does tends to be a genetic component to this. So it tends to run in families. Some other causes and incompletely formed or misshape vertebrae, or different leg lengths can also lead to scoliosis.

So these are things that would then pull the spine sideways on one side or another, so if there's incompletely formed or misshaped invertebrae, that could do it in different leg lengths as well.

52:03

But most commonly it's idiopathic which means, we don't know, it just happens. But it tends to run in families. You know some have hypothesize that maybe for some reasons one set of rib muscle pull harder than the others, and then on the other side and so that potentially could be a cause.

And so because of that, that causes the attached vertebra to twist out of their straight line down the back, and that results in a sideways curve. So that could have something to do with it. These are some things that we know don't cause scoliosis; poor posture, sports participation, heavy book bag or backpack use, these things have not been shown to cause scoliosis.

However they may aggravate the pain of scoliosis. So if you do have pain from scoliosis, poor posture, sports participation, heavy book bags those kind of things make the pain worse, but it's not going to actually pull the curve worse.

53:02

Sort of the symptoms of scoliosis, well early mild scoliosis tends to be painless, but with progression you start to get uneven appearance to the shoulders, and/or the waist. It can get sort of a hump on one side of the back especially when a child is bent over, sort of touching their fingertips to their toes so that their back is making a curve, you'll notice that there can be a hump on one side of the back.

One shoulder blade may stick out further than the other, and it leans lightly to one side and eventually as these progresses you get back pain. So how do you diagnose it? Well, early to mild scoliosis is often does go unnoticed by teens and parents, yearly back screening by your doctor during you well check up is the best way to find it.

And many schools often screen that school with a nurse or during gym or health class, and then they refer you to your doctor if the find it. So many of you out there remember you've been in gym or health class, and you had to lift your shirt up and bend over, and have your fingers touching your toes so your back was curved.

54:09

And someone would look straight down your back and refer to your doctor if there's a problem. Now I think we're already seeing less of that at schools as funding tightens up and school nurse programs and health classes sort of feel the pinch. And so there are many kids out there who may not be getting this screening in school, and so it is important that you see your doctor for your yearly well check up.

And once your kiddo is hitting the pre pubescent years and into puberty if at the yearly well check up your doctor is not checking for scoliosis, say "Hey, can you check for scoliosis." Please don't forget to do that, it's important. So if your doctor – your doctor should be doing that at the well check up, but if they're not, make sure that you ask them to do it.

Now physical exam evidence is followed by X-rays which we use to measure the degree of the curvature. And a serial X-rays maybe followed every six to 12 months especially during times of rapid adolescents growth if you do find scoliosis.

55:06

And if the curvature is progression beyond 10 degrees or so, or if there's any symptoms, even if it's less than 10 degrees of a curve, . If there are symptoms of back pain even with mild scoliosis, then generally we refer to a pediatric orthopedic doctor.

So what so they do? Well, treatment includes braces, molded plastic shells that can be use to slow the curvature. These devices do not correct curvature that's already there, but they can help slow progressions. Sometimes in severe cases surgery is needed and then it's important to practice good posture and avoid over exertion with certain sports and heavy book backs in severe cases to minimize back pain.

So what about outcome? Well scoliosis never goes away. The curve that's there will always be there unless it's corrected surgically. Progression into the adult years is unusual, most scoliosis stops progressing when linear growth is finished.

56:02

And if recognized early and with orthopedic intervention,progression can be slowed and pain can be minimized, however there are cases which do continue to progress. Cases that require one or more surgeries, and cases that result in chronic pain. And you kind of look at the family history for clues.

So if other people in the family had a history of severe scoliosis, then your scoliosis is more likely to kind of go into that severe form whereas if you look at the family history and everyone had mild scoliosis so it's kind of followed, nothing really became of it, then your kiddo's scoliosis is likely to follow that path. Now, that's not a 100% certainly there are folks with severe scoliosis who have family members none of which have severe scoliosis, but some which have mild.

And so, you can't use that 100%, but in general you can usually follow the family pattern. All right. So again if you like to know more information about scoliosis, the link again iscoliosis.com, it's a really good, lots of information and I encourage to check it out and put a link in the show notes again for you.

57:05

So that may been a little more than just a nut shelling of scoliosis. We pretty much covered the whole shebang. But let's talk about your specific concerns, Kimberly. Could your niece's back really have been OK at the first exam, and then progressed to the point of requiring surgery in just two months.

And then your other question now that she's had the surgery, what kind of rehabilitation and lifelong issues is she likely to face. Well, first let me say that 10 years of age is pretty young for a typical scoliosis. We mentioned scoliosis is most likely to occur during periods of rapid adolescent growth which does not describe most 10 year olds.

