Topics

• Finger Foods
• Frequent House Moves
• Second-Hand Smoke Exposure in Cars
• Bed Wetting
• Cool Mist Humidifiers
• Head Lice
• Toddler Behavior

Links

• Nationwide Children’s Hospital – Campus Expansion Updates

• Finger Foods and Healthy Weight

• Frequent Housing Moves and Adult Health

• Second-Hand Smoke Exposure in Cars

• Bed Wetting and Sleep Deprivation

• Bed Wetting and Constipation

• PediaCast 199 – Hypoplastic Left Heart Syndrome

• PediaCast 182 – Temper Tantrums

Transcript

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 once again to PediaCast, a pediatric podcast for moms and dads. We're coming to you from the campus of the Nationwide Children's Hospital in Columbus, Ohio.

This is Episode 200 for February 22nd, 2012. We're calling this one "Finger Foods, Bedwetting and Head Lice." Of course, we have lots more topics coming your way and we'll get to a rundown of our lineup here in just a minute, but I want to pause. As I mentioned, it is Episode 200, and I think this is a big milestone, so I just want to give it a little bit of thought here.

01:08

We started doing PediaCast back in 2006, so we're going on six years now, and as I thought about this to talk about this with you at the beginning of this show, I did a little reminiscing.
I remember when we first began, I was in the basement of my house. We were on a pretty rickety table. We did get a Skype thing going so we could do some interviews and really just tried to make a commitment to getting patient and parent education materials as pertains to general pediatrics into the hands of moms and dads.

Six years later, we've definitely grown. We've had some good times, we've had some bad times. We almost stopped doing it. My family and I, we were down in Florida living after a few years and got a little distracted and really got burnt out with doing it to some degree because I was trying to do PediaCast on top of a full-time 40-hour-a-week job, plus living in Florida and really dedicating family time to…I didn't want my kids to grow up and I'm spending all my time on PediaCast.

02:22

We had the opportunity in 2011, the beginning of the year, so about a year ago now, to come up here to Columbus and bring PediaCast to the campus of Nationwide Children's Hospital, and it's been great. It really revived the program, and here we are, Episode 200. I'm not in a basement on a rickety table anymore. We are in a gorgeous audio studio and we can have guests actually stop by the studio and talk to us, which we did a lot last year and have lots more plans of that this year as well. So it's been great.

And actually, speaking of milestones, in June there's really quite a big milestone for Nationwide Children's Hospital. We're opening up a brand-new building, and it is humongous. In fact, when it's open, we'll be the second-largest pediatric facility in the United States, 12 stories tall, each floor the size of a football field.

03:20

If you want to see what the new building's going to look like and just get a sneak peek at our new facilities, in the Show Notes over at pediacast.org, I'm going to put a link to our Building Update page. So if you just want to see, 'Hey, what's this place called Nationwide Children's Hospital like?' what's the new place going to look like, just head over to pediacast.org and we'll have a link, again, to the building update so you can check it out over there.

All right, enough about our 200th episode. Let's go on with it already. What are we talking about today?
Well, first up, finger foods and healthy weight. If you introduce young babies to finger foods early, is that a good thing or a bad thing? Is baby food better or are finger foods better as you're weaning them from milk, from breast milk or from formula, as you're starting solid foods? Do you want to start the solid foods with baby food or with finger foods? And does it make a difference in their health and their weight later on, depending on which route you go?

04:22

We're also going to talk about frequent moving, as in from house to house, so kids who move frequently. You'll look at my family and we moved down to Florida, then we moved back up to Ohio. Does moving frequently affect their health, particularly their health as adults? So if you take an adult and you look back at how many times they moved as a child, does that have an impact on their adult health?
Secondhand smoke in cars, not a good thing. We'll talk about why. Also, bedwetting. We're seeing some new relationships with bedwetting, which makes you think or rethink how you treat bedwetting, and a couple of those factors, that there's been some recent studies on, include sleep deprivation, could how much sleep that you're getting affect bedwetting, and also constipation. Can the presence or absence of constipation be related to bedwetting. If you slept better and took care of constipation, could that help bedwetting to go away? We're going to talk about that.

05:25

And then we have some listener questions on cool mist humidifiers, head lice, and then on toddler behavior, which, again, that seems to be a recurrent topic here on PediaCast, but I know it's something that lots of you who are out there listening right now deal with on a daily basis, so we're going to help someone talk through some toddler behavioral issues coming up in just a little bit on the program.
I also want to remind you that each episode of PediaCast is really tailored toward you. So if there is a topic that you want us to talk about, you have a question for us, a comment, an idea for a show or a news story you want to point us toward, we really, really like to get the audience involved and participating.

06:11

And it's really easy to do. Just go 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.
I 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 do have a concern about your child's health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, and of course you can find that over at pediacast.org
With that in mind, we will get back to 'News Parents Can Use' right after this break.

[Music]

07:23

Mike Patrick: Our 'News Parents Can Use' is brought to you in conjunction with the news partner "Medical News Today", the largest independent health and medical news website. You can visit them online at medicalnewstoday.com.

I do want to point out that "Medical News Today" has been one of our news partners for many years now, and if you've not checked out their website, you've heard me talk about it but you haven't actually been over there to check it out, tons and tons and tons of news articles that relate to not only your child's health but to your health as well. They cover adult stories, pediatric stories. It's just a goldmine of health-related news. I would encourage you to check them out, again, at medicalnewstoday.com.

08:06

All right, first up in our 'News Parents Can Use' segment, a study published in the "British Medical Journal Open" reveals that infants tend to eat healthier and maintain a healthy weight as they get older if they're allowed to feed themselves with finger foods from the start of weaning. This early introduction to finger foods is known as 'baby-led weaning' and a difference from traditional weaning practices whereby parents feed their infants with a spoon. According to the researchers, findings from the study indicate that baby-led weaning may help prevent childhood obesity.

Findings from the study were based on 155 children between the ages of 20 months and six years. Parents completed surveys documenting their children's food preferences and weaning style. The researchers found 63 parents spoon-fed their children puréed foods throughout the weaning while 92 parents followed the baby-led style of weaning and allowed their infants to eat finger foods early on.
So what did they find? Well, the baby-led group of weaners tended to eat complex carbohydrates such as toast and crackers while the spoon feeders ate sweetened puréed versions of fruits, vegetables, meats and complicated mixtures such as baby food, lasagna. Got to love those mixtures.

09:17

How did these trends affect weight down the road? Well, the baby-led group of weaners were more likely to maintain a healthy weight for height and age while the spoon feeders were more likely to trend toward obesity. And these findings held true even after researchers controlled for such factors as birth weight, parental weight, and socioeconomic factors.
According to the authors, carbohydrates such as toast may improve a child's awareness of textures, which are destroyed when food is puréed. Prior studies have demonstrated that presentation is an important factor in food preference.

Of course, baby-led weaning has its critics who point out the possibility of finger food-related infant choking, but researchers say in their study choking did not surface as a problem, and they conclude that baby-led weaning appears to have a positive impact on babies eating healthier foods and has implications for combating the world-documented rise of obesity in contemporary societies.

10:14

I'm not going to come out swinging as a die-hard proponent or opponent to baby-led weaning. I'll let parents decide for themselves. But I do think the study and the findings have merit. But I don't want to brush the choking risk under the carpet, either. This particular study looked at only 155 kids, so I do wonder if there would've been some significant choking events if they had looked at thousands of kids rather than just over a hundred.

I think the take-home here on choking is if you're going to jump on the baby-led weaning bandwagon, you have to constantly supervise your baby's meal the entire time they're eating. Actually, even if you're doing baby food, the same advice applies. You don't want to put any kind of food in your baby's hand and then walk away. Be there with them right there. Constant supervision is important while they're eating.

11:06

Also, avoid small pieces of food that are the size of your baby's trachea or windpipe. And to give you an idea of what that size is from a diameter standpoint, if you look at your baby's little finger, so their pinky finger, that's about the size of their airway. So it's a small circle, but you want to avoid chunks of food that are about that size or something that could get caught in the airway.

Little chunks of anything like carrots, hotdogs, grapes, these things are definite no-nos. You want to cut them into smaller bits that won't get caught in the airway or larger finger foods that they can take little bites of that are going to be appropriate size. And again, you're going to have to be watching them to make sure that the size of things that they are biting off aren't chokable sizes.

12:02

And I've said this before, too, and I'll say it again now, and I'll probably say it again in the future: all parents, moms and dads, should take infant and child first aid and CPR classes so that you are prepared in the case of a choking or other emergency.

All right, let's stick with the United Kingdom for our next story, another British study, this one published in the "Journal of Epidemiology and Community Health". It suggests that moving frequently, as in from house to house, during childhood appears to raise the risk of poor health as an adult.
Researchers looked at 850 Scottish residents taking part in a longitudinal study of long-term health spanning two decades. Participants ranged in age from 15 to 55 years of age and the team evaluated each one's overall health, including a subjective evaluation of general health, documentation of unhealthy behaviors such as illegal drug use, smoking and heavy drinking, physical health parameters such as weight, BMI, blood pressure, lung function, and aspects of psychological health.

13:03

They divided participants into 'healthy' and 'unhealthy' groups and then took a look back at how often they moved from house to house as children to see if they could make any connections.
So what did they find? Well, 20% of individuals lived in the same address throughout childhood while 60% moved once or twice, and another 20% moved three or more times. Risk factors for moving frequently included living with a single parent or a stepparent and having two or three siblings at home. Interestingly, individuals with four or more siblings tended to stay put in the same house during childhood.

The team found no clear link between frequent house moves and socioeconomic class. Also, there was no association between physical health measures and the frequency of house moves.
However, the researchers did find an association between moving from house to house during childhood and an increased risk of psychological distress, also smoking during adolescence and adulthood, heavy alcohol consumption, and general feelings of poor overall health.

14:03

According to the researchers, some of these effects might be due to changing schools, which can disrupt social networks and turn family life on end. However, this doesn't appear to be the case for a heightened risk of illegal drug use. During adolescence and adulthood, the team found that illegal drug use was independently linked to frequency of house moves during childhood, even after taking into account the number of school moves, parental background, and levels of affluence.
So moving frequently from house to house does not appear to affect physical health of adults, if you look back at their childhood, but it does make a little bit of a difference on psychological health with those who move frequently, having more psychological issues as adults.

Again, as I mentioned in the introduction to the program, having moved from Ohio to Florida to Ohio again, I can see how this is possible.

15:00

Moving does have a psychological impact on families, it's stressful, and changing schools is stressful, and these are the kinds of things that do appear to affect mental health down the road. So I think that's a factor that parents, you should consider when making moving decisions.

Now I know many times you don't have a choice. Jobs change, life circumstances change, and sometimes you just have to do it. But in doing so, we should be aware of the stress that this places on our kids and we need to make sure we're doing everything we can to emotionally support them through those changes.
My daughter likes to point out that she has lived in seven houses in 17 years. My son has lived in six. Now we did stay put in one home for 10 years, so that's a lot of moving in the remaining seven years. Once we moved to Florida, we were having a house built, so we were in a different house for a while, and once we moved back to Ohio, we had lived with family for a brief time. So she's counting some soft ones there that weren't necessarily 'you're setting up your own bedroom that you think is going to be permanent, and then it's not.' But it's still a lot of moving.

16:14

Of course, it did take lots of love and support on our end as parents. It has been definitely required for our family's journey, and I'm sure for your family, too. But in the end, giving opportunities for love and support are good things. You just have to be aware of the stresses as well.
For us, I guess it really helped that our kids home-schooled where we actually did a private online school, and of course with social media these days, it's a little bit easier to stay in touch with friends than it was when I was a kid growing up and had to move. So those are also things to consider as well.

All right, let's move on to secondhand smoke. This is even less of a good thing when you look at it.

17:01

Secondhand smoke exposure among middle and high school students in the U.S.A. has actually dropped over the last 10 years, so say researchers from the National Center for Chronic Disease Prevention and Health Promotion and the Centers for Disease Control and Prevention. But in a report to be published next month in the journal "Pediatrics", the authors say too many kids and teens are still trapped with smoke, and in being so trapped, they run significant health risks.

Regularly occurring inside the car, secondhand smoke exposure for non-smoking children and teens dropped from 39% to 22.8% in the past 10 years, but the nearly one-quarter of all kids and teens who still suffer from regular in-the-car exposure are prone to such problems as frequent upper respiratory infections, exacerbations of asthma, delayed lung growth, and frequent ear infections.
Dr. Brian King, lead investigator for the project, points out previous studies have looked at secondhand smoke exposure in the home, but his team wanted to hone in on smoke exposure in automobiles because of the higher concentration of toxic chemicals the cooped-up kids breathe in.

18:05

Despite a significant reduction of in-the-car secondhand smoke exposure, the authors point out that nearly one-quarter of American children and teens are still exposed to dangerous and deadly toxins on a regular basis, and they believe jurisdiction should expand comprehensive smoke-free policies to not only include work sites but public places and also motor vehicles occupied by youth.
All right, moms and dads, don't wait for smoking in your car with your kids on board to become illegal. Please, just stop doing it now.

Nighttime visits to the bedroom are generally associated with being pregnant or having an enlarged prostate, but the problem can affect youngsters as well. A new study sheds light on why some children may need to urinate more often during the rest cycle.
Danish researchers have found that sleep deprivation causes healthy children between the ages of eight and 12 to urinate significantly more frequently, excrete more sodium in their urine, and have altered regulation of the hormone important for excretion and they also have higher blood pressure and heart rates.

19:04

The study, entitled "Sleep Deprivation Induces Excess Diuresis and Natriuresis in Healthy Children", appears in the "American Journal of Physiology – Renal Physiology" published by the American Physiological Society. Some big words there. 'Diuresis' just means urine production and 'natriuresis' means sodium excreted in the urine. So the title of the study simply means not sleeping enough leads to extra sodium in urine and extra urine volume.
Let's talk about how they figured this out and why they think this occurs, and what it all means to you, the parent, because I am going to bring this home for you. Just hear me out and we'll get there.

Twenty healthy children, 10 boys and 10 girls, were enrolled in the study. The children underwent two consecutive 24-hour stays at the hospital. The first 24-hour period was used to register baseline values including urine data, blood pressure and heart rate and other physiological measures. The second 24-hour period was used to register these values during and following sleep deprivation, and the information was subsequently compared with everyday life records submitted by the parents.

20:14

On both evenings, the children were required to be in a supine position, so on their back, in bed in a dimly-lit room at 8 p.m.. Physical activity, food and fluid intake were not allowed between this time and 7 the next morning.

On the second night, the children in the same position on their bed were kept awake as long as possible throughout the night, if they were willing, by telling and listening to stories, doing small tasks such as word and memory games or making crafts, and daytime catch-up sleep was not allowed.
So what did they find? Well, sleep deprivation had a dramatic effect on nighttime urine excretion with an average increase of 68% among the participants. So you make more pee when you're awake. Even if you're not moving a lot and you're still lying in bed, just your being awake and your brain functioning makes you produce more urine.

21:07

The amount of sodium in the urine from the sleep-deprived night was almost a third greater than it was during the normal sleep night. The levels of hormone associated with water and sodium excretion had numerous differences after the sleep deprivation, and blood pressure and heart rate were significantly higher as well. These findings were similar for boys and girls.
The authors say sleep deprivation leads to numerous physiological differences in children that ultimately resulted in increased urine output and higher sodium excretion. The authors speculate that the reason for these differences could be the result of changes in the regulations of the hormones responsible for setting water and sodium output in the kidney, which also affects heart rate and blood pressure.

Findings ways to address these factors could stem at nighttime urine production, which in turn could potentially help sleep disruption and bedwetting in youngsters.

22:00

So helping your kids get more sleep may curb bedwetting. Now granted this is a small study with a sample size of only 10, but if you're dealing with bedwetting or sleep deprivation because of frequent overnight urination in your home, maybe you should try getting your kids settled down and in bed earlier in the evening. That could possibly help.

Now here's another idea and another thing that could help with bedwetting. New research out of Wake Forest Baptist Medical Center implicates constipation as a common culprit in bedwetting woes, and if it isn't diagnosed, children and their parents must endure an unnecessarily long, costly and difficult quest to cure those bothersome nighttime events.
Reporting online in the journal "Urology", researchers found that 30 children and adolescents who sought treatment for bedwetting all had large amounts of stool in their rectums, despite the majority having normal bowel habits. Following the initiation of constipation treatment, 83% of kids stopped having bedwetting episodes.

Lead author Dr. Steve Hodges, an Assistant Professor of Urology at Wake Forest Baptist, said, "Our studies show that a large percentage of these children were cured of nighttime wetting after constipation therapy. Parents try all sorts of things to treat bedwetting from alarms to restricting liquids, and many children, the reason that those things don't work is that constipation is the problem."

23:21

Hodges points out that the link between bedwetting and excess stool in the rectum, which is the lower five-to-six inches of the intestine, was first reported in 1986. However, he said the finding did not lead to a dramatic change in clinical practice, perhaps because the definition of constipation is not standardized or uniformally understood by all physicians and lay people.

"The definition for constipation is confusing and children and their parents often aren't aware the child is constipated," said Hodges. "In our study, x-rays revealed that all the children had excess stool in their rectums that could interfere with normal bladder function. However, only three of the children described bowel habits consistent with the traditional concept of constipation."

24:04

Hodges explained that guidelines of the International Children's Continent Society recommend asking children and their parents if the child's bowel movements occur irregularly, less often than every other day, and if the stool consistency is hard.

