Toddler Diarrhea – PediaCast 018
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Announcer 1: This is PediaCast.
Announcer 2: You're listening to the Trypod Network. What's on?
[Music]
0:00:27.5
Announcer 1: Hello! Moms, dads, grandmoms, grandpas, aunts, uncles, and anyone else who looks after kids. Welcome to this week's episode of PediaCast. A pediatric broadcast for parents. And now direct from Birdhouse Studios, here's your host Dr. Mike Patrick Jr.
0:00:43.7
Dr. Mike Patrick: Hi, everyone! This is Dr. Mike coming to you from Birdhouse Studio and I'd like to welcome everyone to Episode 18 of Pediacast. The pediatric Podcast for parents. This week we're going to wrap up our poop talk. The discussion on toddler diarrhea. And then we're also going to discuss a couple of interesting news items. One on Google searches being used to diagnose disease, how well that does work? Also going to discuss infant massage. And then we'll wrap things up at the end of the program with a dissection of Grey's Anatomy. That's coming up in just a little while. I do want to remind you that our next episode, which will be Episode 19, is our Listener Feedback and question Episode and you still do have time to ask a question. All you have to do is visit the website at pediacast.org and click on the contact link. You can also e-mail me at mike@pediacast.org or you can call the voice line at 347-404-KIDS. And that'll let you leave a message on the Skype line. We can answer your question that way as well.
0:01:52.1
I do want to make a quick mention of this, this will be the first time that you're hearing about it but it won't be the last time. I'm going to be in a couple of weeks gone on a well-deserved, long needed family vacation. And we'll be gone for a couple of weeks. Now I'm trying hard to get podcast ready so that you'll still have material every week even while I'm gone. Although I can't make any promises. But I'm really trying hard to get that done. So after the Listener Feedback and Question Episode, there will be a couple more episodes that are a little bit abbreviated and I just want to explain why that is. And it's because I'm to be on a family vacation to visiting the mouse, if you know what I'm talking about, in Florida.
0:02:38.0
Speaking of vacation, I do want to share one thing with you. Has anybody out there rented a car lately? You know like you're going to land in the city and you need a rental car. I'll tell you it is one of the most frustrating things trying to get a good rate because there's so many codes that you can put in and you're trying one car company versus another. And we're trying to get a minivan 'cause we're going to have a lot of luggage and both kids. And we're going to be driving to grandma's house and then over to Disney World and so we really needed a car that was a little bit more substantial size than we might otherwise need. And so the price rate goes up because of the classic car that we want. But the crazy thing is that there's such a difference in price between the different car companies and then once you start putting codes in, and you can find those all over the Internet. And there are things that we really legitimately can use the code. You know like, are you a Walmart shopper? Well yeah. So you know we try that code and you try the triple A one and then you got the coupon codes and the promotion codes.
0:03:45.7
I mean you put these combinations in and then you get excited because it's like, at first you know, this is $50 cheaper than this other code. So you write down the numbers and then you do it again, you shave off another $5 and then you shave off another 2.50 and you know if you step back and look at it, you get to the point where you spend another hour on this little project and you haven't really saved that much more money. It just drives you crazy though. I just wish someone would give me the cheapest rate. Just tell me what it is, let me spend 10 minutes, put in my information, I got the rental car. I mean literally the other night I spend a couple of hours maybe even closer to three hours playing with numbers and codes and it just drives you crazy.
0:04:30.2
All right before we get started, I also want to thank the good folks over at the PregTASTIC Podcast. They were kind enough to interview me last week and their latest episode is an interview with a pediatrician and it's yours truly. So you want to check that out www.pregtastic.com. It's a podcast that's aimed at pregnant women. And it's kind of neat way they do it. It's a panel of women who are expecting and then once you have your baby, you're kicked off the panel and then they get new talent. So you want to check them out, again it's www.pregtastic.com. And we'll have a link in the show notes for you.
0:05:12.2
All right the information presented in Pediacast is for 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, call your doctor and arrange for 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.
