Common Cold, Concussions, Toy Safety – PediaCast 306

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Join Dr Mike in the PediaCast Studio for our inaugural show of 2015! Topics include asthma & bed-sharing, common cold & cold weather, concussion laws and concussion recovery, text reminders for flu vaccine, and toy-related injuries.

TOPICS
Asthma & Bed Sharing
Common Cold & Cold Weather
Concussion Laws
Concussion Recovery
Text Reminders for Flu Vaccine
Toy-Related Injuries

LINKS
Toy Safety Site – Nationwide Children’s Hospital
Recalls.gov

Contact Dr Mike – Show Questions, Comments, Topic Ideas
Nationwide Children’s – Request an Appointment or Referral
Nationwide Children’s – Non-Urgent Medical Questions

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.

Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast. It's a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We are in Columbus, Ohio. It's Episode 306, for January 21st, 2015, and we're calling this one the Common Cold, Concussions and Toy Safety.

I want to welcome everyone to the program.

It's our first show of 2015, and right out of the gate, I want to say congratulations to the Ohio State Buckeyes, college football national champions. Those of you who have been long-time listeners of the program know that I'm a Buckeye fan. Of course, I'm also an assistant professor at the Ohio State University College of Medicine, and you know that Nationwide Children's Hospital is home of the Department of Pediatrics for the Ohio State University-College of Medicine. And so, you know, it's just a source of pride, just want to say congratulations to the football team. We do have a connection here on PediaCast, so we wanted to mention that.

Also, before we get started, a quick note. You've heard of measles in the news at Disneyland. There had been at least 20 cases at last count of folks who have caught measles during a trip to Disneyland, and turns out that the majority of the people that has happened to were unvaccinated.

It kind of goes back to a point that I was making at the end of 2014, during one of our last shows of last year, where I had mentioned I thought that people were starting to understand that the association between vaccines and things like autism really was a myth and not based on any scientific evidence.

0:02:20

And this, I guess, as an exclamation point, this comes along. So again, more reason to have your child vaccinated as is suggested by the American Academy of Pediatrics and the Centers for Disease Control. So most of these kids that we are seeing with measles who were exposed at Disneyland, again, were not vaccinated. So please consider vaccinating your children.

Also, I want mention, the big thing here is, OK, your kid gets measles. What's the big deal? Most of the kids in the most recent measles outbreaks, both here in Ohio, which we have talked about in that last episode I was mentioning, and these kids who caught measles at Disneyland, most of these kids have not had complications of the disease. So as a parent, you may be asking yourself, what weren't that a long time ago when measles cause bad things to happen?

Well, we still have pretty small sample sizes. And the measles does have the potential of causing some pretty nasty things, including being associated with meningitis, pneumonia, bacterial infections on top of the measles, and can be life-threatening. So even though we haven't had any deaths from measles in the United States that I am aware of with these recent outbreaks, we get big enough numbers of kids affected, and you are going to start seeing some problems.

All right, so I left you with a teaser at the end of 2014. Coming soon, a new podcast — in addition to this one — aimed at pediatric providers and available for Category 1 CME credit. PediaCast CME is what we're calling it, and it is coming your way a little bit later in the year. We're thinking probably late March, early April, something like that. So stay tuned for more details and I'll fill you in.

0:04:07

I mentioned it because there has been a flurry of behind-the-scenes activity leading up to this, to get that program up and running, along with our yearly planning of this podcast, which is why it's taken a couple of weeks to get this first show of the year into your hands and your ears. Nothing like starting the new year out with excuses, right? Actually, I think the last couple of years, we've kind of had a late starts in January. We kind of went from that holiday break into kind of planning mode, and then into our regular production schedule.

Now, I've got a great show for you today, though, with lots of meat. We're going to start out the year with News Parents Can Use Edition of the program. I also have Listener Show coming your way soon, so now would be a great time to submit your questions to the programs. Here's how that works.

