Pacifiers, Allergy Drops, Caffeinated Gum – PediaCast 255

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Join Dr Mike in the PediaCast Studio as he covers more News Parents Can Use. This week’s topics include tornado safety, introducing infant formula to breast fed babies, parents sucking pacifiers, allergy oral drops… instead of shots, gasoline safety, caffeinated gum, and study drug abuse by teenagers.

Topics

  • Tornado Safety (again)

  • Infant Formula & Breast Fed Babies

  • When Parents Suck Pacifiers

  • Allergy Drops… Instead of Shots!

  • Gasoline Safety

  • Caffeinated Gum

  • Study Drug Abuse (revisited)

Links

Transcription

Announcer: This is PediaCast.

[Music]

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

Dr. Mike Patrick: Hello everyone and welcome. Once again to PediaCast, it's Pediatric podcast for mums and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital in Columbus, Ohio.

It is episode 255 for June 5, 2013. I'll call this one "Pacifiers, Allergy Drops, and Caffeinated Gum. Of course, we have more content coming your way. I'll get to the entire line up here just a moment. I want to welcome all of you to the show and I hope you'll have a great memorable weekend.

01:03

It finally feels like summer here in the Midwest and as a family we've definitely taken advantage of the nice weather. I've been breaking in a new pair of roller skates. And yes, roller like old school quad roller skates.

You know a wheel on each corner not the four in a row. Trying to give my kids to give up the roller blades and switch to old school quads and they're coming around. I think they've really show an interest in trying to switch.

In fact my son and I wear the same shoe size and he's been do a little skating in the old school quads instead of the inline skates. And yeah, he is ready to try and care for his own. So, I'm kind of excited about that because I don't know, I grow up when roller skates were roller skate, you know, the quads not the inline deal.

And yes folks, it shouldn't surprise you that I roller skates. I mean, remember I did my first DJ gig when I was 10 years old. Saturday morning kids fun's skate, United States of America, Springfield Ohio. So you know, more about roller skating and they didn't do it there for a while but this spring and summer really been trying not to just preach you by getting outside and being active with your kids, but actually doing it.

And so that's been in the form of roller skating here of blade. And we've been heading the Metro park skating trails together. So that's been fun. They have a nice three-mile loop at a Glacier Ridge Metro Park in the Dublin area. So that's been fantastic. And then we actually went on a rink scatting this weekend, so that was a lot of fun as well.

So you know, if you're active… I think one of the pushes to go from quad skates to the inline skates was the wheels on quads just weren't quite the area in terms of being a comfortable, safe ride outdoors, but they've really changed a lot in the last few years with bigger wheels.

Sucker, urethane and so it's really quite comparable to right inline skates if you haven't seen the latest in quad skate wheels. You really can have a safe, comfortable ride outdoors with the quads, not just the inlines.

03:08

What else have we done, I see, we've made it up to see their point or are there new roller coaster gig keeper, that was amazing we've hike to see eagles, we've gone to the zoos. So fun time is making memories and in the spirit of our last episode "Leave no child inside…. I have to tell you, I'm encouraged.

I mean my 16-year-old son is so serious about video games as they come. But lately he's been asking if I want to go skating? So there is hope for kidding video games junkies outdoors. You just have to be persistent and find the right motivator.

So what's my point with all this? Get outside with your kids, get active, have some fun this summer. It's important for them and for you. What else are going on? Tornadoes, boy there are been some scary and deadly ones this year.

A few episodes back, we talked about tornadoes safety and I provided some great links for you. That was episode 248. If you want to find that on the show notes, you'll find some great resources for tornado safety.

04:01

I do have one more resource I want to tell you about, it's a free app from the American Red Cross. Some really cool features. Of course it pushes, watches and warnings out to you. That goes without saying. But it also includes audible siren that goes on even if the app is closed.

So that slick. So you can have that on your bedside at night and you get an audible alarm if there's a tornado warning in your area again even if the app is close.

You also gets safety tips on preparing and weathering out the storm and cleaning up afterward, as well as historical information for tornadoes in your area, nearby shelters, multiple ways to connect with family and friends to let them know you're safe.

