Introducing BirdHouse 2.0 – PediaCast 142

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Topics

• Uninsured Kids
• Body Image And Peer Groups
• Brain Abnormality And ADHD
• HPV Vaccine related to Preterm Births
• Baby Lotion
• Milk Allergy
• Vomiting And Diarrhea
• Sleeping Problems

Links

• Survey Finds Fewer Uninsured Children
• Dissatisfaction With Appearance And Peer Group Problems
• Brain Abnormality Found In Boys With ADHD
• Some Preterm Births May Be Prevented By HPV-Vaccine

Nutrition Comparisons

Whole Cow's Milk

• Calories = 20 Kcal / oz
• Protein = 34 grams / L
• Fat = 34.5 grams / L
• Carbs = 48 grams / L
• Calcium = 1.2 grams (1226 mg) / L
• Iron = 0.5 mg / L

Silk Soymilk

• Calories = 13.75 Kcal / oz
• Protein = 29 grams / L
• Fat = 21 grams / L
• Carbs = 25 grams / L
• Calcium = 0.729 grams (729 mg) / L (35%)
• Iron = 1.75 mg / L (6%)

Soy Formula

• Calories = 20 Kcal / oz
• Protein = 16.6 grams / L
• Fat = 37 grams / L
• Carbs = 70 grams / L
• Calcium = 0.7 grams (710 mg) / L
• Iron = 12 mg / L

Soy Go and Grow

• Calories = 20 Kcal / oz
• Protein = 17 grams / L
• Fat = 37 grams / L
• Carbs = 70 grams / L
• Calcium = 1.014 grams (1014 mg) / L
• Iron = 13.5 mg / L

Human Breast Milk

• Calories = 20 Kcal / oz
• Protein = 10.5 grams / L
• Fat = 39 grams / L
• Carbs = 72 grams / L
• Calcium = 0.279 grams (279 mg) / L
• Iron = 0.3 mg / L

Transcription

[Music]

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

[Music]

0:01:04

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 PediaCast, this is Episode 142. After a long hiatus, kind of like a hibernation, you know. It's the first day of spring. What perfect day to get back on track in terms of PediaCast. It is Friday, March 20, 2009. So happy spring everyone. And I'm really glad to be back.

The last time I talked to you was the end of January and I had mentioned, no, it will be two, three weeks. Two, three weeks, you know, it kind of turned in to a couple of months, just about. So I apologize for that. I do have good excuses. I won't spend too much time dwelling on sad excuses. Although they are kind of interesting.

Those of you who are regular listeners to the podcast know that we just moved to Florida back in September and we're in the midst of building a new house and we finally got the house built, moved in.

0:02:12

And let me tell you, setting up a new house takes a lot more work than I thought I was going to. And so you just are exhausted. I mean we're hanging ceiling fans, we're switching out lights, switches with dimmer switches because you know, I don't like the bright lights. Kind of sound like a vampire or something. And that — I just I don't know. I just I really like dimmers. And so you guys have switch all those. No, it doesn't take a month to do.

But you know, you're hanging pictures and okay, what piece of furniture can go here and then there's an Ikea that's just way too close to where we live. Also rooms to go, I don't remember seeing any of those in Ohio. And we spent a lot of time there, I don't know, we're just — it's been a long time since we've set up a new house and we left so much behind in Ohio. I think we have talked about this a couple of times before.

0:03:01

We have like this big, it wasn't even a garage sale. It was a garage give. I mean we just — lots of families especially nieces and nephews with young kids. It was like okay, pop by the garage. You want this TV, take it. You want this — because it was cheaper than moving it to Florida.

You know at the mover expenses, it's just crazy and so it's a lot cheaper just to leave it behind and get new stuff. Plus you know, hey, I'm doing my part to stimulate the economy.

Anyway, I'm like this is going tangent day, I think, because it's been so long since we've gotten together and chatted. So you got to cut me a little bit of slack. We do have a great show lined up for you and I will get to the topics here in a minute.

Some changes that you'll notice. Number one, I didn't actually put a title to this show and if you look through at the website which is all brand new and I'll explain why in a minute, we didn't — I didn't put the title names because I thought the title names are really starting to distract because we pack so much information into one of these programs that I just picked three topics and put it in the title.

0:04:05

If you're just sort of cruising the site and you look and what catches your eyes is just the title, well, you may miss some of the other topics that are just as important to you in the Show Notes. So by not having the titles with topic, I think it's going to help to move your eye down to the topic list for each show and then you have a better idea of exactly what that show entails in terms of topics.

But before we get to the topics, I do just want to explain one thing and okay, it's an excuse. But I really feel the need to go over this because it really explains a very large part of why it took so long for me to get PediaCast back up and running. For years, I had used a web host provider in the United Kingdom and the reasons — their servers were actually in the United States, but their administrative offices were in the U.K.

0:05:00

And I always like them because they were very personable and I kind of like to mock around with the website and get into the code and design things myself. Just a hobby of mine that I really enjoy doing. My wife would call it being geeky, but I call it being creative.
Anyway, so I really enjoy — I really love this web host provider. Well, I did notice that from a technical standpoint that their customer service/tech support type people back last summer really stopped responding. And I had a couple of billing issues and I had a couple of upload issues and server, when it was available, when it was down kind of issues and it took — it was like pulling teeth to get a hold of these people which was really unusual because they had been so great for so many years before.

Because even before PediaCast when I was doing the blog and I have a website that I do for my father in law. He has a business and I design his website in my spare time. And I've actually done that for going on like nine years. So I have been with these people a long time.

0:06:04

And I guess, it would have thrown up red flags that I wasn't able to get a hold of them if it weren't for this move. You know when your mind is on, okay, I got to get my floor to medical license. We've got to sell this house, we've got to buy a new house. I mean I'm doing well enough just to get a show out every couple of weeks when there's that kind of craziness going on in your life.

So I think even at normal times, I would have recognized the red flags, but I didn't. And basically what happened is once we got in the new house and I had the studio pretty much put together, I mean we're still putting the house together hanging things and ceiling fans and then we have switches and all of that, but I probably still would have had the time to eke out a show except that all of a sudden everything disappeared.

I mean the website disappeared. The feed disappeared. I mean everything, poof! Gone. And so a panic time, Karen's — the PediaScribe blog, Katy's Bag of Chips blog, I'm telling you everything was gone and of course, I couldn't get a hold of the hosting provider people.

0:07:03

Well, to make a long story short, if I actually can do such a thing, what happened is that this guy in the United Kingdom actually didn't own any of the machines in the United States. There's a big web-hosting center, I'm not going to name any names, they're at Atlanta and he was running out space with them. And as it turns out, he wasn't paying his bill for a long time.

So he's basically taking my money and all the other people who had websites hosted through him, taking our money and then not paying his bills. And so the folks in Atlanta got fed up with it and shut his machines off. Well, what a nightmare.

And then the people in Atlanta wanted me to pay them extra money to get all my data back. Now should I have had backups made? Yes. Did I? I did, but they were several months old and it was just basically a nightmare and I thought what a great opportunity just to build it new from the ground up, do it the right way, make backups as I go and so rather than having an old site and trying to catch up, and just designed it from the ground up.

0:08:09

And that's taken a lot of time and to find a new hosting provider that I trust. And by the way, one of Karen's blog friends really came through with this and she does basically the same sort of thing where she has a few large servers with a big hosting company then subleases her space and that's what I'm doing now with the website.

Now the audio files themselves were never in question — or never in danger because I have tons of backups of all the shows. And there are at [XX_0:08:37], that's where they're hosted. So they were safe but the feed was gone and I had to recreate the feed by hand. And again, I used the new product from reinvented software called feeder to do that.

And I have to give Kudos to them because it made recreating the feed really easy and so if you're a podcaster and you want something more than just Word Press to do your feed, you might want to check out feeder at reinvented software. No, I'm not getting any promotional kickback because I'm such a terrible business person that you know, I just say these things without thinking about it.

