Skipping Breakfast, Acne Education Programs, Baby Burps – PediaCast 114

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Topics

• Skipping Breakfast
• Acne Education Programs
• Alcohol Advertising
• College Drinking Problems
• Baby Burps
• Hypoglycemia

Links

• Teens Who Eat Breakfast Daily Found To Eat Healthier Diets Than Those Who Skip Breakfast
• Knowledge About Acne For Teens: Education Programs Can Be Effective
• Teens Learn To Say "No" To Alcohol Advertising And Peer Pressure
• College Drinking Problems Could Be Curbed By Parental Supervision During High School
• PediaScribe: 17 Inches

Transcription

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

[Music]

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

Dr. Mike Patrick: Hello, everyone and welcome to this week's edition of PediaCast, a pediatric podcast for moms and dads. This is Dr. Mike coming to you from Birdhouse Studios. I'd like to welcome to the program.

It is Episode 114 and this is for Thursday, March 13th 2008. And I'm calling this on Alcohol Burps – my kids are going to love this one, and Hypoglycemia.

0:01:09

I'd like to welcome all of you to the show. If you've not joined this before, PediaCast, like the tagline says, it's a pediatric podcast for parents. And we do some news, we answer some listener questions and I'd like to thank you for joining us.

If you are an old listener, you'd been around for a while, I have an apology. Last week, I had mentioned I was going to try to get another show and [Sigh] but strep and flu were still at high levels in the office.

They have slowed down this week. This week's been better, a little bit slower. But the best laid plans I had hope to get a couple of shows out over the weekend and then we got this little blizzard in Ohio.

As it turns out, it wasn't a blizzard but they are calling it a blizzard, blizzard warning. It's a blizzard then after the fact, they said no. It wasn't a blizzard. But you know, it was close enough. Look, 17 inches of snow in Central Ohio pretty much brings everything to a stop.

0:02:04

Now, luckily, I had a snow blur. Took me a while to get it started because it had one-year-old gas in it and I hadn't used the stabilizer and yadda, yadda, yadda. But I did get it started and still even with the snow blur, 17 inches of snow takes a while to clear up. And by the time I got done doing that, I was in really no condition to do a podcast.

And when you got 17 inches of snow on the ground, honestly, you'd rather just get the fire going, play some games, work on the taxes, OK. Maybe you don't want to do that, but it had to be done. I hadn't done it. It had to be done and so the podcast got put aside. So yes, I procrastinated.

But you know, I'm here now, we're ready to rock and roll. And you know, hopefully this will be a good show. Actually, we're going to give some love today to the teenagers. Now, I had mentioned this a couple of shows ago that we've been concentrating on babies an awful lot. We've had lots baby news stories, lots of baby questions. So at least in our news section today, we're going to talk about some teen issues, so that's coming up.

0:03:13

Oh, before we get started, I want to give thanks here real quick to – give thanks [Laughs]. Sounds like I'm in church. No, no, no. I want to thank Bill at Sweet Water. I got a new microphone; I can't believe that I didn't mention this sooner.

I'm really excited about this. This is the first episode with the new mic and I have a Newman studio condenser mic and this is the first show that I'm actually using it. It's a really nice microphone; It's one that lots of radio stations use. In fact, a clear channel just purchased a whole bunch of them for studio project that they have going down in Atlanta and so I was really happy to get this. Got a good deal on it, really – the folks at Sweet Water do a nice job. If you need any audio equipment, I highly recommend them and kudos and thanks go out to Bill at Sweet Water.

0:04:11

They're an Indiana-based company and they know lots of stuff about audios. So if you're in the building a home studio, whether it be for podcasting or for music, you definitely want to check them out. By the way, this is not a paid endorsement. I didn't get a discount on my microphone for mentioning Sweet Water. But look, if you go to Sweet Water and you talk to Bill, mention you heard about him for me and who knows me. Maybe I'll get a discount on my next purchase. So anyway, thanks to Bill over at Sweet Water.

