PG-13 Films, Herbal Supplements, and TV Watching – PediaCast 040

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Topics

• We draw a winner this week in the PediaScribe Comment Contest
• PG-13 Films Not Safe for Kids
• Herbal Supplements
• TV watching at 18 months
• Head Lice
• Colic Comments
• Dental Emergencies
• Hand Sanitizers – effective? safe?

Links

• Kids-in-Mind
• Family Media Guide
• Screen It!
• Medline-Plus Guide to Herbs and Supplements
• PediaCast #4 – Head Lice (00:43)
• MotherThoughts – Blog Obsession
• Pediatric Dental Emergency Sheet
• Booze Ooze – from Snopes.com
• HandClens (non-alcohol hand sanitizer)

Transcription

Announcer: This episode of PediaCast is brought to you by Mariner Software.

[Music]

Hello mom, dads, grand moms, grand pops, 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.

Dr. Mike Patrick: Hello, everyone. And welcome to PediaCast, a pediatric podcast for parents. This is Dr. Mike, coming to you from Birdhouse Studio. I'd like to welcome everyone to the program. It's episode 40. And as always we have a full show lined up for you today. The new segment is going to be abbreviated just a little bit and you'll find out exactly why that is in just a few minutes

0:01:00.8

But we do have a story along with our little special segment. As part of the news, we are going to talk about PG 13 movies and how appropriate are they for our children. Also then, in the listener segment this week we're going to discuss herbal supplements, TV viewing for babies and toddlers, head lice. We have a comment about colic. Which we talked about, was that last week? maybe the week before, and then dental emergencies. We're going to discuss those too. And in the research segment, we're going to talk about anti-bacterial hand gel. Now don't forget if you have a topic that you would like us to discuss, all you have to do is go to pediacast.org and click on the contact link. And you can send your message that way. Or you can e-mail me at pediacast@gmail.com. You can just do a regular email or you can record an audio file if you would like. And attach that to the email.

0:01:58.8

You can also call our voice line at 347-404-KIDS. That's 347-404-5437.

All right, before we get started, I do have a little bit of announcement to make that I will think will affect PediaCast for the better. Of course, you all know that I am a practicing pediatrician and have a full time practice. It's very busy. A very active family life, we do a lot of things together. And then write a weekly column and do the show. Well, it's really gotten to be to the point where I'm spreading myself a little bit too thin. So, I've stepped down from writing my weekly column which I've done every week for about a year now over at the "The Dis". It was a column called "Mouse Matters". And I stepped down from that to make time for you. So, I just wanted to really be able to spend more time concentrating on PediaCast.

0:02:57.7

I have some ideas of where I want the show to go. And I wasn't able to get around to making those things happen because of just not enough time. So, one of the things you can expect here coming up soon are going to be special interview episode that are going to be an addition to our weekly get together, where we talk about news, answer your questions and then have a research segment. 'Cause I just have so many questions from people and I hate to rob you of the listener's segment, but we really need more time than the research and news allows for an interview, so, I think what we'll do is just have some special interview episodes coming up here soon. I already have some folks lined up. We don't have actually have dates scheduled yet. But, I need to get on that.

Another thing we're going to have coming soon is a PediaCast stores. So that you can get PediaCast brand merchandise like t-shirts and hats, aprons, those sorts of things. Now, this is not an effort to raise money by any stretch because the plan right now is whoever we end up doing the store with, whether it's cafe press or there is some other ones out there that I've been looking at. But we do have the designs done. So, it shouldn't be too much longer before we have that online.

0:04:14.4

But, I just want to point out that whatever the cost is at the PediaCast store, there is not going to be any mark up on that. Because we don't want to make any money off the store. We just want you to help us spread the word about PediaCast, 'cause if you wear clothing around with our logo on it, then, you going to be able to spark conversation and hopefully it will be able to increase our audience that way.

And of course, there is the newsletter, no. You know, you guys are great in terms of signing up for that. And I really am going to get one out here soon. I do have plans for that as well. So hopefully, I'm, with stepping down with Mouse Matters, because it did take up probably a total of four or five hours of my time every week, between researching and then writing, and re-writing. And it's about a thousand word column every week. So, it did take up quite a bit of time and I'll be able to use that extra time I have on PediaCast.

0:05:07.3

OK. So, let's go ahead and move on. As always, but we have to say it, the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, call your doctor and arrange a face to face interview and hands on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at pediacast.org. And with that in mind, we'll be back with News Parents Can Use. But, there's a special segment before we get into the news, and that's all coming up right after this.

[Music]

0:06:00.0

[Music]

All right. Welcome back to the program. This is the point in the show when we normally have our News Parents Can Use. And we do have a new story for you. But before we get to that, we're going to do something a little bit different. We had a contest over on the PediaScribe blog, going on the last couple of weeks. And the blog is written and administrated and produced and all that business by my lovely wife Karen. She resurrected the blog, what?, it's been a few month ago now. It was basically dead and she revived it. And now it's thriving. Welcome to the show Karen.

Karen Patrick: Hi. Thanks for having me.

Dr. Mike Patrick: I know we've had your voice on some prerecorded segment. I think a time or two on the show. But this is the first, actually I think you called in.

Karen Patrick: That's right.

Dr. Mike Patrick: I think you called in to the Skype line. But anyway, this is the first time that we have you on the show. And there's been quite a few people who have written in saying that they think that you should be on the show more often.

Karen Patrick: Well, I don't like how my voice sounds on tape, so, I'm going to stick on the writing as much as I can.