"These questions focus on functional constipation and cannot help identify children with rectums that are still enlarged and interfering with bladder capacity," said Hodges. "The kind of constipation associated with bedwetting occurs when children put off going to the bathroom. This causes stool to back up and their bowels to never be fully emptied. We believe that treating this condition can cure bedwetting."
Children in the study ranged from five to 15 years old. The constipated children were treated with an initial bowel cleanout using polyethylene glycol, also known as Miralax, which softens the stool by causing more water to enter the bowel through osmosis, and children whose rectums remained enlarged after this therapy, enemas or short course of stimulant laxatives were used.

25:01

Dr. Hodges cautions parents that any medical therapy for bedwetting, including the treatment of constipation, should be overseen by a physician.
The study used abdominal x-rays to identify the children with excess stools in their rectums and Hodges and radiologists at Wake Forest Baptist developed a specific diagnostic method that involved measuring rectal size on the x-ray, and he said rectal ultrasound could also be used for diagnosis.

Hodges says, "The importance of diagnosing this condition cannot be overstated. When it is missed, children may be subjected to unnecessary surgery and the side effects of medications. We challenge physicians considering medications or surgery as a treatment for bedwetting to obtain an x-ray or ultrasound first."
The study involved reviewing the charts of 30 consecutive patients treated for bedwetting. The authors cautioned that some cases may have improved on their own over time and they said a more accurate measure of the treatment's success would be to randomly assign bedwetting children who have enlarged rectums to either constipation therapy or an inactive placebo treatment, an approach that would differentiate true responses from cases that would resolve on their own over time.

26:10

Let's break this down a little bit more, because I think some of you out there may still be thinking, 'OK, now wait a minute. How does constipation lead to bedwetting, for one, and also, what do you mean constipation doesn't mean infrequent hard bowel movement? Can my kid who has a nice soft bowel movement everyday really be constipated?' So let's talk about this.
First, let's talk about why it is that having too much stool in the rectum could cause constipation. Or, I'm sorry, that is the definition of constipation. How could that cause bedwetting?

Well, an enlarged rectum encroaches on the bladder, and this can actually do two things. It can decrease the volume of urine that the bladder is able to hold and it can also stretch the wall of the bladder by pushing into it, and the brain interprets this stretching as you having a full bladder, causing your child to feel like he or she needs to go to the bathroom.

27:08

This can also result in the bladder relaxing the valve that holds the urine and the bladder muscle contracting to push urine out, because the brain thinks that you have a full bladder, even though you don't really. The reason the bladder is getting stretched is not because it's full of urine on the inside but because this enlarged rectum full of stool is pushing on it. Not only could this possibly lead to bedwetting, it can also lead to urinary frequency during the day.
So you can have a kid, you go out to eat at dinner and they've got to go the bathroom two or three times in the same meal, and each time they pee they just get out a small amount, and the reason is, again, because they have too much stool in their rectum that's pushing on their bladder and making them feel like they have to go to the bathroom even though their bladder is not really full.

Of course, there are other medical problems that can cause the same symptoms of frequent urination. Diabetes is one example. So it is important you see your doctor and not try to figure this out at home by yourself.

28:10

What about the constipation part? How can a kid who has a soft bowel movement everyday really be constipated? Well, for this, you have to look at ins and outs. How much poop are you getting out compared to the amount of poop that you're making? If you're making more than you're getting out, regardless of how much that you do get out, that stool is going to start backing up and creating problems. So we do see lots of constipated kids who aren't necessarily experiencing infrequent hard bowel movements.

However, once you add a stool softener and encourage them to go to the restroom on a regular basis and try to make poop and having them sit on the toilet long enough to get out what they can get out, then you start to have an improvement in their constipation symptoms, which can include intermittent abdominal pain and also bedwetting, as we see here.

29:03

So you really do have to get kids…and you may not end up needing a stool softener. It may just take that you need kids to actually sit down and try to get more stool out than they're used to doing. A lot of kids, they go in, they sit on the toilet, they get out one turd. I love being able to talk this way, by the way, but these are the words you understand.

So you have a kid, they're sitting on the toilet, they pop out a turd, it takes them 30 seconds and they're wiping and they're running. But if they had sat there for five minutes, maybe they would've gotten out three turds. So you have the situation where they're not emptying their rectum every time that they sit down.
From the parents' point of view, it's like, 'Hey, they're going to the bathroom once a day, they have a soft bowel movement. There's no trouble here. How can my kid be constipated?' But if they're only getting out one turd when they could've gotten out three, and that happens every single day, it doesn't take long for them to be backed up and still have too much stool in their rectum that can then push on the bladder and can cause problems.

30:08

One more thing, and this is interesting, too. When the large intestine is really full of thick poop, new waste coming from the small intestine can slide by and actually come out as liquid stool because there isn't room in the large bowel to form proper turds, and these kids may actually appear to have diarrhea of sorts. When it leaks out into their underwear, we call that 'encopresis'. But the problem isn't diarrhea at all; it's still constipation.
A lot of times parents will say, 'No way, my kid does not have constipation. They poop all the time. In fact, sometimes they poop in their underwear. It's just their poop situation is just a mess.' Well, no. That can be constipation, because all those symptoms come from having too much poop in there and you've got to make things worse before they can better and get all that stuff out.

Again, don't try to figure this out at home. See your doctor. But I will say this: if you do see your doctor and your doctor says, 'Hey, no way your child can be constipated because they aren't having infrequent hard bowel movements,' if that happens, then you may want to get the opinion of another doctor.

31:12

All right. I really meant to keep this discussion on the bedwetting topic and instead we've taken a big long detour into the world of constipation. Sorry about that, folks.

The final take-home here, if you're dealing with bedwetting problems at home, of course see your doctor, but don't discount sleep deprivation and constipation as possible causes.
All right, lets take a quick break and we're going to come back and answer some of your questions right after this.

[Music]

32:08

Mike Patrick: All right. First up in our listeners' segment, we have Lindsey in Calgary, Alberta, Canada. Lindsey says, "Hello. A friend of mine is pregnant with her female fetus, and her female fetus was diagnosed with hypoplastic left heart syndrome. She has a large community of friends and specialists. However, we're all trying to understand what this means for her and her child, and I'm wondering if you could do an educational feature on hypoplastic left heart syndrome. A listener who loves your podcast, Lindsey."

All right. Well, Lindsey from Calgary, thanks for writing in. I think your question and our last podcast must have passed each other in the night. Dr. Ken McBride, a a geneticist here at Nationwide Children's Hospital, stopped by the studio last week and talked about the genetics of congenital heart disease, and in the course of that conversation we did cover hypoplastic left heart syndrome with a fair amount of detail.

33:01

So if you haven't done so already, make sure you check out PediaCast 199 at pediacast.org, and I'll bet we get a lot of your questions answered on that. But again, thanks for writing in. It's always appreciated.

Next up is Kate in Chicago, Illinois. Kate says, "Thank you so much for your wonderful information. This may sound like a silly question, but here we go." No silly questions, by the way, Kate. No silly questions on PediaCast. Ask away. So your silly question, which isn't really silly: "With cold and flu season in full swing, is there a proper way to use a cool mist humidifier? I have two babies under the age of two and they're miserable with their colds. Not being able to do much for them, I want to make sure I'm using the humidifier in the most effective way possible."
"Thanks again for your podcast. By the way, I have a link to your show under the parent resource area of my classroom website." Well, thanks for the question, Kate, and thanks, too, for spreading the word about PediaCast. That really means a lot to me. I appreciate you taking the effort to do that.

34:01

OK, cool mist humidifiers. The goal with cool mist humidifiers, the goal is to moisturize the nasal passages and to make them less irritated and also to thin the mucus that is obstructing them when your child has a lot of mucus production because of an upper respiratory infection.
Now the best bet on moisturizing the nasal passages and thinning that mucus is saline nose spray, so you're putting moisture directly into the nose. In babies, instead of the spray, you use drops and then suck them out with a bulb syringe, and with older kids and adults, you use the spray. It loosens things up, moisturizes the nasal mucus membranes, and makes it easier to blow your nose and get the mucus out.

But maintaining a humid environment when you're sleeping can also help meet those goals. Now remember, moisture is going to spread out evenly in the room, so having the machine anywhere in the room is fine. It doesn't have to be right next to the crib. But if your baby is sleeping in a large cavernous room, even with the humidifier right next to the crib, it's not going to work well, because remember that humidity is water vapor in the gas form and it's going to spread equally throughout the room. It's not just going to hover over your baby's bed.

35:25

So just keep that in mind; you want it to be in a smallish room. And it's going to work better with the door closed because then that moisture is not going to as easily escape out into the hallway.

Smaller room, closed door, humidifier anywhere in the room: that's going to make the most humidified environment for your baby, which may help them to sleep more comfortably to keep their nasal passages less irritated and to help keep the mucus thin so that they can breathe more comfortably.
Now, having said that, I know some parents aren't going to feel comfortable with their baby's door closed, and that's fine. You just have to realize you're not going to get as much humidity. I'm not saying you have to close the door and make sure your baby's in a small room. We're just saying that you're going to get more humidity in a smaller room with a closed door.

36:16

But certainly, especially if you're not using a baby monitor or you just don't feel comfortable closing the door, leave it open. Leave it open as far as you're comfortable with. Just realize that you're not going to have quite as much humidity in the air if you do it that way. But safety and your comfort level as a parent is also important. And again, humidifiers help but they aren't really as important as saline drops and using the bulb syringe.
Another hint, you can leave it running with the door closed a couple of hours before a nap or bedtime to pre-humidify the room. Also make sure you rinse out the cool mist humidifier once a day with a little bleach water. You don't want to grow and spray molds and bacteria throughout the room. Cool mist humidifiers can get slimy pretty quickly, so you definitely want to watch for that.

37:08

Now here's another question we're often asked: what about warm or hot humidifiers?
Well, hot humidifiers, you can't really find those anymore and they're not recommended because of the burn danger, especially if you have a toddler in the house or a younger child and they're able to trip over or fall into it, knock it over, any of those things. So it's really hard to find the hot humidifiers anymore. And you shouldn't use those; they are definitely a safety concern.

But they do make warm humidifiers now that don't get scalding hot but put out a little bit of heat. In my mind, they're really not worth the hassle. It was the hot humidity that really helped more, I think, than the warm does. The warm one, by the time it actually gets to your child, it's really cooled to room temperature, and I don't think that they offer any advantage over the cool mist humidifier.
So I would just stick with the cool mist. Those are probably the easiest ones to take care of and use and work just fine and are safer than hot ones.

38:13

What about additives like Vicks or VapoSteam that you can add directly to the water or VapoPads that can be inserted in line with the escaping moisture? What about these products?
You know, there's something in my mind to be said for aromatherapy. I love the smell of the Vapo stuff when I'm sick. Now, is that really going to help their symptoms? Is it going to help them get better faster? No. But is it going to hurt, and does the aromatherapy add benefit to your child's comfort? In my mind, it may.

Now, there was one study that showed that using VapoRub could increase asthma symptoms, but that study rubbed the VapoRub directly onto the nose of baby ferrets. So the take-home there is don't rub VapoRub on your baby's nose, especially if your baby is a ferret. But it's probably OK in the humidifier.

39:11

Now, if adding Vicks or any other additive or Vapo-type substance into the humidifier and your child seems to be getting worse, then stop adding it and see your doctor. Just common sense there, folks. But again, for most kids, it's not going to really make a difference one way or the other, but the aromatherapy may help provide them some comfort.

So thanks again for the question, Kate. Hope that helps. And thanks again for spreading the word about PediaCast.
Next up we have Jamie in Pennsylvania. Jamie says, "Hello. Love your podcast. A few months ago, my daughter and her cousins had head lice. My niece visited us from Oregon and she had an infestation, and we didn't realize it until several of her cousins were exposed. I tried everything including a prescription from my doctor. Neither the over-the-counter or the prescription killed the lice. We picked out the nits and cleaned all the linens and furniture diligently."

40:03

"Finally, we found a remedy on the internet that worked: Listerine. We kept it on for two hours then rinsed it off, followed by more nitpicking, laundrying and cleaning, and finally we got rid of them. Can you explain why only the Listerine worked and why our pediatrician may not have recommended this? I heard certain regions have lice that are resistant to pesticides. If we have this problem in the future, do you see any harm in using Listerine again? Thanks for your time. Jamie from Pennsylvania."
Thanks for the question, Jamie.

Head lice, there's basically three goals when you approach head lice. The first is you want to kill the adult lice that are moving around on your child's head, or your head. If you live in the same house, it's likely. You want to get rid of the nits or the eggs because the medicine that killed the adults typically don't kill the nits, so you have to get rid of them or you'll just kill the adult stuff and then the nits will hatch and you'll have a new crop of live adult lice to deal with.
You have to kill the adult live ones, you have to get rid of the nits, and you have to do these things without hurting your child.

41:07

Now, there's several drugs that are available. I'm going to run through the list here just to give you some background.
The first one that was traditionally used for a long period of time was called Lindane, with the brand name of Quell. But we don't use this anymore because of possible neurotoxic effects, including seizures and sometimes death, especially if the medicine is swallowed by your child. There are safer drugs out there now, so we typically don't use Lindane or Quell much anymore.

Then you have the permethrin drugs, and these are the pesticides that you're talking about. Nix and Rid are two over-the-counter examples of permethrin products. Elimite cream is another one that is prescription-strength. There is sometimes some resistance to these medicines, although most of the time they work. And you have to realize that these also only kill the live adult lice. They don't take care of the nits at all.

42:06

Now there's another pesticide called Ovide, and it's called Ovide because it not only kills the live lice but it also is partially ovicidal. Ovide is ovicidal. 'Ovicidal' means that it kills…just think ovicide, ovary, kills the eggs. It kills some of the nits as well.

Now, it doesn't kill 100% of the nits or the eggs, but it does kill some of them along with the live lice, and some of the adult live lice that have become resistant to the permethrin drugs are sensitive to Ovide.
Now the problem with Ovide, there's a couple of problems with it. One is it's expensive and the other is it's flammable. You have to be really careful when you're using that that you don't light your kid's head on fire because you're smoking a cigarette or you're doing something else that's not smart. So you do have to realize that when you're using it.

43:01

There is another type of product out there that contains benzyl alcohol; Ulesfia is the brand name. This one also only kills the live adults, not the nits. It's also expensive and it can be irritating to the skin and the eyes, so it has its pitfalls as well.
So when you're looking at medical treatment for lice, these are the options that are available out there for doctors and for parents. Now, there's some other strategies for getting rid of lice that I've heard of through the years, which oftentimes do work. One is Vaseline.

Basically, the idea with Vaseline is it suffocates the lice, the adult lice. It's not going to kill the nits, you still have to pick all those out, but the Vaseline is in the hair, it's hard to get out, and because of that, it's there long enough and it suffocates the live lice.

44:00

Now, it takes forever and a day to get this stuff out and your kids are going to have greasy-looking hair for a long time, and that may get them into a being-made-fun-of situation at school. The reason that it works is because it stays in the hair for so long, it really does suffocate the lice, and oftentimes even as the new nits that you don't get out hatch, they get suffocated, too, as soon as they emerge because the Vaseline is there for such a long period of time.

I've also heard of people using vinegar and mayonnaise and these kind of things in the hair. I'm not a big fan of using food products in the hair. I don't know, just the thought of covering my kid's hair with mayonnaise, it just turns my stomach. So I'm not a big fan of these. But those are also strategies that have been used in the past.
Now what about Listerine? Well, classic Listerine contains a host of chemicals including menthol, thymol, methyl salicylates, and a high concentration of ethanol. These are the chemicals that are in classic Listerine. Those are chemicals that actually can be dangerous to your kids, and not enough is really known about the potential harmful effects for me to recommend it, how much of those chemicals get absorbed through the skin.

45:20

Salicylate use in kids has been implicated in Reye syndrome, for instance, and Reye syndrome can be deadly. So I think not enough is really known here to be able to recommend it.
Remember, all these drugs that we talk about and the chemicals that are used in the treatment of lice, they're all scrutinized and tested before the FDA approves them. And that's one of the reasons why the drugs are so expensive when they first come out is because it's an expensive process to prove that they're safe.

Listerine may be safe and approved and fine to use as a mouthwash when it's being gargled in your mouth, but to slap it on your kid's head and the possibility of those chemicals getting absorbed through their scalp is a possible concern. I would not be quick to recommend Listerine as a treatment for head lice.

46:15

Now I imagine Jamie's next questions are, why didn't the lice go away? Why did it take the Listerine to get rid of this problem? And what do we do next time?

Let's talk first about why lice might not go away the first time you treat it, and this includes Jamie's case. Of course, it could be resistant to whatever product that you started with, but this is what Jamie's assumption is, that the other products didn't work because the lice was resistant to those pesticides. But that's really the least likely reason the head lice treatment fails.
The most likely treatment is that as hard as you try, some nits get left behind. Those hatch and you have a new crop of adult lice. So it wasn't really a problem with the agent that you were using to treat. The problem was that the nits hatched, so you have new adults, and that's the reason that you're having this problem again.

47:14

Also, remember that nits can be left on clothes, in bedding, on stuffed animals, and they can stay alive on those substances or those places for up to two weeks. You may get rid of kid's head lice, but if you leave nits on their pillow case and you didn't take care of that or it's on a stuffed animal that they sleep with, they can re-infest themselves pretty easily.
Also, you can catch it again from the original source. If you take care of the head lice and your child gets it again in short order, maybe the kid they got it from at school still has not been treated. So that can be a problem as well.