Actually, I'm jumping ahead of myself. Let's do a quick overview of the program in general. It's a nice thing, I think, to do with the beginning of every year, because we always get an uptick of new listeners with new mobile devices and other nifty ways to connect shortly after the holidays. So, if you're new to PediaCast, here's the deal. I started the podcast back in 2006 as a trustworthy source of information for parents. I'm a board-certified pediatrician, fellow of the American Academy of Pediatrics. As I mentioned, an assistant professor of pediatrics at the Ohio State University. I spent ten years prior to doing this in a private pediatric practice and now work part-time clinically in the emergency department in Urgent Cares of Nationwide Children's Hospital in Columbus, Ohio.

My other hat here at the hospital is producer and host of this programs, PediaCast. New shows are typically released on Wednesdays, and we try to get three new shows out to you each month. This month will be the exception, but for the remainder of the year, we're hoping for about three episodes a month.

The shows follow one or three formats. News Parents Can Use, which is the lineup today. We also do interviews with pediatric experts where we take a pediatric topic. We invite a guest, usually a pediatric specialist and discuss the nuts and bolts of that topic with a depth that's just not possible in the time allowed for a typical doctor office visit. It's all the stuff your doctor wish that he or she had the time to tell you.

0:06:29

Then, our third show format is Answers to Listener Questions where you write in and I answer your questions. Now, I can't give medical advice. We don't practice medicine via the podcast, but what we can do is answer general educational-type questions that you have about health and wellness of children in general, or any disease topic that strikes your fancy. Sometimes, if the question is really good, we invite a specialist in to the studio and devote an entire episode to your question. For most questions, we lump five or so together and make a show of it.

The question remains, how do you get your question in my hands and I promise, I'll have the details coming up. First, I want to run through the complete line-up of today's program. We're going to start out with asthma and the bed-sharing. Are these two things related? If so, how so? Could it be possible that one is responsible for the other? So those answers are coming.

And then, common cold and cold weather. You know, I used to be a stickler on this. Cold weather does not cause illness. No matter what your grandma say, micro-organisms cause illness, and we do see more illness in the winter because of school and people spending more time indoors and in close proximity to one another. You got a classroom of 20 kids, and they all have runny nose, and they're within a few feet of each other indoors all day. Of course, things are going to spread and you're going to have more illness during the winter time.

That sounds like a typical doctor response, right? Not so fast. Maybe there really is something to cold weather causing colds. We'll talk about that coming up.

0:08:10

Then, concussion laws, nearly all states have them, but what effect do they have? We'll explore that.

Then, concussion recovery — how long should those with concussion stay out of school and rest? Depending on who you talk to, you may get a different answer, but what does the evidence tell us? We'll take a look.

Then, text messaging for flu vaccine — ever got a text message from your doctor, maybe an appointment reminder? Many doctors are doing it but others aren't. How effective is this practice when it comes to getting parents to bring their children in for their second flu vaccine when the second one is required? We'll talk about that, and I'll have something to say about this flu that's going around right now across the country as well.

Then for my final word, we'll consider the topic of toy safety.

So a lot's coming your way for our first show of 2015. We'll take a quick break. No, not quite yet. I almost forgot. How do you connect with me to ask your question? That's what you were waiting on before I got sidetracked with all these other things.

It's an easy thing to do. You just head over to PediaCast.org, click on the Contact link, and ask away. I read every question that comes through and I'll do my very best to get your question on the show.

All right, just one more order of business before we get started, and that's to remind you that the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. 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 at PediaCast.org.

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

[Music]

0:10:26

Dr. Mike Patrick: All right, we're going to start out the year with a not-so-great study. Now, you may be asking yourself, especially if you're new to the program, Why in the world would he start with a not-so-great study? Well, truth be told, it may serve as a launching point for a better study down the road. And it certainly proves the point I like to make now and then on PediaCast, and that's this — you have to make an effort to look inside scientific studies, really see what makes them tick.