Dr. Mike Patrick: All right. We'll drag you in here from time to time though. OK. So why don't you tell everyone a little bit about what PediaScribe is all about. 'Cause there are some people I'm sure who listen to PediaCast who have not visited the blog, and I'm sure they're interested to know what's it all about.

Karen Patrick: PediaScribe, Mike had me started out more as a parenting issues and maybe a little bit of health topics. But, over the course of the last few months, it's really turned into a, just about anything I feel like writing about. You'll find some parenting issues, some health topics. But, mostly it's just what's going on in our lives and funny things that people in the family have done. You'll get the other side of Dr. Mike in this posts.

Dr. Mike Patrick: It's not a side A necessarily want to see, trust me.

Karen Patrick: You know, from the comments, people enjoy that side of you.

Dr. Mike Patrick: And our kids certainly provide materials for the blog as well.

Karen Patrick: That's right, they'll do something funny and then they'll get embarrass and say "You'll not going to blog about that mom", and by the time they're already done doing it, I'm writing it down as a topic for the next week.

Dr. Mike Patrick: That's incentive for them to behave themselves. 'Cause they're at that age being 10 and 12 almost 13, when it's pretty easy for mom and dad to embarrass them. So, all you have to do is threaten, hey, if you don't stop, we're going to blog about that.

Karen Patrick: And that's right, or hey if you don't stop acting like that, dad is going to start dancing in the restaurant. That pretty much gets them in line right away.

Dr. Mike Patrick: I think it gets everybody in line, and not to watch. All right. So, why don't you tell everyone about this contest.

Karen Patrick: The contest was just a way to encourage participation in the blog. To encourage people to comment and form a little community. Basically you earn points, either by commenting or by writing reviews of PediaScribe or PediaCast on your own blog.

Dr. Mike Patrick: OK. So, how many people are we talking about? We just, you know, like three or four people and we're just going to pick one or how does it work?

Karen Patrick: Actually, there were 103 unique visitors to the blog. And over 276 points were awarded. So, a large number of people to choose from. And what I did, because I didn't want to write everyone's name on a piece of paper once it got to be that many. I assigned everyone a number and as you commented or wrote a review, I just give you a tally mark and then we made little slips of paper, actually Katy did, and just wrote that number, your number on a slip of paper over how many times you had commented. So I have a bowl full of 276 little squares of paper here that Katy is going to pick from.

Dr. Mike Patrick: Is that a Tupperware bowl?

Karen Patrick: That is Tupperware.

Dr. Mike Patrick: Nothing really fancy, all right.

Karen Patrick: That's right.

Dr. Mike Patrick: I do want to make one correction. You said that we have a hundred and some unique visitors. That's actually a hundred and some unique commenters, right?

Karen Patrick: That's right.

Dr. Mike Patrick: There are a lot of people who visit who don't ever comment.

Karen Patrick: That's right. And just because the contest is going to be all over here, that doesn't mean you need to stop commenting. I've had a great time getting to know you guys and hearing the feedback. So, stick around.

Dr. Mike Patrick: And maybe we'll run another contest at some point.

Karen Patrick: Maybe we will.

Dr. Mike Patrick: OK. All right. So, Katy and Nick are both here. Hi, guys.

Nick and Katy Patrick: Hi… Hello…

Dr. Mike Patrick: All right, don't be shy. So we have the Tupperware bowl, and Karen is, actually Katy is going to reach in and mixed them up. See folks this is real. All right, she is going to pick one square and we'll see what number is on it. What number do you have Kate?

Katy Patrick: Number two.

Dr. Mike Patrick: Number two. OK. So we got to go all the way to the beginning of our list.

Karen Patrick: And number two corresponds with Awesome Mom. And Awesome Mom, I'll be emailing you with information about getting your Amazon.com gift certificate. And thanks so much for commenting. And actually, she was my top commenter with 33 points earned.

Dr. Mike Patrick: So, basically, she made a third, almost the third of the comments, right?

Karen Patrick: Actually, more like a seventh or so.

Dr. Mike Patrick: Oh.

Karen Patrick: Honey, but you know, that's why I teach math.

Dr. Mike Patrick: Wait no, a third, how many comments did she… oh…

Karen Patrick: 277

Dr. Mike Patrick: Oh, OK. Yeah, never mind.

Karen Patrick: Looks more like an eighth

Dr. Mike Patrick: An eighth.

Karen Patrick: Just a quick math on my head.

Dr. Mike Patrick: All right. So, she beats the odd.

Karen Patrick: But the point is, the more you had comment, the better chance of winning, I guess.

Dr. Mike Patrick: OK. And I calculated drug doses in my head.

Karen Patrick: No, you calculate, there is a calculator.

Dr. Mike Patrick: No, most of them, I just know by heart. OK, well thanks for joining us for the PediaScribe contest. And something else?

Karen Patrick: Just, hit pause, hit pause.

Dr. Mike Patrick: Hit pause, this is a live broadcast. What are you talking about hit pause?

Karen Patrick: You have a surprise, I have a surprise, but I have to do some tallying.

Dr. Mike Patrick: Oh, OK, OK. Hold on folks, we're going to hit the pause button apparently. And we'll be back in just a second. OK. Well we have to hit the pause button there, 'cause apparently, Karen had a little something up her sleeves. So, I'll let you explain.

Karen Patrick: That's right, I wanted to add another gift certificate to the mix. And I was going to give it to the person who is the top commenter, but seeing that she already ran away with the number one price, I had to do some quick tallying and figure out who was the second commenter on the list. And it turns out, it is a tie. So, I'm going to take that second $20 Amazon gift certificate that I was going to give out. And I'm going to have to split it between two people. Because I have two people who commented or earn the points from writing reviews on their own blog. They each got 18 points. So, Riva, you will be getting a $10 Amazon gift certificate. And Dawn, you also will be getting a gift certificate. So I'll email you the information for that.