OK, don't forget if there's a topic that you would like us to talk about on PediaCast, it's easy to get a hold of me. Just go to Pediacast.org and click on the Contact link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. The information presented in this show 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.

0:05:15

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, right after this short break.

[Music]

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.

0:06:08

Teens who eat breakfast daily are found to eat healthier diets than those who skip breakfast. The University of Minnesota School of Public Health has a new project called Eating Among Teens. And researchers involved in the project have found further evidence to support the importance of encouraging youth to eat breakfast regularly.

Researchers examined the association between breakfast frequency and five-year body weight change in more than 2,200 adolescence and the results indicate the daily breakfast eaters consumed a healthier diet and were more physically active than breakfast skippers during adolescence.

Five years later, the daily breakfast eaters also tended to gain less weight and have lower body mass index levels an indicator of obesity risk compare to those who had skipped breakfast as teens.

The researchers say this study extends the literature on the topic of breakfast habits and obesity risk because of the size and duration of the study.

0:07:02

That those response findings between breakfast frequency and obesity risk even after taking into physical activity and other dietary factors suggest that eating breakfast may have important effects on overall diet and obesity risk.

Over the past two decades, rates of obesity have doubled in children and nearly tripled in adolescents. 57% of adolescent females and 33% of males frequently use unhealthy weight control behaviors and it is estimated between 12% and 24% of children in adolescents regularly skip breakfast. And as it turns out, this percentage of breakfast skippers increases with age.

This study confirms the importance of teaching adolescents to start the day off right by eating breakfast. Although adolescents may think skipping breakfast seems like a good way to save on calories, findings suggest the opposite.

Eating a healthy breakfast may help adolescents avoid eating more than they should later in the day and it disrupts unhealthy eating patterns, such as not eating early in the day and eating a lot late in the evening.

0:08:04

And from food to pimples. Written handouts and computerized presentations are both beneficial when educating adolescents about acne. So says a report published in the February 2008 instalment of Archives of Dermatology.

While an enormous number of teens have acne, there's also significant misunderstanding surrounding its causes and treatment. In fact, surveys of the patients with acne in academic and community settings have revealed widespread misconceptions regarding acne's pathogenesis, its natural course and its response to therapy.

Surveys also showed teens get their information about acne from television, parents, friends and magazines. Doctors says the Yale University School of Medicine in New Haven Connecticut studied teens aged 13 to 17 who visited either a private dermatology practice or one of three general pediatric clinics.

They gave the kids a short questionnaire to assess their existing awareness of acne, then assigned them by random coin toss to receive either written information or an audio visual presentation.

0:09:07

Both forms of teaching included common false impressions about acne and information about the causes, factors that make it worse and treatment options. Researchers gave the kids another quiz immediately following the information session and then a third quiz one month later.

Both groups of teens generally scored higher on the acne knowledge tests in both follow-up quizzes and no significant advantage was found in either group of four or after the information session so the two methods can be considered equally effective.

The authors say the results of the studies support the notion that computerized audiovisual presentations serve as effective teaching tools in the clinic and may relieve the burden on busy healthcare providers. Since this improvement was shown in all groups of patients, the researchers are optimistic for the future of education regarding acne. An improvement and knowledge course achieved by most participants including those who had previously seen a physician for their acne suggests there is room for improvement in acne education.

0:10:06

The authors conclude by saying future studies could provide additional clarification regarding the specific combination of educational interventions that may be most effective and feasible in the setting of an outpatient clinic.

In addition, future studies could evaluate the effect increased knowledge about acne has on adolescent population in terms of self confidence, complains with skin care regimens and most notably, improved clinical outcomes.

OK, enough about pimples. Let's talk a little bit about alcohol. Teens who recognize and resist the persuasive tactics used in alcohol ads are less likely to succumb to alcohol advertising and peer pressure to drink.

The results of a three-year study of intercity middle school students by Cornell Medical College Researchers will appear in the April edition of the Journal Addictive Behaviors.