Think about the methods and the result a little bit before you believe and trust the headlines. So, here goes, our first bit of News Parent Can Use for 2015, even though the real use is not so much about the findings themselves but rather an important insight into the interpretation of results.

So here goes, this study is from the Netherlands. Now, please don't send me angry emails for picking apart a foreign study because we do include plenty of great research from overseas on PediaCast. And I picked apart a fair number of studies from the United States, so I just want to be clear, we are equal opportunity on our analysis.

OK, this research was recently published in the European Respiratory Journal and it suggest that toddlers who share a bed with their parents may have an increased risk of asthma later in childhood. Now to be fair, the investigators never suggest that bed-sharing causes asthma, although it's easy enough for mainstream media to make this conclusion and it's even easier for some parents just to believe it.

So let's dig in and take a closer look. Researchers from Erasmus University Rotterdam investigated over 6,000 mothers and their children by collecting information from questionnaires on wheezing and asthma symptoms every year from 12 months to six years of age. And what did they find?

0:12:09

Well, let's actually start with what they didn't find. Children who had shared the bed with the parent during infancy and specifically at two months of age, which by the way is not a safe practice. Please do not co-sleep with an infant. If you want the exact reasons why and a safer alternatives, be sure to check out PediaCast 302, which we devoted entirely to safe sleep.

So, co-sleeping babies in this study did not have a higher risk of asthma or wheezing at least through six years of age. However, bed-sharing at the age of 24 months, so at two years of age, this was associated with an increased chance of wheezing or diagnosis of asthma in early childhood.

Now, wait a minute, why would bed-sharing be associated with the development of asthma? Could it be that bed-sharing causes asthma? Probably not, and the researchers point this out. Remember, correlation does not equal causation. Just because two things are associated or noticed together does not mean that one causes the other, right? So what's going on? How can bed-sharing be associated with asthma.

As it turns out, the investigators' original hypothesis was this — parents may make the decision to share a bed with their child if they are already noticing asthma symptoms, and they want to monitor their children more closely. However, analysis of the data did not confirm this hypothesis because toddlers who wheeze as infants were not more likely to share a bed with their parents at two years of age, when compared to toddler who had not wheezed as babies.

Investigators present a more likely explanation of their findings. Perhaps, bed-sharing families are more likely to report wheezing because they are more attentive or aware of their children's breathing during the night, since they're lying next to each other in a quiet room. In other words, are bed-sharing families more likely to hear wheezing at night, seek medical help and end up with an asthma diagnosis?

0:14:07

Likewise then, perhaps some children who do not share a bed, perhaps some of them do have asthma but it never gets diagnosed because their parents never hear them wheeze. Of course, you could argue, how significant is the asthma that parents were never aware of it. And are the sounds parents are hearing at night, are those really wheezing sounds or some other noise a child might make in their sleep?

Investigators say their study's a good start but more research is needed to confirm the reasons for the association between bed-sharing and the diagnosis of asthma in early childhood.

So there you have it. I'll be honest. I may be a little hard on the investigator saying this was a not-so-good study. They knew what was going on, and they did not leap to any conclusions. My point really is that this is the sort of thing that mainstream media tend to jump on for the headlines. Co-sleeping leads to asthma, and parents believe it without taking a closer look. My point here isn't really whether bed-sharing is truly associated with asthma, but rather to talk about the engagement of scientific studies with a healthy bit of skepticism, because that's an important part of the evidence-based process.

Don't believe everything you hear, only the good stuff, and you have to do a little digging to differentiate the good stuff from the bad stuff. How do you do that? Well, one way is by exploring pediatric research with us here on PediaCast.

All right, let's move on. According to a new project from Yale University and published in the proceedings of the National Academy of Sciences, the common cold virus can reproduce itself more efficiently in the cool temperatures found inside the nose compared to warmer core body temperature. This finding may confirm the popular, yet often contested notion that people are more likely to catch a cold when it's cold outside. Researchers have long known the most frequent cause of the common cold, rhinovirus, replicates more readily in the slightly cooler environment of the nose compared to warmer lung temperatures.