Dr. Mike Patrick: All right, well, so congratulations, to all three of our winners. And as Karen said, please stay tuned to the blog because there's always going to have fun stuff on there for the most part not medical, it just gets a little too serious if you just talk medicine and health the whole time. So, she's kind of like the class clown of PediaCast.

Karen Patrick: And I'm proud of that title.

Dr. Mike Patrick: All right. That was a fun segment to do, it really was. Let's go ahead and move on to news.

PG 13 films, not safe for kids. At least that's what UCLA researchers say. They call it "Happy Violence". Happy Violence. They're borrowing that from the late communications theorist George Gardner, Happy Violence is that which is "Cool, swift and painless". PG 13 films don't consider the consequences of violent acts such as injury, death and a shattered lives of the people involved. Why this matters say Teresa Webb, a researcher in the Department of Epidemiology in the Southern California Injury Prevention Research Center at UCLA School of Public Health, is simple. Youth violence is a common place occurrence in American society. Homicide is the second leading cause of death among 15 to 24 year olds over all and immediate depiction of violence helps teach such acts to children leading to three effects. Increased aggression, fear for their own safety, and a desensitization toward the pain and suffering of others. In a study published in the June issue of the "Journal Pediatrics", Webb and colleagues report that in a sample of 77 PG 13 rated films, a total of 2,251 violent actions were recorded, with almost half resulting in death. Although only a small sub set of this content contains violence that was associated with negative effects such as pain and suffering. Only one film "Pay It Forward", in which the young hero is stabbed to death, contained violence that will demonstrate to youthful viewers how horrific violence can be. I apologize if you haven't seen that movie yet.

0:16:03.3

A violence permeated nearly 90% of the films in the study said Webb, and while the explanations and causes of youth violence are very complex. The evidence is clear that immediate depictions of violence contribute to the teaching of violence. This is especially true in our society with the average young person's engagement with the visual media and all its forms can run to as many as eight hours a day. The researchers sampled all PG 13 rated films from the 100 top grossing movies of 1999 and 2000 as established by "The Hollywood Reporter". To obtain their results, the researchers quoted each act of violence in the context it was presented and based on features known to put violence in a good or bad light. Such features include the motivation for violence, presence of weapons, consequences, and degree of realism. Cartoonish fantasy violence, is less influential than a hero punching the villain in the face to resolve a problem.

0:17:05.0

Thus the violence in "The Mummy" is less influential than that shown in the "James Bond" flick "The World Is Not Enough". The research follows up on a 2005 study they conducted that looked at movie violence and all the ratings category established by the "Motion Picture Association of America" or MPAA. In that study they found that parents using the rating system to gauge movie contents received little meaningful guidance related to violent content. This time around the researchers selected the PG 13 category because it is become a repository for action films. These films said Webb are often the largest budgeted ones made by the Hollywood film industry, and have also been found to be equally if not more violent than R rated films. Webb faults Hollywood which disavows any relationship to education and insist that it's only commitment is to transport and entertain it's viewers but in no way to edify or transform them.

0:18:01.0

"Well, that's a cop out". said Webb. The science is clear that viewers do in fact learn from entertainment media. In deed popular films can act as powerful teachers engaging children and youth emotionally even physiologically in ways the teachers in classrooms could only hope. Worse, she notes, the MPAA Rating System, which runs from G for General Audiences to NC 17, under 17 not admitted, has in recent years, been subject to ratings creep. Meaning, ten years ago, a film would have been rated R, is now being rated PG 13, she said. So what is a parent to do? Well, Webb notes there are several websites that give more comprehensive reviews of violence and sex in the movies than the MPAA ratings. This include "Kids In Mind", "Family Media Guide" and "Screen It". She and her colleagues cautioned parents against allowing unsupervised viewing of films and call on pediatricians and public health professionals to continue their advocacy role for a more child friendly media environment. And most of all for the film industry and its ratings board to recognize the medium does indeed have an influence on young viewers.

0:19:18.4

Well, there is no surprise there. You know, I'm going to put links on the Show Notes. But the really important thing here I think is just to get these sites out. Because, you just get this PG 13 rating, you really want to know more of what is in that movie. And this three sites have good reviews. Again, it's Kids In Mind, Family Media Guide and Screen It. Now, the only one that we ever use as a family is the Family Media Guide. We had a membership to that guide for a couple of years now. And it really does a nice job of telling you exactly what goes into a PG 13 movie that you are thinking about whether you are going to watch it with your kids. Or where we find it, this will be a movie that we haven't seen in years. And we think "Oh, that movie will be good to watch with the kids".

0:20:01.9

But then we go to the Family Media Guide to remind ourselves exactly what is in that movie. Now, I will say this to, this is just my personal viewpoint, you do have to realize that when you read some of those reviews, these movies always seem worse than what they are when you are actually experiencing the movie. Because they have the section of all the bad language that's in it. And of course, that language is sort of spread out among an hour and a half, where when you look on this site, you know you see like, you know 20 F bombs and well, maybe that is going a little over board for PG 13. But you know what I'm saying. You see them all together there and it makes it seems like it's worse than what it really is, because at least with our kids, a lot of that stuff or at least maybe it's just wishful thinking as a dad. 'Cause over their head they probably understand more than I think they do. But, the other thing that you could say is that, there is entertainment value. You're doing something as a family and when there are violence scenes and innuendos with sex and the language, it does provide an opportunity to talk to your kids.

