Childhood Obesity, Parental Alienation Syndrome – PediaCast 106

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Topics

• Childhood Obesity
• Parental Alienation Syndrome
• Long-Term Antibiotic Use
• Do Doctors Favor Some Patients Over Others?
• Jet Lag

Links

• Obese Children Show Early Signs Of Heart Disease
• Parental Alienation Syndrome Common In Children Of Divorce
• Advancing Circadian Rhythms Before Eastward Flight: A Strategy To Reduce Jet Lag
• Advancing Circadian Rhythms With Afternoon Melatonin And Intermittent Bright Light
• PediaScribe: I Spent The Weekend With Influenza A

Transcription

Announcer 1: Bandwidth for Pediacast is provided by Nationwide Children's Hospital for every child, for every reason.

[Music]

0:00:33

Announcer 2: Welcome to PediaCast, a pediatric broadcast for parents. And now, direct from Birdhouse Studios, here's your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone and welcome to another exciting edition of PediaCast, a pediatric podcast for moms and dads, and aunts and uncles, and grandmas and grandpas, and anyone else who cares to listen. It's episode 106 for Tuesday, February 5th 2007, and we're going to talk about childhood obesity, yes, again. Long-term antibiotics use that comes from a listener question. And another listener question, I love this one, we're going to talk a little bit about jet lag. And not the whimpy L.A. to New York jetlag, that's the listener's wording, not mine.[Laughs] So you can guess what kind of places he is travelling to and from.

01:36

I had a good weekend, it was busy, I was on-call on Saturday. And as most of you know who listen to this regularly, our office has pretty crazy hours as far as primary care pediatric offices generally go. And the on-call guy works Saturday morning and Saturday afternoon, and if you're on call on Sunday, you do Sunday morning and Sunday afternoon, kind of like an urgent care. But Saturday, I was on-call and saw patients from nine in the morning till five in the afternoon on a Saturday. That was crazy. Lots of strep, and flu and RSV, wheezing babies, so I thought, it was going to be kind of a hectic weekend. And I wasn't really all that excited to be on-call, to be honest with you, because it's a weekend.

02:30

And I knew it was going to be busy. And to boot, my wife Karen and my daughter Katie, they had, it was called Dare to Share. It's a sort of Christian conference for girls. So they were gone at that and so it was Nick and I by ourselves. So he had to go to work with me on Saturday. Spent the entire eight hours on my computer in my office, playing games. [Laughs] He was in heaven, let me tell you.

But we did some fun boys stuff too, while the girls were up doing in their thing. We drank from a two-liter bottle. [Laughs] He loves that. We don’t get to do that when the girls are home. Ordered pizza, we had a Myth Busters marathon when we got home because he needed more screen. [Laughs] After the eight hours on the computer, he needed more time in front of the screen. See, this is where even pediatricians aren't always the best parents.

03:28
But tough gone it, I was tired and exhausted from seeing kids and being on my feet all day. And sat on the couch with my son, for a couple of hours, watching back to back Myth Busters on the Discovery Channel. That's our own little slice of boy heaven. OK.[Laughs] We ordered pizza, it was a good time. At any rate, that was my weekend. It was busy and yet fun at the same time.

3:56

Alright so what are we going to talk about today? I mentioned some of the topics, Childhood Obesity, also a news article on Parental Alienation Syndrome, Long-term Antibiotic Use, Do Doctors Favor Some Patients Over Others? We're going to discuss that then we'll wrap things up with the Jet Lag discussion.

Don't forget if there's a topic that you would like to hear, all you have to do is go to Pediacast.org and click on the Contact link. You can also e-mail pediacast@gmail.com or call the voice line, that is 347-404-KIDS and either our next show or maybe the first show next week, we'll get to the Skype line and take some more phone call questions.

Don't forget the information presented in every episode of 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, be sure to call your doctor and arrange a face to face interview and hands-on physical examination. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at Pediacast.org. And of course, with that in mind, we will be back with News Parents Can Use, right after this.

5:10

[Music]

05:43

Dr. Mike Patrick: Our News Parents Can Use is brought to you in conjunction with news partner, Medical News Today, the largest independent health and medical news website. You can visit them online at Medicalnewstoday.com.

05:53

Children who are obese or who are at risk for obesity, show early signs of heart disease, similar to obese adults with heart disease. A study by researchers at Washington University School of Medicine in St. Louis, has found, based on the study, "The subtle markers can help us predict who could be at risk for heart disease and heart attacks," Said Dr. Angela Sharkey, an Associate Professor of Pediatrics at Washington University School Of Medicine and a Pediatric Cardiologist at Saint Louise Children's Hospital. His study was published in the winter 2007 edition of the journal Cardio-Metabolic Syndrome.

Childhood obesity in the United States is an epidemic nationwide. 19 percent of children ages six to eleven and 17 percent of those 12 to 19 are overweight. According to Center for Disease control and Prevention, "Those who are overweight during childhood also have an increased risk of obesity in adulthood, and are at greater risk for complications such as diabetes, high blood pressure and heart disease because obesity increases total blood volume which leads to extra stress on the heart."

07:07

Sharkey and Dr. Steven Lorch, a former fellow at the School of Medicine, now at the University of Texas Health Center in Houston, analyzed data from a hundred and sixty eight children, ages 10 to 18, who had been referred to them for cardiac ultrasound, with symptoms including heart murmur, chest pain, acid reflux or high blood cholesterol.

Based on the CDC guidelines for Body Mass Index per age, 33 patients were found to have a BMI as obese or the 95th percentile or above for their age, 20 had a BMI that classified them at risk for obesity or between the 85th and 94th percentile, and 115 were considered normal or below he 85th percentile for their BMI.

07:54

To analyze the hearts of these obese children and those at risk, Dr. Sharkey and Lorch used a new tissue Doppler imaging technique called the vector velocity imaging, which tracks the movement of the heart's muscular wall. Any changes on the rate of motion of heart muscle were averaged within each group and compared to the normal rate of motion. In the patients who are obese, the rate of motion of heart muscle changed. Dr. Sharkey said, "As a child's BMI increases, we see alterations in both the relaxation and contraction phase of the heartbeat. Many of these changes that have been seen in adults were seemed to be from longstanding obesity, but it maybe that these changes start much earlier in life than we thought.

As vector velocity imaging becomes more broadly available, Sharkey said, "It could potentially help pediatric cardiologists follow these children more closely over time, to see if changes in the heart progress. We may be able to determine whether we could intervene in the process such as focusing the families on understanding the importance of regular exercise and dietary modifications for weight loss and prescribing stat on drugs for high blood cholesterol."

09:07

Sharkey said, "The results of the study give more ammunition to physicians to use in counselling pediatric patients and their parents about the risks of obesity and the need to attain a healthy weight. Even in teenagers, obesity leads to decrease myocardio performance and abnormal diastolic function." She said, "Further study is needed to determine how soon the changes in the heart set in after a child becomes and whether those changes are reversible with weight loss.

Here's just more proof that childhood obesity causes problems now and must be dealt with now rather than waiting until adulthood to control it. And I think that we, as parents, have the responsibility of making sure that our kids are eating the right food, the right amount of food and getting enough exercise, and of course, we all have to be good role models for our children to do that.

09:58

There are just many parents out there who simply aren't taking care of their own bodies, let alone, not sort of taking the bow by the horns here, and taking care of this obesity issue in their kids because it's a lot of work and it's easier just to let the kids sit around and watch TV, and eat what they want. Sad, really. In my opinion to that degree, childhood obesity is probably more often the parents fault than the kids. Please, Moms and Dads, while you can influence your kids to eat right and exercise right and do it before it's not too late, and do it for yourself, too.

I'm not up here on a pedestal lecturing all these to you because we've talked about this before, I need to watch what I eat and make sure that I'm exercising regularly just as much as you do. So let's all work on that together and be good role models and take care of our kids because this is something we really can make a big difference in your kids' life later on.

11:00

All right, moving on, one out of four children involved in a divorce and custody litigation undergo the so-called Parental Alienation Syndrome which consists of the manipulation of children by the custodial parent, who incessantly tries to turn them against the other parent by arousing in them feelings of hatred and contempt for the target parent. That's how it's explained in the book, Marital Conflicts and Divorce in Children's Development.