0:16:01

So what new information did this study uncover? Researchers took the focus off the relationship between temperature and viral replication and placed it on how well our immune system responds at lower temperatures. Dr. Akiko Iwasaki — senior author of the project and professor of immunobiology and molecular, cellular and developmental biology at Yale University — and her team examined cells taken from the airways of mice and compared the immune response to rhinovirus when the cells were incubated at 37 degrees Celsius (which is 98.6 degrees Fahrenheit) or core body temperature, and at the cooler 33 degrees Celsius (which is 91.4 degrees Fahrenheit), a typical nose temperature during bouts of cold weather.

Dr. Iwasaki says, "We found the innate immune response to the rhinovirus is impaired at the lower body temperature compared to the core body temperature."

Researchers added an additional spin to this study. They included a group of mice with known genetic deficiencies in the immune system sensors that detect viruses and additional deficiencies in the antiviral response. In this cases, the virus replicated well at both higher and lower temperatures. Dr. Iwasaki says, "This proves it's not just virus intrinsic, but it's the host's response that's the major contributor."

Although the research was conducted on mouse cells, it offers clues that may benefit people, including the roughly 20% of us who harbor rhinovirus in our noses at any given time. Dr. Iwasaki adds, "In general, the lower the temperature, it seems the lower the innate immune response to viruses. In other words, our research may give credence to the old wives' tale that people should keep warm, and even cover their noses, to avoid catching colds."

Yale researchers also hope to apply this insight into how temperature affects immune response to other conditions, such as childhood asthma. While the common cold is no more than a nuisance for many people, it can cause severe breathing problems for children prone to wheezing. Future research may probe the immune response to rhinovirus-induced asthma.

Bottom line for moms and dads, bundle up those kids, because when your grandma told you they'd catch a code for being outside in cooler weather, she may just have been right.

0:18:15

You may have noticed concussions have been in the news frequently over the past few years, and it's no wonder with all the lawsuits and educational drives and new laws aimed at protecting student athletes. We've even had two PediaCast episodes focused entirely on concussions, Episode 177, where we took a nuts and bolts approach to concussions — what exactly are they, what are the symptoms, how are they treated, how long did the symptoms lasts — and Episode 261, which considered mobile apps aimed at managing concussions.

So you can check out both of those episodes again, 177 and 261, over at PediaCast.org. Not to mention the other 26 episodes of PediaCast that have mentioned concussions in one context or another.

So it's a pretty big topic with lots of new-found awareness. And new laws regulating concussion treatment bolstered by an informed public have resulted in a large increase in the treatment of concussion-related injuries for school-age athletes. Over the past decades, concerns over concussion injuries and media coverage of them have skyrocketed. Since 2009, all 50 states and the District of Columbia have enacted concussion laws regulating concussion treatment. By the way, these are the first laws written to address a specific injury.

The University of Michigan study recently published in JAMA Pediatrics and designed to evaluate the impact of new concussion laws found a 92% increase in children seeking medical assistance for concussions in states with legislation in place. States without concussion laws also showed a 75% increase in those seeking injury-related health care during the same time period.

Dr. Steven Broglio, the study's senior author and an Associate Professor at the University of Michigan School of Kinesiology and Director of the NeuroSport Research Laboratory, says, "There are two stories here. First, the legislation works. The other story is that broad awareness of an injury has an equally important effect. We found large increases in states without legislation, showing that just general knowledge plays a huge part."

0:20:21

Investigators examined insurance data from privately insured 12 to 18-year-olds across the United States to evaluate the effect of concussion laws on concussion treatment from January 1st, 2006 to June 30th, 2012 in states with and without concussion laws. The legislation seems to be working as intended.

Teresa Gibson, the study's first author and former vice president of health outcomes at Truven Health Analytics, says, "My thought was that all types of concussion-related services might increase in states that enacted the legislation. As it turns out, we did not see inpatient visits and emergency department visit increases in states with legislation. Instead, we saw office-based visits go up, which suggests the legislation is having the intended effect on these injuries."

In other words, the intended effect was to have folks see a doctor for these things, but not necessarily rush to an emergency department unless it truly was an emergency.

Dr. Broglio adds, "These injuries are the ones you do want to catch, so that athletes will sit out until symptoms have resolved." He says, "The results of this study underscore the importance of public education and legislation."

OK, so we have more concussion awareness. More student athletes seeking medical attention in appropriate venues, but are keeping concussed children out of school and off the playing fields and courts — we're doing that, we're keeping them out of school and off the playing fields and courts — but are we going too far?

That's the question before researchers in our next study. After a concussion, children and adolescents are instructed to rest, but little real data exist regarding the optimal period of rest following this type of injury.

0:22:05

Researchers from the Medical College of Wisconsin followed 88 patients between the ages of 11 and 22 to determine if five days of strict rest improve concussion recovery. Results of this study will appear in the February 2015 print edition of the journal Pediatrics. But they are also available now online.

Half of the patients were advised to follow strict rest at home including no school, work, gym class or sports for five days followed by a gradual return to physical activity. The other half of patients were told to rest for just one or two days and then return to school. Once symptoms have resolved, they were instructed on a gradual return to physical activity in the same fashion as the group which rested longer.

So what did researchers find? Well, there was no clinically significant difference in neuro-cognitive or balance outcomes between the two groups. However, the group who maintained strict rest for five days reported more daily post-concussive symptoms and slower resolution of these symptoms. These result suggests that five days of strict rest following a concussion offers no added benefit compared to one to two days of rest.

So why did the five-day group have an increased occurrence and duration of post-concussive symptoms? Investigators do not believe this finding is due to the actual length of rest but other factors.

Again, just because two things are associated doesn't mean that one cause the other. We don't think that five days of rest made things worst. So why is it that we do see an association between a longer period of rest and the actual increase occurrence and duration of post-concussive symptoms? Well, researchers think several possibilities could be at play.

For example, teens who are limited to strict rest for five days are missing out on social interactions, as well as falling behind academically. This could have contributed to situational depression and elicited greater physical and emotional symptoms.

0:24:09

Another possibility, recommending five days of rest as compared to one or two days, gave the impression that the injuries were more severe and cause patients to perceive their symptoms as greater or lasting longer.

So I think everyone agrees with the period of rest following a concussion. No school, no work, no homework, no video games, no screen time, just rest. Certainly, no sports or other forms of vigorous activity. But it looks like one to two days, rather than five, is long enough.

Now, gym class and sports remain the exception. You want to wait until symptoms have completely resolved and then embark on a gradual return to full activity under the supervision of a medical provider.

OK, moving on, researchers at Mailman School of Public Health and Columbia University Medical Center studied the impact of text message reminders for the second dose if influenza vaccine required for many young children to protect them against the virus.

Of the children who required two doses of the vaccine, less than half actually received the second dose. Principal investigator, Dr. Melissa Stockwell, equates this to wearing only half a bicycle helmet. The study found that sending text message reminders both increase receipt of the second dose of the vaccine as well as brought children in sooner to be vaccinated.

Children age 6 months through 8 years of age from 660 families who required a second dose of influenza vaccine took part in the investigation. They were assigned to one or three groups. Group number one received educational text messages. In other words, they received the text message reminding them when their second dose was due, but it also contained educational messaging around why you needed a second dose, or why the flu shot was important.

The second group received conventional text messages only, so just a text reminder of when you were supposed to get your second shot.

And then, the third group received written reminders only.