So really it's the most comprehensive severe weather app I've seen. It's free. They also have a hurricane version. Now, I know it's a pediatric podcast, why are we talking about weather? But you want to keep your kids safe.

Plus we come an example weather buff, if I weren't a doctor, I‘d want to work for the weather channel. I mean I have a little Jim Cantore envy in me, if you know what I mean. So, check out the tornado and hurricane apps from the American Red Cross.

05:04

They also have apps for first aid, finding shelter, earthquakes and wild fires and I'll put a links to all of them in the show notes for this episode 255 over at PediaCast.org. It's all by keeping the family safe.

Speaking of the episode 255, that's this week's episode. What are we talking about? I gave you a little hint in the show title. Breast milk is best, right? While a new study shows a little infant formula for breastfed babies may not be a bad idea.

I'll explain why. You know for my own practical opinion on the matter. You all seen mother's do it. Their babies drop the pacifier on the floor, mum picks it up, cleans its inner mouth with their tongue and then pops it back in the baby's mouth.

You cringe, or I don't know maybe you don't cringe. May be you're one of the mums who cleans the binky by giving it a good suck. Well, if you argue may just get the last laugh. I'll explain why. Allergy shots many kids get them, few kids like them. They do work, but what if the same result could be accomplished by an oral drop under the tongue?

06:01

That would be a popular treatment if it worked. I'll clue you in on the latest research on that front. Then we're going to talk about gasoline safety. Actually our topic is a bit broader than that. Hydrocarbon safety, it's not just gas folks there are plenty of hydrocarbons out there.

They are not safe for kids. We use them all year but particularly, in the summer I'll tell you what products are involved explain why they are dangerous for children and give you some tips for keeping your family safe. When you fill up the lawn mower starting the grill, lighting those sticky torches, so that's coming your way.

Then I'm going to clue you in on a concern voiced by the US Food and Drug Administration. It turns out that food companies are starting to add caffeine to a host of products from chewing gums, to waffles and oat meal. Wow! I'll explain why the FDA is concern?

And don't worry I'm not going to tell you to give up your job but I do want you to be an informed consumer and we don't know really the safe daily level of caffeine consumption especially for kids and teens. So caffeine is available in all sorts of products in every turn, the cumulative effect may be too much, so we'll sort all through that in a bit.

07:04

And finally, I'm going to wrap up with the final word on academic doping. Remember we talked a few episodes back about kids abusing study drugs. We have some numbers but the finest scope of the problem, so we'll get to those as well.

Before I move on I do want to remind you if you have a question for me or a topic that you would like us to talk about or want to point me in a direction of a new story, it's easy to do, just head over the PediaCast.org click contact us.

It's up at the top the contact link and that will take you to a form, you just filled that out and I read each and every one of those that come through. So if you have a question or comments make sure you head the PediaCast.org and use the contact link. Also I'll 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, be sure to 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.

08:03

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

[Music]

All right welcome back to the show. First up at our News Parents can Use segment of the program. We all knew breastfeeding's best, right? Human milk is tailor made for human babies with the right amount of nutrients and the added bonus of disease fighting antibodies. In fact, breastfeeding is so beneficial.

09:02

The American Academy of Pediatrics recommends breast milk as the exclusive nutrient source for babies up to six months of age. In other words, don't use infant formula at all. However, new research from U.C. San Francisco and published in the Journal of Pediatrics tells a bit of a different story.

Investigators they advocate the early introduction of baby formula in some breastfeed babies. Not because the formula is better than breast milk but because giving small amounts of infant formula in the first few days of life the babies will experience high levels of early weight loss can actually increase the length of time their mothers and breastfeeding.

Dr. Valerie Flaherman led doctor of the study and an Assistant Professor of Pediatrics Epidemiology and Biostatistics at UCSF explains until now we haven't explored if it is possible to identify babies who might benefit from early formula use. This study provides the first evidence that early limited formula can provide important benefits to some new borns and base on our findings clinicians may wish to consider recommending the temporary use of small amounts of formula to new mums whose babies are experiencing significant early weight loss.