0:09:09

Okay, so anyway, we're already 10 minutes into the show and I'm still talking about my personal life, but you know like we're friends. And it's been a really long time since we've been together. And so I'm just trying to get you caught up on some things. There's lots more to tell you but we'll get to that as we go along.

Okay, one more thing I have to mention. You'll notice in the intro, we brought back the name Birdhouse Studio. I had to do it. When we moved, the transition studio was in the bedroom, we didn't have any wall hangings. I was on some rickety old bookcases. I mean it just suck as a studio, okay. I mean it was just — it was really hard to get motivated. And the most exciting thing was looking out the window because it wasn't the gray clouds of Ohio, there's no rain. I mean beautiful blue skies, so hey, Summerland Studio just really foot the bill. So I had kick around some other names for the new studio and none of them just felt right.

0:10:04

Well then as I was setting up the new studio and opening boxes that we didn't open up in the rental house while our house was being built, all the Birdhouse stuff was packed into a box and over the years, we've collected some birdhouses. And so I put them up here and doggone it, it's Birdhouse Studio 2.0.

So we started as Birdhouse Studio and we're going to continue that tradition. So we are back to Birdhouse studio. Like you care. You just want to know why your kids are sick and what to do about it.

Okay, so what are we going to talk about today. Uninsured kids, kids without health insurance, is it really a big problem? Body image and peer groups, brain abnormalities and ADHD, HPV vaccine isn't related to preterm births. Does it prevent it, does it cause it, we'll talk about it.

And questions from you concerning baby lotion, milk allergies, vomiting, diarrhea and sleeping problems. So we're kind of getting back here to sort of what I would call bread and butter pediatrics. Just the basic stuff.

0:11:04

But you know, what a great way to start, I think, here on the first day of spring. And I don't know, I'm excited to be here. I'm like a little kid at Christmas, I mean back behind the microphone like at the new studio set up, I'm just — I'm really excited.

Alright, don't forget if there is a topic that you would like us to talk about, all you have to do is go to pediacast.org, the brand new website, which is still a work-in-progress, by the way. But the Contact page's up and running. So if you go to pediacast.org, click on the Contact link, you can get a hold of me that way.

And if you have a question that you'd like to us or a topic you'd like to suggest, just drop by there and let me know. Also, pediacast@gmail.com that continues to be the way to get a hold of me if you'd rather just email a question or comment. And of course, the voice line is open (347) 404-KIDS. That's (347) 404-K-I-D-S or 5437. By the way, we are on Skype as well. In fact, that is a Skype phone number. So if you want to add me to your Skype contact list, it's either PediaCast or Dr. Mike. I should probably know that off top of my head, but I don't. Because you know at these programs, you just double click it and you're there. Because you remember all your settings until something goes wrong and then you can – okay, there again, tangents, tangents, tangents.

0:12:15

So what are we doing? Let's go ahead and do our disclaimer, we'll take a really quick break and then we'll come back and do some news stories for you. I have to warn you though, the news stories this week are really going to be heavy on the comment part because I don't know. I just have a lot to say.

So anyway, 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. Yes, that part of the website is also up and running just fine. And with all that in mind, we will be back, I promise, with the News Parents Can Use, right after this short break.

0:13:03

[Music]

See now, there's a little nostalgia for you. That song, which is called Collins Avenue, was our original introduction music way back a long, long time ago before we went into our Motown intro, as it's called.

So anyway, just a little trivia there for you. That was our — and those of you who've been with me on the show for a long time, you'll recognized, hey, that's what you used to use. Yeah.

Alright, our News Parents Can Use is brought to you in conjunction — I have problem drinking, folks. I feel — I don't know. I feel a little loopy. And again, I think it's just because I'm really glad to be back.

0:14:09

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

The number of Ohio children with health insurance increased over the past four years, but more adults were uninsured as unemployment rate increase and people lost their employer-sponsored coverage. That's according to the 2008 Ohio Family Health Survey released on Monday. The state-funded survey of more than 51,000 families was conducted by a Macro International between August 2008 and January 2009 and it was co-sponsored by the Health Policy Institute of Ohio and the Ohio State University College of Medicine at government resource center. Hey, that's my alma mater which I didn't realize actually when I picked the article. So I'm kind of little proud.

The survey was last conducted in 2004. So we are comparing 2004 numbers with 2008/2009. So what did they find? And by the way and why do I think it's important to tell you what they found because that's what we're going to talk about.

Let's answer the first question first. The survey found that from August 2008 to January 2009, during that timeframe, when you compare it to 2004, an insurance rates among children dropped from 5.4% in 2004 to 4% in the latest study. So it dropped from 5.4% to 4% and state officials attribute that drop to the expansion of CHIP, which is the Child Health Insurance Program.

Now, nearly 70% of those ends up being about 111,255 in Ohio, nearly 70% of those uninsured children in Ohio were in families with annual incomes below 200% of the federal poverty level, meaning they were eligible but not enrolled in government-sponsored health coverage.  And by the way, Hispanic children were 3x more likely to be uninsured than white children.

0:16:16

Okay, so why is this all important? I'm going to get a little bit political here and I mentioned in the last show, we have a new administration and in terms of child health policy and topics, I am going to get a little bit and thorough around my opinion because I know a lot of you value my opinion and others of you just laugh at it. So either we're going to educate you or provide some humor.

But a lot of generalizations are going to get thrown out in the political arena as time goes on here in the coming months. Numbers are going to get twisted, facts are going to become distorted and I'm not just saying it's democrats or it's the republicans, I'm just talking in general, the government has a habit of twisting things around to making their case with really what their after is they have an agenda.

0:17:06

And I think this was a nice survey without an agenda. Now, yes it's Ohio, it may not represent the state where you live, but it's probably close. There's always been a long saying around the nation that as Ohio goes, so goes the nation. And there's a reason for that. I mean Ohio is a Mid-Western industrial state with lots of different people living there and they always has gone. I don't think there's been a single presidential election in years and years and years that didn't — Ohio was on the side of the winner.

So anyway, I think this is a valid survey and it shows that not a lot of kids in Ohio are uninsured. I mean 4% is a pretty low number and 70% of that 4% qualify but the parents declined it or don't know about it.

The push for socialized medicine in this country is coming. It's coming. The current administration wants to change the fabric of healthcare in this country. And if the success on the economic front says anything, he's got a good chance of doing it. Now is it the right thing?

0:18:20

And so you're going to hear a lot of statistics. And some of them are going to sound scary. But before you buy into statistics, you really have to think about what's behind the numbers? Do they have an agenda and are things really as bad as they say?

4% of kids in Ohio uninsured, 70% of that 4% could be insured, but they aren't for some reason. And of course, the problem then is greater for Hispanic kids and of course that maybe because a large percentage of Hispanic kids in Ohio belong to parents who are migrant workers, who are not here legally and so they're unable to get insured and they get lumped into those numbers as well and that's a different issue altogether.

0:19:10

So if 4% are uninsured and 70% of those qualify for subsidized plan, they're just not on it, does the system need change or do we have more of a problem getting the word out?

I mean I think the United States has the best medical system in the world. And it's interesting, I'm in a position now where I actually interact with people from all over the world because in the Orlando area, there are lot of tourists and I hear it time and time again that I wish we had something like this in our country and the medical system here is great and I get comments, oh, you don't want our system, comments from Canadian, from folks from the United Kingdom, from France, places where there is socialized medicine and I'm here to tell you that if we change the fabric of healthcare in this country, it's not going to be a good thing. Just let me go on record as saying that right now.

0:20:05

So we cannot allow fear and distortion of facts to change what we have here because a lot of people envy it. It's a perfect no. It's not perfect. And another quick note, okay, this is a tangent, I realized, it's not necessarily related to pediatric health, but the government now wants to stop paying medical bills for injured veterans? They want private medical insurance to start paying for injuries and conditions resulting from war?

