Good News, Grapes, Teen Fighting – PediaCast 263

Join Dr Mike in the PediaCast Studio for another round of news parents can use. This week’s topics include some good news on obesity rates and breastfeeding, high blood pressure, the real benefit of grapes, teen fighting & IQ scores, and listener feedback on homemade baby food and botulism.

Topics

  • Childhood Obesity: Good News

  • Breastfeeding: Good News

  • High Blood Pressure (Hypertension)

  • The Real Benefit of Grapes

  • Teen Fighting & IQ Scores

  • Homemade Baby Food & Botulism Revisited

Links

 

Transcription

Announce 1: This is PediaCast.

[Music]

Announce 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!

0:00:30

Dr. Mike Patrick: Hello everyone and welcome once again to Pediacast. It's a Pediatric podcast for Moms and Dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital in Columbus, Ohio. It is episode 263 for September 4th, 2013. We're calling this one good news. We need a little bit of that now and then. You know what I mean. Good news. Grapes and teen fighting. So I want to welcome all of you to the show. Welcome to the rest of the line-up here in just a moment.

First, I wanna say, school is in full swing here in the Midwest. And I am just waiting for the shoe to drop and to the typical rise in volume in our emergency department and urgent cares. It's right around the corner. So here's what happen folks. You know, people think that as fall approaches, that it's the weather change that starts to make more people sick and that's really not the case. It's all about school and once you start to get 20-30 kids all on close quarters for several hours, they start passing stuff back and forth and then they take those viruses home to their parents and they start passing on with their parents and they take them to work and before you know it, the entire community is sick once school gets started.

And it's not about weather change, when I was practicing down on Florida, we saw the same pattern. School started. Everybody starts to get sick. So it's not happening yet but school's just get under way here and it's you know, it's just a matter of time.

0:02:04

Alright, so what are we talking about today? I mentioned good news. There is some good news with regard to childhood obesity rates and also breastfeeding numbers. And it's always good to know our educational efforts are paying off. And that parents are actually listening to what we're telling them. So I'm gonna share that good news with you.

Also high blood pressure, how common is this in kids? And what about the role of 'white-coat anxiety'? You know many kids are scared of the doctor or sick or injured when they come in. Could that play a role in high blood pressure readings and how do you tell the difference between a real problem and just a spurious reading? So we'll let you know.

And then we're gonna talk grapes. Yes, as in the fruit. New research shows that they may have a surprising health benefit. I'll clue you in on that.

And then teen fighting and IQ points. Now, this is an interesting relationship. We know that fights cause physical harm but what about intelligence harm? And if there is such harm, how many IQ points are we talking about? I mean maybe your kid doesn't mind shedding a few IQ points to duke it out with someone. And what about boys vs girls? Are fights more harmful for one sex compared to the other? I'll let you know.

And then we're gonna wrap things up with a final word on homemade baby food and botulism. We had that in the show a few weeks ago and as it turns out, I got called out on this by a doctor who thinks I overstated the risk so I will share her comments and provide a well-thought out and nicely worded response so that's coming your way as well. I'm sorry I get tickled off myself sometimes.

We have more episodes to answer to listener questions on the horizon. So if you do have a question that you would like me to tackle on the program, it is really easy to get in touch, just head over to pediacast.org and click on the 'Contact' link and send that in and we'll try to get your question or your comment on the program.

0:04:00

Also, a quick reminder that Pediacast is now on iHeartRadio talk. It's easy to find this. Just head over to iheart.com or download the app for iPhone or android and search for Pediacast. You'll find our latest full-length shows as well as a new way to consume our material. It's called 'Pediabytes'. Okay. Pediabytes. Bytes. And Pediabytes are shorter single topic segments and you can incorporate these into your Daily Pulse in iHeartradio, knit them together with other talk show segments, once that you choose and they can even infuse your local news, traffic and weather so that's pretty cool.

Now if you aren't up for all these customization, maybe you don't have time to search through iHeartRadio's library or talkshows, but you would like a pre-fabricated talk show station that's geared towards moms and dads. Well, we have something for you there as well. You can find Pediacast on Mom's Cpcup and the Parenthood. And both of those are available on iheartradio talk. 'Mom's CpCup' is a collection of entertainment, health and family shows. And the 'Parenthood' features parenting, health and financial programs. So it's a whole new way to interact with Pediacast and your other favorite talk show programs. Again, it's all over on iheart.com and through the iHeartradio app for mobile devices. And in particular, iPhone, iPads and Android.