10:09

Dr. Flaherman's team look at 40 full term babies who's mothers had breastfeeding intentions and who are between 24 and 48 hours of age and who had lost more than 5% of their birth weight. The infants were randomly divided into two groups half continued with their intention to breastfeed exclusively but no interventions were made.

The other half however, were given a little bit of baby formula. Now, how much is a little bit? For just one-third of an ounce given immediately following each breastfeeding session and given by syringe. So as much to introduce the possibility of nipple confusion.

How long did the supplemented babies receive this small boost of formula? Just until their mothers begin producing a regular supply of mature milk which is approximately 2 to 5 days after birth. At one week of age all the babies in both groups were still breastfeeding but only 10% of the boosted group had receive formula in the previous 24 hours compared to 47% in the no intervention group.

11:05

In other words, mothers who didn't boost their babies with formula in the beginning were more likely to give in on their own and start supplementing with formula and continue with the supplements one week down the road at time when most of the formula boosted babies no longer receive the boost.

Now what about the long term effect? Well after three months, 79% of the boosted babies were exclusively breastfeeding compared to only 42% of the non-boosted babies. And 95% of the boosted babies were getting some portion of breastfeed at three months of age compared to only 68% of babies in the non-boosted group.

In other words, a very small amount of baby formula to the tune of one-third of an ounce given by a syringe after each breastfeeding session for the first 2 to 5 days after birth. This resulted in babies who are more likely to be exclusively breastfeed or at least receiving some portion of breast milk at three months of age.

12:00

Dr. Thomas Newman Senior Author of the Paper and Professor of Pediatrics Epidemiology and Biostatistics at UCSF urges some caution in interpreting these findings. He says "It's important to see what are these results can be confirmed in future larger studies and in other populations….

So, this is an interesting study and it does turn conventional wisdom on its head a bit but when you think about it, it also make sense. Now keep in mind, mums takes a few days to reeved up and start producing an adequate supply of breast milk.

Of course the small amount that's produced in the first few days is important for new borns to get, it's called colostrum which is low in volume but dense in nutrients and antibodies.

However, because of a combination of factors including this low breast milk volume during the first few days and also the learning curve that babies face with latching and sucking because of this things during the first week of life, many babies do lose weight and many mums freak out about the weight lost. Now the good news is this, most full term babies are born with extra fluid on bore they're ready for this period of low volume feedings.

13:01

It's the mums who aren't ready for it. Now as pediatrician are pretty much fine with in fact, we anticipate up to 10% of weight loss in the first week of life and as long as the baby continues to appear well hydrated and is making adequate amounts of urine and is back to their birth weight by the time, they're two weeks of age but don't worry, mum on the other hand she's worried.

Her baby may be fuzzy and acting hungry. The infant may not be saturating diapers and mum sees the weight loss and her little breast milk volume. She blames herself, she panics and start supplementing with formula which in turn makes baby less fuzzy and the baby start saturating diapers and gaining weight, mum's happy.

But the babies starts to get more and more formula and it's a slippery slope which is the scenario were likely seeing in those well intention mums whose babies weren't boosted with the small amount of formula. Now the question becomes this, "Is it OK for babies to be a little fuzzy not saturating their diapers and losing some weight, is that OK?… Well, as long as the pediatrician is following them closely for signs of dehydration or too much weight loss, sure that's fine.

14:02

And in the long run as long as the baby is monitored and mum has provided information and education and support and reassurance, what would the long term outcome be and that situation, remember that second group the well intention mums were just kind of left on their own. There were no interventions given at all.

What I would like to obscene is the third group in the study. A group where mums are educated and supported throughout the breastfeeding process which is accessory in that case. Of course education and support are more time consuming than handling mum a syringe full of formula.

But long time PediaCast listeners know how I feel about empowering parents with information, might too sense anyway, which is OK, since that's what most of you stop by to hear.

All right on to our next news item and another interesting one, "Parents who suck on their infants pacifiers may protect their children from developing allergies,… that's according to Swedish researchers at the Sahlgrenska Academy in Gothenburg as reported in the Journal of Pediatrics.