0:26:04

By the way, all participants, including the two text groups received the written reminder with the date when the second dose was due at the time of the child's first influenza vaccine. So everybody got one of these little reminder cards, but the two texting groups in addition to that received either an educational text message or just a conventional text message.

So what did that investigators find? Well, children in the educational text message group return for vaccine number two, 73% of the time. Kids in the conventional text message group returns 67% of the time, and those who only received the written reminder, they return 57% of the time. Again, 73% follow-through for educational text messages, 67% for conventional ones, and 57% for written reminder cards only.

Dr. Stockwell says, "Text message programs like these allow healthcare providers to care for their patients even when they're not in front of them in the office, somewhat like a modern-day house call. Timeliness of vaccination is also key, as many children who need two doses are not fully protected until two weeks after receipt of the second dose."
She adds, "Even in children who ultimately receive two doses in a season, the time interval between doses is often beyond the recommended 28 days. This leaves many unprotected when the virus begins circulating."

So a take-home message from medical providers in the crowd, think about starting a text reminder service. Moms and dads out there, requests a text reminder from your doctor if they don't have one. And of course, put an alarm in your mobile calendar so you can remember on your own, kind of make your own text message, if and when that second dose is needed. Don't just rely on the little card.

That's what I do when I'm in the checkout. I go to the ophthalmologist on a fairly regular basis for some chronic eye problems that run in my family. Whenever I get that little reminder card, I always tick it in my mobile calendar immediately as a reminder.

0:28:04

Speaking of the flu, you probably heard we're having a pretty heavy influenza A season in the United States this year, with an H3N2 strain of the virus. Now, here in Ohio, at least here in Central Ohio, it seems that we've reached the peak and things have slowed down, so we're thankful for that. But in other parts of the country, you're just hitting the peak right now. And it is a pretty heavy influenza A season.

As it turns out, the virus mutated after strains were selected for this year's annual flu vaccine. That's the story the scientists are telling us. So this year's vaccine does not contain the predominant circulating strain. So does that mean this year's vaccine was a waste, or that you shouldn't bother getting one next year because we could run into the same situation?

Well, the answer to both of this questions is a resounding no. Remember the flu season is far from over. There's opportunity for additional strains to circulate, so there's still hope that the annual vaccine will provide protection against additional strains that may come along. Also, it's not like this year's vaccine gives no protection. You do still get some partial protection against similar strains, which means you might not get as sick as you would otherwise would have. Even though yeah, you get the flu, but if you haven't had the vaccine, you might have gotten sicker.

Or it makes it more likely, you could get complications if you haven't had the vaccine. For instance, if you have asthma, wheezing and difficulty breathing may not be quite as bad as it otherwise would have been if you would have gone completely unvaccinated even though the vaccine didn't prevent the flu a 100%.

So there's still value. As for next year, you should absolutely get next year's flu vaccine when the time comes. It's likely the immunization and the strains will match up next year, like they do most years. Remember thousands of people die each year in the United States due to complications of influenza infection, complications which are less likely to occur in those who are vaccinated.

0:30:00

And while we're speaking of vaccines, again, if your children are not immunized against measles, please talk to your doctor and get him protected so they can enjoy public spaces, like Disneyland, without fear of becoming infected.

All right, that concludes our inaugural News Parents Can Use for the year 2015. Stick around and I will be back with a final word right after this.

[Music]

Dr. Mike Patrick: We are back. Lots of toys were unwrapped in homes all across America last month. Many of them are still holding your child's interest while others have been tossed aside. And it's very likely your child already has his or her eye on the next great thing, the one that's still sitting on the store shelf.

But are all these toys safe? The ones your child has now, and the ones that are yet to come. Now sure, many toys are safe, but others aren't, and these may pose a serious injury risk to your children.

In a first-of-its-kind study, researchers in the Center for Injury Research and Policy here at Nationwide Children's Hospital had found that well over three million children were treated in United States emergency departments from 1990 through 2011 for a toy-related injury. In 2011, a child was treated every three minutes for such an injury, and slightly more than half of the injuries happened among children younger than five years of age.

