Beetles, Bubble Wrap, White Noise – PediaCast 151

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Topics

  • Massive Fisher-Price Recall
  • Beetle-Tainted Similac Infant Formula
  • Tobacco and Alcohol Advertising
  • Preterm Babies and Bubble Wrap
  • Unique GI Procedure Shows Promise in Kids
  • Food Allergies and Bullies
  • Flu Shots
  • Intermittent Diarrhea in Preschoolers
  • Urinary Frequency
  • Tongue Tied
  • White Noise Questions
  • White Noise Research Roundup

Links

Transcription

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

[Music]

Announcer 1: 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. It is episode 151 for the week of October 11, 2010 and we're calling this one Beetles, Bubble Wrap, and White Noise.

01:01

Of course, we're going to have lots more information for you and we'll kind of go through that in just a couple of minutes. First, I want to let you know some exciting news. iPhones are, of course, extremely popular and there are lots of people who have them.

[Laughter]

And there are other phones out there as well and then, you know, you get some arguments over which one is better. Of course, being an Apple guy, I'm in the iPhone camp. And, you know, I understand what people say, you know, it doesn't have removable memory. It doesn't have a swappable, changeable battery, but I'm there. All right. I'm in the iPhone camp. And I know many of you are as well. And so, we are in the process of developing a PediaCast application for the iPhone and then who knows, maybe we'll be able to expand that out to other phones as well. But thanks to the folks at Wizard Media, they're helping us out with this and we will have more information on it in the coming days to weeks.

02:04

It shouldn't be too much longer. So, you'll be able to listen to PediaCast on your iPhone. Of course, you're saying, "Hey, we can already do that, right?" This will make it a little easier because you won't have to subscribe through iTunes and then actually connect your iPhone to your computer to get the latest episode. This will automatically read the feed and have a player that you can use in the background while you're doing other stuff on your iPhone. And it will also allow you to download episodes just right over the cell network or wifi and you won't need to connect to your computer. So, it will make things a little bit easier for you. So, watch for that and it will be available in the iTunes store and the app store. And just as soon as it's available, we'll let you know. All right. There is a huge Fisher-Price recall. I don't know if you've heard about this. Seven million tricycles and 4 million high chairs and hundreds and thousands of other toys — so, this actually just came to pass after I'd already prepared the show, but I thought it was important.

03:08

So, we're going to just cover it right now in the introduction. The tricycles apparently have a pretend key that sticks out of the front seat. So, it's, you know, something the kids can turn and pretend their starting the engine, but the problem is that it extends almost a full inch above the cycle's body and with it sticking out there — I mean, and — out in front of the front seat, it is causing genital injuries to young girls. They did a design change and now the new pretend key is flattened and it protrudes much less. So, the folks at Fisher-Price think that it's a safer alternative. There's a lot of tricycles that have this problem that were recalled. The Hot Wheels Trike, the Tough Trike, the Little Kawasaki Trike, the Kawasaki Trike, the Kawasaki Tough Trike, the Kawasaki Ninja Tough Trike, the Barbie Butterfly Trike, the Barbie Tough Trike, the Barbie Tough Trike Princess Ride-On, Nick Jr., and Dora the Explorer Tough Trike, Go, Diego Go! Tough Trike, and Go, Diego, Go! Kid Tough Trike, and Thomas and Friends Tough Trike.

04:18

So, there's a lot of tricycles that are involved and of course, we'll have a link for you in the Show Notes where you can find out if your particular product is affected. Also, they're recalling a bunch of high chairs. Apparently, there's a peg on the back of the high chair that's designed to store the tray and children are falling against that peg resulting in lacerations or cuts that actually requires stitches. And the high chairs involved are the Healthy Care High Chair, the Deluxe Healthy Care High Chair, the Link-a-doos Deluxe Plus Healthy Care High Chair, the Aquarium Healthy Care High Chair, Close to Me High Chair, Easy Clean High Chair, and the Rain Forest Health Care High Chair.