0:21:05.8

So, at the very least, if your kids are watching this, because they're going to learn more what goes on in the world, anyway. Maybe this is a bit of a naive opinion, but the way I see it is if they experience those things, but you're able to talk about to them about it. To say "That wasn't real, you know, in real life what would have happened"… then there is going to be more interaction as a family. And I think more learning to go along with it. Now of course, the American Academy of Pediatrics will probably disagree with me on that, we just shouldn't take our kids to see them at all. But, I kind of take the middle of the road approach. I try to be practical on these things, so.

All right, well let's go ahead and move on to our listener's segment. And we'll be back and do just that, right after this.

[Music]

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[Music]

Melissa: "Dr. Mike. My name is Melissa. I'm in the Yakima, Washington. I have enjoyed listening to your podcast for the past month or so. I just recently down PediaCast. And I have a question for you about an older child. We have two daughters, one is almost five years and the other is just three months. But the five year old, my mother-in-law is very into homeopathic medicines and herbs and vitamins and that type of thing. And she is always telling me, you should try this or you should try that or you should try this vitamin or that oil or whatever instead of a medication. And I'm OK with that. But I know that they have not been tested the way that the pharmaceutical company are testing the drugs".

0:23:07.3

"So my question for you is, how can I find out reliable information about these vitamins and what are not it's safe for someone at the age five to be taking? You go to one website and it says, yes. They can take it, and you go to another, and they say don't give it them until they're 15. So there is a lot of conflicting information out there. And I just wonder if you have a way to help us work that all out. Thank you so much. Keep the podcast coming because I just love to listen to them".

All right. Well thanks for the question Melissa. And we're going to talk about herbal supplements and remedies in a moment. But before I do, I just want to remind you that this episode of PediaCast is brought to you by Mariner Software at marinersoftware.com. Now on the past few weeks, we've talked about several Mariner Software products. Programs like Mac Journal, Win Journal and Desktop Poet.

0:24:02.5

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0:25:06.2

All right. So moving on to Melissa's question about herbal supplements and remedies. I got to tell you, this is a tough topic. And it's a tough topic for me because honestly in a medical school and throughout residency training, we really been throughout your continuing medical education as you go on to a career in medicine. These things pretty much are not talked about in very much detail for us. So, if a doctor wants to know more about herbal supplements and what's the deal with those, really we have to take it upon ourselves to look. Now, the reason that this is the case, is because, of course, these substances are not regulated by the Food and Drug Administration. And so there aren't really guidelines for safe dosing and there really few large well done statistically significant studies to illustrate the benefits of these substances or to sort of weed out what adverse effects are possible.

0:26:08.2

I mean there are studies out there, but a lot of them are poorly designed. You don't have a very big sample size, that sort of thing. Now, having said that, we really have to keep this in mind. We kid ourselves, into thinking that homeopathic therapies such as herbs and supplements, they're really not any different than approved medication when you look at it at the molecular level. I mean, All of this things are chemicals, right? They are made out of molecules; we can break them down into atoms. It's just that the approved medications are chemicals that have been studied more, are recognized as therapeutic agents, and thus the government regulates them. Whereas the herbs and the supplements that are part of homeopathic medicine, they're still molecules, they still react with something in the body. It's just that they're considered food substances. And probably because their use dates back to a time before we had a lot of therapeutic agents that we studied.

0:27:16.2

And so, they're not a part of what the drug companies do and make and manufacture, because they're not in the food business. They're in medicine business and that's where the money is. So, if there was a new herb that would, we knew reduce blood pressure, that you can prove in a statically significant clinical study, you can bet that the drug companies are going to shout and holler that shouldn't be an herb anymore, that should be a therapeutic agent so that they can make money on it and patent it and all that.

So, that's the real difference is that, they're both chemicals, they both react in the body in some way. But the approved medicines have more of an earning potential for drug companies. So, the drug companies have to jump through the government hoops to show that the chemical works. To show it's safe, basically jump through the regulations to get it the market.

0:28:06.4

Now, the advantage to that is because they have to jump to those hoops, we know a lot more about those chemicals than we otherwise would. So, we have to be able to tell what the benefits are exactly, and what the potential side effects and problems are with them. Now of course it's not a perfect system. Are there medicines that get through the system and at later you find out that there are problem with them, sure. But a lot of that doesn't come from continuing use of the medicine. Reporting what kind of things happens with them, ongoing research, which in the herbal market, you don't have that. So, it takes a lot longer to figure out, like with ephedrine, that there is a problem because there is no central regulating agency to look at the whole country, to see, is there is a pattern of problems.

0:28:55.4

So, right there, the sort of the established therapeutic agents have a little bit of advantage, either you can figure out what the benefits are and figure out what problems and side effects, and you know more about the approved medicine safety profile. Now, that's not to say there is no benefit to herbal remedies. There may be. I mean they're chemicals, they react in the body, there's receptors that they attach to, they can be a catalyst for different chemical reactions in the body. What is hard to say is are they safe? Are they, will they do what they're supposed to do even after a single dose or after a cumulative doses for a long period of time, are they going to be safe? Are there going to be things we don't know about it. There is more of a question mark with those than there are with regulated drugs.

0:29:45.6

Now, in a perfect world, I think that this herbal remedies and vitamins and things would be regulated so that we could understand more about how they work and do they really work. But of course, the people who make the vitamins and the supplements and the herbal remedies, they don't want that. Because they want to keep selling, and they don't want the expense of performing studies. And really, probably the government doesn't really want it either. Because they have their hands full with testing and approving chemicals labeled as medicine. And I think adding a homeopathic substances to their regulatory panel, would definitely increase cost and gobbled up resources. So, what's a consumer to do? Well, one place that I found that I really recommend you check out is the "Med Line Plus Guide to Herbs and Supplements". And it's a service of the US National Library of Medicine in the National Institute of Health. And I spent a good deal of time, really riffling through the internet to try to figure out a good site to send you to. This one it literally list hundreds of herbs and supplements and vitamins. And it gives their chemical information, their history it goes through the known benefits and the known safety issues.

0:31:02.4

And then what it does is it told you for that substance, whether ginseng or… But whatever it is, all these herbs goes through the research studies that are related to that substance. And then, not only does it tell you the result of the research, it grades those research studies on kind of a A for really good and F for failure. So, A BC D E F kind of system to let you know how good the studies were that looked at that. So how well do we know about that particular herb. And then it also talks about how the studies can be improved and gets recommendations for future studies to learn more about that homeopathic supplement.

So, I highly, highly recommend that site if you been drawn into the world of herbal remedies and medicine. Because again, I think that there are, there something to say for them. Because they're chemicals. I mean, chemicals react in the body and can do different things. It's just a matter of figuring out what they do.

0:32:04.2

The other thing too that I want to mention, is at least with approved medicine, you know what you are getting. You know what is in that pill. Because the herbal supplements fall under the realm of food substance and not medicine. Sometimes there is not a guarantee that what they say in there is really in there. Because the food industry has a lot less regulations than approved therapeutic agents where medicines have. So, and also bioavailability becomes a question too. Because if you get prescription medicine, the drug companies have to show that the pills actually, the chemicals that they're advertising gets absorbed into your body and into your blood stream and will do something. But if you have a ginseng supplement let's say, OK, so it has it in there, but how well does the capsule break down and how much of the actual substance gets into your blood stream or do you just eat it and poop it out.

0:33:02.0

So, because there aren't good studies to show how well something really works clear down at the chemical level. We don't know as much as about those substances.

OK. Let's move on. The link will be in the Show Notes. I definitely encourage you to visit pediacast.org and look for that. Again it's the Med Line Plus Guide to Herbs and Supplements.

OK. Let's move on. This next question is Deborah in Vermont. Deborah says, "Hi, Dr. Mike. I love your program and listen to you on my walk to work. I appreciate all the time you put in answering so many questions so thoroughly. My question is about television. I have an 18 month old daughter who's never really watched any TV but is now completely addicted to watching DVD's. She wakes up in the morning and says "DD", and watch them all day if we let her, which of course we don't. However, I do admit, that while I'm washing the dishes, or sending out my emails, I will cave and allow her to watch her beloved "DD". My husband is concerned as he had read research suggesting early TV watching is associated with attention problems later in life, and the American Academy of Pediatrics discourages TV watching under two years of age".

0:34:08.0

"I would really love to know your thoughts on whether watching TV is bad for children, even if they are actively engaged in good play time for most of the rest of the day. Thanks for your help. Deborah".

Again, I take the middle of the road and not because I don't want to anger one side or the other, because most of the time that's what makes the most sense. I think everything in moderation, OK, maybe not everything, but you know what I'm saying, moms need to get some work done. There emails needs written, communication with family. Got to do housework. Certainly, guided play with toys and using your imagination, is important. But is it a bad thing for a toddler to watch a half hour show in the morning while mom is washing the dishes. A little bit is going to be fine, by the way, variety is the spice of life.

0:35:00.1

If you are letting them have some entertainment with the television, with the computer, with playing with toys, with going outside supervised and running around, it's just part of over-all stimulation. And it's part of the world that we live in. And by saying "hey, you could watch a half hour show", but then you are not watching anything else the rest of the morning, you're teaching self control. So, over all, I think that, it's fine in moderation. Now, study showing early TV watching associated with ADHD later in life, those are really difficult studies to interpret. Because they're not longitudinal long term studies and doesn't mean that TV watching causes ADHD or is it that parents with ADHD are more likely to stick their kids in front of the tube. And then the ADHD, is passed on genetically. So, they need better studies to look at that. It doesn't make a lot of sense that kids who watch even the small amount of TV, have a higher risk of ADHD later in life.

0:36:00.4

From physiological stand point, how does that work? Maybe it does. But I don't think there is enough evidence of that being a true cause and effect sort of thing to make me say it's true. So, again as is with most things in life, moderation is the key.

OK. Next one, "Dr. Mike. Welcome to my iPod. Pediacast is not part of my work week and yes, you have 10 loyal listeners to thank for that. I'm sorry that question was from a while ago. So, I'm not quite sure what he's referring to there. Now, on to my question. Head lice and icky subject, apparently my roommates kids picked up head lice at their school and have generously shared it with my kids. Since their mom and I are divorced, there are 10 days when my children are at my home, how long do lice and their eggs live. I've used generic and Nick's brand shampoos. Followed the instruction of several websites on care, cleaning and hygiene regarding head lice and they still persist. I have not caught any and continue to treat my kids".

0:37:03.2

Their beddings, toys, clothes, furniture, et cetera. What can I be missing and what pharmaceutical precautions can I take. Thanks. Shawn".

Well thanks for your question Shawn. I'm going to kind of punt this one and tell you to check out PediaCast number 4. Because we had a really long in depth detailed discussion about head lice in PediaCast episode number4. And there will be a link to that in the Show Notes. And just to make your job even easier, if you fast forward to minute 43. So, 43 minutes into the show, is when the head lice discussion begins. Now again, PediaCast number 4, so you have to remember, the production is going to be a little rough. OK. But there was a head lice extravaganza in episode 4.

OK. This comes from Dina in Boston. "Hi, Dr. Mike. I was pleasantly surprised to hear you this week on Manic Mommies. It was a lot of fun to hear you with the Mommies, as I am a loyal listener of both shows".

0:38:03.2

"That whole thing with Dr. Rob or Dr. Flea was so strange, I actually wrote about it in my blog if you'd like to take a look". And I did take a look and it was a very nicely done blog entry about the whole situation. And there is a link to that blog post in the Show Notes. "Anyway, the real reason I'm writing is that I just listened to your latest show and I want to make a comment to all those poor new parents who are dealing with colic. My son is almost eight, but I will never forget those early days. It seemed like he cried constantly during his second month. One thing that often isn't mentioned is making sure the baby is receiving enough breast milk. Turns out that my son didn't really have colic per se, I wasn't making enough milk and once we realized that after many tears, and started supplementing with formula, he and we were 100 times happier"

"You also said something that made me laugh about how colicky kids tend to be more difficult in nature. Well, my son is intense, shall we say".

0:39:01.4

"Even today and even now, he will scream when he is hungry, and when he is hungry, he is hungry right now. So trade hasn't really change after all these years. Thanks as always. Great show. Really love that your take on the research articles and how you make them accessible to parents". And that's from Dina in Boston.

All right, and then finally, "Hi, Dr. Mike. I'm one of the many parents who stumbled upon your podcast while researching my daughter's poop issues. Episode number 18 was the relevant podcast in my daughter's case. I never listened to a podcast before. But I'm really glad I was led to yours, because I'm really pleased with the option of being to learn without reading. I've been listening while I work. I started back at episode number one, and I made my way so far up to episode number 24 including a re-listen to number 18. This is my question, recently my 14 month old daughter stumbled and fell face first into the edge of a low table. While trying to console here, I was horrified to see that her mouth had filled with blood and it was starting to roll down her chin".

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"While trying, in a panic, to look at her crying mouth, where the actual source of injury, I wonder what I was looking for and what I shall do about it. Here were my questions. If there was a serious cut, would she be given stitches? If a tooth has been knocked loose, would it be re attached? Of course, this was Friday at 5:30 and I wondered if I should even take her to her children's hospital emergency room or a walk in clinic, or would it make sense to make an appointment on Monday with our pediatrician, family doctor, or dentist. In the end, the bleeding stopped quickly, I thought there was only a minor cut on the inside of her lip under her nose and all her teeth seem pretty stable, so we didn't do anything. She's still not a stable walker and I can see this happening again, so I would like t be better prepared next time. And that's many thanks, Suzanna".

Well, it sounds you did the right thing. If your child falls down and they're bleeding in the mouth, the first priority is applying pressure and getting the bleeding to stop and if won't stop, you got to get them to the emergency room.

0:41:02.3

And if that means calling 911 to get them there the quickest, then that's exactly what you have to do. And then of course you look for the source of bleeding and see if there is any gaping wounds. If there are, or you feel a teeth too. And if there are any loose teeth, or there is a gaping wound, then you call your doctor. And you should have a family practice doctor or a pediatrician that is available 24 hours a day or has someone covering for them so that you can talk to them about it. And you should never feel bad about doing that, because that's what we're here for. Now, the question becomes do you have to take him to the hospital or not? Again, that is going to be up to your doctor when you talked to him. But if the tooth is really loose, it's a choking hazard, and if it were to come out and they were sleeping, and if the tooth, or there is gape in the gum, normally those aren't stitch because the oral mucosa, the gums that is inside the cheeks, all those areas, they do tend to heal pretty quickly even without stitching.

0:42:02.7

Although, if it was a huge gaping lesion, it is possible to put a stitch in. But usually the little ones, you don't. Also, if it's on the inside of the lip, you do have to be careful that it didn't bite through their lips. Sometimes, all you see is the cut on the inside, but when you really probe it and look at it, there's a little tiny bit of it that goes all the way through. And those you have to be more careful with them in terms of being closed up and taken care of, so you don't have any cosmetic issues on down the road. Now if you have a pediatric dentist that you've already seen, a lot of pediatric dentist also have after hour coverage, and so, instead of calling your pediatrician or family practice doctor, you could call your pediatric dentist if your already acquainted with one and seeing the on a regular basis.

So, bottom line, mouth lacerations, heal quickly and often don't need sutures. Still, it's best not to determine this on your own if you have any questions at all, just call your doctor and talk to them.

0:43:05.1

Also, I do have a link in the Show Notes, to a pediatric dental emergency sheets. It's a pretty nice one, and thanks to the folks have at the Center for Pediatric Dental Care in Brookline, Massachusetts. Because I got it from their site. But it's a really nice dental emergency sheet that you could print out and keep with all your baby records and stuff to look out later. So, I'm impressed with their sheet. It's pretty good. And of course there is also more detail, actually there is more detail in their sheets than the American Dental Association or the American Pediatric Dental Association websites. I mean, you can go to their website and look. But this dentist office in Massachusetts, they have a really nice emergency sheet. So, look for that.

All right, that concludes this week's listener segment. And we will return with our Research Round Up right after this short break.