I mean how ridiculous is that? I mean it's not so ridiculous, I guess, if your goal is to bankrupt private insurance companies and drive up the cost of everyone's premiums, make private insurance too expensive for more and more business to afford to offer. In other words, if your ultimate goal is to get everyone on the same government controlled plan, then that makes sense to destroy the competition. And one way to do that is to hand over the care of our service men and women because it will crack the system which I think the current administration wants.

0:21:04

And I told you I would be watching this. So when they come at you at crazy numbers, don't be spellbound. Numbers, in fact, will be distorted and don't believe them unless they tell you the source, the timeframe, who is affected and the extenuating circumstances which is what I've done here.

I mean only 4% of kids are uninsured and 70% of them qualify for something. That is not a broken system. Now what about the other 30% of the 4% that aren't getting any kind of — they're not on any insurance plan and they don't qualify for public assistance. Well that ends up being 1.2% of all kids in Ohio who are uninsured and do not qualify for assistance because their parents make more than 200% of the federal poverty level.

How many of those kids have parents who simply decline any insurance because they can't afford it or they have other priorities of where their money's going to go.

0:22:02

There are also folks who are in business for themselves, they have trouble affording it and how many again, as I mentioned, are in this country illegally. This study does not tell us about those things and those would be nice bits of information to know.

Okay, I know I'm going long on this, especially for a new story, but I think it's important. I think it's important because you can't listen to numbers with blinders on. There is an agenda that changed the fabric of medicine in this country and in the end; I don't think it's a change that we're going to be happy with.

Now I'm saying that not only as a doctor, but I'm saying that as a consumer and someone who is in the healthcare system day in and day out and I can tell you that the type of change that this administration wants is not the kind of change that you are going to like. And so if they are reasonable on their explanations and they can explain what they're saying, that's one thing but I don't think that's going to happen because when you have a system that is only leaving 1.2% of kids out, it's not a broken system. It needs tweak, but you don't need a whole new system. It's craziness.

0:23:12

Alright, let's move on. We're going to move on to something a little bit more health-related. Dissatisfaction with appearance and peer group problems. Being satisfied with one's appearance is an important factor in maintaining a positive self-image. However, in today's appearance culture is the rule rather than the exception that children and young people are dissatisfied with their appearance.

Those children who are teased or subject to bullying are particularly critical of their appearance and they tend to be this way over a long period. This is revealed in a new thesis in psychology from the University of Gothenburg, Sweden.

In her thesis, Carolina Lunde has followed almost 1,000 children between the ages 10 and 14 with the aim of her investigation the study of the link between body image and peer group relationships.

0:24:01

An important conclusion is that boys and girls become more dissatisfied with their body and their appearance during this age bracket. Even though the girls were consistently more dissatisfied with their appearance than the boys, the boys were also dissatisfied. So again, this is the age group of 10 to 14 years.

Thus the early teen years can be regarded as a high-risk period for acquiring negative body image. The children who weigh the most at 10 years old were particularly dissatisfied with their appearance. Furthermore, overweight children, primarily girls, were bullied and teased about their looks considerably more often than other children in the study.

Overweight children who are bullied bare a double burden low self-image and the stress of being bullied. We've talked about the psychological consequences of bullying before but it's important to remember that negative body image can also have serious psychological consequences. For instance, it increases the risk of developing eating disorders and depression and it limits the joys of life's daily activities.

Ms. Lunde says these children often focus to such an extent on their dissatisfaction. They may find it difficult to think about anything else. And they worry about what other kids are thinking.

0:25:10

They worry about playing outside at recess. They worry about changing their clothes in the locker room, and they worry about relationships with the opposite sex.

Ms. Lunde says the title of her thesis, What People Tell You, Gets to You, is a direct quotation from one of the young people who took part in her study. The most dissatisfied young people indicated their parents and their peer groups frequently commented negatively about their appearance.

Okay, so this is a tough one, isn't it? I mean you have an overweight kid, they're getting made fun of the school they have a low self-image because of this and their parents are also commenting on the child's weight on a negative manner.

Alright, folks. All these negativity is not helping, right? But on the other hand, I mean you don't want to encourage bad habits. You don't want to — you have to be careful how you put things but on the other hand, you can't just ignore it especially if a child is eating wrong and not exercising and there's things that they can do to change themselves.

0:26:05

So I mean we don't want to get all freely and nice and just ignore this problem. But you don't want to be so negative either.

Okay, so I'm going to direct my commentary on this topic to young parents out there with young kids because I think you're in the best position to positively affect your child's self-image. You got to catch him before they're in that 10 to 14 bracket. So I'm talking about toddlers. I mean kids who are toddlers, kindergarten, young school age, I mean personally I think the best thing you can do is start with this from a very young age.

And right from that young age, so parents with young kids; listen to me because seriously, I think this will really help you out. You got to teach your kids to eat in moderation. You have to help them make healthy choices in what they eat. You have to make sure they're getting of plenty of physical exercise time and less screen time.

0:27:03

And here's the most important part of all. You can't just tell your kids, this is what you need to do. This is what you need to eat. This is — you need to exercise now. You need to spend less time on front of the TV. You have to do it together as a family. You have to make good choices together, exercise together, eat the right kind of foods together, and discuss body image together.

I mean let the focus be on the healthy lifestyle and not so focused on numbers, on weight, on size because people come in all shapes and sizes. And sometimes, in fact, often, genetics determine size. And all the dieting and exercising in the world aren't going to change who you are and how you look. It will make you healthier, it will make your heart healthier. It will help you live longer but it's never going to make you look like the girl next door. But she's got her own problems and you don't want them.

So you know, be honest with your kids. Work on it together. Keep the lines of communication open and most importantly, do it from a young age.

0:28:02

Help your kids to be proud of who they are and where they come from. Teach them how to respond to negative comments from others and help them understand why those negative comments are coming out on the first place.

But most important on my opinion, teach them to make good choices early, teach them to love their bodies early and make darn sure that you are eating right and exercising right and loving your body right along with them. Okay, my two cents.

Let's move on, researchers are trying to uncover the mechanisms that cause attention deficit hyperactivity disorder and conduct disorder and they have found an abnormality in the brain of adolescent boys suffering from the conditions but they didn't find it where they expected to.

Boys with either or both of these disorders exhibited a different pattern of brain activity that normally develop in boys when they play the simple game that sometimes gave them a monetary reward for correct answers, according to a new study by a University of Washington research team.

0:29:02

The research focused on two brain areas, the striatum and the anterior cingulate cortex. And it doesn't really matter where these places are. Okay, there are two different parts of the brain and this research focus on two different parts.

If you want, I'll let you know a little more of the striatal regions of network of structures in the middle part of the brain that motivates people to engage in pleasurable or rewarding behavior and the anterior cingulate is higher in the brain, it's a higher brain function area and it normally activates when an expected rewards stops.

However, this process called extinction doesn't occur at least as quickly in boys with attention deficit hyperactivity disorder or conduct disorders. Instead, the striatal region continues to be activated, said Theodore Beauchaine, a University of Washington Associate Professor of Psychology and senior author of the paper. "When children engaged in impulsive behavior, they're looking to stimulate themselves and have fun. Children with attention deficit hyperactivity disorder are always looking to have fun and that's what gets them in trouble."

0:30:08

He said, "A behavior should stop when the rewards stops. When you stop the reward for children with these disorders, they continue to focus on the reward long afterward and the anterior cingulate does not appear to become activated." Attention deficit hyperactivity disorder is one of the most common mental disorders among children, affecting an estimated 2 million kids.

The researchers used functional magnetic resonance imaging, or special type of MRI, to compare brain activity in 19 boys with either or both disorders ADHD and conduct disorder and 11 normally developing boys ranging in age from 12 to 16. Their brains were scanned while they played this game.

Okay, let me repeat that. Their brains were scanned while they played this game. That's a tough thing to do.

The boys looked at the screen and there was a button under each of their thumbs. When a light flashed on the left or right side of the screen, they were instructed to press the button on that side. The screen lit up very fast, up to 100 times a minute, and the boys received $0.05 for each correct response and could win up to $50.