It's important that all clothes and linens be washed in hot water and then a high-heat dryer cycle, and anything that can be washed, stuffed animals and the like, you want to put in sealed plastic bags for two weeks where your child will not have any contact with it and where it's isolated in a plastic bag for two weeks, and then that will also kill the nits.

48:17

Next time you're dealing with head lice, after the initial treatment isn't working, make sure that you get out all the nits. You just need multiple nit-picking sessions. Take care of all the clothes and linen, hot water and hot dryer cycle, vacuum carpets and sofas and throw out the vacuum bag, and again, plastic-seal all your other stuff for two weeks to avoid re-exposure.

Of course, if you're using those plastic bags and you have young kids, remember you don't want kids to suffocate in plastic bags, so not only put the things in sealed plastic bags, put the plastic bags out of the reach of your young children. If that doesn't work, then you may need to use a more expensive remedy like the Ovide or the Ulesfia.
But don't take matters into your own hands. Don't try something that's not approved, like Listerine. Instead, see your doctor, trust your doctor. In that way, you won't have a bad outcome that's nobody's fault but your own.

49:11

All right. Hope that helps, Jamie, and again, thanks for writing in.
All right, finally we have 'Anonymous' in Idaho. Anonymous says, "Dear Dr. Mike, thanks so much for your podcast. It's entertaining and informative and I love listening to it."

"Recently, I read about a study, I think on everydayhealth.com, about preschoolers' behavior when they missed a nap. The study had the children trying to complete puzzles, including an impossible one," I know how I would react to that, "when they had slept and then when they had not slept. The article reported the children's reactions, but it went on to say that behavioral problems noted with lack of sleep could lead to behavioral problems as adults."
"I'm interested in your take on this study and the leap to comment on potential adult behavior. My daughter has trouble getting to sleep, most notably keeping us up to 2 am when traveling over the holidays, so this study interested me. My doctor has since suggested melatonin for her to help her get to sleep."

50:09

"Along with that, I have another behavior question. When do you know when bad behavior is just bad behavior and when is it something more serious? My daughter has had a rough time lately. She frequently hits and kicks other children at daycare, often for no reason. She sometimes hits or kicks adults when she's being disciplined, such as being put in timeout."
"Recently, she threw a 20-minute-long tantrum at daycare, during which time she seemed confused as to how something she threw ended up on the floor. Her teacher said she honestly appeared to not remember having done the deed and simultaneously calmed down very quickly, only to then get upset again. This bothers me for many reasons, and I'm not sure if we need professional help. She just turned four and I thought that by done she would be done throwing tantrums."

"When I brought this up with the doctor, he thought it was largely due to her lack of sleep. She's been taking melatonin for about a week. I don't know how soon I could expect to see results. She exhibits similar behavior at home and at daycare. Thank you very much. Would rather remain anonymous from Idaho."

51:07

All right. 'Anonymous', thanks for writing in. Let's break this up.

First, lack of sleep leading to behavioral problems. I don't think this is a mystery to many of us who have experienced being parents or for many of us who have experienced being adults. We need sleep for a reason, and there are lots of consequences to not getting enough sleep.
We've seen a potential one earlier in this show when we talked about sleep deprivation leading to changes in hormones that lead to higher blood pressure and increased sodium excretion by the kidneys and increased urine production, which could possibly lead to bedwetting. And that's the effect on one particular hormone.

What's the effect on scores of other hormones and neurotransmitters? We're talking about complex relationships in the brain, and there's every reason to believe that sleep deprivation leads to or can lead to behavioral problems in children and adults. In adults, we don't call them behavioral problems, but at the end of the day that's often exactly what they are.

52:06

I didn't read the study you're referring to, but it certainly makes sense to me and probably to most of you out there that sleep and behavior can definitely be related to one another.

What about melatonin? Well, melatonin is another hormone that plays a role in the regulation of sleep-wake cycles and it can be helpful for kids who have a melatonin deficiency.
The problem is that you can't test to see if you have a melatonin deficiency because levels of melatonin fluctuate throughout the day and there's really no standard of what a melatonin level ought to be in kids. Doctors will sometimes try giving it, and if it works, great. Maybe you had a melatonin deficiency and you added some and it helped. On the other hand, if you try the melatonin and it doesn't work, then melatonin deficiency probably wasn't the problem in the first place, so you stop using it.

Now, one of the issues with treating with melatonin is what kind of dose do you start with, and there's lots of recommendations out there. There's not really a standardized dose.

53:10

You start somewhere where you have experience starting. This is why you want to do it with a doctor who has experience using melatonin, and then you have to adjust from there, keeping in mind that too much melatonin can cause other problems, including sleepiness, lower body temperature, vivid dreams, morning grogginess, and changes in blood pressure.

So it's a trial and fail or trial and win process. There's not a lot of science to it with melatonin. But you said you've given it to your child for a week? That may not be quite long enough to know if it's going to work. How long should you give it? Probably somewhere between a week and a month. I know that's a wide range, but it is what it is.
And if it doesn't work, it may be that it's not going to or maybe you need a higher dose, but then if you start getting into side effects and it still hasn't helped, then probably melatonin wasn't the issue to begin with and it's not going to help.

54:05

Young children who are having trouble sleeping, improving sleep hygiene is often very effective, so you want your kids to have routines, you want to have a settle-down time well before bedtime, go through the same routine whether it be a bath or reading stories, the same kind of 'let's dial down the stimulation and get ready for bed.' No TV, no stimulating music.
The other thing that can help, too, is positive reinforcement programs. I'm not going to go through this again because we have talked about this on many occasions, but the basic thing is, you do come up with something like a sticker chart and you say, 'OK, you're allowed to get up and bother us a couple of times, you need a drink, you've got to go to the bathroom, but once you've bothered us three times, that's three strikes you're out, and you don't get to put a sticker on your sticker chart in the morning. But if you go to bed nicely, you only bother us once or twice in the morning, you get to put a sticker on your sticker chart, and once you get so many stickers, you're going to get a reward,' whether that be a certain toy, going shopping for something, whatever that your child's currency is, whatever is really going to make them want to succeed is what you want with your sticker chart positive reinforcement-type program.

55:25

And each kid is different. There is some trial and error with this as well in trying to figure out exactly what kind of plan is going to work for your child.
Now, in terms of the temper tantrums, we've talked about these before, too, and there's lots to say about them, but we're running short on time. If you search the archive, you'll find a lot about temper tantrums in past shows. I did a quick search of the archives and PediaCast 43, 96, 150, 157, 158, 182, 192, all of these mentioned temper tantrums.

Probably the best discussion, though, is in PediaCast 182, so I am going to put a link in the Show Notes for you for that one where we really go in detail about temper tantrums and how to deal with them.

56:10

I'll give you a summary here in order to deal with temper tantrums. One, I think, is to maximize sleep. Again, that was not mentioned in PediaCast 182, but I do think it's important, and in my own family, and it's different from kid to kid and from adult to adult. In our own house, my wife and my daughter are particularly prone to having easy meltdown when they're sleep-deprived, and you can just observe that and see it, whereas my son and I don't have to get as much sleep and, in our opinion, don't have temper tantrums or behavioral problems. Maybe if my wife were the one doing the show, she would disagree.

But again, it's something that, make sure your kid is getting enough sleep if you're dealing with temper tantrums.
You want to anticipate their needs and try to head off the temper tantrum when you can. Really focus on communication. Tantrums often result from frustration because your young kid's having trouble expressing complicated feelings, so you want to try to focus on improving communication, trying to anticipate your child's needs so they don't have to resort to the tantrum.

57:20

And one really important thing is you can't let temper tantrums work. Whatever it is that your kid's after, you can't give in once the temper tantrum has started. Otherwise, that gives positive reinforcement to the temper tantrum itself, and then you're going to have a lot more trouble getting rid of it.
You've got to let them get through the temper tantrum, let them have it out, ignore it, and then when all is said and done, big hugs, 'We love you. Now let's talk about what it is that you wanted or why you can't have it,' or whatever.

It's also important to make sure that there isn't an underlying medical issue. Certain seizures could look a bit like temper tantrums, and for those who work with kids, temper tantrums and acting out can be a sign of abuse or neglect. So there's lots of things to think about here.

58:03

In the end, you have the right people involved, your doctor, the daycare workers, and you. You're engaged at figuring out what's going on with your kid and being a loving advocate for your child getting them through this spell in their life or when they're having temper tantrums. Being a loving advocate, I think that's a good descriptor for a parent.

So hang in there, 'Anonymous', and sooner than you think, this trial will be behind you. But of course, you'll have a new one to face, because the trials of parenthood are definitely ongoing and sequential.
All right. Well, that wraps up our listeners' segment this week. We're going to come back and wrap up the show right after this.

[Music]

59:19

Mike Patrick: All right. Welcome back to the program.

I want to remind you, if there's a topic that you would like us to discuss or you have any idea, comment, suggestion, question, anything, it's easy to get a hold of me. Just go to pediacast.org, click on the 'Contact' link. I do read every single contact request that comes through, so you definitely have my attention when you use the Contact page at pediacast.org.
You can also email pediacast@gmail.com or call the voice line, 347-404-KIDS, 347, 404, K-I-D-S. And if you go those routes, make sure you let us know who you are and where you're from. That's asked for specifically on the Contact page, but not necessarily if you email or use the voice line.

1:00:04

One final thought. I want to really thank Kate in Chicago again for helping spread the word by including a link to PediaCast in the parent resource area of her classroom website. That made my day.
Is there any way that you are helping spread the word about PediaCast, whether it be through your classroom, through your school, through your kid's school, the preschool, the nursery, your church, your local YMCA, your doctor's office? If there's any way that you are helping spread the word about PediaCast, write in and let us know about it.

And if you find PediaCast because of the efforts of another listener, let us know that, too, just to start sharing some more of these stories. Our best marketing strategy really is you. So please get involved and help spread the word about the program. It's just really, really important and the best way that we get the word out about PediaCast.

1:01:01

I want to thank each and every one of you for making PediaCast a part of your day and sticking with us through an hour of information. I know it's tedious at times, but we try to have a little bit of fun with it as well.

We do have an opportunity for community participation at the website. If you go to pediacast.org and you have something to say about a topic that we cover in any of the individual episodes, please leave a comment. The Show Notes are a blog of sorts and there's a place for you to be able to write down your thoughts, and as a community of supporters, we can help one another. So I would encourage you to head on over to pediacast.org and utilize our Show Notes area as a community group as well.
I just really appreciate your time. We do have lots more shows coming your way this year. We have lots of interview shows still lined up, and of course we'll get to all of your questions as they come in each and every week. As you've probably figured out, we've pretty much gone to the pattern of releasing a new show every Wednesday and will continue to do that into the foreseeable future.

1:02:04

I also want to remind you, we do have transcripts now available of each show as well, so if you don't get the opportunity to listen, you can read the information online. It also makes it easier to search through content for each episode as well.
We're working on getting some of the back episodes, particularly with some of the more requested topics in the past, so some of those shows we're getting transcribed as well. I don't know that we'll get every single episode transcribed, but I'm hoping to get lots of them done.

All right, 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.

Guest

Dr. Kim McBride
Center for Molecular and Human Genetics
Nationwide Children’s Hospital

Topics

• Genetics of Congenital Heart Disease

• Hypoplastic Left Heart Syndrome

• Aortic Stenosis

• Coarctation of the Aorta

• Genetic Counseling

Links

• Genetics Clinic at Nationwide Children’s Hospital

• Molecular and Human Genetics Research at NCH

Heart Diagrams for Reference

Transcript

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 once again to PediaCast, a pediatric podcast for moms and dads. It is Episode 199, boy, we are close to 200, for February 15th, 2012, and today we're going to be talking about the genetics of congenital heart disease.

It's kind of a complex topic today and it has the potential to be pretty heavy on the science, but we're going to make a genuine effort here to keep things understandable and interesting for those of you without strong science backgrounds. But we're still going to try to go into enough detail to provide some satisfaction for the clinicians in the audience as well. I know it's something that we attempt to do in every episode of the program, but I think it's particularly important to provide that balance today.

01:14
So what exactly are we going to talk about was the title alluded to complex structural abnormalities of the heart that children are born with.

You know, with most disease processes, we take the disease and we primarily look forward, how do you diagnose it, how do you treat it, what are the potential complications, what's the prognosis, and today is going to be a little different. We're actually going to take a look backward and explore why some types of congenital heart disease happen in the first place, and we'll talk about the genetic factors that are involved, and then we'll explore how understanding the genetics of congenital heart disease can help us improve outcomes for babies who are affected by these.

And to help me explore these topics, we have a great guest lined up for you today in the studio. Dr. Ken McBride is a physician scientist with the Center for Molecular and Human Genetics here at Nationwide Children's Hospital. He's going to be joining us in just a couple of minutes to talk about these things.

02:09
I do want to remind you, if there's a topic that you would like us to talk about, it's easy to get a hold of us. 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.

I also want to remind you, the information presented in every episode of 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.

All right. Dr. Ken McBride is a physician investigator with the Center for Molecular and Human Genetics at the Research Institute in Nationwide Children's Hospital and an Assistant Professor of Pediatrics at the Ohio State University College of Medicine.

03:07
He received his medical degree from the University of Saskatchewan, completed a residency in Pediatrics at the Mayo Clinic and fellowships in Clinical Genetics and Biochemical Genetics at Baylor University College of Medicine. He also received his Master's Degree at Baylor in the Clinical Scientist Training Program.

Dr. McBride is the Co-Director of the Cardiovascular Genetics Clinic and also participates in the Pediatric Genetics and Metabolic Clinics where he cares for pediatric and adult patients with a special interest in genetics involving the heart. His research focuses on the genetics of congenital heart disease, which is why he stopped by the PediaCast studio to talk to us today.

Welcome to the show, Dr. McBride.

Ken McBride: Good morning.

Mike Patrick: So University of Saskatchewan, did I say it right?

Ken McBride: That's close enough.

Mike Patrick: That's how Yankees say it, right?

Ken McBride: Canadians might call it University of Saskatchewan. We have a bit of a cut with our vowels and make it a little bit shorter…

04:02
Mike Patrick: Sure.

Ken McBride: …softer.

Mike Patrick: Are you from Canada originally?

Ken McBride: I am from Canada originally.

Mike Patrick: Great. Well, welcome to the show. We appreciate you stopping by. We have some complex things that we're talking about today, and I guess a good place to start, we throw around some words, 'congenital heart disease', 'inherited heart disease' and we contrast those with 'acquired heart disease'. Could you just give us some definitions of what these various terms mean?

Ken McBride: Sure. We'll go back to do a little bit of basic genetics first to guide you through the next part of the topic.

Congenital heart defects are something that you notice immediately at birth or shortly thereafter. They may be inherited or they may not be. They may be caused by environmental things. Inherited diseases can show up at birth or you may not notice them until much later in life. Acquired disease is something that you get later on in life and it may have a genetic component to it as well.

Mike Patrick: What types of congenital heart diseases, and in particular, congenital heart diseases that are inherited, are you studying?

05:07
Ken McBride: I'm studying a specific group that's put together as the left ventricular outflow tract, so that's the part of the heart that involves flow of blood from the lower pumping chamber up out through the valve and then into the aorta. The type of defects in this group include something called aortic valve stenosis, coarctation of the aorta, and hypoplastic left heart syndrome.

Mike Patrick: Let's go back just a second, and those of you out in the audience, you're just going to have to think back to your high school Biology days a little bit. The human heart has two sides, the right heart and the left heart. The right heart pumps blood to the lungs and the left heart pumps blood to the rest of the body. So we're talking about the left heart, which is the bigger, thicker, stronger pumping chamber because it has to pump to the body. So as you go on the left…did I say that right? I said "left," didn't I?

06:07
Ken McBride: That's correct.

Mike Patrick: It's in my brain, 'Did I say "right" or did I say "left"?' The left heart is what we're talking about, which is pumping to the rest of the body, and if you're in the left side of the heart from the atrium, which is the upper chamber, it goes through the mitral valve, and then the left ventricle to the aortic valve, and then to the aorta, and then out to the body.

If you're having trouble visualizing this, check out the show notes at pedicast.org. We're going to have some diagrams for you just to make it a little bit easier, and if you want to head over there while you're listening, you can get a nice visual of what this part of the heart looks like.

Ken McBride: Yeah, it would be very helpful.

Mike Patrick: Yeah. So why is it important that we study these diseases?

Ken McBride: Congenital heart defects are very common. They make up one of the most common birth defects in general. Birth defects occur roughly around 3 or 5% of all people who are born. Heart defects occur roughly in about 1% of people, so this puts it into the realm of other common diseases you might hear about such as autism, which occurs in 1 in 110 is the most recent figure.

07:16
On top of that, congenital heart defects are sometimes quite deadly. The leading cause of infant mortality, that's the death cause for people who are aged one year or under, top cause is birth defects, and heart defects make up about 25% of that group. So these are important birth defects.

Now on top of that, there are some kinds of birth defects, and one which I study called bicuspid aortic valve. It's a different formation of the aortic valve; rather than having three parts or leaflets to it, it's got two. It's actually very common. You can find that in 1 or 2% of people who are adults. Many people don't know about it, but when they do get into trouble, they can get into some very serious trouble where they may need open heart surgery later in life.

08:01
Mike Patrick: One of these heart defects that you talked about is the hypoplastic left heart syndrome. What exactly is that?