The study, soon to be published in Clinical Pediatrics found that the rate of injury rose almost 40% during the 22-year period that researchers analyzed. Much of that increase was associated with foot-powered scooters.

0:32:03

Dr. Gary Smith, the study's senior author and director of the Center for Injury Research and Policy at Nationwide Children's Hospital says, "A child's job is to play, and toys are the tools. We want children to explore, challenge themselves, and develop while using those tools safely." He adds, "Children of different ages face different hazards from toys. Children younger than three years of age are at particular risk of choking on small toys and small parts of toys."

During the study period, there were more than 109,000 cases of children younger than 5 swallowing or inhaling foreign bodies, and is the equivalent of almost 14 cases per day.

As children get older, injuries associated with riding toys increase. These toys, which include foot-powered scooters, wagons, and tricycles, caused 42% of injuries to children 5 to 17 years of age, and 28% of injuries to children younger than 5. Injuries with riding toys were three times more likely to involve a broken bone or a dislocation than other toys. Falls at 46% and collisions at 22% were the most common ways that children of all ages were injured in association with toys of all categories.

Foot-powered scooters are of special concern. From 2000, after a new kind of foot-powered scooter first became popular, through 2011, there were over 580,000 injuries, or about 1 every 11 minutes. Much of the increase in the overall toy injury rate after 1999 is due to foot-powered scooters.

Dr. Smith says, "The frequency and increasing rate of injuries to children associated with toys, especially those associated with foot-powered scooters, is concerning. This underscores the need for increased efforts to prevent these injuries to children. Important opportunities exist for improvements in toy safety standards, product design, recall effectiveness, and consumer education."

Parents and child caregivers can help children stay safe with toys by following these tips: follow age restrictions and other manufacturer guidelines for all toys; examine toys for small parts that could be choking hazards for young children; use riding toys on dry, flat surfaces away from vehicular traffic; closely supervise any child who is younger than eight years of age on a riding toy; wear helmets, knee pads, and elbow pads on scooters and other riding toys with wheels; and check Recalls.gov to see if toys that you own or may buy have been recalled.

0:34:25

For more information on you safety, you can visit the Nationwide Children's Hospital toy safety site, and I'll include a link to that in the Show Notes for this episode, number 306, over at PediaCast.org.

And that's my final word.

All right, I want to thank all of you for taking time out of your day to make PediaCast a part of it. We really do appreciate that. I'm really looking forward to spending a great year ahead with all of you.

Again, just so we're all on the same page, you can expect new shows to come out on Wednesdays. We'll try to get about three of those out each month for you.

All right, that does wrap up our time together. PediaCast is a production of Nationwide Children's Hospital.

Don't forget PediaCast and our single-topic, short-format program, PediaBytes, are both available on iHeart Radio Talk. By the way, you spell PediaBytes, P-E-D-I-A-B-Y-T-E-S, yeah, we try to be cute. So you'll find that at iHeartRadio Talk, which you'll find on the Web at iHeart.com and the iHeart Radio app for mobile devices.

Our show archive, which includes over 300 episodes, as well as our Show Notes, transcripts, terms of use, and contact page are available at our landing site, which is PediaCast.org.

We're also on iTunes, under the Kids and Family Section of their podcast directory. You'll also find PediaCast on Stitcher, TuneIn, Downcast, iCatcher, Pod Bay and most other podcasting apps for iPhone and Android.

We're also on Facebook, Twitter, Google+, and Pinterest. Of course, we really appreciate you connecting with us there, and sharing, retweeting, re-pinning our posts so you can help spread the word about the show.

We also appreciate you talking us up with your family, friends, neighbors and co-workers, anyone with kids, or anyone who takes care of children. And as always, be sure to tell your child's doctor about the program. Posters are available under the Resources tab at PediaCast.org.

0:36:11

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.
PediaCast.