Alright, also I want to remind you that the information presented in every episode of this program 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. You can't do this stuff over the phone or over the internet, folks. Also, your use of the Sadio program is subject to the Pediacast Terms of Use Agreement which you also find at pediacast.org. Alright let's take a quick break and I will be back with News Parents Can Use right after this.

0:06:00

[Music]

0:06:30

Dr. Mike Patrick: Alright, we are back and I do have some good news to share regarding childhood obesity. The Center for Disease Control and Prevention says that 19 US states and territories are reporting decreases in obesity rates among low income preschoolers. 20 States and Puerto Rico held steady at their current rate while obesity increased but only slightly in 3 states: Colorado, Pennsylvania and Tennessee. Overall, 12.5% of US preschoolers are obese.

Now, this is an important number because children are 5 times more likely to be obese as an adult if they are overweight or obese between the ages of 3 and 5 years. Obesity in early childhood increases the risk of high cholesterol, high blood sugar, asthma and mental health problems later in childhood and adolescence.

The CDC is encouraging state and local officials to step up efforts to drive down rates of childhood obesity. Business leaders, childcare providers, healthcare providers, communities and families are some of the groups that influence nutrition and physical activity in the places where young children live, learn and play.

The CDC says "State and local officials can assist these groups by making it easier for families to buy healthy, affordable foods and beverages in their neighborhoods, helping provide access to safe, free drinking water and places such as community parks, recreationaries, childcare centers and schools, helping local schools open their gyms, playgrounds and sporting fields during non-school hours so children can play safely after school on weekends and over the summer, helping childcare providers adopt best practices for improving nutrition and physical activity and for limiting computer and television time and creating partnerships with civic leaders, childcare providers and others to make community changes that promote healthy eating and active living.

0:08:15

So you notice the CDC lists moms and dads last when they present their called action and their both points address state and local officials rather than families. That sort of sad. Now, to a degree, I understand their point. These statistics are looking at low income preschoolers and that these families are more likely to need help getting connected with healthy food and safe venues for physical activity.

But still, moms and dads are important, regardless of the household income. And really more important than the community in the schools. They play their role but let's face it, Moms and Dads, you are in the driver's seat here. So parents, set an example. Do your best to provide healthy food choices and encourage lots of physical activity. Model those behaviors for your kids and be navigant. Help families in your local community who don't make as much money. Donate and volunteer food banks. Point families in the right direction and nag those school and community leaders to provide safe places for our kids to play.

By the way, my home state of Ohio is one of the no-change states so we saw neither a rise nor a fall in the preschool obesity rate. If you wanna know how your state fared, head over to pediacast.org. Find the show notes for episode 263 and look for the link to the CDC Vital signs report on the progress on childhood obesity. Alright, I also have some good news for you today on breastfeeding. More American mothers are breastfeeding their babies compared to 10 years ago. And keeping moms and babies together during the hospital stay appears to be important if we wanted continue seeing progress. That's according to numbers also released from the US Center for Disease Control and Prevention. They say the percent of babies breastfeeding at 6 months of age increased from 35% in 2000 to 49% in 2010.

0:10:03

The percent of babies breastfeeding at 12 months of age also increased from 16% to 27% during that same time period. The data also show that babies who started breastfeeding increased from 71% in 2000 to 77% in 2010.

Dr. Thom Frieden, Director of the CDC says, "This is great news for the health of our nation because babies who are breastfed have lower risks of ear and gastrointestinal infections and lower risk of diabetes and obesity plus mothers who breastfeed have lower risks of breast and ovarian cancers.

Breastfeeding also lowers healthcare costs. Researchers have calculated that 2.2 billion dollars in yearly medical costs could be saved if breastfeeding recommendations were met. He adds that it's critical that we continue working to improve hospital, community and workplace support for breastfeeding mothers and babies and realize these cost savings.

Hospitals are in particularly important setting for supporting nursing moms and infants. The CDC reports that the percent of hospitals implementing key maternity practices that keep mothers and babies together after birth have also increased. The percent of hospitals reporting newborn babies that room-in with their mother at least 23 hours per day increased from about 30% in 2007 to 37% in 2011. And the percent of hospitals were most newborns were skin-to-skin with their mother after birth climbed from about 41% in 2007 to over 54% in 2011.