0:31:15

They were not penalized for wrong answers and their accumulated winnings showed up on the screen. Each boy — can you just picture this. Okay, I mean these guys are in MRI scanners. They've got little things in each hand that they can push a button and there's a screen in the MRI machine. They're laying down looking at the screen and earning money. This is great.

Each boy had four five-minute blocks of trials. The first and third trials involved opportunities to earn the money and the second and fourth trials, the kids thought they were going to earn money but they did not involve winning any money. The money wasn't showing up on the screen as they were told to play this game. But the kids were also told, hey, the game may change at any time. We may start helping you earn money again so keep doing it.

0:32:02

Beauchaine said that there was no difference in the accuracy or speed or in other words, the behavioral response between the two groups. But there was a difference in brain activation. When the non-reward blocks came up. In other words, when the kids didn't get money even though they thought they were going to, the anterior cingulate lit up for normally developing boys but those with either of the disorders which frequently co-occur continue to only show activation in the striatum.

This show's there is an abnormality but not in the place we expected to find it. We expected to find the difference in the way the striatum functions but instead, found it in anterior cingulate functioning, said Beauchaine.

Okay, I couldn't resist reporting this study because I'm going to hammer it. I mean let me explain why. But this is something… this is something that the news media is going to pick this report and they're going to say, hey, we know what causes or we're getting closer to knowing what causes ADHD. It's a brain abnormality.

0:33:00

And a lot of parents are going to get upset. My kid has ADHD, they have an abnormal brain? Of course, they have an abnormal brain. That's where behavior begins, in the brain, obviously. And we do already know a lot about ADHD. But let me focus here on this study. Because I… okay, in general, sure. It's important to know what parts of the brain are involved with ADHD. But I don't think this study did it.

Well, first we have small numbers, right. Sample size is always important and in general, bigger is better when it comes to validating research results. I mean you're much more likely to get a statistically significant results when you have a large sample size. So here in this case, we have 30 kids. 19 with ADHD or — and/or conduct disorder and 11 without it. So we're not talking big numbers here. It's going to be hard to get a statistically significant result.

So then you do functional MRI scans so the kids are in this scanner that lights are flashing 100 times a minute and you're earning money every time you pick the correct side that the flash is on.

0:34:06

Sometimes you don't earn the money and you know, you get a little upset about that. Now my biggest question, tell me the kids, I hope they screen them for seizure disorders. I mean you get — you're in this in close — I don't know how many of you had been in an MRI machine. But you know, they're loud, they're clunky, you're enclosed. So these kids are in an MRI machines with flashing lights. I don't know. I just… I don't think I would have volunteered my kid for this study.

Okay, so here's the thing though. I really wanted to understand what these… what the authors here were getting at, what it was that they were trying to show. But it wasn't clicking with me. I wasn't getting it. So I really tried to put my thinking cap on here. And I still wasn't really seeing a connection with anything remotely hopeful. And then it hit me. The most important part of this study is completely missing.

0:35:05

They mentioned that there's no change in behavioral response. So if there's no change in behavioral response, okay. So these kids, they're saying that there was no change in their behavior. They responded the same in both groups. The only thing that was different is how their brains were working, in which part of the brain was being used and which one wasn't being used. But if that change does not translate into any change in behavior, then who cares?

I mean who cares if one part of the brain is lighting up in one group and not so much in the other and you got small sample sizes. So is it real or is it by coincidence anyway. But there's no behavioral change in the group. Now I think, I think that there was.

Now if you just look at their response in terms of pushing the button and playing the game, okay, maybe there was no difference between the two groups. But I suspect, and it's again, it's just suspicion on my part that there was a difference between the two groups.

0:36:07

And I think this is what the authors were really trying to get at. And was that difference, were the kids with ADHD and conduct disorders, were they thinking bad thoughts during the time that part of their brain weren't firing? Okay, maybe they were thinking, the kids with ADHD and conduct problems, maybe they were thinking this whole thing is bogus. These researchers are nuts. And these thoughts came to the surface because the anterior cingulate wouldn't fire and suppress those thoughts.

Now again this is… this is just taking what I know about ADHD and seeing kids with it and how they act and how they behave and trying to match that up with what the researchers are seeing at the level of the brain. And maybe they're going to do another study that looks into this a little bit more.

So the researchers just looking at them, I mean both groups, they got their fingers on the thumbs on the buttons and they want to earn more money and maybe the ADHD kids are a little more, I don't know. They're getting a little more [XX_0:37:08], like hey, when am I going to start earning some money again.

0:37:11

But just to the naked eye observation, the two groups look the same from a behavioral standpoint. But if you got a kid with ADHD at home and the kid who doesn't, like I do. There's a big difference between the two and if they were both in this situation, one is going to kind of take it and the other one is going to be like get me the heck out of here.

And I wonder if the kids with ADHD basically, those negative thoughts normally would get suppressed by this part of the brain that's firing. Now again, I'm making a lot of jumps and conclusions here that aren't really part of the study. But without that kind of hypothesis, I don't think this sort of study is really worthwhile. Maybe again, I'm being a little too critical because now that we've identified this area of the brain that we can design a study where the kids you can find out is that part of the brain what suppresses impulses.

0:38:07

Okay, so let me kind of get on with what I was saying. Kids with ADHD and conduct disorders are… and again, parents who have kids like these, they have poor impulse control and maybe it is because this part of the brain isn't firing. Maybe you need that part of the brain to fire for impulse controls so if you could find a drug again that stimulates the anterior cingulate and maybe you could improve impulse control issues. And again, I think that's what the researchers were getting at.

But here's my problem, they didn't talk about that at all. I mean they didn't talk about what these kids were doing thinking, saying while they were in the scanners. They were all doing the same thing, pushing the buttons. Was the ADHD kid saying, this stinks. While the non-ADHD kid maybe was thinking the same thing but keeping his thoughts in check. Or maybe he would've thought it except that the firing of this part of the brain allowed him to not care.

0:39:04

Afterward, was the ADHD kids stomping away and telling the researchers where he could put his flashing lights while the non-ADHD kids was wishing he had the guts to do the same thing. And which group would you or I want to be in?

I mean is it such a bad thing in this world to state your opinion? I mean is there such a thing as too much impulse control? I mean who knows.

And again, because we don't really know how these kids were reacting, we don't know if there was a difference between the two groups in terms of what was said or what actions they were taking other than in the context of this game.

And that again is really the important part of all this. So if both groups were responding the same way exactly, not just with the triggers, but in terms of what they were saying, how they were acting, their body language. Then again, I'm not sure it matters what part of the brain lit up. I mean I don't think it really helps us understand because that lighting up of the brain wasn't translating into any type of behavior. So that's why I wasn't getting it, because there wasn't much to get in terms of a study in trying to figure out ADHD.

0:40:06

So in the end, if there was a difference in reactions in terms of how the kids behave, what their thought processes were, were they fidgeting then I bet I'd be responding like if I were in that situation. I have a bit of ADHD, I'm sure, I bet I'd be responding like the kids who's anterior cingulates were firing. I'd be the one saying this is bogus. Turn these stupid lights off if you aren't going to pay me. You're not paying me much anyway. And by the way, what real life situation does that sort of thing simulate anyway?

It's just a stupid study in my opinion. Yet the mainstream media will be all over it. New brain abnormality unleashes the secrets of ADHD, more at 11. I mean give me a break. It's just another example of why you should not fall into step behind someone or some group just because they sound good, whether it's your local news or the President of the United States.

0:41:01

I mean, moms and dads, it is time in this country to look at the facts, to wake up, to stop being that limiting that's heading for the cliff with the pack. We don't need to fix things that aren't broken. And if some kids are more outspoken than others, is that a bad thing? Okay.

I'll — I guess we… I'm — you know, I'm not a researcher by training. And I don't know. I just, to some degree, you have to… if you're going to spend research dollars, let's do something that actually simulates real life. I'm not sure that this did it.