05:00

And then there are toys with an inflatable ball that is part of the toy and it — the ball has a faulty valve, which may fall out of the ball and present a serious choking hazard. So, Fisher-Price is asking parents and caregivers to remove and discard the inflatable ball and the company will gladly provide a free replacement kit that has a safer ball. And the toys affected, they are the Baby Playzone Crawl & Cruise Playground, the Baby Playzone Crawl & Slide Arcade, the Baby Gymnastics Play Wall, Ocean Wonders Kick & Call Aquarium, 1-2-3 Tetherball, and Bat & Score Goal.

So, if you have any of those toys, make sure that you check out the website — actually, if you just go to pediacast.org and there'll be a link there. And one more to tell you about, the little cars – kids – car and ramp toys. So, basically these are little cars that kids can push up and down ramps. The wheels can pull off and pose a choking hazard and the specific products involved are the Little People's Wheelies Stand 'n Play Rampway and the Little People Wheelies Stand 'n Play Rampway Gift Set.

06:09

So, again, to check out if you have a recalled product — actually, the website, it's pretty easy, it's service.mattel.com/us. And if you're not going to remember that, again, we'll have a link for you in the Show Notes at pediacast.org. OK. What are we going to talk about today besides recalls? Well, actually, there's also a Similac Infant formula recall and it has to do with beetles, not the rock band, but actual insects in the formula, isn't that lovely?
So, we're going to talk about that. Also, Tobacco and Alcohol Advertising, Preterm Babies, and Bubble Wrap, Unique GI Procedures Shows Promise in Kids, and Food Allergies and Bullies, and then we're going to discuss Flu Shots, Intermittent Diarrhea in Preschoolers, Urinary Frequency, Tongue Tied, and White Noise. So, as always we have a full line up for you today that we're going to talk about.

07:03

If there's a topic that you would like us to discuss, let us know, or if you have a question or a comment for the show, just go pediacast.org and click on the contact link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS, that's 347-404-K-I-D-S, which turns out to be 5-4-3-7. Don't forget the information presented in PedaCast 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 you doctor and arrange a face to face interview and hands-on physical examination that is required. 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 all that in mind, we will be back with News Parents Can Use right after this break.

[Music]

08:28

All right. Our News Parents Can Use is brought to you in conjunction with our news partner, Medical News Today, the largest independent health and medical news website. You can visit them online at medicalnewstoday.com. Some Similac Powder Infant Formula were found to be contaminated with small beetles and their larva prompting Abbott Labs to issue a voluntary recall. The affected products were distributed to retail outlets and medical facilities in the U.S.A., Puerto Rico, Guam, and some Caribbean Islands. According to Abbott, a fault was discovered in part of a manufacturing facility.

09:00

"A fault was discovered". I like how they put that. "The beetle or a larva contamination risk is remote", Abbott stresses. The company adds that, "The FDA believes infant formula containing these beetles pose no immediate health risk; however, there is a chance that babies might develop gastrointestinal discomfort or decreased appetite. Should any parent or caregiver detect gastrointestinal symptoms and – that last more than a couple of days, they should consult a healthcare professional." And to see if your Similac product is affected by the recall, we do have a link for you in the Show Notes at pediacast.org. There — they basically have a Similac recall look up page and you just follow that link, input your product's lot number and the site will tell you if your particular product is affected. So, again, this is only Similac Powder that we're talking about. And you know, folks, they have to, of course, come out and say this and recall these things. And I'm not telling you, you know —

10:01

If you find out that you have one of the lot numbers that's been recalled, by all means, get rid of it and buy some new stuff. But for the parents out there whose babies have been drinking it – you know, remember that human beings – you know, there was a time that we lived in [laughter] caves and teepees and, you know, dirt. And babies have probably been – having insect products ingested, you know, for a long, long, long time. And, you know, there's actually an acceptable amounts of insect material in lots of different foods that we eat. You don't want to think about it, but it's true. So, you know, it's hard to imagine that this actually causing gastrointestinal discomfort or decreased appetite. But by all means, you know, if your baby has been drinking it and there's a problem, call your doctor. If your baby has been drinking it and there aren't any problems, it is certainly not time to panic. And if you do have one of the recalled products, you know, just switch it out.