Dr. Janet Collins, Director of the CDC's Division of Nutrition, Physical Activity and Obesity says, "The period way after a baby is born is a critical time for establishing breastfeeding. Rooming-in and skin-to-skin contact help ensure that mothers and babies stay together and are able to start and continue breastfeeding. These are meaningful steps hospitals can take to support mothers and families and help improve breastfeeding rates."

So there you have it, our educational efforts are paying off. Breastfeeding is indeed best for your babies' health, for Moms' health and for the economy. Well, except for those working in the infant formula industry.

[Laughter]

Just keeping it real, folks. For more information about the CDC's effort to improve hospital practices to support breastfeeding, which I'm all for, check out the 2013 Breastfeeding Report Card and I'll put a link to that in the show notes for Episode 263 over at pediacast.org.

0:12:32

Ah, let's move on to from the good news now, I guess that means the rest of our stories or bad news I guess. Ah nah, not really. Ah, the next one deals with high blood pressure, our children who have a first elevated blood pressure at the doctor's office are not likely to receive the recommended follow-up blood pressure readings within a month and that's according to a study published in the Journal of Pediatrics. However, when the blood pressure reading was later repeated, most children's blood pressure return to normal for their age, sex and height.

Authors of the study examine the electronic medical records of 72,625 children and teens ages 3 to 17 over a 3 year period at Kaiser Permanente in Colorado, in northern California, children seen by health partners of Minnesota who received blood pressure checks as part of their routine wall childcare were also included in the study. Over 6,000 children so 8.4% of the population studied, 6000 kids had at least one visit with an elevated blood pressure. Of these, just over 20% showed up for another blood pressure screening within a month. So in other words, nearly 80% of those with elevated readings did not have their blood pressure re-checked. Now, here's some good news, of those who did return, for a follow-up blood pressure screening, only 1.4% of them went on to actually develop childhood hypertension which is defined as 3 consecutive high blood pressure readings on 3 separate days.

0:14:01

Dr. Matthew Daley, a researcher at the Institute for Health Research at Kaiser Permenente, Colorado says, "Diagnosing hypertension during entering childhood is difficult because normal blood pressure for children changes as they age and it's fairly common for children to have a single elevated blood pressure reading though when doctors repeat the test, it appears most children will actually have hypertension." He adds that this study tells us that parents should have their child's blood pressure checked and if it's high, re-check it at the same visit. If the reading remains high, the blood pressure should be re-checked 1 to 2 weeks later.

The researchers also found that hypertension risk factors such as obesity or family history of high blood pressure did not significantly affect whether children receive follow-up blood pressure checks within a month of their first elevated blood pressure. Hypertension is a chronic medical condition characterized by elevated blood pressure in the circulatory system which forces the heart to work harder than normal to circulate blood throughout the body. The researchers say a child's blood pressure can be quite variable and excitement and nervousness at the doctor's office can result in elevated blood pressure readings.

For this reason, children and teens are only diagnosed as hypertensive after 3 consecutive readings that are at or above the 95th percentile for their age, sex and height. Screening for hypertension in children and adolescents who don't exhibit symptoms occurs during routine well child care but little is known about patterns of care after a first elevated blood pressure reading. Guidelines from the National Heart, Lung and Blood Institute recommend repeating the blood pressure test 1 to 2 weeks after the first elevated blood pressure reading. Dr. Daley says "High blood pressure during childhood can lead to high blood pressure in adulthood and adult cardiovascular disease including coronary artery disease and strokes can have its origin in childhood so diagnosing and controlling hypertension in children is important for their health later in life.

0:15:54

Ah, so there you have it. We see lots of kids with elevated blood pressure in the emergency department where I work and you can understand why. It's a scary place for a kid. They may be sick or injured and in pain and it's no wonder their blood pressure is elevated. So we get their pain under control. We do our best to calm and reassure and check the reading again. Ah, if it remains high and this is a reminder to the doctor's out there seeing kids and the moms and dads taking in their kids for us to see, if the blood pressure remains high, it should be rechecked in 1 to 2 weeks.