Previous research has shown the connection between advertising and adolescent alcohol use, as well as the influence of peers in promoting teens to drink. There are many pressures on teens and one very powerful influence is advertising. From television to billboards, it's everywhere.

0:11:12

"This study found teens' ability to be critically aware of advertising and their ability to resist peer pressure are both key skills for avoiding alcohol," says Dr. Jennifer Epstein, lead author of the study. Researchers took survey of over 2,000 predominantly African-American adolescents from 13 intercity junior high schools in New York City over a three-year period.

The study found seventh graders who are critically aware of advertising, something the study terms media-resistance skills or significantly less likely to drink alcohol as ninth graders. These same seventh graders are also more likely to develop better skills for resisting peer pressure by the eighth grade, further reducing their likelihood of drinking.

Armed with media resistance and peer refusal skills, otherwise known as saying no, these students were also less likely to succumb to advertising to peer pressure and drink alcohol in the ninth grade.

0:12:06

Alcohol is the number one drug of abuse in the U.S. and among our nation's youth. A recent report by the surgeon general found despite laws against it, underage drinking is deeply embedded in American culture viewed as a right of passage and facilitated by adults.

The authors say, "Our findings point to the need for prevention programs that teach adolescents media-resistant skills and peer refusal skills. To reduce the likelihood, they will succumb to the powerful dual influences of alcohol advertising and peer pressure."

Adolescent media resistant skills and peer refusal skills. [Laughs] God love the researchers. Just got to love it. OK, just say no.

Alright, and what about when these kids go to college? Well, parental monitoring can reduce high school drinking and as a result have a protective effect on students drinking at college, says research published in the online open access journal, Substance Abuse Treatment Prevention and Policy.

0:13:07

The findings strengthened the idea that certain parental practices throughout high school and perhaps college could be use to curve high-risk drinking in older adolescents. Underage drinking is linked to a number of negative outcomes in this group including suicide, high-risk sexual activity and an increased chance of alcohol dependence.

Researchers from the Center for Substance Abuse Research at the University of Maryland College Park interviewed over 1,000 students in an ongoing longitudinal prospective investigation of health risk behaviors in college students, including alcohol and other drug use.

The team assess parental monitoring and student alcohol consumption in terms of drinks per day in high school using surveys during the summer before the students attended a large public university in the mid-Atlantic states.

Students were then followed up with a personal interview about their first college year to assess alcohol consumption at school. Higher levels of parental supervision were associated with lower levels of high school drinking, independent of sex, race or religion.

0:14:09

Although parental monitoring did not directly influence alcohol consumption in college, there was evidence suggesting high school drinking mediates the relationship between the two factors. Thus, the higher the drinking in high school, the higher the drinking in college.

The author uses information to call in to question the opinion of many parents who think responsible drinking should begin in high school. They summed up their findings by saying, "The transition to college marks a high-risk period of escalation of alcohol consumption. Parents and prevention practitioners can benefit from evidence pointing to specific parenting practices that reduce the risk for heavy drinking. While still allowing for appropriate levels of autonomy, critical for young adult development .

And that will put a wrap on today's News Parents Can Use, the teen edition. And we'll be back with your questions, right after this break.

0:15:01

[Music]

Alright, welcome back to the program. It is time for our Listener segment. And first up is Liza from Salt Lake City and Liza says, "Dr. Mike, first of all, I am a mom of two and a full time statistician. I want to thank you for discussing current medical research especially for highlighting study design and statistical significance of the results. You really save me time since you do all the legwork that I would do to determine relevance and believability of the headlines I come across.

Now I'm hoping you can address an issue with my five-month old daughter. She is always perfectly happy to go to bed at 8 p.m. each night. However, she always wakes up within the hour and when I pick her up, she lets out a huge burp and falls back to sleep quickly.

0:16:10

Then for an hour to an hour and a half, she continues to wake up every 15 to 30 minutes, needing to burp again. I've tried using anti-gas drops feeding her less and feeding her more, but have seen no effect. My question is when do babies begin to burp on their own? I have a hard time letting herself soothe if the problem is a big burp that's stuck in her chest. She's exclusively breastfed and does use a pacifier at night. Many thanks, Liza."

Well, Liza, thanks for your question. You know, this is the kind of thing I see pretty often, not babies who aren't able to burp, but parents who get an idea in their head of what's wrong with their child and focus only on dealing with what they perceive to be the problem.

Now I'm not saying that mother's intuition is not a good thing because oftentimes, it's correct. But it's not always right.

0:17:04

And hearing the story, I would actually sort of challenge your burp theory, Liza. To me, this sounds like a reflux issue. So basically, what you have which I think makes for a better explanation is that when your baby lays down, stomach acid flows to the top part of the stomach and sneaks into the lower esophagus and causes heartburn. And then the baby fusses because it hurts and cries and swallows air in the process of crying and being fussy. And then you go in, pick her up and of course, the burp comes out from the swallowed air that she swallowed when she was crying and fussy because of her heartburn which was worse when you lay her down on her back.

She also is happier when you pick her up because the stomach acid flows back down because your baby is now in an upright position and she feels better and goes back to sleep. You lay her down, the stomach acid goes back up, causes the heartburn, she gets fussy, she cries, she swallows air, you pick her up, she burps. OK, you see where I'm going with this. The process repeats over and over and over.

0:18:11

Now, am I right about this or is this a burping issue. You know, it takes trial and error to figure that out. If I were seeing you in my office and you had tried the things that you had mentioned, you tried the anti-gas drops, you tried feeding her a little less, you tried feeding her a little more, I would suggest at that point, again this is if I were seeing you in my office, OK. You have to talk to your doctor. I would suggest trying an acid reducer to see if that helps and if it does, then you have the answer.

The stomach acid still going to flow up toward the esophagus, but it's less likely to cause heartburn if that has that stomach juices have less acidity or less acid content associated with them. Now what options do you have? You can try an antacid like calcium-rich Mylanta. You can try a medicine that stops these stomach's ability to produce acid like Zantac or another class of medications like Prevacid. But again, talk to your doctor.

0:19:15

My only point with this, Liza, is just sometimes you have to turn your thinking upside down to figure these things out. And this is where an experience pediatrician can really help out with baby problem solving.

Alright, next up, we have Kristine from Rochester, Minnesota and Kristine says, "Hi. I bought a home glucose monitor and found my little girl had low blood sugar, it was 63. What do I tell her teachers at school? I would like to know if she should wear a medical ID alert bracelet. Thanks, Kristine."

Oh, Kristine, Kristine, Kristine. I am first and foremost reminded of an important lesson that I learned way back in medical school. You have to treat the patient, not the number.

0:20:00

Now there are several things wrong with what you did, Kristine. And I'm not picking on you, these are important points and there are several rules at play here and I'm going to cover some of those. Because I think this is important for parents to understand, not just in their own kids, but really these kind of rules apply to adults as well just sort of good medicine in general.

First, there is no absolute standard on lab numbers. This is rule number one. The result of any given lab test depends on the exact technique done by the lab or by your test kit, in this case.

So if you took the same specimen of blood and you ran a serum glucose, which is what this test is trying to figure out, in two different labs, the exact same sample of blood, one lab might give you an answer of 68 and the other one might say the blood glucose is 75. So which is it? And does that number really matter?

Well, along with that number comes a reference range and that range is calibrated for the technique that the lab uses and so you have to interpret a lab result based on the lab that did it and what their reference range is.

0:21:14

Now sure you can say in general, it's supposed to be between X and Y, but when you're at the extremes of the normal range which is where you are because you're at the low end of what – it's probably still normal. But it really depends on what the normal range is for that test.

Now the other key point is that the normal range for that test is going to be different for adults and for kids. So what you would want is for some kind of standardization of a kid's blood and adult's blood, many, many samples for the lab to tell you what this means.

So my point here is that when you do a home glucose test, it's not very good for diagnosing. It may be good if you're a diabetic and you need to monitor your glucose and you generally what gross range you're supposed to be in and you want to know if you're supposed to give yourself insulin or call you doctor, that kind of thing.

0:22:15

It's great for monitoring a condition you already know about but it's not very good for diagnosing a condition. So you got to keep that in mind.

And also knowing that it can be different from lab to lab, what does 63 on a home glucose monitor really mean? I mean what would that same specimen yield in a children's hospital lab, would it still be 63? Would it be 58? Would it be 72? I don't know.

But it's OK because that brings us to point number two – rule number two, labs must be interpreted in their clinical context. So I would want to know when was the last time your child ate, what had your child eaten? When you obtained this number 63, did she exhibit any symptoms that she have lightheadedness? Was she shaky or what we call diaphoretic or she's sweating? Was she confused or was she acting normal?

0:23:10

I mean these are all important considerations of 63 in a kid who is shaky and diaphoretic and confused. You know, what I'm worried is if this test is really right and is there glucose really 40? Or if she acting fine and it doesn't really matter what number you got on the home glucose monitor, right?

The other thing to keep in mind and again, this isn't picking on you Kristine; I'm just talking in general about laboratory studies. You have to remember that lab results are a slice in time. So if I get a blood sugar of 63, it means that the concentration of glucose in that tiny sample of blood was 63.

Now does that mean it's 63 throughout the entire body? No, and I'll tell you a story from when I was a resident. I remember a kid in the ER who had blood drawn and he had a bunch of blood test run. And a nurse came along. It was a change of shift and a nurse came along ten minutes later and drew his blood again.

0:24:11

Now, poor guy, he didn't mention, hey someone was just here two minutes ago and drew my blood and the parents didn't say anything about it. I mean they just figured, well, maybe they needed more blood.

But as it turned out, the second person drew blood ten minutes later sent the same battery of tests to lab to run it – OK, I know, the system is broken down in more places than I care to admit, but they did get run and so we have two results, same patient, same lab test run, 10 minutes apart, you would not believe how different this – their results were.

Now they were all – what was normal was normal. What was out of range was still out of range. But in one, let's say the sodium is 142 and then the other one is 135. So which is it? Well, I mean they're both normal'ish.

0:25:01

So again, the important thing here is that our lab result is not some gold number. There's lot of fault in the system and that's where the art of medicine comes in. You have to take into account how you obtained the test, what the clinical circumstances was, what the reference range for the lab is. So these are all important things and why just buying a home kit on your own and testing it and then making a diagnosis and wanting to know if this is what it is, shall I get a medical ID bracelet, that's jumping way too many steps ahead.

OK, and then my fourth rule is only check labs if you have good reason and if you are prepared to act on the result. We don't check in medicine any lab because we're curious about it. Because you may find yourself in a situation where you feel like you have to act when you really don't need to. An example of this is let's say I admit a kid to the hospital because they're wheezing. They're not dehydrated, but I get an electrolyte panel for kicks and giggles.

0:26:04

OK, maybe I think hey, I'm being complete. I'm going to order this electrolyte panel and I really didn't have a good reason to check the electrolytes. But I do it and the potassium comes back really elevated. So I panic because a kid with this high of a potassium level can have a fatal heart rhythm.

So I give the child medicine to bring his potassium level down really quickly and the child suddenly becomes weak, stops breathing and dies.

OK, I know. This is an extreme example. But it happened because I broke all the rules. Now, by the way, this is not a real experience of mine. I'm just using this as a hypothetical story and to illustrate some points.

So in this situation, I didn't have a good reason for checking the lab study in the first place. I didn't look at the clinical situation. As it turns out, let's say this child was difficult stick. The phlebotomist squeezed and squeezed and in order to get the sample, there was hemolysis of the blood which means some of the blood cells broke apart. This broken cells spilled their internal potassium into the sample so the sample had an elevated potassium, but the potassium was not elevated throughout the entire body.

0:27:17

And I acted when I didn't need to and I ended up causing much more harm, much more harm because of it. Now what if I hadn't acted? And what if the result had been real and the child dies from
hyperkalemia or too high of a potassium level?

See, when you get a lab, you got to be prepared to act on it, and once you get an abnormal result, then you can't ignore it. So what would I have done in a situation, let's say that, that happened to me and I – for kicks and giggles, I got an electrolyte panel when I really didn't need one in a kid who wasn't dehydrated. They're not going to get IV fluids. What would have I done when I got it back and I had this really high potassium level?

First thing I would have done it is repeated the lab to make sure – to see if I got that result again. and if I'm really worried, I can look at an EKG to see if there's evidence that this is a true value because you're going to see EKG evidence of hyperkalemia or high potassium.

0:28:13

OK, so let's bring this all back to Kristine, OK. First of all, if your child didn't have any symptoms, you really had no business checking. Now if your child has symptoms of hypoglycemia, so they have weakness and they're kind of shaky, diaphoretic or sweating, confused. OK, the right thing to do in that case is to call your doctor.

And if the symptoms are severe, such as the diaphoretic or confused, you go to the ER or you call 911. Nowhere in this pathway is there room for self-administering a home glucose test. Alright, Let me repeat that. Nowhere in this pathway is there room for buying a home test and checking it out for yourself. But Kristine, you did and now we have to deal with the result. So what do we do?

0:29:01

Well, we look at the number and the context, so am I really worried about a single reading of 63 and a random sample of blood done on a home machine? If the child is playful, they're acting fine, they're their normal self, you just got the for kicks and giggles because maybe hypoglycemia runs in your family and you just wanted to check, but the kid's fine. Then 63 doesn't really bother me.

Now on the other hand, if you checked it and that was 63 and your child was weak and felt lightheaded and maybe was sweating a little bit, now my ears are perking up. And I want to know more. And in this case, a definitive test for hypoglycemia is a glucose tolerance test.

And basically what this is you have a child fast and adults can have this done too. You fast, let's say at midnight, you go into the lab in the morning. You ingest a standard amount of a sugar drink and then you check the serum glucose at one hour, at three hours and then if you're looking for hypoglycemia, you need to check again at about five hours.

0:30:06

If you're looking for diabetes, usually the one to three hours ones are going to be fine. But if you're looking for hypoglycemia, you really got to go do the test longer and check out that five-hour result too and then you can diagnose hypoglycemia.

So a home glucose monitor is not going to do it. You need to talk to your doctor and do a glucose tolerance test and that's how you figure out if someone has hypoglycemic problems.

Now answers to Kristine's question, what do you tell the teacher? The answer to that is nothing. The question should be what do you tell your doctor. OK, so you tell him what you did and ask what you should do.

Now if the doctor is me, I'll scratch my head and wonder why you checked in the first place. And if you had no good reason, I'd say stop checking. If you did have a good reason, I say make an appointment and come see me as soon as possible and we'll go from there.

Now what about a medical ID bracelet? You know, hypoglycemia can be a life-threatening condition to diabetics because if they take too much insulin, the insulin they give themselves causes the sugar, blood sugar to go into cells and so the amount of blood sugar in the blood dips down too low and that can cause death.

0:31:19

But we're not talking 63 and that happening. We're talking in the 20 to 40 range when symptomatic hypoglycemia is going to occur. And if your child is dropping that low, down in like the 20 to 40 range, they're definitely – she's going to have significant symptoms and we're going to need to figure out exactly why this is happening.

There are metabolic diseases, for example, there's one known as MCAD that can do that sort of thing and those kids should definitely have a medical ID bracelet in school. Officials, teachers, everyone should know about their condition.

But most of the kids are the ones who just get a little shaky if their blood sugar drops a little bit. They might wake up shaky if they don't have a snack before bed or they might even vomit if they go too long and their blood sugar dips down into the sort of 50 to 60 range.

0:32:10

So these are the kids who are sensitive to low blood sugar, but they never really drop down into the life-threatening levels. So that's much more common. It tends to run in families. In fact, my wife's brother is like that. And my son is like that too.

But this is not a life-threatening condition. It's a nuisance. This people who are affected by this learned to eat a snack before bed, carbs being better than simple sugars cause it'll last you longer and that you'll learn to eat smaller meals more frequently.

But is this truly a medical condition? No, I don't think so. I think it's just your body has a tendency to use up glucose or sugar in the blood and you start dropping low and you feel a little funny from it, a little shaky, but you're not going die from it. Your body is going to make blood sugar for you through the normal pathways that it does.

0:33:03

Now again, there are some metabolic diseases where that's not the case. It can dip down really low, become very serious. But most of these kids are picked up in childhood. And again, you don't figure this whole thing out by getting a home medical test. You talk to your doctor and you go from there.

And should kids who are sensitive to low glucose, do they need to wear medical ID bracelets? No. Should you tell your teacher? I mean in the end, sure, that's fine. Let the teacher know. But your doctor's got to know first, Kristine. Please, please, do that for me.
OK, let's take a quick break and we'll wrap up the show. Kristine, please don't be offended. I just – it was a great question and I'm glad you did that because it allowed me to point out some things about labs and medicines. So appreciate it, Kristine.

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

[Music]

0:34:32

Alright, thanks go out to Nationwide Children's Hospital for providing the bandwidth for our show. Also, Medical News Today for helping out with the News segment. And Vlad over vladstudio.com for contributing the artwork that you'll find at the website at Pediacast.org and also in the feed.

And of course, thanks to all of you for tuning in and being a part of the show. Those of you who write in, I know, I know, there's lots of you who write in and we don't get to your questions and I apologize for that.

I wish I really, really wish that I could answer everybody's question but I can't. And it just get too many of them. I try to pick questions to give the show a good diverse range of topics. Things we have not covered before, things we can reinforce, baby topics, preschool topics, child and teens.

0:35:19

And so it's not that you don't have a good question if we don't get to it. It just maybe that your question isn't matching up with what we need in the show at the current time. So if there ever comes a time when I can turn this into a true daily podcast, I will really be able to get to everybody's questions, although then the audience are probably growing. We'll be in the same boat, but you know, such is life.

I also, what was I do – oh, thanks. Yes, see, I can tell you what, my ADHD is really kicking in today. So thanks go out to my family as well. I really appreciate the space and time that they give me to put this podcast together. Plus, I get to buy neat, really cool toys too, like microphones. [Laughs]

0:36:03

The PediaScribe blog, 17 inches! It's pictures from the snowstorm, the almost blizzard that we have last weekend. So check out the Show Notes if you'd like to see pictures of Central Ohio covered with 17 inches of snow. And what some families do with 17 inches of snow. So you can find that out too. Just check out the Show Notes and we'll have a link to the PediaScribe blog for you there.

Don't forget the PediaCast Shop is open. We have t-shirts with PediaCast logos, other merchandise as well. I had mentioned that this summer, if you're going on vacation or spring even and you're going someplace that's easily recognizable, take along a PediaCast shirt and snap a picture. We'll put some pictures up on the website of people with their t-shirts on next to famous things and we'll run a contest, pick a winner. More details on that coming up.

0:36:58

iTunes reviews are so, so helpful. If you haven't had a chance to do that yet, I would appreciate it. We have posters at the website so you can download the PDF file, print it out and take that in to your doctor's office, your church's nurseries, the YMCA, all these kind of places and hang them up in the bulletin boards. We'd appreciate that as well.

Alright, this will be the only show this week. I'll be back in next week. I really hope to have two shows next week. I really do. And I am still working on that special Listener Feedback and Rant show and hope to have that down in the next week or so, as well as more news and answers to your questions.

And until next time, this is Dr. Mike saying, "Stay safe, stay healthy and stay involved with your kids…. So long, everybody!

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