In the 1980s, parental alienation syndrome was defined by scientist, Richard Gardner of Columbia University, "Men are usually the target parent since in most cases, the mother has custody of the child. According to this new book, the so-called alienating parent is the one who has custody and uses it to brainwash the child, turning him or her against the alienated parent. In most cases, the process is very subtle. The custodial parent stating such things as, "If I just told you some more things about your father", or by making the child feel sorry for abandoning every time he or she visits the alienated parent.

12:07

I'm sorry, I shouldn't laugh at that, it's just that I hear this in the office quite often.[Laughs] Parents will say something to the kids, right in front of the doctor, the same kind of things as pointed out by the authors of this book who are also researchers at the University of Granada. There are many other factors which influence parental alienation syndrome apart from the unacceptable attitude of the custodial parent, such as children's psychological vulnerability, the character and behaviour of parents, dynamics among brothers or the existing conflicts between the two divorced parents.

Very often reject not only their father but also his family and close friends, grandparents, uncles and aunts, cousins and the new partner of the non custodial parent are also all affected by this syndrome and children undergoing parental alienation syndrome can even expel them from their life.

13:00

Parental alienation syndrome is more frequent among children aged nine to twelve than among teenagers and there are no relevant gender differences seen. According to the authors, "Parental alienation syndrome occurs most frequently in cases where parents are involved in divorce litigation, while it is not usual when the decision to seek divorce is mutual and the break-up and subsequent relationship between mom and dad is amicable.

Here's another problem facing kids and it's another one that's out there, and that those of you who have been involved in divorce or have close friends or family who were involved in divorce, know what I'm talking about here. It's tough on the kids. And here's another problem that we can blame on the parents, or at least, some of them. All right, we're going to take a quick break and we will be back to answer your questions. We're going to do it, right after this.

13:51

[Music]

14:50

We have some really good questions today. No, I mean they're always good, don't get me wrong but I really enjoyed [Laughs] coming up sort with outline of my answers for this. So, Kudos for the three of you.

15:01

The first one up is Tiffany in Australia, and Tiffany says, "Hi, Dr. Mike, we've been listening to your podcast for a few months now and loved it. Just a quick question for you. Our daughter has been on long term antibiotics for 12 months now. We have swapped and changed a few times, but antibiotics have been pretty much continuous for varying issues with her health. You often talked about the over prescription of antibiotics and how they are not needed in viral illness. My question is this, what are the long term issues with antibiotics and what are their effects on a child's body? Hope you can answer this question, I thought it would be an interesting discussion."

I agree, Tiffany. Again, as I've said before, you're right. We don't like to use long term antibiotics but when we do use them, it's always, it has to be because the benefits of doing so, outweigh any risk of doing that. And to see what I mean, let's take some examples.

15:55

There aren't really many conditions that call for long term antibiotic usage. Probably, the most common one that I can think of would be for something we call reflux of the bladder and kidney system. I know we've talked about this before, basically in these kids, the bladder, when it squeezes the urine, instead of all of it going out, like it's supposed to, the valves on top of the bladder, so again, leaky valves, the valves leak and the urine goes back up toward the kidneys. Especially in little girls, the bladder often times has bacteria in it because the urethra, which travels from the outside of the body up into the bladder is fairly short and it's easy for bacteria to get up there. But, if they rinsed out every time the girl pees, they aren't an issue. But if the skin bacteria that have gotten up into the bladder are then being swept up the ureter toward the kidney each time that the bladder squeezes, then those bacteria get carried up to the kidney and you can get kidney infections.

17:03

And the problem with that is that, these recurrent kidney infections would sometimes resilient, meaning, the body takes care of it before there's a high fever and vomiting and the full pledged infection. But there still was an inflammation and over time this can cause scar tissue and loss of kidney function. And these kind of kids can have high blood pressure problems and kidney failure problems as young adults, if this is missed. And by putting them on a chronic antibiotic over a long period of time, from a few months to a couple of years, then you decrease the risk of these frequent kidney infection. The benefit, if we're looking at this condition at terms of what's the benefit of long term antibiotic usage is you are helping to protect their kidney against recurrent infection. Now surgery is an alternative to treating reflux and sometimes it's necessary for it. But surgery comes with possible complications and then many, many kids these reflux is going to go way on its own as the valve matures in a year or two.

18:10

So, in many cases, long term antibiotic use is the best approach because this is a potentially dangerous condition but at the same time, it's self limiting and you don't necessarily want to expose them to the complications that can arise in the operating room with the anesthesia, with the risk of infection there, all kind of problems that can arise during surgery and if this is something that you can prevent kidney damage by using the long term antibiotics and keep them out of the operating room, then that's a good thing. Now, it's only a good thing as long as the risks of doing this don't outweigh the benefit that you get. So now we have to ask ourselves, "OK, so what's the risk of putting a kid who has reflux of the bladder and kidney system. You know, "What are the risks of putting them on a long term antibiotic?"

19:06

Well, the first risk would be that the skin bacteria become resistant to that particular antibiotic and then it no longer works for prevention and they still get these infections. Now the fortunate thing is that this has not been a big problem with the particular bacteria and particular problem that we're talking about. So usually, it's going to be the kind of bacteria that live in the intestine or the enteric bacteria, things like E -coli, Klebsiella, there's a range of them that live in the intestine and are the ones most likely to cause problems. And as it turns out, the soft antibiotics which is usually what's used for this, we have not seen a big resistance issue with them. Though it is still possible, and if they get break through urinary infections that you know about, then you do have to change the antibiotics sometimes with this.

20:00

So, you can get resistance, but it's not as big of an issue as it is in some other diseases for what you put kids on long term antibiotics. We're going to talk about more of this in just a couple of minutes. So that's one thing, one risk you would have from using it. Another is you can have allergic reactions with soft antibiotics, so those are pretty rare and also rare soft antibiotics can cause some bone marrow suppression and so sometimes you need to check some blood work to make sure that that's not starting to happen with the soft antibiotics. But these risks are rare, and the benefit is great. So at least for the reflux of the kidney and bladder system, the benefit of long term antibiotic usage outweighs the risks and so thus continues to be the standard of care in most communities.

20:51

Now, there are some other issues or some other illnesses for which kids get put on long term antibiotics and some of these would if they have an immunodeficiency, so that they're really susceptible to chronic sinus infections or they have a really significant immunodeficiency that can be more susceptible to sepsis or overwhelming infections of the body, and sometimes these kids gets put on long term antibiotics. That's more of a risky proposition for them because the types of bacteria now that we're talking about, they can become resistant to antibiotics a lot more easily, so you really have to be careful there. Also, a chronically recurrent ear infection sometimes put those kids on long term course of the antibiotic, as they try to prevent recurrent ear infections and to keep them out of the operating room as well. And again, with the kinds of antibiotics that we're talking about and the kinds of bacteria that we're talking about, developing resistance is a little more likely with that scenario. Also, kids with the history of rheumatic fever, which we don't see as often as we used to, they get monthly antibiotics.

22:00

Also if kids have an absent spleen from things like hereditary spheropcytosis or sickle cell disease, these can also be another reason to put kids on a certain long term antibiotics. But these are rare conditions and I think the kidney bladder reflux thing, at least in my experience, is by far the most common reason that we put kids on long term antibiotics. You always still get that look because on one hand we really tell them, parents, "Hey, you don't want to use antibiotics unless you have to," and then these kids with the reflux, tell the parents, "Yeah we need to put them into antibiotic like everyday for the next year." So I was like, "What? are you sure you know what you're talking about and really I'm one of a doctor who's going to sit down and explain to you exactly why we're doing it, what the risks are, what the alternatives are, what the benefit is, and then come to the conclusion together on what you need to do based on sort of what the standard of care is.

22:58

And when you explain benefits versus risks to parents and talk about standard of care, what the urologists, the kidney doctors, what they think about it, usually you can get past that. I do want to make another mention about the resistance issue, because that's going to be the biggest issue with long term antibiotic use. The one that you think, why in the world you want to put them in daily antibiotic when there's this whole drug resistance thing going on. I just want to point out, that it's the bacteria that become resistant, not the person. So I hear often times, "We're using so many antibiotics on Joey,  "They're going to stop working if we keep giving it to him," and, "Antibiotics won't work for him." It's not the child that becomes resistant to the antibiotic; it's the bacteria that we're talking about that become resistant. And since we all share the same community bacteria, the ones on shopping cart handles and doorknobs. I mean we share the same bacteria that live in our mouths, or on our skin, in the given community where you live.

24:06

So the development of resistant bacteria from the overuse of antibiotics affects all of us, not just the child who's getting the antibiotics, or the adult who is over diagnosed with bronchitis and put on the antibiotic when it's really a virus that's causing it. Cause I have an adult medicine, too. That affects the whole community. Now of course there's also turn over on the kind of the bacteria that we harbour, so if the bacteria in our bodies does become resistant to the certain antibiotic, there's a good chance that the bacteria that we harbour a year or two years later going to be a different ones and ones that are now once a again sensitive to the antibiotic that we had previously have built a resistance, too, and the bacteria. So just an example to sort of clarify that, if you have a kid, they've got a mouth bacteria, all kids have mouth bacteria, we all do, but they get a cold and something the mouth bacteria might grade up to station to begin to cause ear infections. We put them amoxicillin, but then because we use the amoxicillin so much, we sort of begin to select out the resistance strains, the ones that the amoxicillin are killing and those continue to cause the ear infection.

25:14

So now we have to use some different antibiotics to kill the more resistant ones we've selected from using the amoxicillin, ‘cause it killed the easy to kill ones. Now, the kid goes a year without getting an ear infection and now they get new one and Mom says, "Oh Amoxicillin never works. He has developed a resistance to it," but you have to remember now it's a new set of bacteria in the mouth, that's a different ones. So it's worth a shot of using the amoxicillin again. Don't get me wrong with all these, I'm not making an argument for the overuse of antibiotics by saying, "It'll be fine in a year, you have a different bacteria then," I mean there are definitely times to use antibiotic, there are times to avoid them, lots of times to avoid them, because so many illnesses are caused by viruses and viruses can last two or three weeks easy, or you can get back to back viruses and then be sick for quite a while and antibiotics are not appropriate.

26:08

Then there are times when the benefit of long term antibiotic use outweighs the risk and there are times when the risk outweighs the benefit. Best back here is to go to your doctor, ask your doctor to explain this whole thing of benefit versus risk and what are the alternatives and then go from there.

So hopefully we shot a little light on the topic there for you. OK, next stop is Terren in Forthworth Texas and Terren says, "Hi Dr. Mike, I just wanted to say thank you for taking the time to put this podcast out there. I really enjoy it and am somewhat addicted. I've been listening to the past episodes just so I can say I've heard all of them. I enjoy the older ones as well as the new ones.

My sister in Houston has a three year old and is pregnant with her second. She likes her pediatrician, but doesn't know if he is the right doctor for her and her kid. She said, she gets the feeling, that since her daughter is a healthy, happy girl, he doesn't pay as much attention to her as he did when he first started seeing her.

27:04

So, where am I going with this, do you as a pediatrician do that? Do you pay less attention to the healthy kids and more to the ones with special needs or illnesses? Do you remember all your patients when they come in, especially when they out grow the more frequent well child visits and start yearly checkups. Or do you remember at least generally each of your patients? I know this is a very personal question and does not apply to every doctor out there. I'm just asking if you and your fellow doctors, in general, lose interest in some patients. Thanks for reading through my babbling question, Terren in Fortworth, Texas.

Oh boy. Talk about a can of worms here. But I would [Laughs] like to make a few points. Good doctors tend to be busy. You know why? Because patients like them, there's word of mouth then that brings in new patients and if the area is underserved then it is difficult as a doctor to say no to new patients who are coming in because there's really not a lot of alternatives of where to turn to.

28:07

Now having said that, good doctors also know their limit and they're unlikely to see so many patients, if they're a good doctor that care becomes compromise. But something does have to give and all too often, that something is chit-chat. So then the question becomes, Would you rather see a doctor who's sweet and chatty and remembers everything about your personal life, but practices bad medicine, or is a busy competent doctor who gets the job done right but doesn't have time to visit, the better way to go. Ideally, you'd like both to be true. You'd like a doctor who's sweet and chatty, remembers you, remembers everything and practices good medicine. But unfortunately, it just doesn't always work out that way because good doctors tend to attract bigger patient loads.

28:54

Now, of course, I'm not saying, don't get me wrong, I'm not saying that all chatty doctors are incompetent and I'm not saying that all straight to the point doctors know what they're doing. I'm just trying to explain why many good doctors appeared to be lacking in the bedside manner department, 'cause many are just too busy.

Now with regard to me personally, first I have to say I'm bad with names to begin with. Faces I remember, so if I remember a name right off hand, it probably means that I've seen this patient many, many, many of times, OK? If i remember their name especially after they've graduated to the yearly physicals, it probably means they're coming in more than their yearly physical for me to remember their name. Now, that can be a good thing or a bad thing, right? Usually it's not a bad thing, it's just that the kids with chronic illnesses are the ones I see more often and you know, doctors are humans, the more we see someone, the more we interact with the family, the more we're going to know about them and we're going to spend more time with them and maybe develop sort of a preference for them just because we see them more often. They're more like friends.

30:04

And these are going to be the kids with asthma, with ADHD, with chronic illnesses that they have to come in pretty frequently for. The kids with seasonal allergies, bad eczema, with recurrent ear infections. So I think the more you see someone in general, the more friendly you become and the better you get to know them and you get to know their names and probably a little more about their life. Does that mean that I care less for the healthy kids when they come in once a year? No. I don't care less for them, but it is probably true that I chat less with them I don't know them as well. There aren't as many issues to discuss, they're not coming in every three or four months and during the course of the day, I have a lot of other kids I have to get to and see and so there's less to talk about with these kids.

30:52

So, I can see where this would happen. So what would my advice be here. Well first, I think your friend should definitely count themselves lucky that their child does not have a chronic health problem. I think you'd rather not be so close to your doctor and not have to go in so often than to have a child with a chronic health problem who goes in every three or four months or more and you know your doctor really well, right? I mean, count yourself lucky there. Now, if a friendlier bedside manner and less busy doctor is really, really important to you, by all means look elsewhere, but keep in mind, friendlier does not mean better, that's an important point. And once you leave your doctor, your new doctor who maybe friendly at first because you're a new patient, what happens when you become the once a year visit at that office. Likely, you're just going to end up on the same boat. Doctors are human; we definitely form closer relationships with those we see more often. It's not that we lose interest,  just; it's a part of relationships between people. The more you see someone, the more you interact, the more you know about them and the closer you become. It maybe what you want to hear, Terren, but it's the truth.

32:00

OK, finally we have Daniel in Kansas City, Missouri. Daniel says, "I've got two little girls, ages three and one and we fly back and forth from Asia. The time zone change is 14 hours. When we had one child, we came back from Asia and getting over jet lag was horrible. Although It's worse even going to Asia than coming back. From what we've read, it takes one day per hour of time change. That's what's written about adults, for my girl, it was worst. My question is, in your experience and research, is there anything written about kids and jet lag. I'm talking about real jet lag not woozy L.A. to New York jet lag. [Laughs] I've had jet lag conversations with people who told me they suffered jet lag flying from Chicago to New York, that's what Daniel says. Thanks for your podcast; I find it useful and entertaining and my regards to your family.

32:53

Well, thanks Daniel and regards to your family as well. I do understand why this is a significant issue. I have patients in my practice with extended family in the Middle-East, in the Far-East, so I know this really can have an effect on families. So, it took this question seriously and I did an extensive, took me quite a while, search of the medical literature. Unfortunately, this pretty much yielded no significant studies, related specifically, to jet lag and kids. However, there have been lot's of studies looking at ways to lessen the impact of jet lag on adults and strategies I came across were pretty simple and there were things you could easily and safely apply to kids, I think, as well as adults. The question becomes, do these strategies really work and the results of these studies suggested that they do indeed help at least a little bit. Now, I would think that these are going to help more when the jet lag is a few hours. So, more the woozy form [Laughs] of jet lag, as Daniel puts it.

33:56

The fourteen hour one, boy, that is just tough. I really don't think there's a lot that you'd be able to do in kids or adults to make a big difference there. But what are some of the strategies, let's talk about them quick. One is gradually advancing the sleep schedule by one to two hours a day for a few days prior to travel. And this particular study did it for three days prior to travel and then that combined with morning bright light for three and a half hours during the morning, for those three days prior to travel. So basically, you start going to bed earlier and getting up earlier by one to two hours everyday for a few days before you travel and then when you do get up early, you want to expose yourself to bright light, either sunlight or, of course you got to watch our for sunburn, i know especially on kids, but you want to expose bright light or a light box, you could use for three or four hours each day before you travel.

35:00

And this particular research study was called the Advancing Circadian Rhythms Before Eastward Flight: A Strategy to Prevent or Reduce Jet Lag, and was published in the January 2005 edition of the journal Sleep, isn't that appropriate, and we'll put a link on the show notes, there's actually a link, not just to the abstract but to the full article. That's an interesting one. And then there was another study that basically looked at the same thing it with one more step and added and afternoon dose of melatonin into the equation. And melatonin has been used quite extensively in kids who have developed mental problems and sleep disturbances are related to the developmental problem, so there is some experience with using melatonin in kids and of course it is used in adults who experienced jet lag as well. Now it's probably, if you look at melatonin, you look up the drug information in the PDR, I doubt that there's an indication for it for kids in jet lag.

36:01

But we use medicine, outside of what the recommendations are in kids all the time because often times, there's not appropriate studies to use. So my point is just that, I'm not saying that doctors should do this or shouldn't do it, but it's an unofficial thing that might help. So this study looked at advancing the sleep cycle just like the other one did, it also looked at morning bright light exposure for a few days before you leave and then it also looked at giving melatonin in the afternoon, a dose of that for a few days before leaving and it did show a significant tolerance to the… or improved symptoms of jet lag when these things were done. And that particular study was called Advancing Human Circadian Rhythms with Afternoon Melatonin and Morning Intermittent Bright Light and that was published in the January 2006 edition of the journal of Clinical Endocrinology and Metabolism and I also have a link in the show notes to that the full article as well and not just the abstract, so you can take a look at that.

37:04

Again, these were adult studies, not studies in kids, but again, trying to alter sleep cycles and going to bed a little earlier and getting up a little earlier, actually that maybe tough on kids, but certainly not anything dangerous you could try it and the exposure to bright light in the morning if you have a light box,  that's the kids say, cool, how do you do that and they're definitely sort of issues on how to actually make this happen but my point is it's safe to do and then the melatonin that may be a little bit more iffy in terms of if your doctor is going to feel comfortable prescribing melatonin for a few days for travel. But my point is there has been some experience in the literature using melatonin in kids who've had sleep disturbances so things to think about. Certainly not giving any recommendations that this is what you have to do but something to think about. You can at least direct your doctor to those studies and have them look at it and maybe change what they're doing.

38:00

All right, let's take a quick break and we'll be back and wrap up the show right after this.

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38:34

All right. Thanks to Nationwide Children's Hospital for providing the bandwidth for the show, also Medical News Today for helping us out with the news department and Vlad over vladstudio.com for contributing the artwork on the website and feed, and of course thanks to all of your for tuning in and making a little time during your day for Pediacast really do appreciate that and of course thanks also to those of you who contribute by writing in and asking questions or calling the Skype line. We can't get all the questions and I really apologize for that, but if we get a big name sponsor and I can start actually paying bills with Pediacast then we'll do more shows and answer more questions, I promise. We always make a mention of the blog Pediascribe and there was a winner of the 100 dollar Amazon gift certificate, so if you go to Pediascribe.com or go to Pediacast.org click on the Pediascribe link, you can find out who the winner was. The winner knows who they are and it wasn't rigged or anything it was totally random selection, trust me. Karen put a lot of work into that. Also I wanted to highlight one other blog post and that was one called "I Spent The Weekend With Influenza A…  [Laughs]. There is a link in the show notes to that so while I spent the weekend with patients because I was on call and we're so busy on Saturday and I also spent the weekend alone with Nick, which we talked about in the introduction of the show. Karen on the other hand, she was with Katie but there were other people there too and she spent the weekend with influenza A, so all that you read at, in the blog.

40:11

Don't forget the PediaCast shop is open, we don't have any up-charge on t-shirts, you can find those if you go to Pediacast.org and click on the shop link. Also, there's a poster page at the website as well, you can print off the PDFs of posters hang them up on boards and of course spread on the news about PediaCast, by word of mouth is also very helpful. So we're shooting for another show this week. Flu season is definitely in full swing and things have been pretty crazy in the office, so I hope to get another show at this week, but if not then I'll see you next week. So until then, whether it's later this week or next week. This is Dr. Mike saying, "Stay safe, stay healthy and stay involved with your kids." So long everybody.

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