Now the good news is this, the vast majority of the time, in fact, 98.6% of the time, the reading returns to normal but sometimes, it doesn't and if the reading is still high on the third visit and if these readings are all above the 95th percentile for your child's age, sex and height then by definition, your child really does have hypertension and the earlier way to identify hypertension and address it, the lower the risk of long-term consequences.

And by the way, if we crunch the numbers for this particular study, ah 72,625 children were involved in the study, 6,000 of them had a blood pressure reading greater than the 95th percentile for their age, sex and height, 80% of those did not have a second screening so we're talking, ah, 4,800 kids who had a significantly elevated blood pressure and it was not re-checked.

0:17:20

Now, the incidence of true hypertension in the kids who did return was 1.4%. So if we extrapolate that incidence to the kids who didn't return, then about 67 of the kids who didn't return really do have hypertension that's going undiagnosed. Now, 67 may not seem like many kids compared to our sample size of 72,625 and last of course, one of those 67 kids is your kid. Catch my drift? So moms and dads and doctors, pay attention to those blood pressures and have them repeated when they're high. What's the old adage? Vital signs are vital.

0:18:02

If you consume grapes regularly, you're probably on the right track from the standpoint of a healthy diet. That's according to research published in the Journal of Food Science. Investigators look at the association of grape consumption in the non-alcoholic forms most commonly consumed: fresh grapes, raisins and 100% grape juice. They look at the association of grape consumption with the overall quality of diet for a nationally representative sample of US children and adults.

So what did they find? Well, their data suggests that among adults and children, consumption of grapes and grape products is associated with healthier dietary patterns and increase nutrient intake. Researchers analyze the diets of nearly 22,000 children and adults using data from the 2003 to 2008 National Health and Nutrition Examination Surveys and found that consumers of grapes and grape products had increased intakes of total and whole fruit as well as dietary fiber, calcium, magnesium, potassium and vitamins A, C and B6 versus those who do not regularly consume grapes. Dietary fiber, calcium and potassium are especially important as many Americans are currently not getting enough of these essential nutrients in their daily diets. Adult grape and grape product consumers also had increased intakes of vegetables, whole grains, nuts and seeds along with lower intakes of total fat, saturated fat and cholesterol versus non-grape adult consumers.

Dr. Carla McGill, lead author of the study and founder of the Healthy Science Communications says "It's interesting to note that not only that grape consumers had increased intakes of healthy foods, cortical vitamins and minerals but grape consumers also eat less of the unhealthy foods specifically solid fat and added sugars. This new study complements an extensive body of research supporting the role grapes, raisins and 100% grape juice can play in the healthy lifestyle.

0:20:01

Executive Director of the National Grape and Wine Initiative Jean-Mari Peltier says "The study reinforces the association between grapes and a healthier diet which is good news for consumers, grapes, raisins and 100% grape juice are all foods that people enjoy eating and these information adds another dimension to the grape and health story".

0:20:20

Okay. So as an audience member of this program, you're probably having one or two or one of two reactions to this story. You're either in the camp of "Wow! Grapes are great!". I mean, "I feel so good about them that I wanna run right out now and grab and buy grapes for my family." Or "Hey I'm happy because my family already eats lots of grapes." Or "now we have some grapes but we need to eat more" or "you know, I really need to start buying grapes." In other words, ah, you jump on the grape bandwagon. And if that's your reaction, nah, you're probably a new listener and that's fine, we still have time to work on ya. Ah, others out there may be more critical listeners, you're like 'why in the world did he include the study and mentions nothing of the health benefits of grapes themselves?

He simply says 'if you eat grapes, you are more likely to eat other healthy foods and because of these other healthy foods which aren't specifically mentioned, you're more likely to consume an overall better nutrient panel. Although it doesn't make any indication if that nutrient panel then has better health outcomes, doesn't tell you that. Ah, this study does not come from an academic institution. Instead, it comes from a scientist who has a long, standing history of working closely with the consumer food industry and it's wholeheartedly endorsed by those who have an interest in selling grapes namely the National Grape and Wine Initiative. In other words, red flag's all around.

So you probably lean in one of those directions and at the end of the day, I think both reactions are understandable and the truth lies somewhere in the middle as it often does. We always have to be careful about what scientific studies are actually saying, where they're coming from, and who, if anybody stands the benefit.

0:22:01

So those critical studies like this, ah I see your point. On the other hand, it is an interesting observation and while eating more grapes in a bit itself may not improve your health. It's a start. You know it gets you on the produce you start thinking more about what you put in your mouth and feeding your family so it's not a landmark study and those in academic circles may actually cringe ah, but I don't wanna throw the baby out with the bath water so go ahead, eat more grapes but realize you gotta do more than that.

0:22:30

A new Florida State University Study has found that adolescent boys who are hurt in just two physical fights suffer a lost of IQ that is roughly equivalent to missing an entire year of school. Girls experience a similar loss of IQ after only a single fighting-related injury. The researchers say "Their findings are significant because decreases in IQ are associated with lower educational achievement and occupational performance, mental disorders, behavioral problems and even longevity."

Joseph Shorts, a doctoral student who conducted the study with Professor Kevin Beaver in Florida State University College of Criminology and Criminal Justice says "It's no surprise that being severely physically injured results in negative repercussions but the extent to which such injuries affect intelligence was quite surprising." Investigators outline their findings in the paper, "Serious fighting-Related Injuries Produce a Significant Reduction in Intelligence" which was published in the Journal of Adolescent Health. The study is among the first to look at the long-term effects of fighting during adolescence, a critical period of neurological development.

0:23:34

About 4 percent of high school students are injured as a result of a physical fight each year. Researchers use data from the National Longitudinal Study of Adolescent Health collected between 1994 and 2002 to examine whether serious fighting-related injuries resulted in significant decreases in IQ over a 5 to 6 year time frame. The study began with a nationally representative sample of 20,000 middle and high school students who were tracked into adulthood through subsequent waves of data collection. With each wave, investigators ask respondents about a wide variety of topics including personality traits, social relationships and the frequency of specific behaviors.

0:24:14

Perhaps, not surprisingly, boys experience a higher number of injuries from fighting than girls. However the consequences for girls were more severe. In fact, the researchers attribute to physiological differences that give males an increase ability to withstand physical trauma. The researchers found that each fighting related injury resulted in a lost of 1.62 IQ points for boys while girls lost an average of 3.02 IQ points even after controlling for changes in socio-economic status, age and race for both genders. Previous studies have indicated that missing a single year of school is associated with a 2 to 4 IQ point loss. Investigators say the impact on IQ may be even greater when considering only head injuries because the data they study took into account all fighting-related physical injuries.

The findings highlight the importance of schools and communities developing policies in limiting injuries suffered during adolescence, whether through fighting, bullying or contact sports. Doctoral student Shorts says "We tend to focus on factors that may result in increases in intelligence over time, but examining the factors that result in decreases may be just as important. The first step in correcting our problem is understanding its underlying causes and by knowing that fighting-related injuries result in a significant decrease in intelligence, we can begin to develop programs and protocols in that effective intervention."

0:25:41

So again, we have researchers calling on schools and communities to make a difference. That's fine. But who's calling out the parents? I guess they're leaving that to me. So moms and dads, fights are harmful for your kids physically and mentally. We need to teach our kids better techniques of conflict resolution. We need to dig around on their lives and know what ongoing conflicts they have. Or if they're being bullied and sometimes we, as the adults, have to intervene. We also have to be a role-model on how we handle conflicts. So parents rise to the occasion and parent, don't leave the raising of your kids to schools and communities. Okay, they're important but again, you're in the driver's seat. Do your job. My two cents anyway.

0:26:26

Alright, that wraps up our news, parents, news this week. I'm getting all excited here. I think I need to take a quick break. And then, I'm gonna get even more excited coz I'll be back with a family practice doctor who is calling me out on my homemade baby food and botulism commentary so we'll talk about that. It's coming up right after this.

0:26:48

[Music]

0:27:17

Dr. Mike Patrick: Okay. I am back. And we're gonna have a little bit of expanded final word segment this week. This comes from Dr. Amy Jones in Camarillo, California. She says "Dr. Mike, as a family physician and mother of 3, I'm a long-time listener. I am thankful for the accurate, relevant and evidence-based information you provide parents and I pass along much of your information secondarily as I teach my patients. My question relates to your discussion of infant botulism in home-made baby food. Can you please share with me some references regarding home-made baby food like sweet potatoes and carrots causing botulism?