Okay. I had a fourth new story planned. But those obviously took a long time. We're already 40 minutes into the show. And so I'm going to actually just give you the really quick gist of story number four. But I'm going to keep the link in the Show Notes so if you go to pediacast.org, click in the Show Notes page. You'll be able to link… click the link and find the whole article if you're interested in it. This one actually involves HPV vaccines.

0:42:02

Researchers in Norway are reminding women of another benefit of the HPV vaccine. So we know that human papillomavirus, which is what the HPV vaccine prevents, it can lead to precancerous and cancerous cervical lesions. The cervix being the part of a woman's body that is at the end of the vagina and at the beginning part of the uterus.

Okay, so most of the girls out there know what I'm talking about. For you boys out there, the cervix is the part that separates the vagina from the uterus. And so that's basically the cap, right, that's holding the baby in. And it has a hole in the middle of it and that has to dilate and loosen up and that's how the baby comes out.

But if you have HPV virus infection and in particular, if it's led to some pre-cancerous lesions or cancerous lesions and then you have to have some procedures done in that area, then it can lead to what we call an incompetent cervix. So the cervix is not as good holding the baby in. And that can lead to preterm birth.

0:43:07

So when you're thinking about getting the HPV vaccine for your teenagers, remember, and I think it's a good point that the researchers in Norway are making unlike the researchers doing the ADHD thing. Their point is that you are only preventing cancer, but you're also preventing a baby from being born prematurely in the future.

And so I think it's a good thing to remember when this sort of thing — when the HPV shot is presented in most  doctor's office. And I know I was guilty of this too. I didn't really consider the preterm birth part of that. You know just say, hey, it's a shot that can prevent cervical cancer. But it's important to note that an incompetent cervix can also result even without the cancer from HPV infection. And so you are at more term… more risk for preterm births as well. So again, I'll leave a link to the full story in the Show Notes.

Alright, we're going to move on to your questions here real soon. I do want to… I know I'm kind of… it's kind of been a while, obviously, since I've done a show. So I think I'm going off on tangents a little too much, but I'm not going back and edit it at this point. Because I know, you guys wanted this show out.

0:44:15

So anyway my apologies if I went on a little too long on those things. I just… like I said I just feel very opinionated today. And also a little liberated. I think that's because we have a core group of audience members out there who really enjoy this show and enjoy my opinions. And so I guess I'm getting less and less afraid to speak them. And those of you who just can't stand my opinions, either laugh or leave. One of the two, laugh or leave.

Alright let's move on and we'll be back to answer your questions right after this break.

[Music]

0:45:19

Okay, we are back and there's going to be less controversy this time. These are pretty straightforward bread and butter pediatric-type questions. And first up is Joy from Troy, New York. Joy says, "Winters in New York can be brutal to the skin. When is it okay to put lotion on my three-week old baby? Thanks.

Thanks for your question, Joy. Let's me start by saying this, I'm sorry. It's no longer winter in New York. And I'm certain your baby is not three weeks old anymore. And I'll bet his or her skin is fine by now too.

Okay so it's not… look, there'll be more New York winters in the future. There'll be more winters everywhere. And there'll be babies with dry skin. So there'll be parents who still want to know the answer to this lotion question. So it may no longer be helpful to you, Joy. Well, maybe it is. But it's going to be helpful to someone in the future and for that, we all say thanks.

0:46:07

Alright, so what is the answer? Lotion on babies is fine. Let me say that again. Lotion is fine on babies. But, there's always a but. There are some things to keep in mind. First, is the skin problem really an issue that needs to be addressed?

Scaly, dry skin is often normal for babies that are three weeks old even in warm, humid climates. And this usually just goes away on its own. We think probably the mechanism for that, this is the layer of skin that was soaked in the amniotic fluid for months. And it dries out, it peels off and you have new skin that doesn't have the issue. So when you have a baby at three weeks old whose really, really dry and scaly, that usually just goes away on its own and you probably don't need to put any lotion on them.

Now the other thing to keep in mind is that in very young infants, you do run the risk of causing more problems. And the reason for that is the whole sort of baby acne issue.

0:47:09

And in young infants, there is estrogen that leads to maturing… and where's the estrogen come from in these young babies? It comes from mom in boys and girls, crosses the placenta, goes to the babies' bodies. So after they're born, there's a time period when they have lots of estrogen circulating. And that leads to maturing of oil glands in the baby's skin.

So if you have mature oils… oil glands like you have teenager's oil glands in the skin of your less than one month old baby and if lotion clogs those pores, it can block the gland opening. The gland still makes the oil, but now it's trapped and you get baby acne. So there is the potential and this is why we say don't use lotion on babies because there's the potential to make things worse. That doesn't mean that if you use it every time, you're going to make things worse. And that's what we're going to get to that here in a second.

0:48:06

The third thing is that you do worry and this is kids at all ages, they can have allergic reactions to lotions. They can develop a contact dermatitis. Those kind of things are possible. But if your kid has bad looking skin anyway, does it matter if you're taking that kind of chance if it's likely going to help?

So let me now say there are some young babies who do have dry skin. They have eczema and lotion will help because the lotion creates a fatty barrier that prevents skin water evaporation and it will then keep the skin hydrated, keep it looking better. It will relieve burning and itching of the skin. And in many, many, many babies who have baby eczema, you can put them… put the lotion on them and they won't flare up their baby acne at all.

So what do you do? Here, I'm saying if you use a lotion, you might make the baby… you might make baby acne worse. But if you use it, it might help if they have eczema, dry skin, that sort of thing.

0:49:06

Well, you have to be smart about it. If you and your doc decide together that this is a rash that needs treating, you can try it. And if the baby acne flares up, stop. If they're starting to get a worse rash because of allergic reaction or contact dermatitis, stop. If it doesn't cost those problems in the eczema, dry skin issue improves because of the lotion, then keep using it.

This really depends on the child. And the best way to know is trial and error. But I wouldn't say that every single one-month-old baby that you put baby lotion on is going to do horribly. They may do well. They may not do well. You just have to try it and see.

And what about Joy's situation, this particular situation? I'd probably just wait a couple of weeks. Again, many babies are scaly at three weeks. It's a prime time for them to be scaly. So just wait a couple of weeks and see if the dryness improves. And if it doesn't, then try some lotions like Aquaphor, Lubriderm, Vaseline. Lots of different choices out there user and cream. If the rash gets worse, stop. If it gets better, keep doing it.

0:50:09

And an important caveat here is are you sure that it's just dry skin and eczema? And this is why I say you and your doc should decide together. Because there are lots of things that can cost rashes other than dryness. And in some babies, they occasionally can be serious and even life-threatening.

The serious ones don't generally look like my definition of dry skin. But if you have any question about the quality of the rash or the… or about the cause of the rash or if there's any symptoms accompanying the rash, by all means, see your doctor. But you know when you say dry skin, I have a vision in my mind of what that looks like and it doesn't look like anything serious. But what you see and described as dry skin may not be what I'm picturing.

So if you're concerned about a rash in the baby, you should see your doctor. If your doctor says no, you can't do lotions, ask them why. Why? Why can't I do lotions? Again, this is… I'm trying to empower parents here. Ask the wise because some doctors don't even know why. Because someone in medical school told them. Someone in medical school said don't use lotions on babies. But they don't think… they don't make that next connection of why, why would it be bad? And is it bad for everyone? Okay, I know I'm getting a little philosophical here.

0:51:21

Alright. You know, you didn't ask this, Joy, but it's probably a little bit more pertinent to the seasons that we're coming upon. What about sunscreen? Can you use sunscreen in babies? Well, it's a lotion. So a very young baby, it could flare up their baby acne by the same mechanism we just talked about. It could cause a contact dermatitis or an allergic reaction. It usually doesn't, but it could. But the main reason that we say don't use sunscreen in kids less than, let's say six months of age, is to protect the kids from their parents. Because you're going to get somebody who slaps on a thin layer of sunscreen and then thinks it's fine to let their baby set out in the direct sunlight for three hours without reapplying it or doing anything. And the kids going to get sunburn.