15:00

Investigators point out that allergies are very common in industrialized countries, why? Nobody knows the exact mechanism but the theory goes something like this. Young babies were exposed to fewer allergens are more likely to have allergies down the road including allergic rhinitis, asthma and eczema.

While babies who are exposed to more allergens including harmless bacteria in the environment, developed an immune system tolerance making allergy symptoms down the road less likely. But to which allergens should babies be exposed? When should they be exposed? By what route? And quantity? And for how long? We don't have concrete answers to any of these questions but perhaps the study let's an array of light.

Researchers followed a group of 184 children from birth. They documented how many infants used the pacifier in the first six months of life and by what method parents use to clean the pacifier, also known as binky, fuzzy, bubble milk or dummy after the pacifier have fallen on the floor or otherwise becomes soiled.

16:01

Most parents simply rinse the pacifier with tap water, a few boiled the pacifier and some and you've seen this and probably have an opinion on the practice, some suck on the pacifier cleaning it with their own tongue and saliva before passing it on to their infant.

OK, so what difference do that make? Well, researchers say, children whose parents have to truly suck the pacifier to clean it when it was soiled were three times less likely to suffer from eczema, an allergic skin rash at 18 months of age compared with children whose parents did not suck the pacifier.

And when investigators controlled for factors not to cause an increased risk of allergies such as history of allergies in the parent or delivery by C-section when those variables were controlled the relationship held strong. Now how do researchers explain this relationship?

Well again, it comes down to antigen exposure at an early age. In this case exposure to a wider variety of microorganisms in the mouth. As it turns out mum or dad, we don't want to discriminate here.

17:03

Mum or dad saliva is a rich source of bacteria and researchers believe this microbes where transferred from the mouth of the parent to the mouth of the baby in the group of babies whose parent presucked the binky.

Now why do they believe this? Because cultures and microorganisms in the mouth of the babies and the mouth of the parents were similar in the suck on by a parent pacifier group. However, in the tap water rinse and boiled pacifier groups, the babies did not grow the same variety of microorganisms found in the mouth of the mums and dads.

Dr. Agnes Wold lead Investigator of the Study, says… Early establishment of a complex oral microflora might promote healthy maturation of the immune system thereby counteracting allergy development. OK but what about the down side? Could exposure to more and varied microorganism lead to something bad?

Like the baby getting sick who were not in this particular study the group of children who suck on saliva saturated pacifiers had no more infections or other significant events compared to the groups of children whose parents rinsed or boiled the binky.

18:06

By the way these results mired earlier findings of the team which showed in 2009 that complex gut microbiota very early in life reduces the risk of allergy development. So the question many parents out there right now with pacifier sucking babies at home, the question that I suspect that's on your mind is this, "Should I start sucking on my baby's binky? Is this practice doctor recommended?…

Well I'm not going to make a recommendation one way or the other armed with the evidence you must decide for yourself. But I will say this a little as criticism of the mums and dads you presuck the binky that is something you may want to give some serious thought.

Speaking of allergies, allergy season is in full swing. And with 40% of American kids suffering from seasonal allergies. Millions of mums and dad are very familiar with symptoms. Runny nose, cough, itchy watery eyes and sometimes dangerous asthma flares with wheezing and difficulty breathing.

19:03

For some kids this symptoms are mild just the new sense for others it interferes with daily life resulting in poor sleep, missed school, difficulty concentrating. Some kids get ear infections, sinus infection and pneumonia as a result of their allergies and some kids have potentially life threatening complications like asthma.

So it's a real problem requiring real solutions. Plenty of medicines are available for treating allergy symptoms, you've heard of many of them. Antihistamines like Benadryl, Atarax, Zytec, Claritin and Allegra. Steroid Nose sprays like Flonase, Rhinocort, Nasonex, Singulair is another option and then they are the ones used to treat asthma. Albuterol, Flovent, Pulmicort and many others.

But keep in mind these products only treat or prevent the consequences of an allergy. They don't treat the allergy itself. In other words you're still allergic to x, y or z, you just don't suffer from the symptoms as much. So how do you become less allergic to the things you are allergic to? Well that's where allergy shots come in.