I routinarily counsel my patients to avoid honey in infants but I have never heard of recommendation regarding soil-based foods. All I completely follow your explanation that it is theoretically possible. I am unaware of such cases. I have cared for patients with botulism, wound infections not infant botulism thankfully and know how serious it is but I am concerned about overstating the potential risks with home-made baby food.

Following your logical argument in infant less than 1 year could not be served cooked carrots or sweet potatoes even if they were not frozen. A quick search of PubMed did not find cases related to such foods– though I did find a case related to home-fermented tofu so beware of that. Please enlighten me and if after more research, you consider the risk of these foods to be more minimal than previously stated, please share this with your listeners. Thank you.

0:28:45

So Dr. Jones, first let me say thanks for writing in and for being a long-time listener. I really do appreciate your support of the program. So here is the deal and for those interested in listening to my original comments on home-made baby foods and botulism, you'll find the entire presentation in episode 258 over at pediacast.org. Episode 258. And basically, I said this. The presence of botulinum spores on soil-based produce items so things like carrots and sweet potatoes and potatoes are the presence of spores that cause botulism on these soil-based produce items is not 100%.

In fact, it's pretty rare. And in the rare case that your baby is exposed to botulism's spores on these soil-based produce items, then the chance that your child will develop the symptoms of botulism, well, that's not a 100% either. In fact, that also is really low. So botulism in babies is rare. It's very rare. But it does happen. And when we see it, there are a couple of common threats. First, they happen to babies who have been fed a high-risk food and second, the disease and its treatment seriously disrupt your life and has the potential to kill your baby.

So how does this look in a risk-benefit filter and that's something that you have to decide. There are many benefits to homemade baby food but when you consider the risk is the very raw possibility of infant botulism, that risk, even though it is really really really really low, may not justify the benefit.

0:30:25

Now, personally for me, that's where I am, I don't think the risk justifies the benefit. So I would stick with commercial baby food when it comes to soil-based produce at least until a child's 12 months of age. And I would also avoid honey until one year of age. Okay that's what I said. Now, I did not make a recommendation when it comes to soil-based produce. Okay, I didn't say whether you should do it or not. I said the risk is low for potential harm though rare when it does happen is pretty serious so I give them my personal risk tolerance, I, personally, me will stick with the commercial products. But I wouldn't fault parents for arriving in a different conclusion and this is the R of medicine, folks, there are a lots of gray zones and you have to guide parents through a decision-making process. But there aren't always absolute rights and wrongs. Now where am I coming from? Why am I concerned about soil-based food and this is really rare, the good doctor has called me out.

0:31:26

Well it turns out my source of information is an article on infant botulism published in the Up-to-date database and a lot of doctors out there know what I'm talking about with Up-to-date. It's a internet service that doctors can use to get up-to-date on various topics and this particular article on botulism referenced 57 peer-reviewed journal articles so kinda summarized the findings of these 57 journal articles and the author of this up-to-date article points out that there is no definitive source of botulism found in most cases of infant botulism. And educational efforts to keep honey out of the mouths of babies has done nothing to reduce the incidence of the disease. So in other words, most of the time when babies get infant botulism, we never figured out where they caught it from.

And even though we know that honey is definitely a risk factor, the fact that we've told moms and dads, "Don't give honey to your less than 12 month olds" and they're following that, they aren't giving honey to their less than 12 month old babies, some of the babies are still getting infant botulism. And we don't really know where the source is. Now furthermore, infant botulism rates are highest in Utah, Pennsylvania and California which happen to be 3 states with very high counts of botulism spores in the soil. So then, the next step in logical thinking and I think Dr. Jones asks rightly, "Then why are there no reported cases of botulism associated with soil-based produce?"

0:33:05

Well, as it turns out there's a good explanation for that and the explanation lies in the link of time from exposure to diagnosis, which is typically several weeks. Why? Well keep on mind that the baby is not ingesting the toxin which will have a rapid effect. They're ingesting spores and the spores have to transform into active bacteria in the hospitable gut environment. That takes time. They have to reproduce and they do it sort of slowly. That takes time. Now they do start making toxin inside the baby's intestinal tract but it's a slow build-up before there's enough toxin to start causing symptoms.