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OK. This week our Research Round Up, we're going to do a little something different. I should mention by the way that our new segment, I was kind of in a hurry there because of the PediaScribe blog contest thing. Thanks to the folks at "Medical News Today" at medicalnewstoday.com for helping us out with our news content. And also thank you to research partner, Devon Technologies at deveon-technologies.com. So we're going to take three different listener questions and turn them into a Research Round Up. Because we do talk kind of on the side about research. But, I did get want to get some information out to you as well.

0:44:58.4

And this is on hand gel, like anti-microbial hand gel. This comes from Mary, and by the way, she also had a good question about weight issues and I'm going to set those questions aside. We're going to get to them next week, 'cause today I just want to concentrate on the hand gel thing. So, Mary says, "Hi, Dr. Mike. I have a question about hand sanitizer. I saw a news story about it being dangerous for children if ingested. I have heard of this a while back before the story was so big, and now I don't carry my hand sanitizer in my purse where my children might get it. I was wondering what your thoughts were on this as I have heard you mentioned hand sanitizer in the past. Also, I've looked for hand sanitizer with a child proof cap that I could carry. But I have not yet seen anything. Have you heard of any with a child proof cap?". And this comes from Mary.

So, well alcohol based hand sanitizers compare really well to using soap and water. So, they're effective of what they do.

0:46:00.9

They do a good job of getting your hands clean. And there was a study, again, this is our research segment, there was a study in 2005 at Boston Children's. They looked at 292 families, basically divided them into two groups and of the two groups, one group used an alcohol based hand sanitizer on a regular basis. And the other group, they were just given instructions for proper frequent hand washing with soap and water. And then both groups were followed over time. And what they found, is that there was a 59% reduction in gastro intestinal illnesses or vomiting and diarrhea type illnesses in the hand sanitizer group. So the group that was using the hand sanitizer actually had a 59% reduction in vomiting and diarrhea, viral illnesses. In other studies have been done which show similar results for viral upper respiratory illnesses as well.

0:46:56.2

Now, OK. So, they're great in terms of working and getting germs off of your hands. But, the problem with these hand sanitizers are that they are, most of them are at least 60% and some of them higher of ethyl alcohol, which is booze. So, there have been cases of accidental ingestion and resulting alcohol poisoning even in kids because of the fact that you have all this ethyl alcohol in the hand sanitizer. So, if you go to the Show Notes, I do have a link to snopes which is called "Booze Ooze". And basically there were some emails circulating on the internet, this spam kind of emails that you get. But these are a couple that had stories where the parent is describing the fact that their child ingested some hand gel and then head to the emergency room and had some pretty serious problems associated with that because of alcohol poisoning.

0:48:08.9

And these two particular stories had been substantiated. If you go to the Show Notes and look, there's a link to snopes, where it has copies of the articles and then what they did to substantiate the truthness of these emails. So, the bottom line here is there is potential danger. But you have to look at this on light of the effectiveness and convenience. I mean you don't want your kids ingesting this stuff, but if used properly with supervision, it's a good thing that it does reduce illness. Now, one thing that does bother me a little bit are the companies that makes them smell so good. I think that is one of the reason that kids try to taste the gel, or to eat it or put it in their mouth because it smells like raspberry or it smells like strawberry. So really, one way that you could keep your kids safe is, with help anyway, is to steer clear of the ones that smell really, really fruity. That's smell good enough to eat, you probably don't want it for your two year old.

0:49:04.0

I think the idea of a child proof cap is a good one. I've not come across that. It's probably going to come soon to grocery store near you because it does seem like it's a good idea. And I think that parents would probably buy one with the child proof cap on it. Preferentially which would drive the market into them wanting to make more of them, if they're selling. But of course child proof caps, there is a false sense of security. You could look at it, that you think "Oh my kids are not going to get into it if there is a child proof cap". But on the other hand, I think it's something like one in five toddlers has been shown to be able to open child resisting caps easily. And many more of them figure it out if you give them enough time. So, that's something to definitely think about. I think bottom line is, you got to keep it in a safe place. Keep it out of the reach of your children. Make sure you're supervising what your young children are doing all the time to avoid ingestions from happening.

0:50:03.6

So, now if ingestion is a danger, what about absorption? Alcohol compounds can travel through the skin and into the bloodstream but they also evaporate quickly. So, probably not much as absorb. But someone did do a study. They wanted to see if you could get any increase in blood alcohol levels by using the hand sanitizer too much just from it going into the skin. And this was study that was done by… It was published in the "American Journal of Emergency Medicine", November 2006. And it was done by the Department of Emergency Medicine at Darnall Army Medical Center in Hood, Texas. And basically, they took five volunteers who had no alcohol to drink or on their skin for 12 hours prior to the study. They measured blood alcohol at the onset and all the blood alcohols were normal. And then used one teaspoon of 62% ethyl alcohol hand gel. And basically rubbed their hands with it until their hands were dry. And they repeated that 50 times over a four hour period.

0:51:04.6

There blood alcohol was measured again at the conclusion. And there was no evidence of blood alcohol in any of the participants. So, even if doing it 50 times over 40 hours, it did not show up in their blood stream as blood alcohol. Now, one of the criticisms of the hand gel is it can dry your hands out, although for me, soap and water repeatedly using that, dries my hands out as well. But they do make soaps and gels with the oils mullions in them to try to make it a little bit easier on your skin. 'Cause of course if you get really dry, itchy, broken out skin, then you can get infection just from skin bacteria going in that way. So you do have to be careful with that.