So right of the bat, you're not dealing with a typical situation. And this means all bets are off if you compare your niece to the typical scoliosis picture. Now can scoliosis really have progressed that rapidly in two months? Well account being the doctor who saw her both visits, I don't know, I can't really say for sure.

58:04

I can say it seems unlikely to me. I can say that this is a possible scenario, not saying this is what happened, I'm just saying this is possible. It's possible that the scoliosis wasn't picked up at the first visit, it was there and the doctor didn't see it.

It's also possible that the scoliosis was not only present at this first visit, but it was severe and would have required surgery even at that first visit, if it had been discovered. It's also plausible that the scoliosis didn't get any worse in that two month timeframe. The pain became worse because the scoliosis wasn't being addressed, but it's plausible that the curve itself was about the same even though the symptoms got worse.

It's also likely that the doctor said rest, take ibuprofen, come back if it doesn't get better which I think is reasonable advice for an active 10 year old who presents with their first complain of back pain.

59:01

We see a lot of kids who are jumping on trampolines, and doing gymnastics, and wrestling with their siblings, and they come in and they complain a back pain when they're 10 and there's a doctor you're going to say, your back hurts it's probably a muscle strain, take some ibuprofen and rest and if doesn't get better come back, and that's what happened.

Your niece it didn't get better, and so what she do, she went back just like she was supposed to. And so your niece went in for another exam and your doc found the problem. Should doctors check for scoliosis on every single 10 year old that presents with back pain on their first visit? I don't know if they should. You know, it's much more likely a 10 year old is going to have a back pain from a muscle strain than it is from a scoliosis.

However if it's not getting better, then yeah you absolutely want to check for a scoliosis. So I'm not convinced that diagnosing this two months earlier would have made any difference at all. I mean there are kids with severe scoliosis who have to wait a month or two for their surgery anyway because the scheduling problems, and insurance issues.

60:00

So remember rapidly progressive scoliosis usually occurs during a period of rapid vertical growth. So if your niece shot up an inch a month during those two months, then yeah maybe it happened that way. But that seems kind of odd for a 10 year old. The other thing is that kids with a severe curve at age 10, severe enough to require surgery, and a big family history of scoliosis.

That's the sort of kid that's probably heading for surgery regardless of when the curve was found. So Kimberly, I cautioned you not to compare your niece's case with typical scoliosis. This also means her recovery and lifelong course are probably not going to be typical either.

She likely has a long road ahead of her with the rehabilitation and since she has lots of growth left in her teen years, she may have more complications and need more surgeries. So I don't think she's that severe because mom waited two months. I think it's because she has a typical severe scoliosis.

61:00

And mom shouldn't beat herself up over this too much other than changing which genes she passed on to her daughter -that's probably the only thing she could have really done to change the outcome is to pass on different genes.

So Kimberly I hope this discussion helps, and as always thanks for being part of the show, we really do appreciate it. If you like to join in on the discussion- you the listener, if you have a question or topic idea it's easy to get a hold of me as always just head over to PediaCast.org click on the contact link, you can also email PediaCast@gmail.com, or call the voice line at 347-404-KIDS, 347-404-K-I-D-S.

All right. We're going to take a quick break and we will be back, and I promised to weigh in on pink slime. So that is coming up right after this.

[Music]

62:20

All right. We are back and I was doing a little math during the break and we answered three questions, pinworms, shingles, scoliosis. And we spent about 15 minutes on each of those topics and I have to ask you, if you went to your doctor's office, and you had a question about any of those topics, would your doctor be able to sit down with you for 15 minutes to talk about each of those?

And I'll bet not. On the other hand there's many of you out there who are probably saying I really don't want my doctor talking to me in the room on pinworms for 15 minutes. OK. I get that too, but for those of you who really want the in depth answers, that's what we give you.

63:01

And I would just encourage you to share PediaCast with your families and friends especially those are particularly interested in getting the details of their child's health. All right. So let's talk about Pink Slime.

It's been all over the news this year, McDonald's, Burger King, Taco Bell, and other fast food establishments have pledged to stop using it, but schools are still using pink slime in their lunch programs. And this has lead to a national outcry the Congressman shooting of the USDA online petition with hundreds of thousands of signatures and a ton of internet traffic with the terms pink slime toping the charts with regard to Google searches and Twitter traffic.

So what's the deal exactly? What is pink slime is it a bad thing? And if fast food joints have eliminated it, why are schools still serving it? They are all great questions. So let's get cracking. First what exactly is oink slime? Well better yet let's start with what pink slime is not.

64:01

Pink Slime is not a new product, schools and fast food restaurants have been using it since the 1970's. Pink Slime is not slimy, it's pink, but it's not slimy. So why is it called pink slime? Well we can think of scientist at the USDA who wrote a memo 10 years ago in which he referred to the product as pink slime.