11:03

All right. Despite ongoing efforts by parents, teachers, and the federal government to urge adolescents to just say "No" to tobacco, alcohol, and drugs, more than 25 billion dollars worth of advertising for these products is working to get them to say "Yes". Because of these mixed messages, a new American Academy of Pediatrics Policy Statement called Children, Adolescents, Substance Abuse, and the Media has been published in the October 2010 print issue of Pediatrics and is published online, actually, on September 27th. It calls for a ban on tobacco advertising in all media and it limits — and it places limitations on alcohol advertising and also no erectile dysfunction drug advertisements until 10 p.m. In addition, the AAP recommends that parents exercise extreme caution in letting their younger children view PG-13 and R-rated movies and television shows which often features substance abuse and that all substance abuse prevention programs including those in the class room should include media education.

12:05

The policy statement recommends that pediatricians actively encourage parents to limit unsupervised media use and television channels with excessive depictions of substance abuse. It also calls on the White House Office on drug control policy to begin producing and airing anti-smoking and anti-drinking public service announcements. We'll have a link in the Show Notes at pediacast.org to the full text of the AAP Policy Statement – Children, Adolescents, Substance Abuse, and the Media. They have to go and throw in the "Viagra thing", didn't they? I mean, last week we covered a different AAP Policy Statement regarding sex in the media. The "Viagra thing" fits into that one for sure, but do they have to tag that one into the substance abuse policy statement? I mean, are teenagers really abusing Viagra? OK. Maybe I don't want to know the answer to that. It's kind of like Congress, you know, just tagging on whatever they want to a bill. Now, the AAP is just tagging on things to their policy statements – because I really don't think that one fits in there.

13:04

But there are folks who are in the know who have, you know, personal feelings on that particular topic apparently because she's been asked — he's been asked by his daughter on several occasions, "Hey, what's an ED drug?" And, you know, it is embarrassing and so I understand. OK. Let's move on.

An extremely preterm baby girl survived against the odds after being kept warm in bubble wrap. After cutting the umbilical cord, staff at Worcestershire — boy, I think you have to be British to pronounce that, just right off the tongue. Worcestershire, not sauce — the Worcestershire Royal Hospital in the U.K. — after cutting the umbilical cord, staff at that hospital [laughter] put the baby girl in a plastic — a small plastic bag enclosed in bubble wrap and warned her parents that her chances of survival were not good. But Lexi Lacey who weighed just 14 ounces, that's 397 grams, when she was born after only 26 weeks gestation defy the odds.

14:04

She's now a healthy 11-week-old baby, although at 11 weeks, she still only weighs 5 pounds 6 ounces, which is 2 pounds lighter than the average full-term baby. No surprises there, considering she was 397 grams at birth. Dr. Andrew Gallagher, a consultant pediatrician at the hospital, says "It's normal to wrap very small newborns in plastic to keep them warm. And then they are placed in a plastic bag for about 30 minutes", he added. Parents Chelsea Rowberry, 17; and Lee Lacey, 24. OK. A little bit of an illegal relationship there, at least, in the U.S. And where was Chelsea's parents a few months ago when their daughter was seeing someone seven years older than her? OK. But I digress. The parents say, "When people see Lexi" – OK. Folks. Look. It's not pure news here. OK? We got the commentary thing going too. Anyway, the parents say when people see Lexi, they can't believe how premature she was.

15:02

Rowberry said she was staying at her brother's when she started feeling contractions late one Sunday in June. She rang the maternity unit, but they told her, "Just go back to sleep." Isn't that lovely? She rang her mother who immediately called an ambulance and she said she was frightened because she thought she was going to have a miscarriage. When she got to the hospital, she was three centimeters dilated and gave birth to Lexi. And it doesn't take much dilation to push out a 397-gram baby now, does it? Soon, afterwards, the hospital staff put Lexi in the bubble wrap plastic bag. Gallagher said, "They put premature babies into the bag feet first, leaving just the head outside. This stops water evaporating from their bodies which would cause them to lose heat quickly in those vital first minutes of life before they get to the incubator". So, they didn't put the whole baby in the Ziploc bag here folks. OK? They left the head out. I'm not sure what you were picturing in your mind as we were discussing the story, but remember, you don't — no kid's heads in bags, not a good thing.

16:03

The babies are then transported to the neonatal unit where they are placed in an incubator and taken out of the bags. He said the bags are about the same size as a Ziploc Sandwich Bag. