Strong Bones, Second Hand Smoke, and Night Terrors – PediaCast 038
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Topics
- Building Strong Bones
- Robots Help Kids
- Marijuana and Pregnancy
- Smoking in the Movies
- Second Hand Smoke
- Making Movies in the Operating Room
- Night Terrors
- Viral Meningitis
- Seafood and Pregnancy
Links
Transcription
Announcer: This episode of PediaCast is brought to you by Mariner Software.
[Music]
Announcer: Hello moms, dads, grandmoms, grandpops, aunts, uncles, and anyone else who looks after kids. Welcome to this week's episode of PediaCast. Pediatric broadcast about for parents. And now, direct from the Birdhouse Studio, here's your host, Dr. Mike Patrick Jr.
Dr. Mike Patrick: Hello everyone and welcome to PediaCast, a pediatric podcast for parents. This is Dr. Mike, coming to you from Birdhouse Studio. And as always, I'd like to welcome everyone to the program. I wanted to take a moment to thank the "Manic Mommies" for having me at their show this past week. If you are subscribed to the Mommies, well, you certainly should be. They're a couple of real life working moms who, as they say is trying to do it all and do it all well.
0:01:05.5
You can find their program at manicmommies.com and in the iTunes podcast directory.
The interview was great fun, you know, we answered lots of listener questions during the course of the program on all sorts of topics from infants through toddlers and childhood, and on up to teen age years. So, make sure you check out that program over at manicmommies.com.
OK. What about this program? Well, we have a full one lined up for you. In the "News Parents Can Use" segment, we're going to talk about to build strong bones. Robot helpers for kids with developmental disabilities. The effect of using marijuana during pregnancy. Smoking in the movies. And new data on the effect of second hand smoke exposure. That, plus video cameras in operating room in the state of Massachusetts, we're going to discuss that as well.
0:01:58.8
And in our listener's segment, we're going to talk about night terrors, colic,. lead in the house, viral meningitis and fever. And we'll wrap things up with our Research Round Up and talk about seafood intake during pregnancy.
So, I told you we have a pretty full show this week. And these are all things that are going to be coming your way. If there is topic that you would like us to discuss in PediaCast, it's really easy to get a hold of us. All you have to do is go to the website, at pediacast.org, and click on the contact link. You can also email me at pediacast@gmail.com. You can either do a text email or you can attach an audio file. And our voice mails is 347-404-KIDS, 347-404-5437. You are more than welcome to get a hold of us that was well.
0:02:50.5
All right, this past week was also interesting. Sort of in the medical blogging world. I don't know if any of you out there follow the news with regard to medical blogging. But there was a medical blogger whose went by the name "Flea", you know, as in what dogs and cats have. Although he called himself Flea because apparently, where he trained, that's what the surgeons called pediatric residence, they were fleas, ain't that lovely? But anyway, that's he went by. And things were going well for him, and actually he have a pretty good blog, I read it a few times. And I know he have a pretty big following in the medical blogging community. But he was involved in a medical malpractice trial. And in his blog, he commented on the trial, sort of as it was going along. And said some, sort of inflammatory things about the plaintiff's attorney and the jury. And basically it came out in the course of the trial that he was Flea. And so, you know, rather than have all the bad things that he had said about the jury, entered into the court record, the case was withdrawn and it was settled out of court for an undisclosed sum.
0:04:06.0
So, in response to that, there were some other medical blogs that was sort of taken down. Most of these were ones in which the doctor was sort of hiding behind a pseudo name and maybe talked about patients. And I got some questions myself, you know, do you feel if this is a huge liability risk doing PediaCast and are you going to take your show and your blog down? And the answer to that is at this point, no. I think there are two principal rules for this program that we've talked about before. Number one, you are not going to hear me talk about any, or at least recent patients that I've seen. Any stories that I tell happened years ago. Or, you know, enough details are changed that it will be very difficult to know exactly who it is we're talking about. But, really, I don't talk about my patients very often anyway. And certainly, we want to maintain a patient physician confidentiality. You know, all around.
0:05:01.2
It's not just ethical, it's the right thing to do from a personal stand point. The second thing is, is medical advice. And I do, in terms of the recent events in the news, I want to, again, I know I try to make this as clear as possible. There is no way that coming to you through an iPod, or on your computer, or other listening, digital listening device, there is no way that I can get an adequate history and do a physical examination that is required and tell you how exactly what is wrong with your child. So this is not an exam room. PediaCast is more of a classroom. And that is where really the niche that PediaCast falls into. I mean look at this as sort of like the baby books that are out there, except the digital version of it. And that's really what PediaCast is all about. It's the place to come to get information to help you understand things better.
0:06:01.2
But when you have a genuine medical concern about your child, there is no substitution for taking him to the pediatric office. So, that is sort of where PediaCast falls into this. I'm not hiding behind any names and, we're really careful to not break patient confidentiality or to distribute inappropriate medical advice on the program.
OK. I do also, that kind of goes in with my disclaimer so I feel like we don't have to go through that again. Just remember that your use of this audio program is subject to the PediaCast terms of use agreement, which you can find at pedicast.org.
OK, with all those things in mind, we'll be back and get started with our "News Parents Can Use", right after this short break.
[Music]
0:07:00.6
[Music]
Our News Parents Can Use segment this week is brought to you in conjunction with news partner "Medical News Today", the largest independent health and medical news website. And you can visit them online at medicalnewstoday.com. OK, first up, the importance of building strong bones in young people. Childhood, especially the teen and tween years, is critical for developing lifestyle habits that support good bone health. Boys and girls in this age group have calcium that cannot be satisfied once they get older. The American Academy of Orthopedic Surgeons, and the National Institute of Child Health Human Development, have joined forces to create a public service campaign that promotes the importance of calcium and exercise in a growing child's life.
0:08:04.0
Bones grow in size and strength during childhood. Bone mass at child is able to bank while young, helps determine his or her skeletal health for the future. The more bone mass deposited to the bank while young, the more protection one has against loosing bone density later. Bones helps us to stand up straight, to run, to jump and to play, say Laurie Carol, Pediatric Orthopedic Surgeon and Spokesperson for the American Academy of Orthopedic Surgeons, between the ages of 10 and 18, you make the bone must last your lifetime. This campaign hopes to reinforce the message that you will not get a second chance. And their tips to build healthy bones, first, teach children to make daily deposits to their bone bank by including exercise, calcium and vitamin D. Exercise your bones make them strong. And some ideas on that of course are walking, climbing stairs, bicycling or dancing.
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Participate in sports such as basketball, volleyball, softball, soccer, field hockey. And ensure calcium and vitamin D are part of the daily diet. Include foods like milk, yoghurt, spinach and salmon.
OK. Robots, to help children form relationships. A project which is using robots to help children with developmental or cognitive impairment to interact more effectively, has just started, at the University of Hertfordshire. Prof. Kerstin Dautenhahn, Dr. Ben Robins, and Dr. Dr. Ester Ferrari at the University School of Computer Science, are partners in a project which is investigating the use of robotic toys to enable children with disabilities to develop social skills. Dr. Robins, the team member responsible for the work with robots and special needs children, has carried out extensive research into the types of robots which can help children with autism and other learning difficulties to interact most effectively.
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He is now taking "Casper", a robot that resembles a little boy, into schools, in the Hertfordshire region to carry out a series of trials to assess progress. "During our earlier work on Aurora, we used very plain robots which were received well and a more elaborate doll with the few movement abilities that could encourage imitation and turn taking behavior during playful interactions. This previous research led us to using Casper, a child size humanoid robot with minimum facial expressions, which can move it's arms and legs, and allow the child to interact with it", says Dr. Robins. Over the next three years, scientist will investigate how robotic toys can become social mediators encouraging children with disabilities to discover a range of play skills from solitary to social and cooperative play. And provide opportunities for other children, care takers, teachers, and parents to join in.
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"The idea is that the robot will be a mediator for human contact", said Dr. Robins. "We were seeing already that through interacting with robot, children who would not normally mix or becoming interested in getting involved with other children and humans in general. And we believe that this work could pave the way for having robots in the classroom, and in homes, to facilitate this interaction".
All right, moving on, fetal brain damage linked to maternal marijuana used. A critical step in brain development is governed by indigenous cannabinoids, which is the brain's own marijuana. Studies conducted as Swedish Medical University, Karolinska Institute, with the participation of scientist from Europe and the United States, are now published in science magazine, and show that this indigenous molecule regulate how certain nerve cell recognize each other and form connections.
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The scientist believe their findings will significantly advance our understanding how marijuana smoking during pregnancy may damage the fetal brain. The formation of connections among nerve cells occurs during a relatively short period in the field brain. However, proper wiring of hundreds of millions of cells in our brains, determine whether we can think, remember, move or show emotions, throughout our lives.
For a nerve cell, recognizing its partners and establishing connections with them is the key to survive and contribute to the control of brain functions. The process through which the nerve cells recognize each other is guided by specific chemical signals whose availability instructs neurons to target or to ignore specific cells. So it helps to make all those connections. Scientist have now identified the indigenous cannabinoids. OK, so, the marijuana that is naturally in your brain. They function similarly to external marijuana.
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And they play unexpectedly significant roles in establishing how certain nerve cells connect to each other. These new and exciting results, not only bolster our knowledge in the brain's normal development, but may also take us closer to understanding if and when marijuana damages the fetal brain. Indigenous cannabinoids use the same mechanism engaging the CB1 cannabinoid receptor. As marijuana does to exert their effects on nerve cells. Therefore, the finding that indigenous cannabinoids controls the establishment of connections among certain nerve cells convinces the scientist that they have defined the key mechanism to rule which maternal marijuana use might impair fetal brain development and impose lifelong cognitive, social, and motor deficits in affected offspring. Besides identifying a fundamental mechanism in brain development. Our findings may provide new perspective to identify the molecular changes in the brain of individuals prenatally affected by maternal cannabis abuse, says Dr. Tibor Harkany, who has lead the studies.
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This is of social impact even the continuing growing use of marijuana, the most common illicit drug in our society. Earlier studies have already found that children of marijuana smoking mothers more frequently suffer from permanent cognitive defects, concentration disorders, hyperactivity, and impaired social interactions compared with non-exposed children of the same age and social background. Of course, they do have one big thing indifferent, this is my own comment here, the parent, the kids who are growing up with marijuana smoking mothers, I mean, they got moms who are using dope, so, they are not exactly the same kind of mom that the kids who weren't exposed to marijuana are. You can say that we are going to make these two groups, the marijuana smokers and the non-marijuana smokers. The same age and social background. But, come one, are they really going to be the same social background, probably not.
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So, that's a little flawed. But, anyway, something to think about. I'm certainly not encouraging marijuana use during pregnancy, or any other time.
OK. American Pediatricians urge elimination of smoking from the movies with less than an R rating. Each day, nearly 4,000 children and adolescents smoke their first cigarette. 1,000 of them become addicted smokers expecting a lifetime of medical conditions from which more than 400,000 die each year. A significant body of research indicates that exposure to movie imagery of tobacco smoking by attractive movie stars is among the strongest factors that leads nonsmoking adolescents to try this highly addictive behavior. The American Academy of Pediatrics is concerned that the Motion Picture Association of America's recent statement, that it will consider smoking as a factor in ratings will not effectively prevent children from being exposed to onscreen smoking.
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Because of the potent effect of motion pictures in persuading children and teens to smoke, the American Academy of Pediatrics along with other leading organization of health professionals in the United States, 32 state attorney's general and the Harvard School of Public Health, calls on the Motion Pictures Association of America and Movie Studios, to act immediately to eliminate depiction of tobacco smoking from films accessible to children and youth. The American Academy of Pediatrics recommends the following four steps to help reduce smoking initiation among children and youth.
Number one, require an R rating for all new films portraying smoking, unless they show smoking by a real historical figure who actually smoked. Number two, convey an effective anti-smoking message before all films portraying smoking. Number three, certified that no payments were made for tobacco product placements in the film
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And number four, eliminate brand identifications. The American Academy of Pediatrics is pleased there is an increasing recognition of need to protect children and teens from becoming addicted. The largest avoidable cost of death in the United States, said the organization's president, Dr. JE Berkelhammer.
OK. Well, I certainly agree that we need to reduce the amount of smoking that children are exposed to, but I do think it's more important than getting the motion picture industry to follow these guidelines. The most important thing for parents is to be a good example to their kids. Do not smoke around their children, if they do smoke, it should be definitely outside of the house. But they should also be good example by trying to stop. Because it's definitely is a bad habit that leads to a lot of bad things.
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And, oh, this is a good one. Healthy children with smoking parents aren't really so healthy. It's kind of goes along with the last one. Children of smokers who don't show any signs or respiratory problems, may still be experiencing damaging changes in their airways that could lead to lung disease later in life, according to a new study presented in the American Thoracic Society, 2007, International Conference on Sunday, May 20th. Everyone knows that children of smokers have more respiratory problems. More puffing, wheezing, cases of pneumonia. But until now we haven't known if lung function is impaired in children of smokers who don't have any respiratory complaints or diagnosed lung problems says researcher Bert Erretts, MD, PhD of the University Medical Center, Utrecht, in the Netherlands. The study included 244 children, ages 4 to 12 without any history of a lung or airway disease. They were divided into four groups according to the smoking patter of their parents. Never smokers, smoking after birth but not during pregnancy, during pregnancy but not after birth, and both before and after birth.
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The researchers found that children of smoking parents had significantly reduced lung functions similar to that seen in smokers. Smoking after birth appeared to be more harmful than smoking during pregnancy alone. The researchers have now expanded their study to include 2000 healthy children of smokers. Dr. Erin speculated that in the future the growing number of smoking bans in public places might cause parents to smoke more in their own homes thereby increasing a harm to the developing lungs of children. He says. "We may see an increase in diminished lung function in children of smokers because of this trend.
OK. And finally, in our News Parents Can Use segment, and this one is not specific to pediatrics. But I did include it because I thought it was an interesting story that has some sort white sweeping ramifications.
0:19:57.9
This says "Hippo" goes to Hollywood. Legislation introduced in Massachusetts this past January would mandate that all surgical procedures be videotaped. It will even go so far as to find hospitals for neglecting to do so. Well, the bill's sponsor, state representative, Martin J. Walsh, feels that videotaping will help detect medical errors, it is widely opposed by physicians in the Massachusetts Medical Society. Physicians nationwide should take note because the tone of the bill indicates a couple of disturbing national health care trends.
Number one, a growing mistrust of physicians, and number two, the priority of legal over medical considerations. It seems natural that personal injury lawyers will support this measure, as it is likely to increase the adversarial relationship between patient and physician, and thus lead to more costly and unnecessary law suits. The addition of more legal intrusion into patient care continues to erode the one solid physician patient relationship.
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Surgery is an exacting art that takes years of training to master. Surgeons ability to maintain concentration and comfort in the operating room are key to successful outcomes. With a video camera watching every move, the increase in pressure may actually impact patient's safety negatively. As reality TV has shown, the presence of a camera can affect the outcome. Further the presence of the camera makes it clear that physicians are presumed neither confident nor trustworthy until proven otherwise. While lawmakers go the presence of video camera will help detect medical errors, most experts' doubts that this is realistic. Surgeries are often intricate procedures involving detailed work inside the patients' body, as well as involvement of a large medical team performing a multitude of functions in the operating room.
A video recording would be neither narrow enough and scope to observe small detailed work nor broad enough to monitor the actions of everyone involved.
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The sort of multi-camera, multi-setup necessary to capture everything, would be extremely cost prohibitive and effectively turn the OR into a movie set. Even if videotaping could effectively record errors, the fact is, that surgical errors, that lead to malpractice claims are rare. As they account for only a small portion of over claims hardly worth the cost of implementing such a plan in exchange for modest benefit at best.
While analysis shows the potential benefit to be negligible, the potential for harm may be significant. Through training and experience, surgeons developed instincts and intuition to respond to situations and trouble shoot on the spot in order to address any complications that may arise. Second, guessing oneself due to video cameras and associated liability concerns can only interfere with the surgeons judgment and command of the operating room, thus potentially increasing the potential for error.
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As the bills intend is to catch errors, it does become a sort of self-fulfilling prophecy doomed to failure. This is yet another example of law maker attempting to solve problems in health care, but actually making them worse. The problem is not the rare surgical error, but the excessively litigious climate that will make this sorts of ridiculous measures seem sensible. Physicians don't need Big Brother watching them do their job. What they need is a proactive solution to the problems of frivolous law suits that leaves them free to trust their patients and practice good medicine.
And obviously, is an editorial, not a news story per se. But it is one that I agree with and we will put a link to that in the show notes so that you can read it for yourself.
All right. Lot of things to think about in our news segment this week. That wraps it up and we'll be back with your questions and comments right after this.
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[Music]
Once again, I would like to thank this weeks' sponsor, Mariner Software. You know, from Play-Doh to the present day, people have recorded their lives in personal journals. Today, Mariner Software, unveiled the release of Win Journal. Integrated journaling, blogging and podcasting software for Windows. Win Journal offers a new twist to traditional paper by using technology to incorporate digital photos and live website and links to journal pages.
0:25:06.5
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I have not tried Win Journal myself, but if it's anything like Mac Journal, it's going to be a wonderful program. Because I use Mac Journal all the time. In fact, as I record this, my script is also now in Mac Journal. I'm using it right now. So, definitely visit them. They are a friend and sponsor, marinersoftware.com.
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OK. Up with he first listener question. "Hi, Dr. Mike, I've been listening to your broadcast for the past few weeks. And I really enjoy it. I was wondering if you can talk a little bit about night terrors. My three year old has them occasionally and I've heard that they're normal but frankly they scare me. Is there anything that parents can do to prevent night terrors or are they something that children will eventually outgrow. Thanks". And that comes from Susan.
Well, Susan, you know, night terrors do then to run in families. About 2% of all children are affected. The fact that they ran in families let you know that there is this genetic component to it. So, to some degree, treatment is going to be sort of difficult. It's just these kids are prone to having these episodes. They usually began about one or two hours after going to sleep. And for most kids, they last about 10 to 30 minutes. So, what happens during one of these night terrors episode. Well, the child may seem agitated and restless. They may sit up and get out of bed. they can cry, sometimes they'll scream. They can talk wildly.
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But, you can't really awaken them very easily during one of these episodes. Things that you would normally do to comfort your child just don't seem to work. Now if they're up and about, or they're sitting up in bed, their eyes might even be wide open and staring straight ahead. But they don't realize that your there. And even though their eyes are open, you know, they're still basically in a sleep state despite sitting up, maybe even walking about, you know, being agitated and restless, and doing things that you would normally associate with someone who is awake. But they still are and I said, in this deep dream stage of sleep.
In the morning, the child does not usually recall the event, again, because they are sleeping while it's happening. Now, it's important to differentiate, these are not nightmares. OK, these are not bad dreams that kids are having. In fact, they don't happen during the dream stage of sleep. So, during the dream stage of sleep, you don't see this sort of thing.
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Basically, what's happening is, the emotional activity center that causes you to be agitated and restless, and to cry, and to scream. Those activity centers of the brain are simply being stimulated, as sort of firing on their own. So, it really is kind of evidence, sort of, an immature portion of the central nervous system. Then it just sort of fires on its own. And that's why this happens. If it in were a motor area that this was happening, it would manifest itself as a seizure. But it's not a seizure because it's not the right part of the brain that sort of firing on its own. It's most commonly seen in toddlers and young school age children.
So what do you do? Well, when they're having one of these, you want to speak in a comfortable voice. If the child is up, sort of direct them, guide them back to bed. You don't want to shake them or shout at them because that usually does not work very well.
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And sometimes though, they will sort of start to come around. And when they, if you were a kid, and your asleep, and the next thing you know, mom and dad are shaking you and shouting at you that will be pretty scary. So, you don't want to do that. If they wake up and find you there, you want them finding you talking to them in a comfortable voice so as not to upset them. The most important thing with this is you want to protect them against injury. Keep their floor clear of tripping hazards. You may want to put barriers around the stairs. If they're small enough, you could use a, like a baby gate on the top of the stairs, 'cause you don't want them up walking and falling down the stairs. I guess, the good news with this is the fact that it's usually pretty early on during sleep when this happens. So, hopefully you're still awake and you can hear them when it occurs. But, another thing about the baby gates, if you have an older kid who is doing this, obviously, you want to talk to your doctor about it. But you do want to be careful that the baby gate, that your child is not so tall that they could fall, flip over the baby gate if you put it at the top of the stairs. So you have to be careful about that.
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OK. So, how do you prevent these things. Well, you do want to make sure the child is getting enough sleep. It does seem that if your child is sleep deprived, that they're going to have more incidences at night when they're in this non dream deep sleep state. And since that's the stage when night terrors typically occur, if they're spending more time in that stage of sleep, and they're more likely to have night terrors. But then again if they're getting enough sleep over all, then they're not going to spend too much time in that really deep sleep state. So, naps are going to be important. If your child wont nap, you could institute a quiet time which would at least help them, maybe in the future nap, or at least their brain is getting some rest.
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If they're difficult to awaken in the morning. And your child is having frequent night terrors, by moving their bed time earlier each day by about 15 minutes intervals until they're waking up on their own in the morning, then that also helps to encourage sleep at night.
Now, one thing that has been shown to work for some kids, actually, I should say it works for most kids. I think it ends up being about 90% of kids who are affected by really recurrent frequent night terrors. And if it's an older child, these are the kids that this is going to work on the best, basically you keep a diary of the episodes. You try to pin point how many minutes these episodes occur after sleep on sets. So you just sort of observe them for a week or two. And they can know of when they fall asleep and when the night terror happens. So you can begin to predict about how far into sleep this is going to occur. And then you begin waking up the child. About 15 minutes prior to the expected episode time. And you have to really wake him up.
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You have to make sure they're fully awake and just get them out of bed, walk around. Out of bed for at least 5 minutes, and then they can go back and go to sleep again. And then you continue to do that for a week, and then stop. And what will happen for most older kids with frequent night terrors, for about 90% of them, is that will temporarily stop the problem. And if the frequent night terrors come back, then you can repeat it as necessary, where you wake him up 15 minutes prior to their expected time of a night terror. Then keep them up for about 5 minutes and back to sleep. And do that for a week.
Now I do want to point out, why would you do this? It's really for your sanity, on your child's'. Remember, your child doesn't even know this is happening. And, as long as they're not the kind of kid that when they have the night terrors, they're getting up and walking around and are a danger in terms of hurting themselves. But if they're just screaming out in bed, and you go in and they really don't know that you're there, they're not waking up and you know that this is a night terror, then do you have to do anything about it, not really. But if it's driving you crazy, then the prompted awakening is something that you can do to help and be less taxing on you as a parent.
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It is important to do though, if your child is at risk of hurting themselves because they're getting up out of bed during this episodes. Now warning signs of other conditions that could be going on such as seizures or emotional disorders or even rare signs of brain tumors. If you child is drooling, jerking, shaking, stiffening with the episodes. If each episode last longer than 30 minutes. If they do something dangerous during an episode, or if episode occur during the second half of the night, that would make you also concern about it. If they have several daytime fears or if these episode correspond to a lot of personal or family stress, these are all signs that there could be something other than night terrors that are going on.
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And as always, this is just an educational discussion about night terrors and their current thinking about them. If you are concerned about your child's night terror, make sure that you visit your doctor and talk to your personal doctor about the problem.
OK. We're going to move on to listener question number two. This comes from Conrad in Poland. And, Conrad says "Dear, Dr. Mike. First of all, thank you for amazing show. Before I discovered your podcast, I had spent quite some time digging through many shows, which turned out to be, well, not really as good. I don't know how many listeners tell you this, but, not only is your podcast very useful and informative, but it is also fun to listen to. You have a genuine natural style which makes the show sound both light and very, very professional unlike many other shows which are rarely both". Well, you're making me blush, Conrad. Thank you very much. Conrad goes on to say, "I also have a question. It looks like my newborn son is one of the many unfortunate colicky babies. My wife and I have been researching the subject on the internet, and not surprisingly, we're mighty confused".
0:35:08.6
Different websites offer conflicting advice as to whether or not anything can really be done about it, or what foods to avoid. Looks like my wife should go on a bread and water diet as even the healthiest foods like broccoli or milk are believed to trigger colic. My question is, is there a reliable blacklist of foods. Or are those lists just very hypothetical at best? Are there any tricks to help avoid colic?. Thank you, Conrad".
Thank you, Conrad. I also received an audio comment from Nicole, who has a similar question. So, let's go ahead and take a listen to that.
Nicole: "Hi, Dr. Mike. My name is Nicole and my husband is a long time listener. I am a first time caller. I have a question about something that is almost as afraid to talk about as poop, gas".
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"I have a two months old son. And sometimes he is inconsolable with crying due to belly pain and gas. We tried to give him like Mylicon drops. And then, I don't know if that did have any effect. I'm just wondering, if there is anything we can do to help him, or what is the cause of the gas so we can do something about it. I am nursing him. In fact, that that would do no help in the reduction in the amount of gas. But, sometimes it's just pretty severe. And, once he does pass gas or burps, he seems to be doing better. So, any comments or thoughts for me. Thank you very much. Have a great show".
Dr. Mike Patrick: All right. Thanks for your questions, Conrad and Nicole. So let's talk about colic. And I think in the course of our discussion about colic. We'll get most of the answers to your questions.
0:36:54.6
First, what is colic? Well, it's unexplained bouts of crying in an infant. And basically it follows the rule of 3's. That the baby cries at least three hours a day. It occurs at least three days a week. And last at least three weeks. And unexplained is the other key. Now if you suspect that your child has colic, you must see your doctor. Because, they really have to rule out other causes of infant's crying. And there are things like acid reflux that could do it. Bowel obstructions, ear infections, corneal abrasions. When they scratch their eyes with their finger nails. They can get a hair tourniquet, where you have a piece of hair that gets wrapped around a finger or a toe and causes pain. So they really, if you have a baby who is just crying a lot, you need to see your doctor so they can make sure that there is nothing else is going on.
So, the rest of this discussion assumes that you have seen your doctor and your doctor has said, there is nothing wrong except for colic. Well, if that's the case, first, you got to realize, you are not alone. One in five babies is affected to some degree or another with colic. And there are various degrees of how severe the colic is.
0:38:09.6
They usually begin in the first month of life. Most commonly between two and four weeks of age. And it's usually gone by the time that they're four months of age. So, if you're listening to this. And maybe your expecting and you don't have any kids at home of your own yet. You may think, OK, so I can deal with colic. It's only… most last for about four months. Well, let me tell you from the prospective of a dad who had an infant daughter who is colicky, four months is a long time. OK. Each crying bout, usually last one to two hours. And the infant usually appear normal between these bouts of crying. They typically occur around the same time each day. Well, that's not always true. They can occur at anytime. But most commonly, they're going to occur in the late afternoon and into the evening hours.
0:39:00.9
Now the baby when they cry with colic, they appear to be in pain. Their stomach muscles are contracted so that their belly feel hard and distended. They usually have their legs drawn up. They may arch their back, flex their arms. Struggle, act like they're angry and things that you would normally do to comfort a baby just don't work very well.
But just because they appear to be in pain doesn't mean that they are in pain. Now, when you look at a baby. If you get them upset for any reason, they sort of have that same look to them. In terms of having their belly muscles contracted and their belly feels hard. Their legs are drawn up, arching their back. I mean, that's just how babies act when they're upset about anything. It doesn't necessarily mean that you can say this is the cause of them acting this way.
0:39:58.4
Because they are flexing their stomach muscles, it's common for them to pass gas. Or they may even have a bowel movement from tightening their belly muscles. And their belly maybe distended also. Not just from firming up their belly muscles, but also because they tend to swallow air as they cry. So if they're crying for one to two hours, they're going to swallow quite a bit of air when they do that. That's going to make their belly look even more distended and they're going to pass gas with little stinkers as they're doing that, and they can have bowel movement with it as well.
So, because of this pattern, in the past it's been thought that, well, they must have a belly ache or the gas that they pass is the problem or they act this way, then they have a bowel movement, so, oh, they must have been constipated. But, the newer thinking is, that that is really not the case.
0:40:56.2
There is probably something going on inside the brain that makes them do this. Because, you have other kids that swallow a lot of air when they eat, when they're sucking with the nipple. Or at the breast, they swallow air as they do that. And they stinker all day long. And they're not crying with their gas. And their belly can seem distended too. We also know that there is a lot of kids who are constipated. Have hard firm difficult to move bowel movements ever few days. Or they may have soft bowel movements, but it will go a week. And hardly cry at all.
So, we think that probably there is something more than just a stomach ache or constipation or gas that is causing this babies to cry so much and to follow this pattern. I do want to mention too, that when you have a baby that cries a lot, something else that makes you concern about. If it's suddenly a new onset of those symptoms, that's why we talk about those Rule of 3's, you really want to see this happening over a period of time. If you have a child who is fuzzy now and then, but nothing too terrible. and they get to be two months old and they're suddenly crying all the time, that's a lot more worrisome than the colic patter that we have described here so far.
0:42:09.2
OK. So, what is exactly happening? Well again we don't know. There is a few theories and probably the truth lies in the combination of this things.
The first theory, kind of goes along with what we are talking about before with night terrors. That the central nervous system, the part of the brain that makes the baby upset and cry, probably just fires on its own. Because it's immature. So, again, it's not a seizure, because it's not the isolated to the motor areas of the brain. But basically, the area of the brain that controls crying fires. And so they act this way because of their brain just telling their body to do that. It doesn't mean that they are upset or they're in pain, it's just a sign of an immature nervous system. And that's why, almost universally, by four months of age, it goes away.
0:43:03.7
If it were constipation or if it were gas, it's beyond usual for those things to correct itself right at about four months for everybody. But, it does make sense, that in about four months, the brain has matured to the point that this sort of thing, can stop. It's also interesting to know that in premature babies who become colicky, it's about two or three weeks after they get to their due date that colic's sets in. And by the time they're about four months old passed their due date, it's when it goes away. So, when you look at it that way too, it's seems more of a developmental issue with the brain. OK, so that's one theory.
Another theory is that, this is from stimulation overload. So if you have a baby who has been sort of floating around in the amniotic fluid. It's dark, it's their warmth. And suddenly they come out to the cold, cruel world. But, there's a lot of stimulation that they weren't used to being quite so in their face before, plus, they're becoming more aware of sounds and things around them.
0:44:12.7
So now you got, all day long, the telephone is ringing, the TV is on, the vacuum cleaner is going, there's kids playing. They're waking up to eat, they're getting their diapers changed, and basically by late afternoon to early evening, they're just on stimulation overload. And by going into to this crying phase, they're able to basically block out all stimulation, and kind of retreat back into a dark, warm spice. If that makes sense.
On the flip side of that, there are some that theorized that maybe it's the opposite. And they're not stimulated enough, and so their brains sort of stimulates itself by having this episodes happen.
0:44:53.8
Third theory is that it's basically the baby's temperament. Because it is the least anecdotally. I don't know if there's been any study to show this. But, it does seem that colicky babies do become more challenging children during the child years, school age years and into the teen age years. So, there is probably some temperament pattern that is associated wit this as well. And then still, in that, in the theory, there is still some that believe, maybe an oversensitivity to gas could cause colic. But again, this is sort of falling out of favor in terms of an explanation for it. And again, the truth probably lies somewhere in the combination of these theories.
Well we know that it is not happening. And many internet sites claim that this are the issues, but really, it's not true. Because if any of these were that things that were happening, it's not colic. Because colic again is unexplained crying. So, some of them will talk about colic is caused from gas. Again, gastroesophageal reflux or basically, heartburn from spit ups causing colic or constipation or formula intolerances. But again, that's not really colic, it's reflux. That's not colic, it's constipation.
0:46:15.4
So, if you look into those things, and determine if it's a problem or not, you try to treat it, it doesn't go away, that may not be what the problem is. In which case you revert back to, this is probably colic that is going on.
With gastroesophageal reflux, about 2% to 4% of colicky babies actually, have shown in some studies, to have evidence of reflux. So, in those babies that probably is heartburn rather than colic. And for those kids using an acid reducer like Zantac or thickening their feeds with cereal, and consultation with your doctor would help those kids. But then again, when kids are vomiting or spitting up, he do have to rule out a bowel obstruction as a problem. So that's definitely not a diagnosis you make on your own at your home.
Constipation again, which is more infrequent hard formed thick bowel movements. Soft stools every few days can be normal for kids. Formula intolerance, that happens a lot less often than we like to think. But you could try a soy formula if you think that they're lactose intolerant or lactose free milk based formula. And milk protein sensitivity, usually that results more in things like blood in the stool, upper respiratory drainage, eczema, dry skin, and wheezing. That kind of thing and not just cranky crying episodes. But, changing their formula doesn't hurt anything to try. But in most cases for colic, it's not going to work, because that's not what the problem is.
And then what about mom's diet? Well, if you noticed a specific correlation, you avoid that food, it's easy enough. But for most infants, there is really no true correlation between specific food and crying episodes.
0:48:02.6
And that's why this lists, these black lists that Conrad speaks of are so large because pretty much everybody, you get the whole gamut of things people are eating. And babies are having this colicky episodes every day, and so, one time or another everything gets put on this list. But usually there is not much of correlation. But, if you notice something specific, fine. Avoid that. But that's probably not going to help you out too much. Now, there is one exception to that, you do want to watch out for stimulants such as caffeine, which is would be coffee and teas and sodas. Because caffeine is a central nervous stimulant that stimulates the brain and so they're is possibly the potential that it could also stimulate the cry center which would cause these colicky episodes to occur. So, that's something else to think about.
0:48:54.0
So what do you do if your child has colic? Well, again, you see your doctor to rule out other problems, that is very, very important. But really, if you have the diagnosis colic, the thing to remember is, it's not going to last too long. Even though it seems like it's forever. And you want to try to soothe them just as best as you can. And what works for one baby, is probably not going to work for another baby. There is no formula of these what you need to do to make your baby better with colic. Because it's going to really vary from one baby to another. But some ideas are, one of these baby slings that you wear in front of you on your belly and carry your baby around with you. For some babies that helps. White noise, such as vacuuming, a clothes dryer, a hair dryer, the white noise machines tend to help. And that would go along with that theory they're just trying to drown everything else, all the other stimulation out. So white noise might be able to do that for him. Of course, don't put your baby on top of a dryer, they can fall off. Don't aim the hair dryer right at them, just using those things to helping you by for noise.
0:50:02.0
Rocking your baby, music and dancing. Taking a walk with the stroller, going for a car ride. These are all things that have been reported to help for some babies and, but not others. Also, this sees pretty obvious, but I do want to make a point of it. Of course you never ever shake a baby, you've heard that before. But you can, if you have a colicky baby at home who is crying a lot. I mean they are crying a couple of hours, two to three hours, nonstop every day, it gets to you. You can understand why some people would get to the breaking point and loose and shake their baby. Obviously, I'm not saying that's the right thing to do, but, you have to understand, that it drives you to that point. And so, really, its better when you find yourself getting frustrated to put them in their crib, close the door, walk away.
0:51:03.9
And you get a sitter, a friend, relative, someone to be with them a little while. While you take a nap, while you clean the house, while you get away and go out for dinner in the movie. It's get to be a good mom and dad. You have to be strong emotionally and sometimes that means getting out and doing something for yourself. Of course, you want to warn the sitter what to expect and make sure that they have a plan on what to do. And again, this is if you know its colic. It's following the same pattern. If you have a baby who is inconsolable, and that's not like them, those aren't the kids you want to put in a crib and walk away. They could have meningitis or something bad going on. You want to make sure to get medical attention. But, I'm talking about the kids that you know its colic and going on for a long time. And you're at your breaking point. It is fine to ignore them for a little while.
0:51:56.9
All right, so thanks again to Conrad and Nicole. And with all of these things, it is important that you watch where you get information about colic. Because there are lots and lots and lots of internet sites out there on colic with bad information. I know that because in researching this particular article, this particular presentation, I always like to try to include, if I can websites that has further information for you. And I came across lots of websites that had bad information about colic. And lots and lots of ads. I think colic is one of these things that really get parents upset and rightfully so. So, your frustrated, you go to the internet, you type in colic, and these people who have these sites are relying on your click through for their web based advertising. So, you really do want to watch where you get information about colic.
There is a nice colic over view from Web MD that I found. And I will put a link to that in the show notes for you.
0:52:58.1
OK. Let's move on, the next topic is lead in the house. And this comes from Bristol in Lake Wales, Florida. Bristol says, "Dr. Mike, I have to tell you I'm really upset over what I am going to ask, it has become an issue so large with my husbands' parents that they have started attacking me as a mother. They are, I think overly so, concerned about lead paint in my home. My home was built on 1913. I've had my 23 month tested and myself, and there was no concern by either doctor. I have had my home inspected by three independent inspectors who all say, there is lead based paint, but they will not be concerned to raise a family there. The problem is that they're insisting, the in laws, that we move out. They said, even this morning that living in our house is the equivalent of doing cocaine around our daughter. They have told me that I am worshiping my house because I am not willing to move out immediately. I say that if the situation becomes worse, if our next lead test causes concern, that I will be willing to discuss the situation"
0:54:03.5
"When we find peeling paint, we take care of it without my daughter being around and clean carefully with dish detergent as recommended. Should I be doing more? I have gone as far to say, that I'm causing my daughter to be mentally retarded. She is just fine with no developmental issues at all. Nothing it seems will calm them. In turn, they had my husband all worked up. He wants to be tested for lead and wants to consider moving. I frankly think it is ridiculous. I am concerned and cautious about many things, including lead. I want a good school district, and I use car seats. I don't want my neighbors to be sexual predators. And I keep her immunizations up to date. We live in a flawed world. I could worry myself to death if I wanted to about numerous things, but I do not think that I am poisoning my child or myself. My husband, then, keeps badgering me about moving out and having the whole thing redone. Am I being too relaxed about this. I really value your thoughts. Thanks, Bristol".
0:54:57.9
OK, Bristol. Let me just say that, my opinion based on what you've said, and again, I can't give you the opinion without knowing all the facts. But based on what you said, it sounds like to me you are doing the right thing. If you live in a house, this is for the rest of you, that you are concerned about, there being a lead issue, you definitely want all the kids to have their lead level tested to sort of see where you stand. And consider having the adults tested in the house as well. If anybody has a high lead level, that has to be addressed through your doctor and you want to also contact your local health department for lead inspection and then you want to comply with any recommendations that they give you. So, Bristol, I guess if it's three independent inspectors who did this, you might want to contact your local health department and have them do an inspection. I find at least in our area, that they are not overly dramatic in terms of things that they recommend that you do. They are pretty simple things that are terribly expensive for the most part. Like you said, with using the detergent, and trying not to create dust when you are doing any, taking off paint chips and crack paints and that sort of thing.
0:56:17.7
I know if the paint is intact, they usually recommend just using like a latex paint to paint over the lead based paint. That can kind of thing. But then again, I'm not an expert at lead cleaning up. And the folks at the health department are experts. But I wouldn't be afraid of having the health department do the inspection. Because they're going to steer you on the right direction and tell you what you need to do to make the place safe. But I would say that the fact that all the kids have normal lead levels and the adults in the house has normal lead levels, that's very reassuring that there is not inappropriate lead exposure to the inside of the body. And that is what causes nervous system damage. When the lead levels in the blood are high.
0:56:58.6
Now, there is controversy as to how high is the lead level has to be in the blood in order to cause damage. And that's a different discussion. But there is definitely controversy there. So if your child list lead level is elevated, I think it's wise to remove them from the environment until your house is inspected and whatever remedies the health department thinks ought to be done are applied. If the lead levels are all normal, then suggesting that you're doing the equivalent of using cocaine around them, really in my opinion is just simply an inflammatory way of applying guilt so you'll submit to their wishes, which is a pretty immature tactic if you ask me.
Certainly many people live in old homes and have healthy children. If an inspection reveals lead risks, you need to safeguard your family by correcting the problem, which again is often an easy thing to do. Actually there is a great website at the EPA, the Environmental Protection Agency, has a very thorough lead sites that includes facts about lead, the health effects of lead, where it can be found, where lead is likely to be a hazard, how to check your family and home for lead.
0:58:05.5
It talks about lead in drinking water and what you can do to protect your family. It has information for buying or renting homes that was built before 1978. And it discusses how to safely remodel or renovate a home with lead based paint. And of course, it has additional resources and links, that's really a great all together lead site. And of course we'll put a link to that in the show notes.
OK. Listener question number four. This one is on viral meningitis. "Dear, Dr. Mike and team. I really, really like your podcast. And I have been listening for a few months now. I learned something new every time. When my son was getting the Rotavirus vaccine, I became a little concerned based upon some of the risks of complications. But your podcast specifically addressing it put me at ease. Thank you. My question has a sense of urgency. Yesterday, I was informed that there is a confirmed case of viral meningitis in my seven month old son's daycare room.
0:59:03.3
The child that has it is a staff member's two month old and a preemie son. So I sensed that this is really hitting home for them. Currently, the child is in the hospital on antibiotics. The daycare provided a fact sheet, regardless, I contacted my pediatrician to see what we should do. Pediatrician comforted me somewhat, and says it's basically a wait and see. And stress the importance of good hand washing and basic things to watch out for. In dropping my son off today, I discovered that half his class quit yesterday. My question is this, should I withdraw him as I understand that the incubation period is 14 days. so in essence, if my son is going to get it, it's going to happen regardless of unenrolling or not. I think the larger issue at hand is the cleanliness. Hand washing, toy cleaning, et cetera. And consistency with cleanliness within the classroom. It might have some bearing that his is my third child. And I am somewhat more relaxed and comfortable with him, where is with my oldest, I freaked out and took her to the doctor for a recoiled hanged nail and so on.
1:00:10.6
The other parents that withdrew were first time parents. I think his caretakers are great with him. And the school in general is nice. My older children are school aged and away as summer camps, so their presence doesn't have direct bearing just yet. Sorry for the rambling message. If you need more details of what you have don't hesitate to let me know. Thanks". And that's Cathy and Hank.
Well, thank you Cathy and Hank for your question. And this is an important question as we head into summer here in Northern Hemisphere. I'm going to simplify this a bit.
What is meningitis? It's an infection of the membranes and the fluid that surrounds the brain and the spinal cord. And in general, there are two main types of meningitis, bacterial and viral. Which is also called Aseptic Meningitis.
1:00:59.6
Now, there are other forms of meningitis. But these are the two named ones the we see in the pediatric population. Now, bacterial meningitis is very serious. And it can result in brain damage and death if it's not identified promptly and treated appropriately. On the other hand, viral meningitis is far less serious. It almost always results in a full recovery. And it has to resolve on it's own. Antibiotics do not help viral meningitis. So, viral meningitis, not so serious for the most part. Bacterial meningitis, very serious. The problem though, is that the outward symptoms of the disease are about the same. So, when you have a diagnosis of meningitis, you have to assume it's bacterial meningitis until proven otherwise. And the children are admitted to the hospital, started on IV antibiotics, until bacterial meningitis is ruled out, with a spinal tap and a culture.