[Music]
0:06:16.7
All right we're going to go ahead and move on to the news segment this week. Got a couple stories for you. The first one is a story about Google and how useful it is to use Google to search for a medical diagnosis. This was actually a research study done at the Princess Alexandra Hospital in Brisbane Australia. And the researchers there wanted to see how well Google searches faired in figuring out a diagnosis. So what they did is they took 26 difficult to diagnose illnesses and they selected three to five symptoms from each disease and they use these as Google search terms. And then they looked at the top-ranked results and they picked webpages that include information about any disease which is known to result in that particular set of symptoms that's in question. And then they compared the diseases that came up in Google with the actual diagnosis that they had in mind when they did the original search. And their goal was just to see how often Google brought up information about the correct illness based solely on a list of symptoms, in this case around three to five symptoms for each of the 26 difficult to diagnose illnesses.
0:07:25.1
And what they found was that Google brought up the correct disease 58% of the time. OK so what's the take home message here? Well if you or your children have a group of symptoms and you Google the symptoms, Google will be wrong close to half the time. So don't panic if a terrible disease pops up if you try this. Go see your doctor instead. Now I know I say this all the time but it's another reason you can't dispense medical care from a vending machine, you know. You need a face to face interview and hands on physical examination with your doctor. You've heard that before, right? Well there's a reason for it.
0:08:03.9
All right moving on. Baby massage, The Warwick Medical School at the institute of education at the University of Warwick in the United Kingdom, lead researcher on this was Angela Underdown. And basically she looked at nine different studies that involved 598 babies who were all under 12 months of age. And all of these studies involved parents who massage their babies after receiving training by health workers. And what she found was that the studies all had a common theme, some showed that babies who were massaged cried less, slept better and had lower blood levels of stress hormones like cortisol, compared to those who did not receive massages. Others of the studies found that massages helped moms who suffer from postpartum depression to develop improved bonds with their baby. One study compared massage to rocking and found no significant difference in the soothing effect of the two techniques. And another of the study showed that the massaged infants had improved sleeping patterns. None of the study showed any harmful effect of infant massage.
0:09:13.6
So how do you do it? According to one source, you touch the baby's body with gentle pressure and you let your fingers slide from the head to the toes while looking tenderly into your infant's eyes. OK I know it's a little sappy but that's the way it was described. If you want more information about infant massage, I suggest that you check out Infant Massage USA at www.infantmassageusa.org and there will be a link in the show notes. I clicked around the site, it looked really good. Had a lot of helpful information, resources, discussions, and research studies, and it really seemed like a well put together site. So if you're interested in infant massage, I recommend you check them out.
[Music]
0:10:33.6
OK as I mentioned before we are going to wrap up, finally our poop talk this week. We're going to talk about toddler diarrhea. Let's say you have a toddler at home. They have a two month history of diarrhea. And by that I mean they're having two to six watery stools every day, now it's not really all that foul-smelling, there's no blood in the stool, no blood. And sometimes you do see some undigested food particles in there. Maybe you've tried multiple diet changes, dairy products have been eliminated, and just in case it's issue with lactose intolerance. And because of this your toddler's drinking lots more fruit juices but you've been watering him down and diluting him so that hopefully they will not contribute to the diarrhea either. Come this with the fact that most toddlers are picky eaters and that they have low fat in their diets and also tend to have low amounts of protein in their diet as well. And for some reason, which we will get into in a little bit, makes the diarrhea worst and last longer.
0:11:37.2
Let's say also your doctor has done an extensive stool work up; including stool cultures, both bacterial and viral, also looked in the stool for evidence of parasites and worms and that sort of thing, and also tested for occult blood, meaning microscopic blood you can't see but test can pick up, and basically all these work up has been negative. So if that's the case, if you have a toddler at home and they've basically followed the kind of history that I just outlined then that would fall into the realm of toddler diarrhea.
Toddler diarrhea is a common pediatric condition, also seen in babies; and when it's in babies instead of toddler diarrhea often we call it chronic diarrhea of infancy. So the ages that we're talking about here are between 6 months of age to about 3 years of age. And again they have about two to six watery stools per day, they do have some intermittent days without any stool at all which kind of give the parents some false hope like, "Yeah it's over, it's over," and next day the diarrhea's back again. And as I also mentioned undigested materials often commonly found in the stool.
0:12:48.5
The important thing in determining if this is toddler diarrhea is you want to make sure that their having normal growth. So their weight and their height or length and their head circumference is not falling off the chart. They're continuing to gain in terms of their growth, just as they had always done even before the diarrhea started. Also another thing too is with toddler diarrhea there is an exception to the normal growth thing. If a parent has put a severe dietary manipulations on their child over a long period of time resulting in decrease calories, then that could affect their growth a little bit. But again that's usually only after a really severe change in diet that the parents have been trying over a long period of time. Otherwise there's really no evidence of malnutrition on the physical exam and the child looks well and there's no history of other symptoms like abdominal pain, no evidence of infection like fevers, there's no blood in the stool; none of those things.
0:13:52.5
There is a often a family history of other GI; gastrointestinal problems in the family, so there may have been other babies who had colic, maybe some gastroesophageal reflux or heart burn issues. And in some cases there may be folks, older, children, and adults in the family who have been diagnosed with irritable bowel syndrome. So a lot of times these chronic diarrhea kids do come from a family where there's history of other gut problems. Now before you call something toddler diarrhea, you want to make sure that it's not something a lot more serious than that. So I'm just going to go over some of the alternatives of what chronic diarrhea can be. Sort of things to consider and what causes them and what kind of further workup we generally do and then also what kind of treatment for each of these conditions. And we're just going to quickly go through some of these.
0:14:46.5
The first one would be cystic fibrosis. Cystic fibrosis is one of these diseases that a lot more states are screening for as part of the newborn screen. So hopefully a lot of these kids who had been diagnosed a little bit later on will get diagnosed with it earlier. Basically in cystic fibrosis, what causes diarrhea is there's a deficiency in pancreatic enzymes. So the pancreas usually makes enzymes which help breakdown food and in this case they're not made very well. And so you don't have enough enzymes to break down the food and digest it properly so it can't get absorbed and it basically moves through the intestine and then causes the diarrhea.
0:15:28.1
Often they also have a history of respiratory problems, such as frequent wheezing, recurrent pneumonia, significant loss of appetite. They usually do have quite a bit of weight loss. So that right there is not going to qualify as a toddler diarrhea. Because usually they're not growing very well at all because their malbasorption also leads to malnutrition. Abdominal distention is common, the child may appear weak, they're inactive, might be evidence of anemia, they have vitamin and protein deficiencies. And the diarrhea that kids with cystic fibrosis get, usually it's a real foul-smelling and greasy diarrhea because the fats in the food are not getting broken down and they're going right through basically.
0:16:09.6
In terms of the diagnosis of this, often times there's a family history. So that's important to think about, that does tend to run in families. A sweat chloride test is often a good initial screening test, it's where they put some electrodes on the kid's skin and those electrodes cause the child to sweat and then you collect the sweat and measure it for chloride and then that can help you decide if cystic fibrosis is present.
There's also genetic studies and then again as I discussed on the newborn screen, we do look for cystic fibrosis. So at some point I think we'll do a show on cystic fibrosis because it's one of those diseases that a lot of people have heard about but unless it's affected your family you might not know much about it. And of course it's always good to know about these things. Just in terms of understanding what others are going through or when you hear about a certain disease, you'll know what's involved with that.
0:17:04.8
In terms of the treatment, these kids are taken care of a Pediatric Pulmonary Specialist, but in terms of the diarrhea in helping that, there are enzyme replacements that these kids can take orally that help them with the digestion of food. Basically you're just supplying the enzymes for them rather than relying on their body to make them. And that usually helps with the malabsorption and with the diarrhea.
OK. Another thing that can use chronic diarrhea in toddlers is food allergies. Now with food allergies, vomiting may also be present, blood in the stool is common especially with milk protein allergies. And often there's a family history of other allergic type syndrome such as eczema, asthma, allergic rhinitis, the sniffles, hay fever; that kind of thing, also recurrent hives, some kids get urticaria which is just a hive illness that certain things that they're exposed to or viruses can make them happen or it can just happen where they get intermittent hives. And that's all related to the immune system and its allergic type syndromes.
0:18:12.5
Also with food allergies, often times kids have poor appetite and weight loss with it. And we did talk specifically about some food allergies in previous episodes of PediaCast. In Episode 9 we discussed milk protein allergies and in Episode 10, we discussed gluten allergies which causes Celiac Disease. Basically with food allergies, once you figure out what they're allergic to, dietary manipulation to avoid those kinds of foods usually solves the problem. And to help with diagnosis of these blood tests to look for the antibodies against specific foods often times is helpful, so that you can diagnose the food allergy that way. And of course the treatment is to avoid the culprit foods.
0:18:56.5
Now the good news with this is that with a lot of these food allergies, as time goes by the immune response to these foods usually lessens. And so that kids, as they get to be a little bit older are able to eat some of these foods again that causes diarrhea such as milk protein allergies. A lot of times as they get older, they're able to tolerate milk protein again. But again that's something to discuss with your doctor because there are some blood test that can be run to help follow that kind of thing along.
0:19:24.4
OK. Another cause of chronic diarrhea in toddlers would be lactose intolerance. And this was also discussed in Episode 9 of PediaCast. True lactose intolerance in babies and toddlers is actually rare. Most lactose intolerance usually begins in school aged children. Now temporary lactose intolerance in toddlers is common. And this usually happens after they have an episode of acute gastroenteritis; usually caused by a virus, so that they have diarrhea from a stomach virus. And that diarrhea washes away the lactase enzyme that their body naturally has. So the lactose stays in the GI tract and doesn't get broken back like it's supposed to because the enzyme that normally breaks it down has been washed away from the diarrhea. And then as that lactose moves into the colon, water enters by osmosis and so you get increased water component of the stool. And then that diarrhea can persist.
0:20:25.4
It usually improves on its own, but it can take two or three weeks before it goes away. And it's sort of a vicious cycle in one sense because the body is trying to make more of this lactase enzyme and yet the diarrhea is continuing and continuing to wash it away. So sometimes what you have to do is decrease, after they had a stomach virus, they may have diarrhea for a week and a half from the virus itself, and then that diarrhea turns from a viral diarrhea into a lactose intolerance diarrhea. So what you have to do is decrease the lactose in the diet. You can do that by using soy formula or soy milk instead of cow's milk.
Current researches suggesting, you don't have to eliminate milk and dairy completely from the diet. But if you decrease the amount so that it's a much smaller amount than they're usually used to, then that may help. And again with soy formula and soy milk is probably the best way to go with that.
0:21:25.6
If you have an older child, like older than age two or so, adding lactase which is a little tablet that they can chew up that has that enzyme and it breaks down lactose or you can also use Lactaid Milk instead of soy milk. That's possible too. That's just cow's milk with that lactase enzyme already in it. Also if it's a post viral gastroenteritis kind of diarrhea, something else that might help is a probiotic; which is a pill that you can crush that has the acidophilus and bacillus. These are bacteria that are supposed to live in the intestines. So the idea is if the diarrhea has washed out the normal good bacteria that aid in digestion by replacing those in the intestine that may help to normal stools a little bit quicker.
0:22:14.8
There are specific test approve test approve lactose intolerance that we did discuss in Episode 9, but usually you can tell with diet manipulation. You know if it’s a true lactose intolerance, you get of lactose in the diet and then the diarrhea gets better. And then if you re-introduce milk, if it's not one of these temporary lactose intolerances, if it's more of a genetic one, that they’re just going to have for a long time, then that diarrhea's going to come back when you re-introduce the& milk again.
Also kids who are on a decreased lactose diet, you do want to still make sure that they find adequate sources of protein, fat, calcium, iron, and all of those kind of things. So you definitely want to talk to your doctor about what kind of foods that you can use to avoid lactose but still not running in into any deficiencies in those areas.
0:23:05.6
OK. Another thing that can cause chronic diarrhea in toddlers is going to be Giardia and Cryptosporidium. These are specific organisms that can cause chronic diarrhea that are not picked up on standard stool cultures. So your doctor has to order specific tests to find them. Usually with Giardia and Cryptosporidium, the stools are just really watery and lots and lots of it. A lot of times these kids get dehydrated to the point where they need to be in the hospital, and they're getting IV fluids. But it's not always that severe.
Usually the stools are very foul smelling and crampy abdominal pain and weight loss are common with these illnesses. They tend to be water-bourne. Both of them can also transmit from other people through the fecal-oral route. And animals, particulary with Cryptosporidium, it can also live in animals, so the fecal-oral route in animals can happen as well.
In order to find these things you have to test the stool specifically for Giardia and Cryptosporidium. And it's one of those things where I don't see these in the office all that often, but when you have a kid with really severe diarrhea that's lasting a long time, it's definitely one of those things they keep in mind that we do order.
0:24:23.0
One of the ways that kids get these, you know if they're out hiking and they get water from a creek, they can get it that way or from a well that's old and has not been tested recently. Sometimes these things can get into well water as well. In terms of treatment, there's specific antibiotics that you have to use for both of those to help them go away.
Another one that you may have heard about is C. Diff, Clostridium Difficile is the name of the organism, sometimes we just call it C. Diff for short. This is often a normal inhabitant of the bowel that doesn't cause a problem. But it's one that is not easily killed by the typical antibiotics that we frequently use for other infection. So if you have a kid who has been on a lot of antibiotics, maybe for ear infections, that kind of thing, and their normal gut bacteria has largely been killed off by this antibiotic use, if those antibiotics don't kill the C. Diff that's in their intestine then the C. Diff can grow and increase numbers because of decrease competition in the bowel.
0:25:29.2
And when there's too many C. Diff in the bowel or in the intestines, you end up with watery, foul smelling stool, and it may even have blood in the stool as well. This is another one of those organisms that generally is not picked up on a routine stool culture. You have to order a test for C. Diff. And again it's not all that straight forward, because even if you get a positive result back for C. Diff, it can be a normal inhabitant in the intestine and so you don't know for sure if that's what's causing the diarrhea. Also C. Diff can be the culprit and the test can still be negative because it is hard to grow in the laboratory.
0:26:06.2
Usually what we do is three tests in a row for C. Diff. And if you get all three of them back negative, then that makes you feel pretty good that that's not the cause of the diarrhea. But if there's history there for recent antibiotic use and you have a high index a suspicion that it could be C. Diff and then one of those three tests comes back positive, we certainly consider it, this is the kind of thing where the art of medicine comes in, you have to look at the whole picture and then make a clinical judgement based on all of the individual variables. And again for C. Diff like these, like Giardia and Cryptosporidium, there are specific antibiotics that have to be used to help them to go away.
So let's say your doctors considered all these things, they've tested for C. Diff and Giardia and Cryptosporidium, you decided it's not lactose intolerance, it's& food allergies, they don't have cystic fibrosis; but they do have this watery diarrhea, two to six times a day and it's been there for several weeks. Then we get into point where we're calling it a toddler diarrhea. So what in the world causes that?
0:27:12.4
Well the main culprit in toddler diarrhea is probably increased gut transit time. So in other words food is carried through the intestine too quickly, so proper digestion and stool formation don't have time to complete. But still there's usually enough digestion occurring that these kids are not losing weight, appearing malnourished, they don't appear sick at all. It's just that things are moving through a little bit too fast and that's why they have the diarrhea.
Now are treatment of the diarrhea, up to the point where we call it toddler diarrhea, probably makes it worst and last longer because fat in the diet actually slows down gut transit time. So when we eliminate milk from the diet because we're thinking about lactose intolerance or milk allergies and that kind of thing, when we decrease milk fat in the diet, you end up increasing transit time. So when you decrease dairy and milk in the diet when it's a toddler's diarrhea, it's actually going to make it worst and continue to be there.
0:28:19.1
Also parents often avoid fatty foods and not just milk when your kids have diarrhea, 'cause you just thing their stomach's upset they don't need greasy food. So these kids often are on low fat diets. Also because this chronic diarrhea is there, the parents don't want their children getting dehydrated, so they're pushing lots and lots of fluid. But increase fluid intake along with increase transit time just leads to more watery stool because those increase fluids just go right through. Also a lot of parents substitute juices for milk and then those juices have sugars in them that don't get digested and those undigested sugars end up in the large intestine and that takes more water in to the gut by osmosis, so you end up with watery stool.
0:29:02.5
So the ways that we treat more of an infectious diarrhea, if it's really a toddler diarrhea, those things are probably going to make it worse. OK so what do you do? Well after you eliminate the possibility of the other problems that we mentioned and after you make sure the child's healthy, they're developing and growing well, I mean you really do feel it's a toddler diarrhea, then the best thing that you can do as a doctor is to offer these parents reassurance and really encourage them to return to a regular diet. So put milk back in the diet, decrease all those fluids that you're giving them, increase the fat again in their diet, decrease the juices, increase the fiber, and you know sure that's fine. But medicines are not necessary for this chronic diarrhea and they can actually makes things worse. You know a lot of parents still say, "Isn't there an antibiotic you can give?" You only want to give an antibiotic if you know what is that you're trying to kill, like the Giardia or the Cryptosporidium, or the C. Diff. You don't want to just use any antibiotic that's going to kill off the food bacteria in the intestine because it's just not going to help and in fact probably will make things worse.
0:30:13.7
Probiotics in this case, we talked about that a little while ago with Bacillus and Acidphillus and the bacteria that are supposed to live in the intestine. But with toddler's diarrhea, that's probably not going to help much because the gut bacteria are normal in toddler diarrhea, just the transit time that's really the issue.
Now what about Imodium? Imodium is a medicine that decreases gut transit time. So that would probably help. But the problem with Imodium is it can have significant side effects often times it'll over correct things leading to constipation, fluid retention in the gut which can lead to cramps and vomiting, and the gut muscle can sort to become dependent on the Imodium for proper functioning. So really we don't recommend Imodium over a long period of time.
0:31:02.6
Really again, reassurance and time are the most important thing. And of course reassurance; it's very difficult because most parents with toddlers who have toddler's diarrhea are convinced that their child has a serious problem and their doctor's not able to figure it out. It's like "Hey, what kind of doctor are you? You can't even tell me what's causing this diarrhea." And so a lot of times they demand a referral to the gastrointestinal specialist and we do it. And that of course overloads the system 'cause usually most children's hospitals have a limited staff in their GI Department. So these kids take up schedule spots and overload the system and it cost more money. But you know there's something to be said for peace of mind, right?
And if the primary care doctor and the specialist are saying the same thing and given reassurance, then parents do tend to feel better about it. So I don't take offense to this. And when I say, "Oh they're overloading the system and costing money," it's true they are. But I'm not saying that it's the wrong thing to do because as a parent myself, there's definitely something to be said for reassurance. And when you're hearing the same thing coming from your regular doctor and the specialist, you're more likely to believe it. And of course this is all where the art of medicine comes in.
0:32:16.8
OK. So that wraps up our talk on toddler diarrhea. If you have any other questions about it that we didn't hit, feel free to e-mail me mike@pediacast.org or use the contact page on the website. Also you can call us at 347-404-KIDS.
All right we're going to take a quick break and then we're going to come back and talk a little Grey's Anatomy.
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0:33:10.3
OK. This week on Grey's Anatomy, the episode was Where the Boys are? And this is the one where they guys were all out on a camping trip. And again the reason for this little segment of PediaCast is, it's my personal mission to make Grey's Anatomy the best medical show on TV. Plus it's just kind of fun talking about it. If you're a Grey's Anatomy watcher, you'll know what I'm talking about. And if you're not, I suggest that you start watching it. I don't watch a lot of TV. There's just a couple of shows really, Lost and Grey's Anatomy are the two I like the most and we watch Survivor as well. But with Grey's Anatomy I think that all the interpersonal relationships or the soap opera component to it just seems very real from someone coming from the medical field who has seen this kind of interrelationships between people. But as I said before there are some issues with the show in terms of its believability from a medical standpoint. So that's where the idea to do this little segment came from.
0:34:12.0
So what do I have in terms of thumbs this week? Well I think that Webber's response, this is Richard Webber, played by James Pickens Jr, he's the guy in charge of the Surgery Department. His response to the gay couple on the camping trip, I thought that was pretty funny. The fight between George and Alex, you know the slap fight, I thought that was great. It was kind of realistic how the surgeon mentality is, let's not hurt the hands. That was pretty good.
Then getting back to the hospital, Addison Montgomery Shepherd; you know I'm not sure what to call her. You know it's like, is she a Neonatologist, is she an Obstetrician? I guess she's a Perinatologist or something. But anyway she had to do like three different residencies. I mean her character is not very believable in terms of the diverse things that she does. But OK, fine I'll look the other way on that one.
0:35:10.7
I will say that her losing it, you know she deals with baby death all the time. But her losing it like she did, I thought that was actually pretty realistic because all of us in medicine, you see these things day in and day out. And from someone who did a year of fellowship in pediatric emergency medicine, you don't get used to kids dying and you don't get used to infants who don't survive and pass away and that and pain that goes on in parent's lives because of it. And even when you've been doing it for many years and you have the experience of someone like Addison Montgomery Shepherd, you definitely have moments in time when you just lose it. So I thought that was very realistic as well.
I do also want to say, a lot of times babies don’t look very real in these medical shows. And I think Grey's Anatomy has done a good job with making sure that the babies that they use look real. Obviously they look bigger than newborns. But the one that the baby that was supposed to be dead in this episode looked dead. So they did a good job in terms of making that realistic.