20:00

And the thought behind the allergy shots is this, the exposure – the tiny exposure to an allergen over a long period of time results intolerance of the allergen by your immune system. When allergy shots worked, they work great but there's a downside, they're shots not exactly a kids favorite thing.

But what if allergy shots didn't have to be shots? What if an under-the-tongue oral drop could be used instead? OK now I have your attention right? Well the idea of allergy drops replacing allergy shots is a little closer to reality, thanks to researchers at Johns Hopkins Children Center.

Their review, recently published in the Journal of Pediatrics is an analysis of 34 previously published clinical trials. The research teams has allergy drops can be as effective as allergy shots and alleviating the bothersome symptoms of allergic rhinitis and asthma, and an addition to being a better tolerated by kids who don't like needles, the oral drops can be given at home, sparing the family a trip to the doctor's office.

Dr. Julia Kim, lead author of the project and a Pediatric Research Fellow at Johns Hopkins Children's Center says, our finding suggest the needle-free approach is a reasonable way to provide much needed relief to millions of children who suffer from seasonal allergies and asthma.

21:12

All right, so mums and dads out there, especially those with kids suffering from significant allergy and asthma symptoms, you're like – sign us up right? Well not so fast, while the under-the-tongue allergy drops are widely available in Europe, they are not approve by the United States Food and Drug Administration which means there availability in the USA is currently limited to off-label scientific use.

However, Dr. Kim says, the current findings are encouraging enough to prompt the second look at oral drops as a legitimate treatment options. The researchers' first look at 13 studies involving 920 children, this study's compared allergy shots to either placebo or standard allergy medicine, things like Zyrtec, Claritin, Flonase, etc.

Overall allergy shots fared better at controlling symptoms than placebo or the standard medication. Next the team analyze 18 trials involving 1580 children, this group of studies compared under-the-tongue allergy drops to either placebo or the standard allergy medication, again the oral drops fared better than placebo or standard therapy.

22:15

Finally, the team looked at three studies that compared allergy shots and allergy drops head to head. Investigators would have liked to have included more of these but that's all that were available.

The three studies focused on allergy and asthma symptoms caused by dust mites and the results supported the hypothesis that under-the-tongue oral drops are as effective as allergy shots at controlling cough, sneezing, runny nose, itchy eyes and wheezing.

The investigators say, more head to head comparisons may shed light on the comparative effectiveness of drops versus shots. By the way, what about adverse reactions, well both allergy drops and allergy shots were associated with relatively mild side effects including itching sensation in the mouth or at the shot injection site, skin rashes and occasionally mild wheezing. A single severe allergic reaction was reported by one child in these studies who had received an allergy shot.

23:06

So, interesting stuff, again this is not yet available in the United States but as more studies we're done down the road, looking at allergy drop effectiveness compared to shot in a larger variety of allergic situations not just those involving dust mites, as we see a larger sample sizes in this investigations and if the studies continue to show that oral drops are safe and effective then the FDA may have eventually put their stamp of approval on the products.

Time will tell, and when the time comes, you can expect PediaCast to pass the information on to you. By the way, you may be asking if there are in Europe, what's taken so long here in the good all USA?

Well remember this allergy shots or the injections are tried and true, we know they work and remember sometimes allergic reactions can be life threatening, you don't want your child life depending on an under-the-tongue drop that might work when we have an allergy shot that does work, also someone's stands to make a lot of money in the United States if drops are approved in take off, so let's do it right and make sure they really work, that's how we want to bring them to the market, that's better than introducing under-the-tongue drops for the sole reason of making a quick buck.

24:13

Who's with me on that? All right let's move on to a summer safety message, hydrocarbons, chemically compounds commonly found in household items from cleaning products to gasoline, they're among the top 10 causes of pediatric poisoning deaths in the United States, that's according to a new studies from the Central Ohio Poison Center in the Center for Injury Research and Policy here at Nationwide Children's Hospital.

Researchers found these injuries are most likely to occur during months when the weather is warm and they are associated with activities such as [24:43 moringa 1 using tee-torches] and breaking up the lighter fluid for outdoor cooking.

These study, published in the Journal of Pediatrics, found nearly one-third of hydrocarbon exposure incidents occur during the summer, a fewer than 20% are seen during the winter months. Investigators examined the 10 year period between 2000 and 2009, and found parents made 66,000 telephone calls to Regional Poison Centers and more than 40,000 visits to Emergency Departments because of hydrocarbon exposure and children under the age of five.

25:10

The study also found boys more commonly affected than girls and children between the ages of 1 and 2 years, affected more often than those younger than 1 and older than 2. Gasoline resulted to the highest number of hydrocarbon exposures and the highest number of gasoline exposures occurred during the refueling of a vehicle.

OK folks, keep those kids buckled in the car were you're at the gas station, means seriously, who's letting kids running around outside while you're refueling? Don't do that! Dr. Heath Jolliff study co-author and associate director of the Central Ohio Poison Centre says, the good news is the total number of injuries declines significantly between 2000 and 2009 because of changes in Packaging Laws and Public Awareness but more children were poison from hydrocarbons at home demonstrating a greater need for preventative education, for parents.

OK so you're refueling in the driveway, whether be the car or the lawnmower, maybe with the can of gas you got for free because you brought a whole bunch of groceries, you know what I am talking about, again don't let your kid run around while you're doing it.

26:11

Now I know gasoline isn't the only household source, keep the kids away from the tiki-torches and kerosene and lighter fluid and lamp oil and mineral oil and cleaning solvents too. So, how exactly are hydrocarbons dangerous?

Well they're dangerous in many ways but perhaps the greatest hazard is when children attempt to swallow and choke on the chemical, breathing it into their lungs, which results in life threatening damage to pulmonary tissue. Study co-author Dr. Laura McKenzie, principal investigator in the Center for Injury Research and Policy at Nationwide Children's says, inquisitive children mistakenly identify hydrocarbons as food or beverage, and attempt to ingest the poison.

She has changing seasons should remind parents to insure proper storage of hydrocarbons in their original containers. By the way, most phone calls to Regional Poison Center resulted in home management without the need for an emergency department referral.

27:03

Other studies had demonstrated the same trend and which for demonstrates the potential cost savings of Regional Poisons Centers. So, utilize your local Poison Center mums and dads, do you know the number? You should TZ in the USA: 1-800-222-1222. So you have to call them first rather than rush them to the emergency department, obviously if your kids a sick, you know if they're not responding or they're blue or you know, you're really worried, you call the 911.

But if getting to something and you're not sure whether it's dangerous or not, rather than rushing them off to the emergency department, consider call the Poison Center because they can give you a good idea of whether you need to make that trip or there's something that you can do at home.

The investigators of these current study also offer up some safety tips for parents in preventing hydrocarbon exposures, they say store products properly in high up when children can't see or reach them, keep products in their original child resistant package containers, supervise children when these products are being used in and around the home.

Keep cabinets with products containing hydrocarbons locked, keep children safely in the vehicle during fuel fill ups at gas stations and in the driveway and if your child is expose to a hydrocarbon call your local Poison Center and its toll free and all of you know the number now, let's say it together: 1-800-222-1222.

28:22

All right, let's move on to our final story this week, the US Food and Drug Administration is unhappy with the growing trend of snack company's adding caffeine to their products and they plan to investigate the safety issues of these practice particularly as it relates to children in adolescent consumers.

Michael Taylor, Deputy Commissioner for Food and Veterinary Medicine at the FDA says, our concerns is about caffeine appearing in a range of new products including ones that may be attractive and readily available to children and adolescence without careful consideration of their cumulative impact.

So what kinds of products are we talking about? And how much caffeine are they adding? Well in addition to soda and energy drinks, food companies will be going to adding this stimulant to jelly beans, marshmallows, sun flower seeds and chewing gum, with the equivalent of four cups of coffee in an eight stick pack and they haven't stop there, you can buy instant oatmeal with as much caffeine as a cup of coffee, don't like oatmeal for breakfast? Caffeinated waffles with caffeinated syrup is another option.

29:19

So what's the big deal? You know, lots of folks aren't fund of coffee, how can they exercise their right for a caffeine fix? Well Mr. Taylor says the problem lies in accumulative effect of consuming multiple caffeinated products throughout the day.

He says we have to address the potential consequences of all these caffeinated products in the food supply to children and to some adults who may be at risk from excess caffeine consumption. You better understand caffeine use patterns in determine what is the safe level for total consumption of caffeine.

Importantly we need to address the types of products that are appropriate for the addition of caffeine, especially considering the potential for consumption by young children and adolescents. So what is the safe level of caffeine consumption?

30:00
Well for healthy adults the FDA site the maximum of 400 mg of caffeine per day as the upper safe limit. A number that works out to about 4 or 5 cups of coffee. The FDA has not set a safe level for children and the American Academy of Pediatrics discourages any consumption of caffeine by children and teenagers.

With regard to current rules the food companies are breaking them yet many factories can add caffeine to products if the addition "meet relevant safety standards and is included on the ingredient list…. So what are the relevant safety standards? Well, they aren't defined.

An evidence based studies on the effects of caffeine aren't available probably because the very investigators who'd conduct such studies are second down their own cups of gel and don't want to be responsible for banning it for themselves. OK that was my opinion not the stands of the FDA, just to clarify.

Mr. Taylor points out that the only time the FDA explicitly approved adding caffeine was from cola in the 1950s existing rules never anticipated the current proliferation of caffeinated products.

31:04

He says "Good companies are now on a potentially dangerous path and if the science supports the danger and if the food companies aren't willing to self-regulate this trend then the FDA is prepared to go to the regulatory process to establish clear boundaries and conditions for caffeine use….

And they're also prepared to consider enforcement action against individual products as appropriate. Some companies within the food industry have step up for the plate most notably Mars Incorporated which pulled a caffeinated version of its popular Wrigley brand chewing gum off the shelves shortly after the FDA voiced their concerns.

So if you're not a food label reader you should become one. Read ingredient list and watch out for the addition of caffeine to your favorite snacks and other food. Now just to be transparent here, PediaCast is partially filled by caffeine. But little take us a long way and as with many things in life moderation is key and if caffeine is it every turn, we could easily consumed too much.

32:00

So I think the FDA makes a valid point, keep the caffeine and coffee and soda those who don't want it or need it or take in moderation but for those who want to smartly limit their intake or avoid it all together and for those with medical conditions worsen by caffeine and for the safety of children and teenagers, the drug because that's what it is shouldn't be added haphazardly to snack and food products.

Again my opinion and perhaps the more valid one and researcher are voiding the issue of caffeine safety to support their own addiction.

All right, let's just wrap up our News Parents Can Use edition of our program this week. Stick around I will be back with a final word right after this.

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33:09

All right. A few episodes back we talked about high school students using so called study drugs. Basically this is when a teen takes an ADHD medication like Ritalin, Concerta, Adderall, Metadate, Vyvanse and the like. But they don't have ADHD.

They take the medication which has usually been prescribed to someone else. They take that to help them study during exam time. Remember that story it was back in episode 247. I acquitted it to academic doping and the American Academy in Neurology came up with a voice against it.

Now some of you may have asked yourself when we covered that story just how big of a problem is this. Well, researchers at the University of Michigan ask the same question to parents and teenagers and the answers are really surprising because they show a pretty big disconnect between a parents and their kids.

When pulled parents believe that about 1 in 100 students abuse study drugs and only 25% of these parents have talked to their kids about this practice but when you pulled the kids you find that 1 in 10 admit, Yes! I have used study drugs.

34:13

So parents think 1 in 100 students takes medication that's been prescribed the other kids to help them study but 1 in 10 students admit to doing it. So come on mums and dads get with the program that means some of your kids right now who were listening to my voice, some of your kids are taking someone else's medication to help them study and not telling you about it.

That's a problem. Dr. Matt Davis a Pediatrician at C.S. Mott Children's Hospital has a YouTube video where he presents the study data it's actually a fairly entertaining five minutes of your time.

If you'd like to see it head over to PediaCast.org and find the show notes for episode 255, this one and I'll provide a link for you there. As I said before and I'll say it again, parents it's our job to know what are kids are doing.

35:00

In Michigan and I suspect elsewhere when in 10 of them are abusing controlled substances to help them study. Are you OK with that? I hope not and that's my final word. I do want to thank all of you for taking time out of your day and making PediaCast a part of it.

So we really appreciate the support that I get from the listeners. We don't have a big advertising budget here at PediaCast. We really rely on you guys spreading the word and so one of the ways that is very helpful is reviews and iTunes. So if you have not reviewed PediaCast and iTunes, I encourage you to do so. It's really easy to do.

Just open up iTunes. Go to iTunes store click on podcast go to the kids and family section, you'll find PediaCast there and just click under review just to let people know of what you think about the show.

I know a lot of you who are my regular listeners found the show through iTunes. You read some of the reviews, you know there are a lot of parents who trusted PediaCast and so you decided, well I'll give it a try and now you trust it for yourself.

36:00

And I would just ask that kind of give forward and help out those parents who are going to come along in the future and think about listening to PediaCast themselves and your review may help them decide to do that. So, I would really appreciate that. Also, just sort of sharing PediaCast in the social media space is also very helpful. In fact, when you guys share the program that's when we get our biggest boo stop of new listeners, so when we put out announcement on Facebook and twitter, and goggle plus and pinterest if you could just share those. Share those on you own timeline or retweet them or share them on google plus or repin them on pinterest that's really helpful in terms of spreading the word about the program and also be sure to tell your family, friends, neighbors, co-workers and of course your child's doctor. So the next time you're in for a well checkup or a sick office visit just let your doctor know about PediaCast and ask them to pass on the information with their other patients. We do have posters available under the resources tab at PediaCast.org which can go up on a bulletin board, doctor's offices, nurseries, daycare centers, YMCA, churches, you know wherever, wherever parents hang out and there's a bulletin board where you can hang it up, and again these posters are available under the resources tab at PediaCast.org.

37:19

One final time, I want to remind you if there's a topic that you would like us to talk about or you've a specific question for me that you'd like me to answer on the program or you want to point me in the direction of the News Story, it's easy to get hold of me just head over to PediaCast.org, click on the contact link it's up at the top contact us. And you'll open up a form and just fill that out, send it in. I read every one of those that come through and I'll be able to get in touch with you to answer your question on the air. We don't answer every single one of the questions that you send because we got a lot of them and there's only so much time and we want also interview experts and cover new stories. So we don't have time to answer all of them but we get to a majority of them. So please send those along.

38:03

We really appreciate it. We also have a link on the website at the bottom of each show notes that says connect now at the pediatric specialist. And I just wanted – kind of make clear what that link is.

That is a link if you want to connect with one of the pediatric specialist here at Nationwide Children's Hospital. So if your child has a condition and you would like to see one of specialist or if you want a second opinion, you just have a question for a specialist that you would like answered and that may end up being the specialist as… hey we need them… have you made an appointment so I can see your kid and I give out medical advice, you know without doing it appropriately.

But this is just a handy way for you to connect now with the pediatric specialist and if you end up meeting a referral for that, that's something that the especially the clinic would let you now. Hey… you know, we're going to see you. We can get a schedule but we do need a referral from your primary care doctor to satisfy insurance requirements, that's the possibility. But this is a way for you to connect directly with one of our specialist.

39:00

It's a special form just for PediaCast listeners and once you filled that out someone from our hospital will get back to you and help you facilitate the process of seeing one of the specialist here at Nationwide Children's Hospital. So I make sure you utilize that as well.

All right, once again I really appreciate all of you for joining in and being part of the greatest audience in the history of podcasting. We really have a great group of folks and I just really appreciate you taking the time and helping us spread the word about the program and until next time.

This is Dr. Mike, saying stay safe that's what I'm trying to say I got to get my lips working saying stay safe, stay healthy, and stay involved with your kids. So long everybody.

[Music]

Announcer: This program is a production at Nationwide Children's. thanks for listening. We'll see you next time on PediaCast.

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