1:02:03.4
So, if this child is known to have viral meningitis, and bacterial meningitis is ruled out, then he does not need antibiotics for meningitis and he'll probably go home very soon. So, I suspect what's going on, is that the child is still on the hospital, on antibiotics. They think it's a viral meningitis, but they're probably waiting a couple of days to make sure that the cultures are going to be negative bacteria and then go ahead and send them home. And then retrospectively can say, won't really a big deal. If the child had had bacterial meningitis, then it becomes, well which bacteria caused it. And that's going to determine what you do. But since this is a viral meningitis, we're just going to kind of run with that and since we're kind of running late on our segments here.
So, viral meningitis, well let's talk first about contagiousness. Bacterial meningitis, again there are different forms of this. Some are not very contagious, some are highly contagious. So you have to know which bacteria it is that is causing the meningitis. For viral meningitis, now most of these are very contagious because they are viral in nature. Cause viruses are very contagious and easy to pass around. But here's the kicker. The Enterovirus family of viruses, those are the ones that most commonly cause viral meningitis. Most people who get an enterovirus infection do not get meningitis even when they are exposed to someone with meningitis. Usually what they'll get is upper respiratory symptoms. So you get a cough, runny nose. You can also get a rash and a high fever associated with this enterovirus infection. So, whether a person gets meningitis from the enterovirus, is more a function of their immune system and luck rather than the virus itself most of the time. Now, there is a Enterovirus 71, it is seen more in Asia and not so much in the United States at this point, that maybe more specific for getting into the central nervous system and causing meningitis specifically.
1:04:11.2
But we are not seeing much of that around the United States right now. There's also some other viruses that are not enteroviruses that can cause viral meningitis that you can catch from another person. And that is more specific for just causing meningitis. But again, those are rare and actually more often transferred through mosquito bites than anything else. So, what we are talking about here, most viral meningitis is going to be cause by enterovirus which is contagious but you'll probably just get a cold from it and not meningitis. So, you can be around someone with an enterovirus infection who has cold like symptoms from it and you could end up getting meningitis. And you can be around someone with enterovirus meningitis and just get cold like symptoms.
1:04:57.7
So, when your pediatrician says it's a wait and see, it really is. And basically if you're around someone who has viral meningitis and you get a high fever, headache, any symptom. You want to go ahead and see your doctor so they rule it out and you. But most of the time, this is not a serious situation. The daycare gets upset about it and makes a big deal about it, because that's the word, meningitis. And if it had been bacterial meningitis, then you do need to make a big deal, about it. Enterovirus infections are very common. 10 to 20 million people are infected with enterovirus in the United States each year. And it is rarely someone will get viral meningitis from enterovirus. But, the vast, vast majority of these 10 to 20 million cases each year just result in upper respiratory symptoms like cough, runny nose sneezing and they can also have rashes and fever.
OK. Just because someone has meningitis from enterovirus and you're around them, it doesn't mean that you're going to get meningitis from it too. Odds are that you won't.
1:06:01.2
But even if you do, viral meningitis is rarely serious. In terms of pulling your child out, seek medical advice. So, I'm not going to do it, instead you got to call your doctor and ask. But you can probably tell from the tone of my conversation what my advice would be to someone in your situation that I was seeing in my office practice.
OK. One more listener question. This one is on fever. "Dr. Mike I love your show and Karen's blog. My 10 month old daughter recently and still has a viral infection. Her doctor is guessing Roseola. Well, on her high fevers, I got so many mix messages from friends in the medical field to family members with years of experience. So, what is the low down on fevers? How high is too high? How can your child get brain damage? And how long should it take the fever to come down? And how often can I rotate Motrin and Tylenol? At what temperature should you take your child to the emergency room? And really any info you think that is important about a high fever….
1:07:00.6
"It is scary enough when it happens, and when you add confusion on top of it, that makes it worse. So I really want to be prepared next time. Thank you so much, Chrissy in Mississippi".
OK, Chrissy. Well thanks for your question. You know you have to remember that fever is a normal by product of your body fighting an infection. And the reason that we treat fever for most kids, is to keep them comfortable. 'Cause having a fever stinks. I mean, you have decrease energy, your muscles hurt, your joints aches. You can have a headache and this kind of things. So, you feel lousy when you have a fever. And that's the main reason that we treat fever in kids, not because there dangerous. Now, fevers can be associated with febrile seizures, but, it's not… febrile seizures are not the result of brain damage from a high fever. It's really more genetics that play a role in febrile seizures. And it's not so much how high the temperature goes, it's more a function how quickly it rises. I think we've discussed this before.
1:08:07.5
Basically if you have a kid whose been cruising along with a normal body temperature, and all of a sudden, they're a 102, a rapid rise is what sets off a febrile seizure if they're genetically inclined to having that happens. So, if you… you're cruising along a normal body temperature, then you're 100.5 and an hour later, you're 101, and then an hour later you're 101.5, you're less likely to have a febrile seizure, then when you have that rapid rise. And that's why most febrile seizures, the parent actually witnesses the seizure and then they realized "oh my kid has a fever", because it's usually right on the onset of the fever. So it's very difficult to prevent because you didn't know the kid was going to have a fever in the first place. So, when you have a kid who is 103, 104 and they don't… they didn't have a seizure, they probably not going to have one. It's usually in the beginning when this happens.
1:09:06.5
Also, the ultimate height of the fever does not necessarily correlate with how sick your child is. Some children are just good at making high fevers even if the illness is only a virus. And then there are some serious illnesses that may only have a low fever associated with them. By low fever we're talking 100.5 to 100.9 in Fahrenheit that's measured rectally and a high fever more 101 clear up to 105 or so. I rather not go in to dosing and how you alternate the medicine, cause again, that's medical advice and I'd rather you call your doctor and ask them how you dose Motrin and Tylenol and this sorts of things. But if you are concerned about your child having a fever, call your doctor. That's why they get paid. If you're worried about it, don't feel embarrassed. Call your doctor and let them know, "Hey, I'm worried. My child has a fever".
1:10:03.0
If you're interested in more information about febrile seizures, I did write an article about a year ago, called "Respect Your Childs' Fever But Please Don't Fear It" on the PediaScribe blog, back before I started the podcast. And I was writing regularly on the blog. And I'll include a link to that in the show notes. I do know Chrissy that your question about fever and brain damage is also addressed in that article. So, be sure to check it out and again I'll put a link to it in the show notes.
OK. That concludes this week's listener segment, and we will return with our "Research Round Up" right after this short break.
[Music]
OK. Moving along to our Research Round Up. It is brought to you in conjunction with research partner Devon Technologies. Creator of robust information retrieval software for the Macintosh platform. And you can visit them online at devon-technologies.com.
1:11:12.3
OK. We are definitely running over on today's program. So we're going to do only one research topic, since we did a little bulkiness on the News Parents Can Use and our listeners' segment. This is an interesting study though, seafood intake during pregnancy more maybe better. This was a research study done by the US National Institute of Health. the University of Illinois in Chicago and the University of Bristol in the United Kingdom. And it was published in Lancet, February 2007. Now, the question before the researchers, well actually, they started to do this study quite a while ago. And in March of 2004, the FDA and the EPA published advised that women should restrict seafood consumption to no more than 12 ounces, which is 340 grams or about three portions of seafood per week to limit fetal exposure to mercury.
1:12:11.6
But seafood is also a major source of Omega 3 fatty acids, which are important for fetal neurodevelopment. So the question became this, does lower seafood intake affect neurodevelopment? So, again the researchers were doing this back in the early 90's. But, as they got to the point where they were completing their study, they thought, this is a good response to the March 2004 FDA and EPA advise. That you should restrict your seafood consumption to no more than 3 portions per week.
Now, what they did with this study, again it started in the early 90's and we'll explain here in a minute why it took them so long to get it finished. 11,875 pregnant were included in the study. And these were all women who had expected delivery dates between April 1st 1991 and December 31st, 1992.
1:13:08.3
And all of these women were given food frequency questionnaire at 32 weeks gestation. So, they were 32 weeks along in their pregnancy when they answered this questionnaires. And based on the questionnaires answers, they were divided into three groups. The first group had no seafood each week, the second group had up to three portions. So, one to three portions of seafood each week. But it was 340 grams or less. Which was the FDA and EPA in March 2004 recommended. And then the third group, ate over 340 grams or more than three portions of seafood each week. And then they assessed their children's development in this three groups. They assessed all the kids development at six months of age, 18 months of age, 30 months of age, three years of age, six years of age and 8 years of age.
1:14:03.3
So, they follow these kids for almost a decade. They did multiple tests used to study these children including the Westler Intelligence Scale. The Denver Developmental Screening and questionnaires that asses for social interactions, peer problems, hyperactivity, emotional symptoms and conduct problems. And then what they did, is they adjusted these three groups for 28 potentially confounding factors such as maternal age, their housing, education, socioeconomic status, the child's birth weight, gestational age at delivery, the child's sex. They corrected for all these things to make the three group very, very similar except for one variable, and that was how much seafood mom was eating during pregnancy.
1:14:52.2
And the results were that the no seafood group and the less than three portions of seafood per week group showed statically significant increased risk for lower IQ, fine motor delay, communication delay and social development problems. So, the no food group and less that three portions a week, did have a statistically significant increased risk for developmental problems and a lower IQ. Furthermore, in the over three portions of seafood per week group, there was no evidence of any adverse effect on child's behavior or development.
So, the authors conclude that this study did not find any evidence to support the warnings of the US Federal Advisory that pregnant women should limit their seafood consumption. By contrast, maternal consumption of more than three portions of seafood per week appeared to be beneficial for a child's neurodevelopment. Suggesting that an advice to limit seafood consumption could actually be detrimental.
The authors conclude that any benefit accrued from reduced methylmercury exposure was outweighed by the reduced intake of fatty acids essential to the developing fetal brain.
1:16:07.2
This is an interesting study because there is all this hoopla over mercury in immunizations and were causing problems with that. And the reason that we felt that mercury should be taken out of the immunizations, is because over the course of a child's first year of life, with all the immunizations out there, they were getting exposed to more and more mercury. However, still, when they decided to take it out of the immunizations, the mercury still was equivalent to the amount of mercury in one can of tuna fish that a child was exposed to over the first year of their life. So, I think this is just another study that shows small amount of mercury exposure probably aren't quite as bad as we really think that it is. I think that's an important point to make with this study.
1:17:03.0
Now, I do want to mention to that why was the mercury there in the immunizations. You could think, well, why not take it out? But remember, it was a preservative and the shelf life of these immunizations in multi-dose vials, which are a lot cheaper than single served vials, the shelf life was much longer. And we didn't ran into this supply kind of problems that we ran in today with the not as good of a preservative in the vaccine material. So, all things to keep in mind. I thought that was an interesting study though. That looked at seafood use or eating seafood during pregnancy. I"m getting a little loopy here, 'cause I'm not used to these podcasts running quite this long.
That includes our Research Round Up this week. And I'll be back to wrap everything up right after this quick break.
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Once again the information presented in every episode of PediaCast is for general educational purposes only. It's not an exam room folks, it's a classroom. 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 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. PediaCast is licensed under an attribution non-commercial, no derivative works creative comments license. For more information on this copyright license, please visit pediacast.org and click on the creative comment at the bottom of the page. If you're interested in using PediaCast material for a commercial project, please email pediacast@gmail.com for detail.
1:19:00.3
Don't forget over on to Karen's PediaScribe blog. She's still running her contest. If you submit a blog comment, then you'll get one entry for every blog comment that you make. If you review PediaScribe, the blog on your blog, then you'll get two entries. And if you review PediaCast, the podcast, on your site, you'll get three entries. You just have to send the URL that shows your review and then we'll put you into the contest. And what do you get? Well you get $20 Amazon gift certificate to one lucky person. And we will be drawing the name for that during a PediaCast episode that we are going to record on, I think it's on June 17th. So you have through the 15th to get your blog comments and blog reviews and podcast reviews out there, and then we'll draw one lucky person at random to win the $20 Amazon gift certificate.
1:19:59.6
Now, my favorite blog post of last week was "A Box From My Memories". And it talked about creating a memory box. Small things with index cards and it will help you remember funny things that your kid say or funny things that they do or just things that you find precious. I really enjoyed the blog post because it helped remind me of some of the things my kids had said and done that otherwise honestly would have forgotten about. But there are some pretty funny things, and it was nice reading them again. So, we'll put a link in the show notes to "A Box From My Memories" over on Karen's PediaScribe blog, which is the blogging compliment of the podcast.
Also, you know, my other project is "Mouse Matters". And anything and everything Disney column that I write every week for "The Dis". Last week it was on "Love Bugs". If you live in the South Eastern United States, you know exactly what I'm talking about. And it also relates love bug activity to predictions on the hurricane seasons. So, you may want to check that out. We'll put a link in the show notes to "Love Bugs". "Herby Is Not Alone", is what I called it.
1:21:05.3
OK. Next week, we're going to talk about tracheomalacia. We're going to discuss a strange rash. And also sleep apnea. And of course we'll also have News Parents Can Use and we'll add to our Research Round Up.
Thanks again to news partner "Medical News Today", research partner Devon Technologies. And this weeks' sponsor, Mariner Software. Website and feed artwork are brought to you by Vlad Studio. Be sure to check out their website at vladstudio.com. Thanks go out to loyal listeners by subscribing, listening and contributing to PediaCast, you were the ones who keeps this project going. And of course, last but not least, thanks to my family. Karen, Cathy and Nick. Thanks for the time, thanks for the love and thanks for your never ending support. Don't forget if you will have a topic that you'd like us to discuss, you can go to pediacast.org and click on the contact link. You can also email us at pediacast@gmail.com. You can also attach an audio file or call the voice line at 347-404-KIDS, that's 347-404-5437.
1:22:08.5
Promotional materials are available on the poster page of the website. Reviews on iTunes are also appreciated. So, if you haven't done that yet, please do. Also you can dig us at digg.com and there is a link on the website to dig us. So, be sure to tell your friends, family, co-workers and neighbors about the show, so we can empower more parents to make great decisions regarding the health and well-being of their children. 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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