Ken McBride: It's actually a complex of things that happens because of probably a defect of the aortic valve.

Hypoplastic heart syndrome comprises a narrowing or a total closure of the aortic valve, that's the valve that controls blood flow from the lower chamber out into the aorta, a similar problem with the mitral valve which controls blood flow from the upper chamber on the left side to the lower chamber. Because there's no flow of blood through either of those valves, then the left ventricle, the lower pumping chamber on the left side, can't develop very well, so it's very small, and because there's no blood flow that goes out into the aorta, it also doesn't develop very well, so it is small.

So these are children who have a very severe heart defect; fine at birth, because of how the circulation works when you're inside the mother, but as soon as that circulation changes, these children become ill very rapidly, and if they're not identified and have medical and surgical treatment in the first week or so of life, they could die.

09:11
Mike Patrick: For the doctors and nurses in the audience and those with Biology degrees, there's a couple of structures in the heart, the foramen ovale and the ductus arteriosus, and these are things that shortly after birth close, but in babies who are born with hypoplastic left heart syndrome, they're really dependent on those things to provide flow to the rest of the body, so it's important that we try to recognize these defects as soon as possible so that those structures that are supposed to close don't close, or at least we can delay the closure until we can get things fixed. Otherwise, it could be deadly.

Ken McBride: That's correct. These are a group of defects that are classified as ductal-dependent. As soon as that ductus closes, which it normally does in most people, is when they get into trouble, so one of the therapies is to identify that before that duct closes and then give medications to try and keep that open to buy you some time for surgery.

10:06
Mike Patrick: Sure. And I have to apologize, I didn't mention this before the show to you, but there is a little bit of controversy out there with the name of this, whether it should be called hypoplastic left heart syndrome or is it a defect, and it's interesting that some folks are arguing over the nomenclature.

Ken McBride: It is. I've weighed in on this one as well because it's very confusing. As a geneticist, you like to reserve the term 'syndrome' for something that has a specific cause, usually a genetic cause, sometimes an environmental cause that then leads to a variety of downstream problems. So you have one thing that causes a bunch of different stuffs.

When you think of typical syndromes like Down's syndrome, for instance, due to a problem with having an extra Chromosome Number 21, you may have intellectual disability, you may have specific kinds of facial features, you may have a heart defect. People argue that that syndrome may not be particularly applicable for hypoplastic left heart. I've argued otherwise in saying it is a syndrome, although it's not in the typical sense of the word that people use.

11:10
Mike Patrick: Sure. Yeah. The hypoplastic left heart syndrome that we talked about, and you also mentioned bicuspid aortic valve is another abnormality in that left ventricle outflow tract, what's the definition of aortic valve stenosis and coarctation of the aorta? What do those terms mean?

Ken McBride: Aortic valve stenosis is an inability for that valve to be able to open properly, so the bloodflow through that valve has less flow through it or the heart has to work harder to get the same amount of flowthrough.

Coarctation of the aorta is actually a narrowing of the aorta, usually in a very specific, discrete spot, right at where that ductus, that's the connection between the pulmonary side to the systemic side occurs, there is a definite, discrete narrowing there so the blood can't flow through the aorta. Same kind of a narrowing idea as the aortic valve.

12:08
Mike Patrick: Sure. Like the hypoplastic left heart, do we think that that originates with the problem with the aortic valve or is that something a little bit different?

Ken McBride: The working idea that we have through research we've done in our lab and from other labs, these are all related to each other because of maybe a problem in how the aortic valve develops and also how the aorta itself develops, at least that section that occurs as it comes off of the heart.

The hypoplastic left heart syndrome, we think, is an aortic heart disease, because if we can find fetuses during pregnancy where we can see an aortic valve narrowing or a stenosis early in the pregnancy, say, 18 weeks or 20 weeks, then we are following these individuals along during their pregnancy, we notice that the left ventricle becomes progressively smaller and smaller and the aorta doesn't grow. So we think probably then it's the aortic valve disease and the rest of these things are secondary.

13:03
Interesting thing, if you take a look at people who have just an aortic valve stenosis or a bicuspid aortic valve is they often have troubles with the aorta just above where the valve is. So it's something about the formation of that valve and that part of the aorta that seem to be linked. These problems are where the aorta can get bigger or dilate and can lead to a rupture which is called an aortic dissection.

It's interesting, too, that when we take a look at families who have one of these things, so we find people who have a bicuspid valve and we start looking at their relatives, we can see people who have just that dilation and dissection of the aorta but not the valve problem. We can see some people have both the valve problem and the dissection as well.

The other thing, too, that's very important, I think, for families is that if you have a child with a hypoplastic left heart or a coarctation of the aorta, the relatives can have a bicuspid valve, and we've done this before and done echoes on parents and on siblings, we can find a bicuspid valve in those individuals in 5 or 10% of the time.

14:03
Mike Patrick: Is that why we started to think that maybe there is an underlying genetic factor involved with this?

Ken McBride: I think that's what started it off, yes.

When we started looking at these families, we were saying, well, we should be finding other people with hypoplastic left heart. Those families are very rare. Or if we're looking at people with coarctation of the aorta, we should be looking at more families who have just that. We can find them, but more often actually when we start looking at these families and we can see people who might have a hypoplastic left heart syndrome, there may be someone who's got a coarctation of the aorta. We can see someone else in the family, an uncle, who has had a bicuspid aortic valve.

And we were taking a look at many of these families over and over again and we kept seeing the same pattern where you could see any one of these defects that involved that left ventricular outflow tract in the families. Not necessarily the same one, but repetitively we see this. And if we were looking for other kinds of heart defects, they weren't occurring very commonly in there, so there seemed to be some sort of a link about these defects within families.

15:01
Mike Patrick: Now, prior to going down that road of there being a genetic factor, it was thought that maybe something in the environment was causing this to happen. And I actually have a little bit of a personal experience with this.

A good friend of mine from college, and we remain friends to this day, their first baby was born with hypoplastic left heart, and this was maybe 15 years ago or so and he did pass away and didn't survive the surgery to try to correct that, but I recall they lived in a rural area and there was some concern that it seemed like that area, that particular area, had a higher rate of congenital heart defects than other areas that you may look at, so there was a question of whether fertilizers or there's something in the environment that might be having a factor here.

Is that still thought or do we think it's just genetic? Or are there environmental causes? Or can the genetics and environment influence one another? What's your take on that?

16:03
Ken McBride: Good question.

Environmental causes can be very hard to pull out even more so than genetic causes. If we were to take a step back and look at heart defects in general, we know that there are a few things that can cause heart defects.

For instance, one of the more commonly known ones are fetal alcohol syndrome, or FASD is what the term is used now. People who have exposure to alcohol during the pregnancy have a higher rate of certain types of heart defects. Usually it's a defect where there's a hole between the lower chambers of the heart that are called ventricular septal defects.

If the mother has diabetes and it's not well-controlled during pregnancy, that baby is also at higher risk of having heart defects.

For hypoplastic heart syndrome, there has not been as good data, so we see these clusters of things. For instance, in Wisconsin, we'd noted that people who lived in highly industrialized cities had a higher rate. I've done similar searching in Texas where we looked at birth defect registry data there and we could find that in certain counties in Texas, we noticed that there were increased rates of these things. What actually leads to that increased rate, we don't know yet.

17:10
There was one very large, nicely-done study back in the '80s called the Baltimore-Washington Infant Study where they took a look at all babies who were born in the Baltimore and Washington, D.C. area and they took a look at detailed backgrounds of these pregnancies. They think that perhaps organic solvents might increase your risk but weren't able to pin it down any further than that.

Mike Patrick: Yeah. Could it be that you start out with a genetic propensity for this so if you have a certain gene that maybe then an environmental factor could turn it on or off?

Ken McBride: That's certainly possible, although at this point we don't know what those might be.

Mike Patrick: We just don't understand it.

Ken McBride: Yes.

Mike Patrick: Tell us a little bit about your research concerning the genetic influences for the development of these defects.

18:01
Ken McBride: Again, we talked about this a little bit earlier in the podcast, we're finding families where we seem to have an increased rates of these things where we would expect by chance. We are finding that if you had one person in a family that had a heart defect and we looked hard enough, say, they had hypoplastic left heart, we could find about 20% of relatives, going back out not only to the parents and the siblings but aunts, uncles and grandparents, about 20% of the time we could find at least one person who had another heart defect. We thought, 'That's pretty strong evidence that this is a strong genetic component.'

We started off with some very traditional techniques. We'd take a look at families, we would collect all the people in the family and then look to see if we could find what chromosome you might find this gene, and we do tests that are called 'linkage analysis' where you try and trace bits of DNA. If you're familiar with "CSI", for instance, where they're coming up with these DNA profiles on people, you can use these same profiles and track them through families and see if you can find if one of those little markers that the "CSI" guys use might actually track with your heart disease. Hasn't been quite as successful with that technique because there's a very complex genetics involved.

19:14
Mike Patrick: Sure.

Ken McBride: We are now using some newer technologies to do sequencing. We think back about the Human Genome Project and the sequencing that was done on that using old technology, so it took 10 years to get one individual. We now have the ability to actually sequence an entire individual in two weeks.

Mike Patrick: That's incredible. I mean, I remember when I was in college, they were still working on the first one. It took years.

Ken McBride: It's evolved rapidly. No, it's exciting for me; I can use these technologies and it's actually proved a lot more fruitful at finding genes.

Mike Patrick: Yeah. So basically you're saying this family has a high number of these defects, so let's try to find an area on their chromosomes where they're all abnormal compared to the general population, and then you zero in on that?

20:05
Ken McBride: We actually try and track it. We may find a region that says, well, this region on Chromosome, let's say, 1, tracks through this family the same way that the heart defects track through this family. That might be a large region with which we wound up with.

Mike Patrick: Sure.

Ken McBride: And then you have to narrow down within that region, there may be 100 or 200 genes in there, to try and pick out the one you think is the most likely culprit.

Mike Patrick: Yeah. How close do you think you are to figuring that out?

Ken McBride: A lot better in the last couple of years.

Mike Patrick: That's the million-dollar question.

Ken McBride: Yeah. The studies I've done, I've been at it for 10 years to try to do these linkage studies in families, since we've developed the sequencing technology here at Nationwide Children's, we actually now have one family which we've located the exact gene we think is causing the problem, and we are now just queuing up our other families.

Mike Patrick: To see if they have that gene.

Ken McBride: To find that gene or if they have something different. So it's become a lot more exciting in the last couple of years.

Mike Patrick: Yeah. Now, apart from just the interest of finding this gene, there's actually a good reason to be able to identify if someone has this gene and are they at risk for it. Talk to us a little bit about why it's important to actually identify these things for families on a clinical level.

21:14
Ken McBride: Sure.

One of the basic questions we get asked when someone comes to the clinic is, 'I have had something in my family that we think is a genetic problem. What's my child with having a child with the same condition?'

The way that we're doing that currently, because we actually don't know what causes hypoplastic left heart, is to say, well, let's take a look at the last several hundred families who had a child with hypolastic left heart who then go on to have another child. How often do we see that second child also have a heart defect? So we can give you a rough risk, but that's really rather crude because it applies to a big group of people but it may not apply to that person individually who's sitting in front of you.

If I can find out exactly what causes the heart defect and then can test for that on the family, I can tell them a lot better what their risk might be. So I might be able to say, 'You know, your risk is pretty close to zero,' or 'You know, you've got a genetic defect here that's a high risk.' That makes big differences for families if they're trying to plan out how many children they want or if they want more children.

22:15
Mike Patrick: Yeah, just what are the risks of this happening.

Ken McBride: Right.

Mike Patrick: What about early identification in terms of if you can early identify that a baby might be affected. Is there a way that we could intervene to help them survive earlier?

Ken McBride: Certainly. The traditional techniques now is just to rely on the regular ultrasound that you get during pregnancy. They're not bad. They may pick up, say, 30 or 50% of people who might have a heart defect, which is helpful, but then there's a lot where they're missing. And as I explained before, you may find a person who's got this aortic valve problem who then goes on to have the heart defect, but finding that aortic valve problem to start with can be very hard.

If we know what causes the disease and can test, we're going to be a lot more accurate. And that's quite important for a couple of reasons.

23:04
One is that if we know someone has a heart defect and we can get them to deliver in a place where they can attend to the baby quickly as opposed to waiting for them to get sick, we'd do an awful lot better.

There is also now a few groups across the country who are trying to intervene during the pregnancy. If we say that we have this aortic valve problem but no hypoplastic left heart, is there something that we can do to that valve so that baby then doesn't go on that could develop to full-blown hypoplastic left heart syndrome?

Mike Patrick: So if the aortic valve that we talked about, stenosis or atresia, where you have decreased flow through that valve, this is really kind of cutting-edge science sort of stuff…

Ken McBride: Yes.

Mike Patrick: …if you could go on in while the baby is still inside mom and with a balloon dilate that valve so that you increase flow through it, then maybe you can avoid the left ventricle from not developing fully or maybe prevent the aorta from not developing fully and maybe prevent the whole defect. I mean, you still have an abnormal aortic valve, but you won't have these other problems associated with it.

24:10
Ken McBride: Yes, so the surgery then becomes an awful lot easier for the guys after the baby is born and also he'll have a better outcome with it.

And people are doing this in Boston, for instance. There's a group that's trying this. There are not many people who qualify for the type of intervention, but the ones who do qualify, they have had not bad success at being able to open that up and have a better outcome later.

Mike Patrick: We should point out that doing this, of course, has its own risks, and you certainly worry about the spontaneous abortion and the baby dying because of the procedure that you're doing.

Ken McBride: Yes.

Mike Patrick: So it's not something that you do as a cavalier kind of thing. You just…specific cases.

Ken McBride: Very careful selection and being done by a group of people who really know what they're doing.

Mike Patrick: Yeah.

Now, do you see in the future that there could perhaps then be universal genetic screening, just like we do a newborn screen and try to pick up PKU and sickle cell disease? Someday could it be that we could do a screening for congenital heart defects in terms, of course, they were going to be born with the defect itself, but just to say, 'Hey, this is in your family. This is something you have to look at,' or not really?

25:22
Ken McBride: Well, I think personalized medicine or personal genomic medicine is out there. We're not ready for it right now because we still have a great deal of difficulty deciphering what all these different genetic changes might mean for an individual.

But the type of technology I'm using in the research lab where we're sequencing someone's entire genome is now out there and available clinically for people to use, so potentially, you could have your entire genome sequenced for you, put on your little flash drive, and you carry that with you for life. And as people understand what these changes mean, they'll be able to predict better what might happen to that person.

Potentially, we're there. A little science fiction at the moment, but it's out there.

26:00
Mike Patrick: Right. Now, talk a little bit about genetic counseling. I guess it would be really easy for that genetic counselor if the person's whole genome, we knew exactly what genes did what and what they were risked at, if you were going to have a baby with this person, what are your chances at X, Y, and Z. We're not quite there yet, but what is the role of genetic counseling today?

Ken McBride: I think genetic counselors play an extremely important role for families who are worried about a genetic disease.

A genetic counselor is someone who's got the basic science background, so they have a bachelor's degree and then they have a master's degree specifically in the genetic counseling part. Their role is to try and take a look at individual families and see what's there. They do something called drawing a pedigree or your genealogy and looking through it for diseases and then trying to help you come up with what might be a relative estimate of risk for any particular disease that you might be worried about, and then help educate the family and the individual about this disease and guide them along in what might be the best decision for them with this information.

27:10
Mike Patrick: And we obviously have genetic counseling services here at Nationwide Children's Hospital. How do folks get in touch with that, get plugged into that service?

Ken McBride: We have a large group of very good genetic counselors here at Nationwide Children's. At the moment, for someone who's interested in genetic counseling services for, say, something like a heart defect, would be to have a referral to our genetics physician at the clinic, and with the help of a physician and a counselor would be able to advise you on information on your family.

Mike Patrick: We'll put a link in the show notes to the genetics clinic here at Nationwide Children's Hospital, and it has location and phone numbers and referral information and all that business on it so it will be real easy for folks to get in touch.

And you don't just see folks from Central Ohio. If someone from Missouri didn't have the genetic counseling program close or if they wanted a second opinion, you take folks from all over the place, right?

28:05
Ken McBride: We certainly do, and actually get contacted by email because I'm doing research in this area from all over the place. As an example, in the last week I've had someone from Oregon and someone from Pennsylvania email me about worries they had about their families.

Mike Patrick: Sure.

Ken McBride: And I have physicians and other researchers from essentially around the world who contact us, I'm thinking New Zealand, South Africa, Australia, Belgium, Germany, on a regular basis.

Mike Patrick: All right, let's say there's a family out there who says, 'Wow, we have this. There is a cluster of folks with these heart defects in our family.' Are you looking for more families to get involved with your study?

Ken McBride: Definitely. If you have a history of this or it's in your family, and this would be aortic valve stenosis, bicuspid aortic valve, coarctation of the aorta, hypoplastic left heart syndrome, we'd be very interested in seeing you. My focus at the moment has been in families where we have people who have more than one person in the family.

29:06
And it doesn't have to be confined necessarily to this specific set of heart defects. If there are other people who have a different kind of heart defect running through their family, we'd be very interested in hearing from you.

Mike Patrick: Sure. And again, they can get a hold of you just going to that genetics page. We'll also have the link to your profile at Nationwide Children's Hospital and there's also contact information there as well. So if you just head over to pediacast.org and look for the show notes for Episode 199, we'll have all that information for you there.

Well, we really appreciate you stopping by the studio today to talk about these things. Before you go, one last question for you, and we ask all of our guests the same thing. I really have a passion for families doing stuff together around the table that don't involve television screens and video games and just really putting your minds together and having some fun as a family, and in our house, we play a lot of board games. So we just ask all of our guests what your favorite board game is now or as a kid, just to put you on the spot.

30:07
Ken McBride: Well, I guess as a kid, I grew up playing Risk.

Mike Patrick: Oh, sure. Yeah.

Ken McBride: We had a blast with that. We'd get friends together and sometimes we'd play two and three world Risks, so we'd each bring our games over and tack them all on together. We do that as a family now. We sometimes play Risk. I think our favorite games probably for me and my kids, I've got two teenagers, would be Backgammon. That's a board game.

Mike Patrick: You know, a couple of other people have mentioned Backgammon, and I've never played it, so I think we need to check that one out because we love to play games. And it's a strategy game, right?

Ken McBride: It's very much a strategy game.

Mike Patrick: Yeah. That sounds great. Now, if you like Risk, have you done Axis & Allies?

Ken McBride: You know, I tried that when I was a teenager, and I haven't actually gone back to it very much.

Mike Patrick: It's very complicated and it takes a very long time. My son got it for Christmas and we've played a couple of times, and it's a marathon session, but he beats me every time we play. [Laughter] Risk is a little easier. There's less going on. Or there's still a lot going on.

31:10
All right. Well, once again we appreciate you stopping by. I just want to, and of course we want to thank all of you for taking time out of your day to allow PediaCast to be a part of it. We really appreciate it.

I do want to remind you, again, if there's a topic that you would like us to discuss, just head on over to pediacast.org and click on the 'Contact' link. You can also email pediacast@gmail.com. And again, the voice line, 347-404-KIDS, and you can just leave a message that way and we'll try to get some answers to you.

And just make sure if you do email or use the voice line that you let us know where you're from, because that's always interesting. On the 'Contact' page, there's a place for you to put that, but sometimes folks forget when they email. So just remember to let us know what part of the world that you are living in because we always think that's interesting and appreciate it.

We also want to remind you to spread the word about PediaCast just next time you're at your doctor's for a well check-up or a sick office visit. Just say, 'Hey, there's this great evidence-based podcast out of Nationwide Children's Hospital,' so that your doctor has this tool in their hands to let their patients know about it.

32:11
Again, we appreciate you taking time, 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.

Topics

• Vitamin D and Depression
• Dissolvable Tobacco and Nicotine
• Flavored Cigars
• Milk Consumption and Colon Cancer
• Food Marketing Update
• Folic Acid and Language Development
• Mozart and Epilepsy
• Boys vs Girls: Differences in Concussion Symptoms

Links

• Cleft Lip and Palate Center at Nationwide Children's Hospital (Facebook)
• Snap Crackle Pop – PediaCast 163
• Folic Acid Supplements in Pregnancy and Severe Language Delay in Children (PubMed)
• The Long-Term Effect of Listening to Mozart in Children with Epilepsy (PubMed)
• Sex Differences in Concussion Symptoms of High School Athletes (PubMed)
• All About Concussions – PediaCast 177

Transcript

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 once again to PediaCast, a pediatric podcast for Moms and Dads. Also for clinicians too. We have a growing number of physicians and nurses in the audience. We would like to welcome all of you to the show too.

We really try to keep things in a language that parents can understand, but provide enough depth for the rest of you as well. And hopefully we're doing a good job with that. If you have suggestions for the show of course we are always open to them.

01:01
We are coming to you from the campus of Nationwide Children's Hospital in Columbus, Ohio. And it is February 8th, 2012. We're calling this when Vitamin D, cigars, and Mozart. We'll talk a little bit more about exactly what's coming your way and because there's always more topics.

And just what we've mentioned in the intro here, especially for our news. And actually this is not going to be a listener's show, we're doing a research round up today. We haven't done one of those in a couple of months. So, wanted to get back to some research topics which are pertinent for moms and dads. So, I think you'll find them interesting. And we'll put them again in the terms that you can understand pretty easily.

Before we get started with that though, it is our one year anniversary here at Nationwide Children's Hospital. So, we used to do PediaCast in Orlando, Florida. And we moved up North, thought we're going to have some really cold winters.

02:00
This is not turning to be one of them. Although last February I know we were greeted to a couple of ice storms right off the bat. So, that was trying, but this year we really had a mild winter, I think yesterdays high was almost 60 degrees which is unheard of in this neck of the woods. So, we're enjoying the warmer weather.

I mean, you kind of miss the snow a little. I don't the ice, don't miss the ice at all. But I have miss having a couple of snow storms. We live in Ohio before we moved to Florida for many many years. And so, we are used to Ohio winters. Anyway, I guess I was hoping for one good snow storm this year and we haven't really had it. So, now I just want spring to get here. At this point we're being teased with a nicer weather.

Also, this is kind of cool, we have another brand new Facebook page for you, that's affiliated with Nationwide Children's. We're really tying to build more specialized Facebook pages so that we have communities around specific topics. And I mentioned a couple shows ago that we had launched our sports medicine Facebook page.

03:04
And that we've launched another one, this one is for cleft lip and cleft palate. So, if you have a child or someone you love, or no who has cleft lip or cleft palate, you could either join that Facebook page or let others know about the resource.

So, it's not just about the happenings in the cleft lip and cleft palate center here at Nationwide Children's, we really wanted it to be an entire support community of folks who are dealing with cleft lip and cleft palate. And so, even if you aren't in Central Ohio, you may have a voice on that page and can help other people who are threading the path that you have once trod. So, make sure you check that out, just go to Facebook, do a search for Nationwide Children's Hospital cleft lip and palate center.

And if you want a real easy way to do it, just go to the show notes for this episode 198 and we'll have link for you to the cleft lip and palate center the Facebook page here at Nationwide Children's Hospital.

04:05
Also, want to remind you this is sort of new, we are doing transcriptions now of all of our shows. So, if you go to the show notes, we have all the topics lined up, the guest, but then we also followed that up with a transcript -a written transcript of the show. So, if you don't have time to listen, you can interact with it at the website.

Also make it more searchable in terms of finding topics that we talked about that weren't necessarily included in the title of the show or in our topic list that just kind of came up because I decided of the cup to talk about it. It will make things a little easier to search for each episode. So, we're excited about that.

OK. So, what we're going to talk about this particular episode Vitamin D and depression is a possible that Vitamin D supplementation could increase your mood and cause less depression symptoms, we're going to talk about that. Also dissolvable tobacco and nicotine products, not good things. And flavored cigars aren't good things either. We're going to talk about those.

05:04
What about milk and colon cancer. Can milk intake whether it be increased or decreased, have an effect on colon cancer later in life. We're talking about milk drink during childhood. How much you drink, does that cause more colon cancer or less colon cancer down the road?

Food marketing update, we talked about a few episodes ago the death, the potential death of our beloved cereal box characters. So, Tookie and Sam, and Snap, Crackle, and Pop, and the like, Lucky the leprechaun, Tony the tiger, OK, you get the picture here. We're going to have a little update for you on the food marketing debate that is going on on Capitol Hill.

Also, folic acid and language development, what's the relationship? How about Mozart and epilepsy, is there a relationship between listening to Mozart and better control of epilepsy? That's an interesting idea.

06:02
And then, boys versus girls, the differences in concussion symptoms. So, all of these things are coming up your way. I want to remind you if there's a topic that you'd like us to talk about, it's easy to get a hold of me, just head over to pediacast.org, and click on the contact link. You can also email pediacast@gmail.com, that's another way to get a hold of us, or call the voice line at 347-404-KIDS, that 347-404-K-I-D-S.

And finally, I want to remind you the information presented in every episode of 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 along with the hands on physical examination, it's very important.

Also, your use of this audio program is subject to the PediaCast terms of use agreement which you can find at pediacast.org. And with all that in mind, we will be back with 'News Parents can use', right after this.

[Music]

07:34
All right. We all know that Vitamin D is important for calcium absorption in the gi tract, that's why it's added to milk. Vitamin d helps transport the calcium from the milk across the intestinal wall, and into the body where the calcium is used for growing bones.

But Vitamin D may have a mood altering effect as well. Researchers at Bristol University in the United Kingdom looked at Vitamin D levels in 2,700 children between the ages of nine and thirteen. T

hey found those with the lowest levels of Vitamin D, were the most likely to suffer from depression symptoms and those with the highest level of Vitamin D were the least likely.

08:10
The study investigated two forms of Vitamin D, D2, and D3, and found the strongest anti depressant link came from the D3 variety. Now, milk isn't the only source of Vitamin D it's also found in oily fish, and the skin produces Vitamin D when it's exposed to sunlight.

This relationship may contribute to seasonal effective disorders, since long bouts of cloudy days leads to less sun exposures which leads to less skin production of Vitamin D. Of course too much sun exposure is also bad with sunburns and an increased risk of skin cancer, very real possibilities.

And researchers warn, it's not time to change recommendations regarding daily Vitamin D allowance quite yet, until additional studies confirm this findings and establish safe levels of supplementation. So, Vitamin D has been sort of touted as a wonder drug lately in the realms of alternative medicine.

09:01
You see it on magazines, you know, if you're shopping at the store and you're in the grocery, check out line, you'll see something about Vitamin D and how it's important, and it'll change your life. And I guess, this study does give its possible mood altering effect some legs, but I do want to throw in a warning here.

Vitamin D is a fat soluble vitamin, and that mean that if you get too much of it, you can't simply pee out the excess. So, you know other vitamins, like Vitamin C for instance, you take too much of it, and the extra you just pee it out. But that's not the case with the fat soluble vitamins like Vitamin D.

And that means if you take too much, it get stored in your body for a long time. And too much Vitamin D does come with its own set of problems like fatigue, irritability, muscle weakness, vomiting, decreased appetite, dehydration, constipation, high blood pressure, kidney stones, Polyuria which is peeing too much, and Polydipsia which is being thirsty all the time. So if you want to supplement Vitamin D for your kids, be sure to consult with your doctor regarding a safe way to do it.

10:09
Now here is something that's not safe for kids or adults for that matter. The Food and Drug Administrations tobacco product scientific advisory committee is meeting now to discuss dissolvable tobacco products. These new products looked like candy, and contain enough nicotine to cause quick addiction and possibly deadly overdose of an entire packages consumed.

The FDA will look at composition of these products, also characteristics used trans health effects and current product marketing. Then they'll send their report to the Secretary of Health and Human Services next month. In the meantime moms and dads, be aware that they are out there, know what your kids and teens are doing, and be sure to keep them far away from this potentially dangerous products.

And parents you should stay away from them as well. Just no good can come of dissolvable tobacco products.

10:59
While we're on the topic of tobacco, flavored cigars are the new darling of the smoking industry. Manufacturers are using candy like flavorings to lure kids, teens, and adults to their products. Of course the sweet tasting cancer sticks contain the same toxic chemicals as any other cigar or cigarette.

So, again steer clear. A group of U.S. senators is urging the FDA to ban the flavored cigars and the cigars industry in typical form is fighting back. The International Premium Cigar and Pipe Retailers Association is circulating a petition warning that the FDA should not regulate this because by regulating flavored cigars, this would devastate local stores across the country.

Of course, never mind the devastation the local stores are causing on families, who see moms and dads and other loved ones to die because they are addicted to their products that they're selling.

Look folks, I'm a capitalist, and if you're in the business of selling dangerous and addictive substances, I think it's time to diversify your product offerings.

12:02
I mean, it's only going to be a matter of time before Uncle Sam is going to step in whether you like it or not, and regulate these things. So, you might want to get on a different product program while you still can. And of course in the meantime, consumers can have the final say by not buying the products.

All right, enough about tobacco and cigars, let's talk milk and colon cancer. Researcher in New Zealand looked at 571 adults between the ages of 30 and 69, they looked back at their milk intake as children, and then they looked ahead at their adult frequency of colon cancer to see if there was a relationship. The results recently published in the American Journal of Epidemiology, revealed that those who drink the most milk had the least chance of developing colon cancer later on.

Now, before you get too excited about this, it's a retrospective study, right? So, we're looking back, and in fact we're looking way back and relying on a person's memory regarding their milk intake as school kids, which may have been as many as 50 years ago.

13:03
Well, it's not exactly true, over 1,000 people were studied and half of those went to schools that when they were kids had a free milk program, while the other half did not. And back at that time, milk is not routinely given in schools, so the fact was the adults who when they were kids went to schools that had the free milk program that they would have had more milk intake than the other groups.

So, all together they studied 1,000 people and those in the free milk program when they were kids who we think drink more milk, that group had 30% fewer cases of colon cancer cancer compared to the group that were not part of the free milk program when they went to school a long time ago.

But here's the real kicker, previous studies have suggested that increased calcium intake actually increases the risk of colon cancer. So, researchers aren't sure why their study shows the opposite effect. They plan to return to their labs in an attempt to figure out why.

14:00
So, bottom line here moms and dads, keep giving your kids milk, it's a great source of calcium and Vitamin D, and maybe just maybe they will decrease your child's risk of colon cancer down the road, but the verdict is still out on that one. Now, how much milk should your child be drinking?

That's an answer that really differs from kid to kid. And the best way of knowing is to check in with your doctor on a yearly basis, see how they're looking on their growth chart, talk about their diet, and go from there. And finally in our, 'news parents can use', an update on marketing food for kids.

Now, if you recall back in episode 163, and I actually entitled that one 'Snap, Crackle, and Pop. And in that particular episode we discussed food companies and their marketing techniques toward children. Health experts have been lobbying Congress to pass laws that prevent companies from marketing directly to kids unless the food in question can meet a healthy standard.

Passage of such a law would in effect kill beloved food mascots such as Tony the tiger, Tookie and Sam, and Lucky the leprechaun, and others.

15:00
And we've talked about all of them at length in that episode 163. Unless the products they represent undergo major ingredient changes to push them below that healthy threshold. Well, the update is this, Congress isn't buying it, or shall I say they aren't passing it until the proposal undergoes a rigorous cost benefit analysis.

The plan is already been in the works for over a year and a half, and this latest blow could keep it from becoming a law. If you're interested, my opinion on the whole food marketing to kids issue, I'm not going to rehash it here, because really, it would take up the rest of our time together.

But if you really want to know my thoughts, check out PediaCast 163, again it's called "Snap, Crackle, Pop", and to make it easy for you, we'll put a link in the show notes for this episode back to episode 163, so you can find it pretty easily. All right. Well, that wraps up our 'News parents can use' and we'll be back to do our research round up right after this.

[Music]

16:26
All right. We are back and this is our research round up that we're up to now. And this one is as interesting, I think we have some good studies for you. The first one comes out of the Norwegian Institute of Public Health, and it was published in the Journal of the American Medical Association, October 2011.

And we have a link to -we're just going to talk about three studies here, and we'll have a link to all three of them in the show notes. So, when you look at the -there's a place on the internet called PubMed where you can look at the abstracts and then they have some other links if you want to see the full text.

17:02
Some of them you have to purchase to see the entire text because the articles owned by a journal, unless you're affiliated with an academic institution and then you can probably get a hold of it at no cost. But there's links available, so in the show notes for this particular show there will be links to the study that we're talking about at PubMed.

So, if you want to go check it out yourself you're more than welcome to do that and it will be easy to do just by heading over to the show notes page. OK. So, this first one was a study looking at prenatal folic acid and language development. The institution is the Norwegian Institute of Public Health and this was published in the Journal of the American Medical Association, October 2011.

The question before the researchers, among children aged three years, what is the association between mothers use of prenatal folic acid and the risk of language delay. So this was a prospective study, it involved 40,000 children.

So, this is a huge sample size, and you know we've talked in the past that prospective studies are better controlled and really just sort of better quality studies compared to retrospective studies where you take a group of people and then looked backwards.

18:11
So, these are cases where you're going to enroll people in the study and follow them forward, and it's easier to control your variables that way. And in this case they looked at 40,000 kids. So, they actually started when the children's mothers were expecting for them and enrolled expectant mothers between 1999 and 2007, and they enrolled them when they were 17 weeks gestation.

And they asked the moms, 'did you take folic acid supplements during the time period of four weeks before conception through eight weeks after conception?'. So, in the month before and the two months after you conceived, so very very pregnancy, were you taking a folic acid supplementation?

19:00
And based on the answer to that question, the women were placed into four categories, those with no supplements whatsoever, so no vitamins of any kind, they did take a vitamin, but not folic acid, that would be group two. Group three is they took folic acid and other supplements, so multivitamin plus extra folic acid. And the fourth group they took folic acid only.

Now I want to point out that this study was done in Norway, and there is no folic acid supplementation in the food in Norway. So, if you try to do this study in the United States, you also would have to control for the mother's diet because they'd be getting folic acid that way. But in Norway there's no folic acid supplementation in the food, so the only source of folic acid would have been through this extra supplementation.

OK. So, they enrolled in that way, and kind of divide them into those groups depending on their folic acid exposure. And they waited for the kids to be born, and at age three they assess their language skills. And they did this base on a questionnaire completed by the mothers.

20:02
And based on the answer to that questionnaire, or the answers the children were categorized into a language category, one of three language categories. Either their language was one word, one word phrases, or unintelligible. And those kids were considered to have a severe language delay at age three.

If they could do two to three word phrases, they were considered to have a moderate language delay, and if they could do fairly complete sentences, then they had no language delay. OK.

So, once they've divided these kids into severe language delay versus moderate language delay, versus no language delay, then they calculated odds ratios for each group of women based on their folic acid supplementation status at the time of conception and they compared that to the resulting language category of each particular child at age three.

21:00
And these resulted in a lot of numbers. And so, I'm going to boil it down to you. The statistically significant results was this; the mothers who had folic acid supplementation whether it was by itself or in addition to other supplements, had a decreased risk of having children with severe and moderate speech delay at age three.

So, the authors conclude that the maternal use of folic acid supplements four weeks before to eight weeks post conception was associated with the reduced risk of severe and moderate language delay in children at age three years. So, this is a well designed large sample size prospective study, and it provides another good reason for mothers to get plenty of folic acid during the very early stages of fetal development. And for those of you expecting or soon to be expecting, be sure to talk to your obstetrician about getting the right amount of folic acid.

All right. Moving on to Mozart and epilepsy. This is an interesting study done at Kaohsiung Medical University in Taiwan and it was published in the Journal Epilepsy Behavior in August 2011.

22:06
So, the question before the researchers, among children with epilepsy, does listening regularly to the Mozart K448 Sonata affect frequency of epileptiform discharges. So, what is this all about? OK. And by the way -I'm really sorry about this. I'm not sure now that I looked at it. I actually wrote this down in two different ways.

Is the Sonata 488 or 448? I'm not sure, so don't quote me on that part of it, sorry about that. I think it was 448, for some reason I wrote 488 and half my script and 448 to the other. So anyway, does Mozart Sonata affect epileptiform discharges? The researchers looked at 18 children, 10 girls and eight boys, and they range and age from seven months to 14 years.

The mean age was seven years and 10 months, and all of them had a diagnosis of epilepsy for at least six months with persistent epileptiform discharges on their EEG, but they are well controlled with anti convulsant medication.

23:13
So, I used a lot of big words there. So these were all kids who had epilepsy or seizure disorder for the past six months. They are all well controlled on their medicine, so they're not actively having seizures, but if you do an EEG where you put the electrodes up to their brain and do get the tracings, they do still have some abnormalities on their EEG, they're just not having active seizures with those abnormalities.

But they are having those discharges which would let you know that if you stop their anti convulsant medicine they probably would have a seizure again. I also want to mention that none of the kids that they looked at had musical genic seizures, so they didn't want to do a study involving music and kids in whom music might be the initiating factor of their seizure.

So, none of these had music related seizures. Also, of the 18, 16 of them have focal seizures, so it wasn't whole body seizures, although that was the case in two of the kids they looked at.

24:06
But in 16 of them, they had a history of focal seizures meaning that the epileptiform discharges that you picked up on EEG, the abnormal wave forms were just originating from one particular part of the brain. And that would only make there be a certain abnormality associated with that part of the brain with regard to their seizure, that could be a motor seizure where just like their arm shakes, or it could be in a different form -a different part of the brain which can cause different types of seizures.

So, these are mostly kids with focal seizures although two of the kids they looked at did have generalized epilepsy. OK. So, what did they do then? They actually had all of these kids listen to the Mozart K either 488 or 448, sorry. I will get to the bottom of that Sonata for eight minutes before bedtime for six months.

25:04
And they performed EEGs at one month, two months, and six months after they started doing this. And the results are pretty impressive. At one month, the epileptiform discharges, so again the abnormal waveforms they see on the EEG decreased by 53.2%, at two months, they decreased by 64.4%, and at six months, they decreased by 71.6%.

So, now those were the results if you looked at the group as a whole. However, if you took out the kids with focal occipital discharges, so that means their abnormal brain waves were occurring at the back of the brain. So, if you took out those kids because those kids that didn't work very well.

At six months, the only saw a decrease of 3.7% in their discharges if the abnormal waves on the EEG, just when you put the electrodes up to the head, they only had saw 3.7% decreased.

26:05
Now, for those who had focal seizures in the front, so they had frontal focal seizures, they saw 100% decrease in their epileptiform -abnormal epileptiform waves. If it was a central focus, they saw a decrease of 99.1%, and if it was in the temporal lobe on either side it was 96.6% decrease in the amount of epileptiform discharges, and if they had generalized -so, the two kids who had generalized seizure where the abnormal brain waves are everywhere, they actually saw a 97.2% decrease in their abnormal brain activity.

So, this is pretty impressive, and by the way there was no relationship with age or gender. So, if you then mixed up all the kids and separated them by age, or by gender, there was no difference that would be accounted for by their age or their gender, just base on the location of where their abnormal discharges were located.

27:02
So, the authors conclude that long term listening to the Mozart K448 Sonata may decrease epileptiform discharges. And by the way, I did looked at up it is 448 not 488, I don't know why I wrote 488, I just confused myself and confused all of you. But it is the Mozart K448 Sonata.

So, it is pretty impressive, now we do have a small sample size and only of the studies had kids with generalized seizures. So, I definitely would not stop your child's anti convulsant medication in favor of Mozart, at least not without talking to your neurologist first. All right. And finally up in our research round up, boys versus girls, differences in concussion symptoms.

So, this is a study that came out of three universities including the Ohio State University here in Columbus, also the University of California, and the University of Virginia. It was published in the Journal of Athletic Training in January and February 2011.

28:05
And the question before the investigators for this one was among male and female high school athletes with sports related concussion whether the difference is in symptoms, symptom resolution time, and time to return to their sport. They looked at 100 high schools, and all the schools had at least one certified athletic trainer on staff. Schools were also divided into eight categories based on geographic location and school size.

And athletic trainers reported head injury exposure to the researchers each week. Now, in order to be qualified as an injury event, the head injury had to take place during an official practice or competition,had to require the attention of the team's certifies athletic trainer at the time of injury, and they had to result in play restriction for at least one day.

They looked at nine different sports, boy's sports included football, soccer, basketball, wrestling, and baseball. And for the girls they looked at soccer, volleyball, basketball, and softball.

29:02
And by the way the study was done during the 2005-2006, and 2006-2007 sports seasons. For each injury occurrence the athletic trainers recorded the child's symptoms, the time it took for the symptoms to resolve, and the time it took for the child to return to play. A total of 812 concussion were studied, 610 of them were in boys, and 202 of them were in girls.

So, what they find? Well, the result showed that headache was the most common symptom for boys and girls, but boys were more likely to have amnesia, confusion, and disorientation, while girls were more likely to have drowsiness and noise sensitivity. When you looked at boys versus girls, there was no difference in the number of symptoms reported, and with regard to symptom resolution time for the boys 72.2% had their symptoms resolved within three days of the injury, and for girls 66.7% have symptoms resolved within three days of the injury.

However, that difference was not statistically significant, but still about 70% on average of the boys and girls have symptom resolution of their concussion within three days after the injury.

30:15
Now, what about how long it took to return to play, well for boys 63% had returned to play by nine days post injury, and for the girls 66% had returned to play by nine days post injury. So, they were out for about a week and a half, and it was not statistically significant with regard to boys versus girls when you looked at their time it took to return to playing.

So, the authors conclude that after sports related concussion, male and female high school student athletes present with different types of symptoms with males reporting more cognitive symptoms, and females reporting more neuro behavioral and somatic symptoms. Symptom resolution time and return to play time however did not differ between the sexes.

31:01
So, again boys are more likely to have disorientation, confusion, amnesia, along with their headache, whereas girls are more likely to have drowsiness, and noise sensitivity along with their headaches. So, it's interesting that the concussion symptoms is a little bit different when you look at boys versus girls.

So, these are some interesting observation regarding concussions, but I do want to point out to parents it is important that we take concussion seriously. It's important that your child have a period of rest from sports, gym, and sometimes academics following a concussion. And it's also very important that your child is recheck and cleared by your doctor before they return to play.

And if you want to know lots more about concussions from why they occur to a comprehensive list of symptoms and long term risks,, be sure to check out PediaCast number 177, that one was an entire episode devoted to concussions.

And PediaCast friend and Chief of Sports Medicine here at Nationwide Children's Hospital Dr. Tom Pommering, and certified athletic trainer Steevie Carzoo, they both stopped by the PediaCast studio to discuss All things concussion, and you can find the link to episode 177 in today's show notes.

32:12
All right. That wraps up our research round up and we're going to come back and wrap up the rest of the show, right after this break.

[Music]

OK. We are back and I'd like to thank all of you for joining us for the program today, really appreciate it. I want to remind you that iTunes reviews are very helpful, so if you found us through iTunes, I bet you look at the reviews in order to decide that you wanted to take part in the PediaCast community.

33:05
So, if you have not taken the time to write a review on iTunes, would really appreciate you taking the time to do it. Doesn't take long 30 seconds or so, just jot down some notes, and let the rest of the world know what you think about PediaCast. Also mention us in your blogs, on Facebook, and you tweets are very important to us.

And speaking of Facebook ad Twitter, we do have Pediacast has its own Facebook page and also a Twitter account, so you can follow us that way as well. And of course we welcome community participation in the show notes, it's basically a blog, and so if there's a particular show, and you want to share some helpful information, or you have another comment or question regarding that program, you can leave a message at the blog which really the show notes, at pediacast.org.

Also, if there's a topic you'd like us to discuss or you have question, comment, concern, anything regarding the program, just go to pediacast.org, and use the contact link. You can also email pediacast@gmail.com, or again call the voice line at 347-404-KIDS, 347-404-K-I-D-S.

34:07

And you can leave a message that way, and basically you won't talk to anyone, it's a voicemail, you leave your message, make sure you let us know who you are and where you're from. And then we'll get the audio of your question on the show.

All right. 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.

Topics

• Vaccines for Parents
• Pertussis Outbreak — For Real?
• Handwriting and Academic Success
• Asthma and Infant Growth
• Unfair Child Abuse Suspicions
• Donated Breast Milk
• Baby Cereal
• Pain Tolerance
• Sugar Cereal Solution
• Self-Esteem

Transcript

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 once again to PediaCast. A pediatric PodCast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital in beautiful downtown Columbus. You have to excuse my voice a little bit this week, just you know, just kind of nagging little cold, nothing big.

But enough to make me a bit hoarse and I might be reaching for the water bottle a little bit more often in this episode compared to others. It is 197 -PediaCast 197 for February 1st, 2012. Welcome to February folks.

01:06
Whopping cough, hand writing, and self esteem. Of course we have a lot more coming your way, and we'll get to all of the topics here in just a moment. So, tomorrow is Groundhog's Day, right. So we got to find out if we have six more weeks of winter. And I'm hoping that we don't because I'm ready for spring.

It's really been kind of a miserable winter so far here in Ohio, I mean we'd had very little snow, lots of rain, and just kind of cold and gray. And I don't know, I'm ready for the sunshine again. I need my vitamin D, and I'd rather get it from the sun, than from supplements. But you know, you get it whatever way you can. We do have some exciting news for you.

We are doing something new over at pediacast.org on the show notes page. You'll find that we are starting to add transcripts to each of our shows.

02:04
And so, this is going to be helpful in a few ways. Number one; it will make it easier to search, so you can find the individual topics that aren't necessarily listed in the show notes themselves in the topic index or there aren't tag on the post. So, basically anything that we talked about on the show, it's going to make it searchable at the website by adding the transcript.

And then also if you have a busy day and you don't have time to listen, and you just want to glance through it, we have a written copy of our content for you as well. We're going back and doing some of our more popular and interesting shows. And then moving forward most of the new shows should have transcripts for you. So, if you head on over again to pediacast.org click on show notes, and you'll be able to access the written transcript of each of our shows that way. All right. So what are we talking about today? Vaccines for parents. Should moms and dads also get their shots?

03:03
Now, you know kids out there who are listening to this right now, if your mom or dad and you're in the car, you got kids in the backseat, they are jumping -or they shouldn't be jumping, they should be restrained, but I'm sure that they're very excited at this point saying, "Yeah."

Shots for moms and dads you bet, we're all for it, so we're going to talk about that. Also, Pertussis speaking of shots for moms and dads. Pertussis outbreaks, are all of them real or could there be false outbreaks or pseudo outbreaks as the CDC calls them. We're going to talk about that.

Also hand writing is it linked to academic success? Doctors have poor hand writing, right? Doctors are kind of known for that. So, does poor hand writing mean greater academic success or is it the other way around? Does good hand writing have positive indicator for future academic success, we'll discuss that also.

04:00
Asthma and infant growth, unfair child abuse reporting practices, and then we're going to get to your questions. What about donated breast milk? Another on baby cereal, pain tolerance, and self esteem. So, these are all things coming your way very shortly.

I want to remind you if there's a topic that you would like us to talk about or if you have a question for the show, it's easy to get a hold of me, just go to pediacast.org, and you can 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.

And I also want to remind you if you get a hold of us in some way other than the contact link, make sure you put in your first name and where you're from. Everyone is always interested in knowing those things. You have to do it on the contact page, but if you email or call the voice line, we don't always get that information. So, please provide that for us and we'll get your question and answer on the show.

Also, I want to remind you the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals.

05:07
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 at pediacast.org. And with all that in mind we will be back to cover news parents can use right after this short break.

[Music]

So, children aren't the only one's who benefit from vaccines. Moms and dads need them too, not only for their own health, but also to prevent t he spread of potentially deadly germs to their kids.

06:07
Many adults are behind on their Pertussis vaccines and may not have been vaccinated against diseases such as Hepatitis A, certain forms of Meningitis, and Pneumonia, and even the flu. So, it gives, you know ,as long as children get these shots they're fine, right? They're protected.

Well, not necessarily. Vaccines aren't a 100% effective in every person. So kids not only rely on vaccines stimulated antibodies to fight off illness, they also rely on those around them being vaccinated to minimize exposure in case your child is one of the few who didn't make adequate antibodies against their vaccines.

And since parents are around their children a great deal, it's important that moms and dads don't harbor deadly germs to pass on to their kids. Of course we also want parents to be healthy so they can continue to parent and have healthy relationships with their children and grandchildren down the road.

07:00
So, how does this relate to pediatric medicine? Well, lots of parents are healthy and don't see their own doctors very often if it all. The age range that most parents, it's typically a healthy period of your life. But moms and dads do spend lots of time in the pediatrician's office. So, this pegs the question, should pediatricians offer shots for moms and dads?

Well, that's the recommendation from Dr. Herschel Lessin and Dr. Kathryn Edwards of the Committee on Practice and Ambulatory Medicine, and the Committee on Infectious Diseases from the American Academy of Pediatrics. In a recent article in the Journal of Pediatrics, researcher say, "Ideally, adults should receive immunizations at their own physician, but to provide greater protection to these adults and reduce the exposure of children to pathogens, immunizing parents or other adult family contacts in the pediatric office setting could increase immunization coverage for this population to protect themselves as well as children to whom they provide care."

Of course more questions comes to my mind. Questions like who pays pediatrician's to purchase, store, and administer the vaccines?

08:07
Do parents have to pay out of their pocket? Do their insurance companies pay for this? And the fact that it's not their regular doctor giving the shots to them would that be an issue? Also would this constitute and to what degree will this constitute? because I think it will.

A doctor-patient relationship between the pediatrician and the parent. And there are charting issues, liability issues to deal with here. So, I'm not trying to be 'Debbie Downer', I'm not saying it's not possible or that it's a bad idea, but they're certainly are logistical issued to consider before this idea sees the light of day.

In the meantime though it is important for parents to be as up to date on their vaccines as your children are. So, be sure to ask your doctor what you need. First go to your doctor, even if you're healthy and get your shots done for your kids and for you. Speaking of vaccine preventable illness, Pertussis also known as whopping cough, is a bacterial infection that results in severe difficult to control coughing.

09:04
The infection can interfere with breathing and result in death. In fact around 300,000 people die from whopping cough or Pertussis each year. But most of these deaths occur in children living in under developed countries. Still with many kids going without proper immunizations in America, the disease is on the rise here at home.

According to the CDC there are more than 27,000 cases reported each year in the US with 27 deaths in 2010, nearly all of which were infants younger than one year of age. Pertussis often shows up in communities as clusters of outbreaks has occurred in California a couple of years ago when 9,000 people tested positive and 10 infants died. But sometimes what appears to be an outbreak isn't.

For example what appeared to be a Colorado outbreak of Pertussis in the summer of 2009 wasn't really an outbreak at all. The CDC has determined that the laboratory which tested the positive samples had Pertussis DNA on laptop computers, counters, club containers, and medical equipment, and the Pertussis identified in the test samples likely came from these contamination rather than from the patients.

10:08
The CDC became suspicious because when they went back and talked to those supposedly infected with Pertussis, their symptoms didn't matched up with classic Pertussis symptoms. And as it turned out the amount of Pertussis DNA in their samples was much less that what would be expected with a real infection.

This isn't the first time the CDC has encountered a pseudo outbreak of Pertussis, that's the word they use for an outbreak that appears to be real on the surface, but turns out to have another explanation. Other pseudo outbreaks occurred in New Hampshire, Massachusetts, and Tennessee between 2004 and 2006.

The CDC has published some best practices guidelines for laboratories and medical offices to help prevent pseudo outbreaks in the future. Recommendation includes setting up different areas for Pertussis vaccine preparation and laboratory work. So, you know don't put the shots together and drum up in the same place that you're going to test for Pertussis because DNA from the shot might show up in the sample in the lab sample.