He wasn't too happy with pink slime, and he felt consumers were being misled, and still making a clear argument for his feelings he resorted to creating a beef slur and coined the term pink slime. Of course nobody wants to eat something called pink slime, I mean even if it's not really slimy. And the food industry of course they don't call it pink slime, they call it lean finely textured beef.

So we probably got two extremes there, you know I mean one pink slime really that's kind of negative. And lean finely textured beef you know, that probably puts in a little positive, but the truth is somewhere in the middle.

65:02

All right. So what is it already? So here's the deal, traditional cuts of meat so sirloin, tenderloin, porter house, T-bone, rump roast, flank steak, OK. The traditional cuts of meat, this cuts only make up about half the weight of a cow.

Now traditional ground beef, so hamburger comes from not so tender muscles and most often from the shoulder and neck muscles which is the chuck, which is how we get ground chuck. Now when butchers separate the choice cuts, trimmings fall to the floor, and these trimmings consist of the edges of the choice muscle.

So you know the sirloins and the tenderloin, the edges of those choice muscles, but they do have fat and connective tissue mixed in with them as well. So those are the trimmings, that you know, you cut out the good meat and the edges have some fat and connective tissue mixed in, and so they just -they fall.

66:03

And the meat companies called this trimmings. Now what do the meat companies do with these trimmings? Well they collect them, and they put them to a centrifuge to reliably separate the muscle from the fat and the connective tissue that was in remix. And the centrifuge actually does a pretty decent job of this and it creates a product that's at least 90% lean.

Now the product is not a pure choice cut, it still has five to 10% of the fat and connective tissue mixed in which is why it has more of a pink appearance than a deep red pure muscle sort of look.

Now to be fair, when the stuff is inside the centrifuge, it is slimy, but the centrifuge separates out the slime which is really the fat and the connective tissue, and we are left with the beef product that's lighter in color than ground chuck, so it's pink not red.

67:00

But it's not really anymore slimy at that point once you separate out the fat and the connective tissue. OK. So next this beef is squeezed through pencil think tubes, just like ground chuck is to give it that textured hamburger appearance.

And as it goes through those tubes, the product is exposed to ammonia gas and this is where the guy from the USDA 10 years ago who wrote the memo, they had a problem with the fact centrifuge were used to separate out the fat and connective tissue, and he also had a problem with the ammonia gas being at it.

So why they do that? As it goes to the tubes, the pencil thin tubes, and the meat is exposed to ammonia gas. The ammonia gas reacts with water in the beef to form ammonium hydroxide and the presence of a small amount of ammonium hydroxide in the beef raises the pH of the beef and kills bacteria that's in the beef. The fact that the pH goes up that kills bacteria like salmonella, and e-coli.

68:01

So this is actually an important step in the process because these trimmings have been handled a lot and they fall on the floor. So they run through a centrifuge and they have lots of opportunity along the way to pick up bacteria.

So exposing the beef to the ammonia gas renders it infection free. And at this point the lean, finely textured beef is either packaged as it is it's mixed with ground chuck to form a hybrid product. So how much beef are we talking here? Well for the average cow, 10 to 12 pounds of beef can be collected in this fashion. So is this a bad thing?

Well ultimately I want you to decide whether you think this is OK or not OK. But I'm going to give you the pros and cons as I see them. So what are the pros? Well, we have beef from choice cuts that is at least 90% lean. So it is beef that is on the edges of these choice cuts, they tend -the muscle is there, is more tender muscle, and it is 90% lean when they spin it out to the centrifuge.

69:02

If you compare that to ground beef from the chuck, that's 70 to 95% lean,so it's definitely comparable and sort of on the leaner side of ground beef that's coming from the chuck muscle. It's also bacteria free so that's good. The FDA says it's safe the USDA says it's safe, and we've been eating it unbeknownst to us since the 1970s without any known problems.

The beef industry also says the process is thought to save 1.5 million animals from slaughter because you're getting that extra what I say 10 to 12 pounds of beef, so if you weren't getting it in this fashion you will have to slaughter an additional 1.5 million animals to come up with the same amount of beef. And of course that decreases the cost of beef for restaurants and schools. So these are all the pros, what about the cons.

70:00

Well, disadvantages -technically it's an animal by-product, it's not the choice cut, it's the trimmings that have fallen off and we're re cooping what we can out of those trimmings, so it's a by-product of your primary process.

But then again that's also how we get the meat for chicken nuggets, hotdogs, and fish sticks. So my question is, do those things -are they the next to go. OK. It is exposed to ammonia gas and it contains a small amount of ammonium hydroxide, but then again we do add chlorine to drinking water, we pasteurize milk, we give children immunization, I mean there are lots of things that we do to prevent infection. The question is, is ammonium hydroxide safe and does it change the taste of the meat?