0:36:16.8
OK. So where’s my thumbs down this week? Well you know waiting that long to tell a couple that their baby inside is dead, that's crazy. I mean, really I think most doctors as they're doing the ultrasound would say, "Oh there's a problem, the baby's not moving." The mom would start asking questions and the whole thing's going to come up right then.
OK. So for the show to get some of these other things in, you know the wait a little while, fine. But they waited a long time. It means Addison had her whole breaking down and losing it incident. And then they were talking and the mom and dad were in the room, it just seem like a long time between when Addison knew that the baby was dead and when she told the couple about it. And it seems to me that to make that a little more realistic, it should happened quicker.
0:37:09.8
OK. Another unrealistic thing this week with Grey's Anatomy was searching through the poop. I mean come on. OK, yeah it was funny. But if a kid swallow a whole bunch of Monopoly pieces, first of all it's going to take days for these things to pass. They're not all going to pass in an afternoon. And the other thing too, why not instead of, now I know it was because Dr. Bailey was upset and was basically punishing Christina. But the crazy thing with this is, really what would happen is that the kid would be sent home, as long as he was not having a belly ache and wasn't vomiting. And with that many pieces probably what you would do is wait a couple of weeks and if there hadn't been any more symptoms, take another x-ray just make sure that they're all gone. That's what I would do, I think.
0:38:06.9
But certainly people wouldn't be searching through the poop in the hospital. You know maybe you'd make the parents do that at home, that's fine. The other thing too is that the kid ended up perforating and having an acute abdomen and ended up in the operating room. Come on, what Monopoly Piece is going to perforate the intestine for crying out loud? I mean that was just completely unrealistic. But again how else do you do that story line and make it lead to perforation and the operation? I don't know. He would have to swallow something other than Monopoly pieces. I'm pretty convinced of that.
0:38:43.7
One other thing I didn't like this week is the whole breast cancer thing on the guy who was taking the hormones and wanted to have the sex reassignment operation. It just seem like that just came out of nowhere. They were planning on doing this thing and then all of sudden they have to come in and say, "Oh you have breast cancer." There was no precursors to that. There was no foreshadowing; no one mentioned any kind of biopsy. Just seemed very unrealistic that that just came out of nowhere.
I do want to end on a positive note. I think at the very end of the show with George's dad being in the hospital that was definitely an appropriate surprise and makes you wonder what's going to happen next week.
0:39:28.7
OK. This is not a Grey's Anatomy podcast. I just want to say a few words about it. And with the next couple of episodes and with my vacation coming, oop, phone call, it's a true podcast. When the phone rings at the background, you know you got yourself a podcast. I do want to say thought, OK it's not a Grey's Anatomy podcast, it's a pediatric medicine one. But I know there are a lot moms and dads out there who watch Grey's Anatomy and I do have folks at work who watch it. We talk about it a lot, and I have parents who talk about it quite a bit too especially when they overhear nurses talking about it.
So if you think this is a good part of the podcast, send me a e-mail and let me know. If it’s something that you're really could care less about and you don't think should be in PediaCast, let me know that as well.
0:40:20.1
OK. Finally we're going to go ahead and wrap things up here with Episode 18. I want to remind you to check out the Tripod Network. That's www.trypodnetwork.com and check out the other great shows that are on Trypod.
Also I'd like to thank this week all the listeners, including the old regulars and the new comers as well. Also I'd like to thank my family for allowing me the time to do these things. Also I want to thank Vladstudio.com for the artwork on the website. Just a reminder, you can submit a question or comment, view the show notes, sign up for a newsletter, and read the blog at Pediacast.org. And if you like Pediacast, please spread the word by telling your friends, relatives, and neighbors about our program. You can download free promotional material on the poster page of our website. And there's a couple new posters up this week. One of them even includes, one that you can hang up and then cut the little strips and then that will have PediaCast the name, and the website so you can take it with you. So if you put that on the bulletin board, like at the gym or a day-care, that would be helpful.& 'Cause then people could just rip off the little tab and take that home with them to find us.
0:41:38.9
So again you can find that on the poster page at the website. And of course reviews on iTunes are also most helpful. So until next time, this is Dr. Mike saying, "Stay safe, stay healthy, and stay involved with your kids." So long everybody.
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0:42:14.0
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