11:07
Health workers should also put on new gloves when handling Pertussis vaccine and when collecting Pertussis swabs, and they should dispose off these gloves immediately after finishing the job at hand. The CDC stresses that other outbreaks of Pertussis have been real and deadly. So, despite this findings it's still important that kids and parents are up to date with their Pertussis vaccines

I commend the CDC for announcing this, be to just keep it quiet, OK you have the report, let's not make a big deal about it. And some would say, the CDC and other government agencies are in the business of scaring parents so that they feel that they have to get their shots, and make money for the drug companies who are lobbying the government.

I mean, there's some sort of conspiracy theory I think that's out there. But I think it's nice when the CDC says, "Hey, you know, OK this is something that we identified as an outbreak, and you know what, it really wasn't an outbreak. We found XY and Z out."

12:05
So, I think that's good to have that transparency in the government and I think that just again goes against those who say there's this big vaccine conspiracy out there. All right. Let's move on to off of the topic of immunizations and on to the topic of hand writing.

The art of hand writing is in a fight for its life as students migrate to keyboard. But researchers at Florida International University say not so fast. The investigators want to see if there is academic value associated with good penmanship. So, they studied the hand writing skills of a thousand second grade students, and found out that those who wrote well and legibly tended to get better grades.

They're carrying the researches step further and they plan to work with struggling pre-case students to see if writing intervention will lead to better results in Reading and Math. So, my question with this and maybe you were thinking it too. Why is doctor handwriting so bad?

13:04
I mean, if you look at doctors, you'd think that bad handwriting is associated with academic success, like I mentioned in the intro to the show. Well, I can tell you from experience that my handwriting before becoming a doctor was fabulous, OK. I don't mean to brag, I don't want the pride to bubble up, but I had good handwriting.

In fact as a young doctor I was often told that my handwriting didn't match my profession. And I was always sort of proud that people could read my writing, few pharmacy's would call me to ask about my prescriptions because it was very legible exactly what I wanted. But thousands of prescriptions and medical charts, and school notes later, my handwriting began to look and of a lot like the typical scribblings of a doctor.

So, my point here is that doctors don't necessarily start out with bad handwriting, it just deteriorates. Which is a different thing all together. Of course I migrated to keyboards myself and don't have a ton of opportunity to write by hand, but when I do it's not quite so bad anymore.

14:03
So, handwriting it's important and might be important for academic success. We don't want to just rely on keyboards. All right. Moving on, what about infant growth and asthma? We talked about that we're going to discuss that topic in the intro. Is there a relationship between the two? Well, researchers in the Netherlands say there is a relationship.

Now, when I first heard this I thought, OK, they're going to say that infants with asthma don't grow as well as infants without asthma. But actually that's not it at all, that's not what they were going after. The authors of this study which was recently published in the American Journal of Respiratory and Critical Care Medicine.

They see that rapid growth during the first three months of life is associated with an increase risk of asthma symptoms. Previous research has shown a link between low birth weight and asthma. But this is the first to look at a specific growth pattern after birth and its relationship to the occurrence of asthma symptoms.

15:00
The team says, the mechanisms underlying this relationship were unclear, but they think accelerated weight gain in early life might adversely affect lung growth and might be associated with adverse changes in the immune system. They say, for the research is needed to replicate their findings and explore the mechanisms that contribute to the effects of rapid infant growth on respiratory health.

They would also like to examine infant growth patterns beyond the three month window to see if these relationship with asthma persist. You know, I'm also wondering if they looked at infant feeding or diet. And as we begin to understand the immune system's role in the asthma development, I'm left wondering if perhaps feeding differences could account for more rapid growth.

For instance the kids were getting more calories, and then the asthma could be because if they're getting more food or a particular diet, that perhaps they're getting more anogen exposure and that's then causing an immune response. So, could it be that feeding differences could account for this.

16:03
So that again, in some kids they get more food or different food. And they get more calories and more anogen exposure which results in weight gain. And more of a chance to have asthma problems. So, I wonder if our Dutch investigators have a suggestion box somewhere. If I find it, I'll be sure to tell them to control for feeding differences. I think that should be an important component as they continue their investigation.

Our final story in our news, parents can use segment of the program. It's a little bit disturbing; researchers at Indiana University School of Medicine in Indianapolis surveyed more than 2,000 Pediatricians and in the survey, they presented a case study of an 18 month old with an ambiguous leg fracture.

So, let me explain this, as doctors we get stuff in the mail all the time. And one of the things that we get are surveys that are from folks doing research to say, "Hey, as a Pediatrician, how do you handle this? How do you handle that? What do you tell parents to do."

17:03
As investigators try to get information about the practice habits of Pediatricians. So, in this particular case the investigators looked up 2,000 Pediatricians sent them a survey, and basically gave them a case scenario. And they said, "OK, you've got this 18 month old, they have a leg fracture, it's a leg fracture that the parent does not have a good story for how this leg fracture occurred."

And so, it is one that abuse or neglect have to enter into the doctor's mind because there's not a good story for this. I mean obviously it was an 18 month old, they fell down some stairs, they broke their leg, OK the story matches up the fracture. But in this case it's a leg fracture and the story doesn't quite match up.

Now, all of the 2,000 Pediatricians that were surveyed got the same story. OK, the same fracture, the same 18 month old, the same ambiguous story from the parents. But what they did change or make different from person to person that they sent this out too, is for some of the Pediatricians the family was described as African American, and for others they were describes as Caucasian.

18:11
In addition to varying the cases by the family's race, they also varied the families socioeconomic status. And they did this by mentioning what the parents employment was. So, if it was a high socioeconomic status case, they mentioned that the parent was an accountant or a bank manager.

And if it was a low socioeconomic case, then they mentioned that the parent was a grocery clerk or a factory worker. And then they took the the pediatrician's responses and just they wanted to see if there was a difference in the suspicions for abuse if you took a race or socioeconomic status as your indicator.

So, is there difference between the number of times that the doctor would say they suspected abuse based on race or socioeconomics.

19:00
As it turns out, race did not seem to make a difference in doctors analysis of the situations. So, when the family was portrayed as black, 45% of doctors believed abuse was almost certain or possible, 32% wasn't sure, and 23% didn't suspect abuse at all.

When the family was portrayed as white, 46% suspected abuse, 28% were unsure, 26% didn't suspect it at all. So, again the difference there if they're black about 45% abuse was possible, and if it was white 46%, so only a difference of 1% there. However there was a discrepancy when you compares socioeconomic status of the families.

When the family was portrayed with a high socioeconomic status 43% still suspected abuse, but when the family was portrayed with a low socioeconomic status, that went up to 48%. So, from 43% up to 48%, so an increase in 5% of those who suspected abuse. Now, it's not a big number, but it is statistically significant.

20:02
Study investigators point out that child abuse and neglect is not limited to those in lower socioeconomic classes, it happens in all income levels. And doctors needed to look at objective data, not race or socioeconomic status to determine their level of suspicion. So, you know that 5% OK, you know that's a shame.

But what I find even more disturbing with this study, there's something even more disturbing than the results that the investigators display for us. I think what's most disturbing for me is the high numbers who weren't sure if they suspected it or didn't suspected at all.

In almost half of the cases regardless of race, and regardless of socioeconomic status, in about half of the cases the doctors indicated that this 18 month old with a leg fracture without a good story for how it happened, 50% of the doctors weren't really all that concerned about abuse as being a problem.

21:03
Now, we've talked about this before, we've talked about child abuse. And it is a doctor's responsibility to report if they're suspicious. It's not an accusation. It doesn't mean of you report it that it's a concern. Now, I understand in this study they didn't ask how many would you report this as abuse. They didn't asked that specifically.

But the fact that so many weren't even suspicious or they weren't really sure, they should have been suspicious. I mean, a 100% of doctors should have said,"I have a suspicion. Doesn't mean I'm saying 100% that's right. I'm not accusing, but I have a suspicion in my mind because there's not a good story for this leg fracture in an 18 month old."

So, that should be way closer to 100% not 50%. So, I really think that's pathetic. And it saddens me, really, if we're suspicious we need to be more assertive in our suspicions and not just, "Oh, I'm not really sure about it."

22:06
Now, the good news here is they mentioned that they were just pediatricians they sent it too, and I suspected the bulk of them were General Pediatricians. And they don't see a lot of leg fractures in their primary care offices.

My hope is that if the same survey went out to a group of emergency medicine doctors who are the ones seeing most of these injuries would have a higher percentage of those who suspected abuse. Again without regard for race or socioeconomic status, but that they are at least suspect, at least have a notion of this is something that ought to be reported so that someone can look into the family.

Because when we fail to suspect it, then we fail to report our suspicions and we're doing family this service by returning children to dangerous situations or rather potentially dangerous situations, rather than giving the families the social hope that they need.

23:00
So, I get off my soapbox now, but you know just one of those things I feel a little passionate about because, I mean you don't want a kid just because they're in a high socioeconomic status, they can still be abused and neglected. And we don't want to miss that, we shouldn't miss it. And we really needed to be advocates for the kids that we see.

All right. We're going to take a quick break and we will be back to answer your questions right after this.

[Music]

All right. Welcome back to the program. First stop in our listener's segment is Tara in Irvington, New York.

24:02
And Tara says, "I have an eight months old son, who I have adopted. A friend who just had a baby has donated breast milk to my son. We have since found that breast milk must be age appropriate. Her daughter is five months older than my baby. Is her breast milk useful to my son? Thanks. Tara."

All right. Thanks for the question, Tara. First let me say, there's really two parts to this answer. The first is there is evidence you're right that the nutritional components of breast milk do change over time. But the changes are subtle, and as a whole human breast milk is preferred over formula. And really regardless of the baby's age, especially in the first 12 months of life, and regardless of how far out post partum the mother is.

So, a mismatch between your baby's age and the age of the nursing mother's baby isn't really that big of a deal. And just to kind of give you an example that there are, and we talked about this in episode 195, just very recently we had our breastfeeding extravaganza show.

25:04
And we talked about human breast milk banks where lactating moms can donate breast milk and then that breast milk is used for kids who needed primarily for premature babies who aren't able to get breast milk from their moms for one reason or another. Either their biological mom is not in the picture or the mom is not able to produce breast milk, or she's on medication, or she was on drugs.

So, the baby in the neonatal intensive care unit has a need especially in premise for human breast milk, but they're not able to get it, and so they use donor milk. That donor milk is not necessarily from moms who just had a premature baby.

So, human breast milk can be used even for premature babies even if the mom is way further out post partum than that baby is. So, it is used, it's still better than formula, but and this is as they say a big 'but', I wouldn't do it.

26:05
Now, I don't think that it's a good idea. And the reason for that is, when I answer this question you know, I kind of put myself into the position of the parent. And so, what will I do? If this is my situation and my kid. And there are things about your friends that you don't know.

Does your friend, do they have Hepatitis B? Do they have other diseases that they could transfer? How well was the milk stored? You know was it definitely at a constant temperature in the freezer?

There's all kinds of safety questions that would make me kind of step back from this a little bit. And so, using basically a biological human product, for your baby from another person, even if it's your best friend makes me very leery about that.

27:02
And probably not a good practice. Now if your friend, she was lactating, if it's the milk storage issue, we really don't again know for sure how it's stored. Did the temperature stay right? How old is it? And personally, I would think that a milk bank is not going to take that. I think that they are more after fresh milk and they are also going to test it.

And there are some quality assurance practices that go into place. But if she's lactating and wants to pump, and wants to provide milk for that kind of situation, I think that's great. But in terms of her having some old stored milk in her freezer that she wants to give to your baby, if I were in that situation, I would say no thank you.

And again, when we're looking at risk versus benefit ratio, I think if you personally don't have enough breast milk, so that you have to supplement with some formula or let's say that you've already because you didn't mention that.

28:03
But let's say you've already stopped breast feeding and switched to formula, and now there's human milk that's available, I think if you're looking at a risk versus benefit, then in that case formula might better than breast milk from even though you're best friend. Best friends don't always share everything or think of the things that are important.

So anyway, that's just my opinion. If your friend is interested in donating to a human milk bank, back again on PediaCast 195, we kind of touched on that. And in the show notes for PediaCast 195 over at pediacast.org, we do have some links to you, there are some resources with regard to human breast milk banking.

All right. Let's move on to Carmen from Saskatoon, Saskatchewan in Canada. Hope I'm saying that right, Saskatchewan, I think that's how you say it. Anyway, Saskatoon in Canada pretty cool sounding place anyway.

29:01
Carmen says,"Hi, Dr. Mike. First of I just want to tell you how much I appreciate the effort you put into the show. You had answered a question for me back in show 148 about temperature control, and my son who has epilepsy. You were the first doctor who actually answered my question in detail and explained to me the reason why. Thank you.

I have two questions today, my nephew still gets baby cereal every morning for breakfast. He is six years old. I think he still gets it because he is picky and likes the same thing day in and say out. Plus he just seems to love it. In my mind this can't be that great for him as the GI index of this food must be very high. To me it's like feeding him a bowl of sugar. Can you weigh in on this. Is it bad for him?"

So, I'm going to pause here and just answer that question right off there for you Carmen. Yeah, baby cereal is going to be pretty dense in calories, but then again so are a lot of the alternatives that parents use at these age, like sugar sweetened cereal. I think and my practical is it really sort of depends on his own growth and his growth chart.

30:01
I mean if I was seeing a kid like that in my office and they really love baby cereals still, but on their growth chart they look good, although six years old, OK, that's a little old for baby cereal I understand that. But at the same time you got a kid, they're six years old, they look great on their growth chart, their weight and height are proportional, acceptable where they are on the chart, and their BMI looks good.

You know, they're growing great. And they love eating some of that baby cereal in the morning, probably not going to make a big deal out of it. And as the aunt , you probably shouldn't either. This is between the mom and the kid, and their doctor.

Having said that, if you know that the kid is obese and the kid has a high BMI, is large for his age, and obesity is a concern, then absolutely I would say that is a lot of calories and they probably ought to switch to something different.

31:01
So again, it really depends on the scenario, and the kid's specific growth chart. Again, this is another reason why you have to actually have a thinking head as a pediatrician and not a vending machine or something that use in flow charts to make decisions because there's a lot of factors that you have to take in into account.

OK. Carmen goes on and says, "Here are some background information for my second question. My son was born at 28 weeks gestation, and was in the NICU for eight weeks. At four months of age, one month corrected age, he had a simple hernia operation which causes him to have a stroke and he almost died. This is why he has epilepsy and he is developmentally delayed.

After all of these trauma, the poor guy had several lung infections and spent the next three years in and out of the hospital. I think he was admitted about four times. He also has to have blood drawn routinely for his epilepsy meds. Needless to say, he is one tough nut. My question is about pain threshold for him.

After the Christmas holidays we were sitting down the dinner and I noticed a huge water blister and burn on his finger. It looked very fresh and was quite large. We asked him how it happened and he pointed to the kitchen. We think he must have touched the stove.

32:09
The thing is, he never cried or screamed when it happened or indicated that it hurt. He did have trouble falling asleep that night, so I suspected it did hurt him, but he never complained ones. Do you think that his pain threshold is really high because he was poked and prodded so much since birth. Could a burn of this nature really not hurt?

Has there been any studies on this and premise are sickly children. I'm really curious about it and a bit worried. What if something is wrong and he doesn't feel the pain associated with it. Thanks." That's a great question, Carmen. And of course I'm not going to be able to give you an exactly absolutely right answer for your particular child, but I can offer you some insight. And I think two things are at play here.

Chronic kids, they are used to a degree of discomfort. And so if you have a kid who is getting lots of blood draws, you have a kid say a diabetic kid and they are poking themselves for their insulin everyday, I mean there are kids who go through challenges, and they're painful challenges.

33:08
And so, in the scheme of things they get hurt, and they do have something to relate that to. I mean if they're also getting hurt on a fairly regular basis because of their medical condition then when they get hurt accidentally out in the real world, they have something to compare that to.

And it may or may not be worst than what they are used to experiencing, and so they may make class of it. And we've seen this a lot in the emergency department urgent care setting because we do ask kids, "Hey on a scale of one to ten, one being it not bothering you at all, 10 being like the worst pain you've ever felt. Where do you put your pain?"

And we see kids who say,'oh this is a 10." and they're sitting there and they're fine, they can jump up and down, they're playful, but they say that their pain is a 10. And you know, to them that's a 10, but now take a kid who has a ruptured appendix, or who has head injury with a broken skull, and their 10 means something a little bit different.

34:06
And so, our pain -sort of where we put pain is relative to our other experiences. and for kids with chronic illnesses, that experience and relatively maybe a little bit different. So, I do think that there are some degree with that. Now, your child in particular though may have some other reasons for having a little bit of a different in pain processing as compared to other kids.

I mean, the fact that he had a stroke and has epilepsy, that tells you that his brain took a hit and he may very well have some issues in processing pain. And so, in a kid like that, not only is it a relative issue, but there may be an absolute issue as well. And that their brain isn't quite as good at processing that pain and interpreting that pain, and reacting to that pain, as it is in another kid because they have some deficit in their brain because of the stroke which the epilepsy also doesn't cause that problem in pain processing.

But the fact that they have epilepsy following the stroke, let's you know the brain took enough of a hit that they could have other issues with that as well and disturbances and pain processing might be one of those problems.

35:14
So, I do think it is a concern for future injuries. I mean, he is going to be a kiddo, I think you have to watch closely to keep him safe and intervene when he hurts himself. Of course, we want to do that for all of our kids, really at the end of the day, I mean all of our kids will be safe and we want to intervene as soon as possible when they get hurt.

And we have to sort of moderate that by not over protecting them too, and that's part of the art of parenting, right? But in a kiddo who had a stroke, and has epilepsy, and who doesn't get too excited about a burnt hand, I agree with you that's a kid you probably want to keep a pretty close tabs on him.