Well the FDA and the USDA says it safe, and we've been using this since the 1970's. So it does have a fairly long track record. And we've been eating McDonald's and school lunch hamburgers for years without necessarily complaining.

71:03

Well I know some of you may complain, but you know what you're getting, OK? It's a McDonald's burger, it's a school lunch hamburger, you know it taste a certain way, and maybe that's from the ammonium hydroxide, but is that an issue? You know where do you stand on the issue moms and dad when you know the facts and synthesize the pros and cons for yourself.

Social Media has definitely created an uproar over this. But it's an educated uproar or is it mass hysteria? The voice of social media has been heard, no doubt, and that's the reason fast foods joined to stop using the product, not because it's a problem, not because of a safety concern, not because of the cost, it's because you've said you don't want it there.

And they want to keep you buying their product which is quite sort of silly that Congressman are writing letters to the FDA saying, "Hey fast food companies won't feed to their customers why are we feeding that into our kids." That's just silly. If fast food companies eliminated it because the safety concerns or heath concerns absolutely asked that question.

72:04

But the fast food companies haven't eliminated it because of safety or health concerns, they eliminated it because some due that the FDA used the term pink slime, and it went viral. And next thing you know, hundreds of thousand of people are signing petitions without hunting down the facts for themselves.

That behavior makes me glad the internet was not around when we started adding chlorine to drinking water, or when we started pasteurizing milk, or when we start giving kids immunizations. If the internet was around back then we might still be dying from cholera and small pox in this country. OK. So what am I saying? Am I coming out in favor of pink slime? Not necessarily I mean, I'd rather eat the choices red meat, and I'd rather my kids eat the choices red meat.

On the other hand folks at the meat companies are losing their jobs by the hundreds as at least two manufacturers have shut down processing plants due to loss of business from fast food companies. You know, I don't want to see people get sick and die from salmonella and e-coli in their beef. And yes that does happen.

73:03

And what's next with the social media masses have their way with hotdogs, and chicken nuggets, and fish sticks. I don't know, maybe that's a good thing, I mean maybe we don't need hotdogs, and chicken nuggets, and fish sticks. I don't know, I guess in the end I got mixed feelings. How about you? If you'd like to chime in on the pink slime, we should just stop calling it pink slime.

OK. I agree do we need to call it lean finely textured beef, but it probably not, but we need a name that's somewhere in between the two. If you'd like to chime in please do. Add your comments to our Show Notes over at PediaCast.org. All right. before we head out the door, I want to remind you once again about the new app from Nationwide Children's Hospital, it's called my children's.

Everything pediatric we have direction to all of our facilities, how you do referrals, topics, news, social media. It's a great resource and it's yours free. My Children's available in the iTunes store and on Google Play. Also remember especially of you're in Central Ohio,. this Sunday we have our community celebration block party extravaganza.

74:06

You can come and actually tour the new hospital, see the inside, before it's filled up with sick and injured kids, and see what's all about. So I invite you to come this Sunday June 10th, 11:00 a.m. to 4:00 p.m.,so that's this Sunday and again behind the scenes tours of the hospital, interactive education stations, you can take part in a live version of the Columbus Wishing Tree project.

And there really will be fun activities for all ages. So I do encourage you if you're here in Central Ohio to come on out and be a part of that would really welcome you. All right. I also want to remind you that liking PediaCast on Facebook, following us on Twitter, tweeting with hash tag #PediaCast and hanging out with us on Google + is always appreciated.

Also be sure to swing by the show notes at PediaCast.org, add your comments on today's show. And of course we always appreciate you telling your family, friends, and neighbors about the program and don't forget to talk us up with your child's doctor at your next well check up or sick office visit.

75:05

We also have posters that you can download, and hang up wherever moms and dads hang out. And you can find them under the resources tab over at PediaCast.org. All right this program has gone on quite longer than I expected, but we had lots to cover, and if there's a topic that you would like us to talk about in the future just head over PediaCast.org, and click on the contact link.

You can also email pediacast@gmail.com, or call the voice line at 347-404-KIDS, 347-404-5437. And until next time. This is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody!

[Music]

Announcer 2: This program is a production of Nationwide Children's. Thanks for listening! We'll see you next time on PediaCast.

One thought on “Booster Seats, Pinworms, Pink Slime – PediaCast 214

  1. Hey, Dr Mike:
     
    I just wanted to comment on the meat thing….I am one of those people that objected but I only objected to not having the ability to choose because it wasn't on the label. I think that they should have to list it so that I can make an informed choice.
     
    On another topic: I love the show. Thank you for doing such good work. It is most appreciated and informative.

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