0:51:53.2

OK. Now, Mary went on to ask about non-alcohol containing hand sanitizers. And 72 link to a product called "Hand Cleanse". And of course in the Show Notes, we'll have a link to that as well. It does not have alcohol in it. The active ingredient is "Benzalkonium chloride", 0.13%. And the makers of this product cite four studies showing that it to be as effective or more effective at eradicating bacteria and viruses compared to alcohol based gels. Now, I looked at one of the studies, we won't get into it here for lack of time, but, it looked like a well design study with statistically significant results. However, it does not evaporate nearly as quickly or completely as alcohol based sanitizers. So the critics asks, what's the effect of this chemical staying on the skin for long periods of time in trace amounts. And particularly in young kids who might be putting their hands in their mouth often, does that chemical absorbed into the blood because of the fact that's it's there longer or because they're putting their hands in their mouth. And what are the internal effects, both immediate and with chronic use.

0:53:05.5

It seem that it would be safe, because this particular chemical also uses a preservative on eye drops which you put directly in your eyes. And it's also used in anti-microbial soaps and some face cleansers as well as some mouth washes and spermicides. So, our bodies gets exposed to this benzalkonium chloride from time to time. And it does have a safe track record. On the other hand, what about using it on your skin 50 times in four hours. Is that going to be a problem? And the verdict is still out on that. So, what would I do? And again this is just what I would do, not necessarily what you have to do. But what I will do is use an alcohol based one that doesn't have a yummy scent. I'd keep it out of the reach of children and use it in a smart way like that. So, that's my own personal opinion on that.

0:53:54.9

OK. Now, there's another issue with hand gels. And here is a couple of emails that deal with that. The first one is Kristen in Barnesville, Georgia. She says, "Dear, Dr. Mike. I first heard about your podcast from the Manic Mommies. And I've been listening ever since. I appreciate all the hard work that you put into your podcast and can't to listen every week. My questions concern hands sanitizing gels. Before my children were born, I never had a problem, but since then, I'm becoming a tad germophobic. I even have a bottle of "Purell" attached to my key chain. How do I balance the need to protect my children from infection with killing off all the bad bacteria but how do I not create super germs. I have heard lots of theories and I'm interested in your opinion. Thanks again for the great podcast". And then this one from Caroline in Dayton, Ohio. She says, "Hi, Dr. Mike. I was wondering what your position is on the use of anti-bacterial hand gel. My sister works at a school where it has been banned because apparently it eliminates the good bacteria on your hands. I was under the impression that the absence of good bacteria on one's hand was not harmful. Is this correct? Have you heard of other schools, instituting such a ban. Thanks and keep up the good work. Sincerely, Caroline".

0:55:05.0

OK. What understand my feelings on this, you have to have a little bit of understanding about how antibiotic works. I mean, they kill bacteria or keep bacteria from reproducing by stopping some important function that the bacteria needs to survive. And resistance develops when bacteria mutate in such a way they can perform the important function, whatever it is, by different mechanism. One that that particular antibiotic does not affect. It's like a closed road. You can't get where you need to go because the road is closed, but if you find a detour and take it, you're still going to get where you need to be. And it's the bacteria mutating change, because they have generations so quickly. They're reproducing all the time. They mutate and change. And the one's who survive are the one's that develop a detour around whatever action that the antibiotic takes. Or the bacteria may mutate in such a way that it produces a chemical of its own that renders the antibiotic ineffective, that's another work around.

0:56:03.2

So, are there substances that which just kill everything or at least 99.9% of everything.? Well there are. And these are the type of things that we put in anti-microbial surface cleansers. Ethyl alcohol and benzalkonium chloride, there are other examples too, but these basically are things, and of course washing with soap and water, are things that just kill just about everything or at least 99.9% of everything. Now, we can't use them to kill bacteria inside of our bodies because the amount that you would need to do this would be toxic to your own cells. So, the difference between an antibiotic and a sanitizer, antibiotics kills things selectively so there's room for bacteria to overcome the mechanism, by which it kills the bacteria. Where as sanitizers kill virtually everything, so resistance formation is much less likely because there are no organisms left behind to survive.

0:57:00.2

So, microorganisms, also this is important too, microorganisms that do survive properly used sanitizers tend to be spore forms that aren't significant contributors to human illness. So, the bad bacteria the sanitizers kill, it kills the good bacteria but it typically kills the bad bacteria as well. So, with all of this in mind, you see why the judicial use of antibiotics is extremely important and why like the antibiotic impregnated plastics has sort of fallen out of favor. But, hand sanitizers, they have an important role in disease prevention, and preventing transmission of disease. And they're not associated with the formation of resistant bacteria nearly to the same degree as antibiotics are. So, they are important. I do recommend them. I think that the whole thing, are we going to make super germs because we are using hand sanitizers, I don't think so. Personally, I think the benefits of using hand sanitizers outweighs the disadvantages and the risks associated with them, as long as you know what those risks are in terms of ingestion.

0:58:06.0

The proper way to use hand sanitizers and proper way to wash your hands with soap and water. The danger of not washing your hands. Situations where you should wash your hands. All of these things are available from a hand washing website from the Mayo Clinic. And we'll put a link to that in the Show Notes.

All right, that concludes our hand sanitizer party. And we'll be back to wrap up the program right after this.

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0:58:58.9

All right, we are seriously running a little on time. So I'm trying to keep these right at an hour. Once again, don't forget that this is general education here folks. This is not medical advice and that tone you want to do with your kid, OK? So you got to still talk to your doctor, we're just discussing topics here. Congratulations to the winners of our PediaScribe contest. Also thanks to all of our news partners, research partners, this week's sponsor, Mariner Software at marinersoftware.com, thanks for that. And don't forget we will be back next week, until then, this is Dr. Mike saying stay safe, stay healthy, stay involved with your kids. So long everybody.

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