Is there something that you can do about that? Is there a way to make their pain processing normal again? Or to make their relative sensitivity to the pain increased, probably not. But certainly talk to your doctor and see what they have to say as well.

36:03
All right. Next stop is Beth from Virginia Beach, Virginia. And Beth says, "Dr. Mike I've been listening for years and really enjoy when PediaCast shows up in my feed. In our house the kids have fallen victim to the love sugar cereal. I use to never get it, but there are times they just beg for it. I had a friend tell me their sugar cereal solution and I loved it."

Sugar cereal solution, try to say that five times fast. OK. So, what is the sugar cereal solution that you love Beth? Well, she says, "Each of my kids pick one box of sugar cereal to have in our pantry, on Saturday morning only they are allowed to enjoy a bowl. It's sugar cereal Saturday, and it's a treat for them and they let the lazy parents sleep in one morning a week.

A few weeks ago they forgot it was Saturday and they had regular breakfast cereal. Later when they realized they had missed their ones a week treat they were bummed, but they knew that wait till the next week to enjoy it. OK. Come on, Beth. You didn't let them.

37:00
OK. So, they have their regular cereal on Saturday, you couldn't give in and let them have the sugar cereal the next day, OK. That's OK again the Art of Parenting. I like that it's a special thing for them and we don't battle it any other day of the week. We too like the steel-cut oatmeal like you've mentioned.

But I found that most mornings it was tough to get it cooked, so I started cooking it in the crock pot overnight a few weeks ago. Turns out great and the kids loved the warm breakfast. And I love the breakfast is ready when we wake up. Any ways, thanks again for the amazing PodCast, I feel so much informed on my parenting because I understand some of these childhood illnesses, Beth.

And P.S. Thanks to your PodCast, I'm friends with your wife on Facebook, and just love her. Well, thanks for the nice comments, Beth. Yeah, my wife Karen had incredible Mommy Blog going once upon a time, and especially if you get sarcasm which I'm always surprise with just how many people don't get sarcasm and they are offended by it. And of course now that we're affiliated with Nationwide Children's Hospital, we have to be a little more cognisant of certain sarcasms.

38:06
So, I'm not sure that Karen will be showing up on the blog anytime again soon. But hey, you know message her on Facebook and you know, you can put the idea in her head. Maybe she would just come up with an independent one again at some point. She has talked about it, I think she enjoyed writing the blog when she did.

So anyway, who knows what the future holds. We do all appreciate you sharing your sugar cereal solution with us. And I have to agree with you, steel-cut oatmeal cooked a few hours before you wake up in the crock pot. I'm in agreement. That is some good tasty stuff. All right. Finally up in our listeners segment this week is Tammy in Indiana.

Tammy says, "Hi, Dr. Mike, love the show. My daughter just turned five and is in kindergarten. She did start kindergarten early three months past the cutoff, but she's reading at a second grade level, and we didn't want her to get bored. We put her in with the intention of having here repeat kindergarten if she had social issues.

39:03
We are noticing that she refuses to try to do things that she notices she isn't doing as well as other kids or things that she just thinks that she cannot do. She has always been a bit reluctant to participate in activities that she think she's not good at. But lately it has gotten extreme. For example at gymnastics,she does extremely well in the bars and the balance beam and is very proud of her abilities.

On the flip side, she cannot do a cart wheel, and now she just refuses to try. She'll tell her teacher that she is sick, she has an injury, anything to get out of that part of the class. What I can't seem to get across to her is that no one else in her class can do cart wheels either. They are all just learning and everyone else in their gym class is a year or two older than she is.

I'm worried about her self esteem. We were teaching her checkers today and she ended up in a bit of a breakdown because she is "just a loser", that's what she calls herself "just a loser' because she isn't good at anything, but painting and singing. Although she is not good at those things either, I'm not sure where they came from. And she also says, "there has to be more to life than this."

[Laughter]

40:07
She's a little dramatic too. Bailey, has always been put into groups at school Montessori before public kindergarten, gymnastics, swimming, etcetera because she is physically the size of kids a year or so older than her, and academically a year or two above her age group. The problem is that maturity wise, she is not that advanced. She has the emotions of a kid who just turns five spending her days with kids who are turning six.

Now, for the questions; can you recommend any books about how I can help foster her self esteem? I do a lot of the love and logic type stuff already. In your opinion, should kids be entered in the kindergarten early like we did with Bailey? Is her behavior a common occurrence around this age or are we being a bit sensitive because of her situation?

What can we do to help her through this phase? And if we continue to struggle with this issue, should we hold her back even though her teacher assures us that she should go on with the rest of the class. I've been listening to your show since the beginning, and I love it. Thank you for your work."

41:02
Well, thanks for the question, Tammy. And thanks for being a loyal listener over the years. So, we're really back at the Art of Parenting here aren't we? That's exactly what this is, and I can't answer these as a pediatrician because they don't teach us this kind of stuff. But I can answer as a father who's been there. And I can relate to pretty much everything that you're saying.

In fact that story I was kind of -laugh, I was really through that because there are some of that I can seriously relate to. My own daughter who now is 17 years old and won't appreciate that I'm going to share some of the stuff with you, but she was very similar to this. And I can remember a time, I don't know if you guys all remember the game Hi-Ho Cherry-O, where you have the cherry trees, and you spin the spinner, and you have to take the cherries.

I don't know, I think you're taking the cherries off and put them in little bucket, and whoever gets the cherries of their tree first wins. There were times when she would lose that, I mean she literally would flip out.

42:00
And the game would go flying the little cherries go everywhere and she goes storming up to her room that she's a loser and very upset about this. And I can laugh about it now, but at that time it was distressing like, 'Come on, you know what the fun is playing the game all right. Get over the fact that you just lost."

I mean the fun is that we're sitting down together as dad and daughter and doing this thing and spending some quality time. So for me that was the goal, I don't care if I win or lose, it's kind of hard to cheat, when it's a spinner because you got a smart kid who knows what the number is and how many cherries come off the tree. It's a little hard to cheat and let your kid win, when you're playing Hi-Ho Cherry-O.

Now, because of her disposition there were other times that I have to admit that I would let her win, now my wouldn't. See, my wife is very competitive. And so, she had to win. So, I'd take a step back and I didn't care. Again, I didn't care if I won or not. And so, we play air hockey for instance and I'd let her win.

43:02
And quite often I'd let her win. And you know, that kind of build up her self esteem a little bit, although I would say it backfired on me because as she recently learned that I let her win and she got seriously upset about that. Like, "How could you just let me win? You mean every time that I felt good about myself that I had won it was a lie?"

He can't win sometimes. And again I think this is where the Art of Parenting is really comes into play here. And I also think that a parents gut feeling on some of these stuff is really what you have to go with. I mean, I can't say, "Is it right to go ahead and put a kid in kindergarten or not?"

And you as a parent, you have to make that decision based on all of the factors, looking at your kid's academic success, how they react with their peers, what are the teachers saying. You have to synthesize all of that. But then ultimately you have to go with your gut. And once you go wit your gut, you just have to go with and you don't look back.

44:03
You say, whatever comes, comes, and we'll deal with it. And you can always say, what would have been like if we'd kept our back? Or what it would be like if we put – well, you didn't do those things, you didn't hold her back, you didn't keep her in it, you know whatever.

And so, you just deal with where you are and you go with your gut. And I think that's the biggest part of advice that can share with you. Ten years from now, it's not going to matter whether you kept her back a year or whether you went ahead and let her go with it.

It's not really going to matter, and so don't get too stressed out about it, whatever you decide to do, go for it with gusto, stick with it, and deal with it, and deal with the outcome, and go from there to make your next decision.

And I don't say this to lighten your situation at all. Did this kind of help me through some of that? You know when you're a parent and you're struggling over -for us it was home schooling, do we home school or not. We lived in a school district that we didn't particularly trust at that time, and we wanted to home school.

45:05
But of course you can agonize over that, do we really -what's this going to do when my kids wants to go to college? Are they going to be social; with other kids? Are they going to grow OK and be OK? So, we had to make the decision, yeah we're going to home school.

And just go for it. And provide other social opportunities, and we did that, and you know, my kids get along with other kids just fine, they have best friends, they have sleep overs, they are socialized as society would call being socialize today, because we sought opportunities for that to happen. And my daughter is going to college next year.

She has a great merit scholarship, she did fine on her standardized testing, it all worked out. And I think in many cases it does all work out regardless if she'd been in public school, I think in the end of the day she'd have friends, she should have done well, she'd get in to college. I don't think personally that I would have a strong of a father-daughter relationship with her as I do today.

46:03
But, you just go with it. You go with your gut, you go with life, and that's where you are. So, I hope that helps. I know Tammy if you're wanting me to say, "Yes you should hold her back. And this is what you needed to do to boost up her self esteem." I think to some degree I will offer this too.

With kids if they are reluctant to do something they're not good at, you got a couple of choices. As a parent, again this is the Art of Parenting, do they have the potential or are they just not going to get it. If they have the potential and it sounds like your daughter does, I mean she can do the balance beam and the bars, she probably can do cart wheel. It's just a matter of getting over the fact that she's not as good as the other kids.

She just got to get over the fact she's loss the Hi-Ho Cherry-O, you know what I'm saying? And so, practice, encouraging her to do it at home, coming up with the good old fashion positive reinforcement program.

47:01
OK, you're going to practice your cart wheels at home, none of the other kids were looking. You're going to practice the cart wheels and here's the cool thing, when you practice the cart wheels for 10 minutes, you just try them over and over and over again. They don't have to be perfect, they don't have to look good, just the fact that you're trying them for 10 minutes, we're going to put a star on your sticker chart.

You got five stars we're going to Dairy Queen. Some, OK, if they have an obesity problem, maybe Dairy Queen is not the right one to do, but you know you can go ride the horse at WalMart, whatever it is. Whatever your kid's currency is, that's what you want to go for, make that positive reinforcement routine, and they're going to get better because they're practicing, and they're going to get more self esteem and feel better about doing it at the gym in front of other kids. And so, I think that's going to help you out. Now, if you have a kid that you know what, this is not their gift. OK, you see people every week on American Idol singing is not their gift. And some parent, push them and push them and said, "Oh you've got a great singing voice." And you know, the kid makes a fool of themselves on national TV because they can't sing.

48:08
So, I mean when they don't have that gift, not everybody has every gift, and so you do have kind of figure out what your kids gifts are and direct them in that way. And again, it doesn't sound like it's the case for your child in terms of gymnastics, but there are some kids that gymnastics is not their gift, and so if you push them, and push them, and push them, it's not going to have a pretty ending.

It's going to have the ending of some of these people singing on American Idol on national TV, right. I mean, it's not going to work out. And so we can't all be good at everything. For my kids they are not very coordinated, they are not good at organized sports, they are good at music. So, you kind of pick and choose and what are they good at, don't just throw them to the wolves in every single situation.

So, I think that helps with self esteem is figuring out what they're good at and nurturing those things, and helping them to get beyond their failures.

49:02
And to try as best as you can to stress that it's having the fun, it's not when you're loosing, it really is having the fun. And I think too you can model that through playing games at home. And that's one of the reasons that board games are such a passion of mine.

And why when we have interview shows we kind of talk about them a little bit because I think it's a great opportunity to show that, 'Hey, it's not always about winning and losing, it's about having fun'. And my 17 year old daughter who used to pass out when she lost a Hi-Ho Cherry-O, she does a little bit better with losing games now.

She's still competitive like her mother, and she sometimes does throw a hand of cards down, and I have still seen her stump here and there, but 17 years,, it's better. Sometimes it's all we could ask for.

All right. Well, thank you so much Tammy. Not sure that's exactly the answer you bargain for, but it's the answer you get. So, there you have it.

50:00
I want to remind all all of you if there's a topic that you'd like us to talk about, it's easy to get a hold of me, just go to pediacast.org, click on the contact link, I'll answer your question as best as I can without providing actual medical advice.

I want to always point that out of you're really concern about your child talk to your doctor. It's important your doctor not me. You can also email pediacast@gmail.com, or call the voice line 347-404-KIDS, 347-404-K-I-D-S. OK, we're going to take a very quick break and we'll be back to warp up the show right after this.

[Music]

51:12
All right. we have lots of resources for you at the website. So, pediacast.org is kind of the landing place for our program, kind of the home of the show. So, I do encourage you to go there, we're going to start to have transcripts of the show, written transcripts. OK. So, let's say you think, "Oh this is great. I'm going to go with the transcripts now." Keep us in your feed, OK.

We appreciate the downloads, really we do. And so, keep us subscribed, but if now and then it's easier for you to read it rather than listen to it, we'll have the transcript of the show available for you starting now over at pediacast.org so you can check that out.

We also have a few of our old ones and we're going to be adding more of our old ones as time goes on. And we have the time and energy and resources to do that.

52:00
I want to thank all of you for taking time out of your day to listen to PediaCast we really appreciate it. And we also appreciate it when you share PediaCast with your friends and in particular tell your doctor whether it's a pediatrician, or a family doctor, the next time you go in for a sick visit or a well child check, tell your doctor about PediaCast.

We really want to spread the news through the America's and around the world network of child care provider. So, let them know that there is an 'evidence based', use that term 'evidence based PodCast' looking at pediatric issues. And we'd really appreciate it if they listen because I think that they'll get a lot out of the show. And also can spread the word to their own patients about PediaCast.

Also, we do have a flyer that's available on the website, if you go to the resources tab at pediacast.org. It's a pdf file that you can download and print out, and hang out wherever you want, bulletin boards, in gyms, in nurseries, in churches, and schools, wherever you're aloud to hang out flyers. Exam rooms too for pediatricians.

53:02
We just really appreciate you spreading the word about PediaCast that way. We don't have a big marketing budget, we don't have billboards in the major U.S. metropolitan area telling folks about PediaCast. So, just through word of mouth. Also, if you could mention us in your blogs, on Facebook, in your tweets, all those kinds of things, and iTune reviews are also very helpful as well.

But most of all I just want to thank you for being a part of the show. I mean, we credit several listeners today who's like I've been listening since the beginning, I've been listening since the beginning. And to me that kind of loyalty, you can't pay for that. And I just really from the bottom of my heart appreciate those of you who take the time out of your day to listen to the show, and who get something out of it. I really appreciate that.

And for those of you who understand my own sense of humor and sarcasm, I appreciate that too. All right. Once again pediacast.org, contact link you can email pediacast@gmail.com, or call the voice line 347-404-KIDS. If you have a comment or suggestion, topic idea, any of the above, just give us a holler.

54:03
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.

• Food Presentation
• Physical Activity Linked To Academic Performance
• 12 Ways To Get Fit in 2012
• Back-Talking Teens
• Alopecia Areata
• Epi Pens, Fluoride, Potty Training, Growth Spurts
• Strep Throat and Dogs

LINKS

• Sports Medicine at Nationwide Children’s Hospital (Facebook)
• Does Food Presentation Make a Difference?
• School Performance Linked to Physical Activity
• 12 ways to Get Fit in 2012
• Back-Talkers Resist Peer Pressure
• Childhood Hair Loss (PediaCast 55)
• Interview with Meagan Church (PediaCast 131)
• Unique as Pete: How Autism Does Not Mean Different (Amazon)

TRANSCRIPT

• Breastfeeding

Guests

Dr Nehal Parikh
Neonatologist
Nationwide Children’s Hospital

Megan Harrison
Registered Nurse
Advanced Certified Lactation Consultant
Nationwide Children’s Hospital

Links

• La Leche League International
• Neonatal Medicine at Nationwide Children’s Hospital
• Clinical Nutrition and Lactation at Nationwide Children’s Hospital
• Breastfeeding Resources from Nationwide Children’s
• Human Milk Banking Association of North America

Transcript

TOPIC

Sickle Cell Anemia

GUEST

Dr Melissa Rhodes

Director, Comprehensive Sickle Cell Program

Nationwide Children’s Hospital

LINKS

Comprehensive Sickle Cell and Thalassemia Program at Nationwide Children's

TOPICS

Noisy Toys and Hearing Risk

Unhealthy Food at Children’s Hospitals

In-Store Calorie Signs Influence Teens

FDA Releases New Warning on Infant Acetaminophen

Incidence of Basketball Injuries

Effect of Lace-Up Ankle Braces on Basketball Injury Rates

Effect of Increased Sleep on Basketball Performance

LINKS

Big Green Egg

Looftlighter

Lighting Big Green Egg with Looftlighter (YouTube)

Settler’s of Catan (Amazon)

Five Crowns (Amazon)

Noisy Toys May Put a Child’s Hearing at Risk

Unhealthy Foods at Children’s Hospitals

In-Store Calorie Signs Reduce Teenage Sugary Drink Consumption

FDA Issues Warning on Infant Acetaminophen

Incidence of High School Basketball Injuries (PubMed)

Effect of Lace-Up Ankle Braces on High School Basketball Injury Rates (PubMed)

Effect of Sleep Extension on Collegiate Basketball Performance (PubMed)

LINKS
World Against Toys Causing Harm – Top 10 List
Too Much Sugar in Breakfast Cereal
Environmental Working Group – Cereal Top 10 Lists
Fluoride Discussion – PediaCast 189
Every Gift Matters – Nationwide Children's Hospital

GUEST
Dr David Repaske
Chief of Endocrinology, Metabolism, and Diabetes
Nationwide Children's Hospital

LINKS
Diabetes Center at Nationwide Children's Hospital