And once symptoms do begin, they're usually mild at first and involve fuzziness, just not feeding as well, maybe some constipation, they might not be gaining weight as well as they usually as they did previously and as it turns out in half of the cases, infant botulism isn't even on the doctor's radar at the time of admission to the hospital. So there's often as delay in diagnosis before things really go downhill. So by the time you're looking for the source of the botulism, the corporate which major may not be a soil-based produce, the corporate is long gone. Okay, you don't have that carrot or potato or sweet potato to test.

Now honey on the other hand, a jar of honey lasts several weeks or months in the kitchen so it's still around to test and identify if it's the source so that's why we hear reports of infant botulism from honey and we don't hear reports from other potential sources because these sources are no longer around by the time we get to a diagnosis and search for the cause and again, keep on mind that the majority of cases we never find the cause which makes soil-based produce a possibility in my mind.

0:35:03

Enough of a possibility that I'm fine reaching for the jar of commercially prepared soil-based food rather than serving it fresh from my garden or the produce department. At least until my baby is 12 months of age. Now, I will say this, there are gonna be parents out there who serve their child fresh, soil-based produce everyday of their infancy and that baby will never get infant botulism.

In fact, that's gonna be the case most of the time coz this is a rare thing that we're talking about. So it really does come down to risk of tolerance and as a parent, you have to educate yourself and make the choice that best suits your situation. That's where I was back in episode 258 and that's where I remain today. Thanks again for the question, Dr. Jones. I really hope that provides some clarity and that's my final word.

0:35:54

Alright, I wanna thank each and everyone of you for being part of the program today. For being listeners of Pediacast. I really appreciate it. Don't forget Pediacast and our single topic short format programs Pediabytes, are both available on iHeartradio talk which you'll find on the web at iheart.com and the iHeartradio app for mobile devices for iPhone, iPads and the Android devices.

Also, reviews and comments on iHeartradio and in iTunes would be most helpful. Have you had any iTunes reviews for a little while. So if you have not, especially if you found Pediacast through iTunes, if you just, just kinda pay it forward, you know you probably read a lot about the reviews before you made a choice to actually subscribe and listen to Pediacast so those who came this way before you, left a little note and that made you try it.

And if you could just pay it forward and leave a little review, and it won't take much of your time, that would be helpful. And we really need some of those over at iHeartradio as well so if you head over to iheart.com and then just search for Pediacast and Pediabytes and just leave a comment.

0:37:08

Say "Hey, you know this is a really helpful show" so that the folks who have never heard of Pediacast or Pediabytes who have come across us in the iHeart app or on the web, they can see "Hey, there's some parents here who really like this program" and it would just make more likely good of a try and see if they like it for themselves and then we can enlarge our audience which just gets the evidence-based information into more hands, which I can think empowers parents and that it's an important thing to do. So reviews and comments in iTunes and on iHeartradio would be most helpful. Also, be sure to link to us, mention us, share us, retweet us, repin us, all those things. Pediacast is on Facebook, Twitter, Google+ and Pinterest.

Over on Pinterest, we also have a News Parent Can Use Pinterest board and that has links to news stories that may not make it under the program but I think that there's still important ones. I mean I really don't have time to cover all the news stories that I think you ought to hear and so, some of those other ones, I do put on the News Parents Can Use board over at Pinterest. So be sure to check that out. It's under Pediacast so the idea is just that's what the board is called News Parents Can Use.

There's also an episodes board and I write some blog posts now and then and a collection of my blog posts are also over at Pinterest on a certain, on one of their special boards. So just go to Pinterest and look up Pediacast, you'll find all those things. Also, be sure to tell your family, friends, neighbors and co-workers about the show. Most of all, tell your child's doctor. When you go in for your next sick's office visit or well, check up, or if you visited Pediatric urgent care or Pediatric emergency department, just let the staff and doctors know about Pediacast so they can spread the news and tell their other patients about this resource and the posters are available under the resources tab at pediacast.org.

0:39:03

We do a quite a few answers to listener question episodes and we have more of those coming up on the horizon so if you do have a question that you would like me to tackle on the program, just head over to pediacast.org and click on the 'Contact link', I do read each and every one of those that come through and we'll try to get your question or your comment on the show, just like Dr. Jones. Alright, that really wraps things up for this week. Hope to see you soon and until next time. This is Dr. Mike saying "Stay safe, stay healthy and stay involved with your kids".

So long everybody.

0:39:38

[Music]

0:39:54

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

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