0:52:05

So it's not that the sunscreen is bad for babies. Most of the time, it's because you don't want to get parents the false sense of security that the sunscreen's going to help. And then they end up with a bad sunburn.

So I mean it's best to keep young infants out of the sun as much as you can especially direct sunlight. But if it's unavoidable, using a little bit of sunscreen is going to be fine. Use the highest SPF you can find, put it on thick. Reapply it often.

And things to consider. I've always used that advice over the years and it's never come back to bite me. You just don't see kids with sunscreen that's being used properly and then the child kept out of the sun as much as possible and you're just using the sunscreen for the just in case areas.

And I've never seen that be a problem in terms of a bad skin reaction, in terms of flaring up bad baby acne, in terms of the kids getting a bad sunburn. But I had a pretty smart group of patients that I took care of and would explain to them. This is why we say no. So again, when your doctor says no, don't use a sunscreen on your baby, ask why.

0:53:14

Okay, let's move on. Milk allergies. This one comes from Lauren in Nashville, Tennessee. Lauren says, "Hey, Dr. Mike. I am a pediatric nurse practitioner with about one year of experience. And I absolutely love your podcast. All of your info is very practical and it is great for me to hear you say things the way you might teach it to a family and one step more. I always get a lot out of your program."

Thanks, Lauren. "I've done a little research online about milk allergies in infants, but I've had a hard time finding exactly what I'm looking for. This question came up at a one-year checkup when we usually recommend switching to whole milk until age two.

If a child has an established IGE-mediated milk allergy, what is the best way for him to get the nutrients he needs particularly the fat and fatty acids found in milk until age two?

I know soy is an alternative but I'm not sure if the fat content is equivalent and if it is okay to do soy milk and seek fat in other foods. If so, what do you suggest for picky toddlers? Thanks so much for your help, Lauren."

0:54:15

Alright, Lauren, it's an excellent question. And it's actually a question that I had to do some research on because now being an urgent care physician, I haven't really put a lot of thought for the last several months into nutritional supplementation. And I have to admit, I don't really miss it too much. Because it's… it's tough, it's really tough. And as I started to explore this topic, I realized no one reports their nutritional information in the same… in a way that you can compare it very easily.

I mean some of them report how many calories per ounce, some how many calories per 240 milliliters, how many calories per liter, how much calcium and milligrams and other label does it in grams. Another one doesn't even give you a milligrams or grams, it gives you percent of the recommended daily allowance.

0:55:03

So I had to do a whole bunch of math here, it's the bottom line. It took me a couple of hours. And it took me a couple of hours because I wanted to double and triple check my work and my wife was talking to me and my son was showing me the cat food he had just put together and the wet cat food and pretending it was my breakfast. And at the same time, trying to get my daughter out of bed. Okay, you get the point, life was interfering. So that's why it took a little long.

What I've done and probably the easiest way to do this is just to say go to the Show Notes and look because I — in the Show Notes, I'm going to actually have all of these information. And I'm going to go through it very quickly because it's a bunch of numbers and I'm a visual person and so for me just to recite the numbers back to you is probably not going to be all that helpful. But since you had your main thing was what about fat content, let's do that one first.

Whole cow's milk, it was kind of standard, I'm comparing these things too. Whole cow's milk — and I'm going to give you everything in the same units. So all of this, calories are going to be per ounce and all of the other things are going to be per liter.

0:56:10

Now obviously, you don't give your kid a liter of drink at a time. But this is just a convenient way for us to compare numbers. So whole cow's milk, the fat content is 34.5 grams per liter. Now if you compare that to soy milk, you're only going to get 20 and by soy milk, I'm just talking about plain soy milk. Actually, I use Silk which is sort of an enhanced soy milk but not all that enhanced. So it's basically very… it's got some flavoring in it. But it's very close to just plain old soy milk.

So what's the difference? Well, a liter of whole cow's milk has 34.5 grams of fat and a liter of the soy milk has 21 grams of fat. So you're going from 34.5 grams down to 21 grams. So there's less fat in soy milk.

0:57:00

Now if you look at soy formulas, they have 37 grams of fat. So there's an option. You could just do a soy formula like Isomil, that's the Similac product from the folks at Ross. You could also use in Carnations or Mead Johnson's formulas. What's that one? No — what is this the — no, it doesn't matter. You can use a soy formula from many company and these numbers that I'm talking about are going to be similar.

So from a fat content, there's nothing wrong with doing a baby formula until a kid is two years old. Now they're making these newer formulas that they're sort of marketing for kids, for older kids. So the Similac does make one that is called go and grow soy. And it's basically like a step two soy formula. But that one still just has 37 grams of fat, the same as the regular formula has in it. And by the way, human breast milk is 39 grams of fat.

So if you use just plain soy milk, yes, you probably want to try to get some other sources of fat in the diet. If you use soy formula or the Similac stage step two type thing soy, Silk, Go and Grow, then you're going to be fine just with because they add the extra fat into it.

0:58:15

Now the… in terms of the other things, sort of what really pops out at me, one of the main ones is going to be calcium. Whole cow's milk gives you 1.2 grams of calcium. But soy milk only gives you 0.729 g. So let's do that one in milligrams. You go from 1,226 milligrams of calcium in cow's milk, a liter of cow's milk and the equivalent soy milk only has 729 milligrams.

If you go to the soy formula, it really does not match up much better than the enhanced… the Silk. Just the regular slightly enhanced soy milk. You only have 710 milligrams. But if you go to the Similac Soy Go and Grow, they jump it up to 1,014 milligrams. So these stage two formulas do have… now they got the same — from a fat content standpoint, you're fine. But they do have more calcium in them. So that would be a good way to get a little extra calcium in.

0:59:15

I did, by the way, put the numbers for human breast milk in this as well. And one of the interesting things is protein. Whole cow's milk is loaded with protein, 34 grams per liter. Soy milk only has 21. Soy formula only has 16 grams of fat per liter and the Go and Grow only has 17 grams per liter. Human breast milk only has 10.5 grams per liter of protein.

Now why is that? Like if you're trying to make something more the equivalent to cow's milk, why wouldn't you bump up the amount of protein that's in these supplements and the soy formula and the Go and Grow stage two type thing.

Because our kids aren't baby cows, right? I mean cow's milk is made for baby cows and baby cows need lots of protein to turn into a great big adult cow.

1:00:06

So you do have to sort of use some good judgment here that may just because something has a little less fat and protein in it, that may not be a bad thing. Especially if you're looking at the comparison to breast milk.

So again, I have all these numbers, the whole cow's milk, the breast milk, the soy milk, the soy formula and then the stage two soy. I got it all, all the nutritional values in the same units so the bottom line here, go to the Show Notes at pediacast.org, click on the Show Notes. And for this episode, 142, you can see all the numbers for yourself and make the comparisons.

The biggest issue is calcium. And your kids do have a need for calcium in terms of good bone growth. Now you can't get too much calcium. Some kids are going to be prone to getting blood in their urine if they have too much calcium in their diet and some kids even can get kidney stones from too much calcium in the diet.

1:01:00

So I mean there's always too much of a good thing. But it does appear that human babies need calcium more than cow babies or soybean babies. I know it doesn't work like that, I'm being silly.

Okay so that's enough about the numbers. I wrote down some more notes on this but they just starts to get so confusing and I've already confuse you enough with my whole tirade on the ADHD study, which I have to apologize for again because I know I was just out of control.

Alright, let's move on to our next topic. This one is vomiting and diarrhea and it comes courtesy of Heather in Bonham, Texas. Heather says, "I'm a new listener from Texas. New as in listening to a few episodes, but I love the few I have listened to. So I have a 10-month-old daughter, Kyler who has a stomach virus and we are on day six of the stomach virus.

The first day was severe vomiting. Days two through six were severe diarrhea. There's not been a diaper rash, thank goodness. We have been to the doctor three times this week which is 27 miles one way from our house, twice per visits. And today, we had to take in a stool sample.

1:02:02

So the results from the lab work take five to seven days to get back. I asked nicely and pointed out, I wasn't trying to be rude here, but in five to seven days, Kyler would have been on day 11 to 13 of the virus, so she'd probably be back to normal.

This seems like a dumb question, but why do the lab work? I thought about this question after I was in the car going home and became very confused which is how these things usually happen. I'm hoping my question makes sense to you. Keep up the great podcast. I really enjoy them and ready for my sick baby to feel better down in Texas."

Again, Heather, my apologies. I suspect your child is all better and you have the lab results back. But let's talk about this for the next parent with the problem.

First, I'm not going to criticize your doctor although I sort of want to. But I'm not in their shoes and so that makes it difficult to do so. So instead, let's focus on expectations for viral illnesses in the gastrointestinal tract and then I'll just tell you what I would've done in this situation.

The typical viral GI illness, you have vomiting for a couple of days. You might have fever for a couple of days. You have diarrhea that lasts about a week, give or take. And you got to watch for dehydration. You've got to watch for blood in the stool. You've got to watch for signs of bowel obstruction, projectile vomiting, bile in the vomit, and those sorts of things.

1:03:19

And you also have to consider other illnesses because vomiting and diarrhea may actually and the fever may actually be the symptoms of something else and not a primary viral GI illness.

So you do want to go see your doctor at least once, make sure that they don't have strep throat. I've seen kids with really bad vomiting and diarrhea that ended up having strep throat. That was the problem. Urinary tract infections can cause vomiting and diarrhea. Ear infections can cause vomiting and diarrhea.

So let's assume that your child didn't have any of those things. They really just had a viral gastroenteritis. To me, it sounds like your kid was following the expected course. Vomit for a day or two, diarrhea the last for a while. So why have you come back each day? Well — or all those times.

1:04:01

One, would be to check for dehydration. But that's pretty uncommon once vomiting has stopped. I mean as long as kids are drinking, let him have all the diarrhea, flush out that virus. And then things will get better with time. And it's unlikely for kids to get dehydrated when diarrhea is the only problem. As long as they are drinking and the drink that they are drinking is the kind you want it to be, you know like Pedialyte, something that has the right amount of salts and sugars in it, not just plain — lots and lots of plain water.

So and I have to kind of change my thinking on this.  Back in Ohio, Gatorade was a no-no. Because Gatorade has a lot of sugar in it to make it sweeter and when that sugar can actually cause more of a osmotic diarrhea. I'm in Florida now and I'm telling you, Gatorade is like gold down here. And you don't criticize Gatorade. I'm telling you. You do not criticize Gatorade. I mean they invented the stuff. And Gatorade has helped professional athletes for years and they can help your baby too. So and I have to admit, I'm not seeing any real problems with it.

1:05:08

So anyway, it sounds like your… it sounds like you had the expected course for vomiting and diarrhea as caused by GI illness. And I wouldn't say you have to go back all those times unless you aren't following the expected course or if there are signs of dehydration.

Perhaps your doctor just wanted you to keep coming back because it made him feel better about himself. He could double check and make sure he wasn't missing something. And we all do that from time to time. Perhaps it was to make you feel better. I mean you didn't mention this in your message, but they are moms who keep calling and finally, it's like have her come in. Let's look again, we'll make sure we didn't miss something.

So — and I don't think you did this Heather. But sometimes the doctor has you come in because they think that you're concerned. And that's fine. So any of those sort of things are possible.

1:06:01

Now what about the stool studies? Well, I would do stool studies in that situation, me personally. If I had a high index of suspicion that I was going to find something. If there's blood in the stool, then stool studies I would say are a must, as long as it's really blood.

I mean if you gave your kids something red to drink and it went through them, their poops going to look red. So there is a quick test you can do, a hemoccult test that looks for — to test the stool to see if there really is blood there or not.

If there's blood in the stool, you worry about things like salmonella, shigella, campylobacter, yersinia, c-diff, there's lots of different things. So if there's blood in the stool, stool studies are definitely warranted.

Now having said that, if you get the result back, okay, you know what it is, you can let other parents know what it is, but you don't always have to treat those some of those things. For instance, salmonella, if you have blood in the stool for salmonella but you don't have a high fever or any evidence that the salmonella has invaded the blood stream, it actually is more helpful to let your body's immune system take care of it because if you try to kill it with an antibiotic, you can actually cause some of the salmonella to go dormant so that then it avoids the antibiotic and then it can reactivate later and cause some intermittent shedding of bacteria that is still infectious.

1:07:17

So your child can be infectious with salmonella longer if you treat it with an antibiotic than if you don't. Although, if they have evidence of the salmonella's gone to the blood stream and they have high fevers, then you do treat it regardless.

So there's lot of nuances and that's why they have medical school. And so again, I don't want to criticize your doctor too much because if there was — especially if there's blood in the stool, then they certainly would want to — would check those kind of things out.

Alright. Also a rotavirus test, that may have been useful if they have a rapid test in the office. It won't really change what you do because rotaviruses, there's no real treatment for it. But if you test and it is rotavirus, then you know it's going to last longer. And they're going to have some intermittent vomiting that might come back in a couple of days and it'll be gone for two or three days and they might vomit one more time and then they're finally getting better.

1:08:07

So you can get some more recurrent vomiting with rotavirus and the diarrhea tends to last a lot longer, can last up to two weeks, sometimes even a little bit longer than that. So the benefit of doing the rotavirus test is just to say, oh yeah, I know what it is. I'm not going worry when it continues.  Although once the fever has been gone for a few days, if the fever comes back, I would always worry about that.

But on the other hand, if they don't have a rapid rotavirus test they can do there in the office, it doesn't make a lot of sense to send off rotavirus and when the results going to get back to you in a week because number one, it's not going to change anything you do and like you say, Heather, most likely, by the time you get the result back, your kid's going to be fine anyway.

So I'd say like — I'd say it does sound like a virus the way you described this. And I would just have given it more time. Your doctor made you drive the 27 miles three different times and did stool studies that probably weren't immediately useful.

1:09:06

But I'm not going to criticize your doctor because I don't have all the facts. I don't share your doctor's experiences or the nuances of this particular situation. But with the way that you described it, Heather, I would say this. Don't worry too much about being confused because I was a bit confused about why they would do that as well. I'm not saying it's wrong, just saying I might have done things a little differently if the facts are as you say.

Alright, we have one more question. And we're an hour and nine minutes. I'm probably have like lost half the audience by now. They just got sick of my answers and sarcasm.

Okay, the last one, this is Scott in Milford, Michigan. And Scott — see, we even let people from Michigan on this program. There was a time when they were banned. No one from Michigan was welcome on PediaCast because we were the Buckeye podcast. And the whole Ohio State-Michigan thing. But we've lightened up, so Scott, you are more than welcome.

Scott, Milford, Michigan says, "Dr. Mike, I just started listening to your podcast after hearing you on [Little Reports_1:10:03] Jumping Monkey's podcast. So I'm just catching up and may have missed this topic. I'm hoping we're not the only ones dealing with this problem."

1:10:11

Now, you never, never, you are never the only one dealing with any problem. Trust me. Okay, so Scott goes on to say, "Our four-year-old son has a lot of trouble going to bed for the last six or more months. We have tried to make it a quiet routine bath and then bed. We've moved bedtime back from 9:00 p.m. to 8:30 p.m. because 9:00 pm was becoming 9:30 or later.

He seems to want to talk or see what we are doing. He's very talkative, read extroverted child, but he will also turn on his light and hang out in his room sometimes. We think he's getting enough total sleep, generally around nine hours per night. What can we do to get him to go to sleep easier. Thanks so much for your advice."

Well, Scott, you described my daughter, who's now 14. You described her to a tee at this age. You know, she slept well once she was asleep, but she seriously encroached on grown-up time at night, which is grown-up time is important.

1:11:07

It is important for parent sanity and you're going to be a better parent if you get some quality mom and dad time in the evening. And so it's important for kids to be able to get themselves to go to sleep.

Now I can tell you what we did. I think that's going to be the quickest way to do this is just explain what we did. Because it's kind of creative actually. And your mileage on this may vary, but I do think this similar system would work for you.

My daughter was about this age that you're describing. We were saying — how old — I got to run back here real quick. You did say, right, how old your child was. Oh, maybe you didn't. Oh, four years old. Okay, yes. Katy was right around four years old when this happened.

We were out of the toy store and they're having this big mega sale, things like KB toys and this particular one who was going out of business. And they had this huge box of Polly Pockets. I mean there's like 10 houses, 10 little Polly Pocket houses in this set.

1:12:07

Obviously, for you, Scott, I realized that Polly Pockets probably aren't going to work for you. But for her, she loved these things which is kind of crazy. They don't even make them anymore because the little Polly Pocket figurines were highly chokeable, now I think about it. I mean they're like perfect tracheal size, but that's another story.

But back then, ten years ago, these things were hot. And Katy really loved them and so we've got this big box of like 10 of them and we showed it to her and said, you are not getting any of these, but they're in the house.

But here's what she got to do to get one. We are going to make sharp and we're going to put it on your door and you are allowed to call us or come out of your room twice. Okay, you're allowed to use two freebies of calling us to say goodnight one more time or calling us to get a drink of water, coming down for one more goodnight hug, but when you do that, we're going to put a little X on your chart for that day.

1:13:11

And then in the morning, if there's one or two X's, so you used up yours two times and that was it, then you get to put a sticker for that day, that next morning.

If there are three X's, you struck out. Okay, three strikes you out, you don't get to put a sticker on there. Once you get three stickers, you can pick out one of those Polly Pocket houses and coupled with the figurines to go with it.

And it worked. It worked because she was motivated. She wanted that Polly Pocket house. Now some kids are crying until you give in. We're not give-inners in our house. So if you want something and then you go into hysterics, it ain't happening. And she knew this. So she knew the only way that she was going to get that Polly Pocket was to do what we said. And so it became kind of a game and it worked very well.

1:14:02

Now we started with like three stickers. You got to get three stickers to get the first house. After that, we upped the [XX_1:14:09]. Okay now, you need to get four stickers to get it. The next time, let's see if you can get to five. Let's see if you got it in you to get five stickers to get that next house.

And we weren't mean. I mean we never went more than a week. And you got to be reasonable about these things. And it really did work. So we had 10 weeks of really great — of quiet in the house. And she stopped calling us and stopped coming down all the time.

And when the thing was over, for us, it became — I actually — I think it was over before we even got to all 10 because she was doing so good, it was like you know what, you can just have the last three because we really trust you now. You know not to bother us. We need mom and dad time and so it really it worked out for us. So Scott, that's the sort of thing that you could tackle.

1:15:02

By the way, this is not the kind of thing they teach at medical school. This is on-the-job training and I'm sure that there are moms and dads out there right now who have other ideas that worked for this kind of thing. Because this is more in the psychology room than it is in the true medical ground. But I love doing it and talking about it obviously.

Little too much now that we're an hour and 15 minutes into the show. But anyway, it's also a reason why I think eventually and maybe sooner rather than later, we are going to get a forum board and with the new website, I'm not using Word Press anymore. I'm actually using some Mac programs to actually do the site with HTML and try to really customize it.

It's actually going to be easier to get a good forum board going. So I think that is going to be in the future. And this is the sort of thing that you could post to the forum board and say, hey, anybody got any ideas on this? I mean I can give you my idea of what we did, but I'm sure there's some other — there's probably lots of other ways to tackle this problem that a lot of parents out there in the audience are going to have great suggestions too. So this just reminds me that we need to get forum boards going as well.

1:16:12

Alright, we are way over which I kind of expected with this first show because I had a lot to catch up on and explain and do and I knew that we're going to be covering some controversial topics and I might go off on some rants and that always takes time.

So in any case, we will just take a one more quick break here and then I will be back to wrap up the show.

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1:17:01

Okay, bottomline, it is great to be back. Weekly shows are going to be back on track, the studio set-up, the house is looking great, the website is coming along well enough. There'll be lots of improvements there in the future. So we're here, we're back and I'm really glad to be here and thank you so much for sticking that out with me.

I'm sure we've lost some listeners with that long of a break. But as the new ones come along, that makes — there's more room for you. So thanks go out, of course, to Nationwide Children's Hospital for continuing to help us out with our bandwidth. Also Vlad at vladstudio.com for helping us with the artwork, both on the site and in the feed. The great folks at Medical News Today. You can visit them at medicalnewstoday.com. They're always very helpful with our News department. And of course, again, listeners like you thank you so much for sticking it out with me here.

In terms of the PediaScribe and the Bag of Chips blog and those of you who had been long-time listeners know what I'm talking about. These are the blogs of my wife and daughter. They're gone. They're closed. They died when PediaCast, the old PediaCast died.

1:18:09

And I have been so busy and still want to be busy making these shows. And I also have some plans for some premium content in terms of commercial-free, not really a show on questions and news and interviews, but separate half-hour programs on different medical topics that you can purchased. You know, $0.99 per download, that sort of thing. If you want to know more about otitis media. You know like there's a half-hour show on otitis media, half-hour show on strep throat, half-hour show on ADHD. That sort of thing.

So if you do have topics that you would like to recommend for that, please give me a [howler_1:18:47] as well. But I do want to start actually making some money because the sponsors are gone. The economy hit the wall and people are taking out their ad support and podcast go first. And they're going to stick with radio and TV and you know, you understand that. But I do need to generate some revenue from this because it actually takes up a lot of time and expense to do it. But I don't want — but I still want the show to be free for moms and dads.

1:19:13

So I've got this idea about doing premium content, half-hour shows, very topical, download the one you want to listen to yet not expensive but enough to make it worth of our while to be here. And it's also motivation on my part because people are buying these, there's going to be more motivation on my part to make more of these.

So anyway, there is a part of the new website that says Premium Content. That's what that's basically all about. And so as I'm trying to do — again, I run off on a tangent — as I'm trying to get together this premium content, I really don't have time to redesign websites for family members, even my wife and daughter. Sorry, girls.

So in any case, if you missed PediaScribe and Bag of Chips, because I got the tools for them to create their own websites and easy. That Rapid Weaver is great program on the Mac, easy to do.

1:20:10

They just haven't had the motivation to sat down and do it. And they've been busy too. But I think motivation for them would be hearing from you if you miss them. So there's not really a great way to contact them right now. They're sort of placeholder, pages in place at PediaScribe and Bag of Chips, but if you just go to pediacast.org and click on the Contact Link and just write me a message. Write me a message that says, hey, we miss PediaScribe and Bag of Chips, I will forward it to them and then that maybe motivation on their part to get moving on creating those websites again.

So we're going to keep the regular shows up and running. You can expect a one week and don't forget if there's a topic you'd like to talk — like us to cover or question that you have, just go to the Contact page at pediacast.org. You can also email pediacast@gmail.com or call the voice line on Skype (347) 404-KIDS, (347) 404-5437.

1:21:14

Also on Skype, it's Dr. Mike or PediaCast, next show I'll let you know for sure. If you see me on, say hi. Because when I'm working at night, we'll keep the Skype line open and if you have some comments and want to talk to me live, I will be able to incorporate that as well.

Although I may actually, if you're interested in that and we hook up that way, get your permission to actually record our conversation and then some of these discussions can be a little bit more interactive, like a radio — like a real radio show.

Alright. So until next time which will be soon, I'm back on the horse here, folks. We're back on the wagon, you know what I'm trying to say. Until next time, this is Dr. Mike, saying stay safe, stay healthy and stay involved with your kids. So long, everybody!

1:22:01

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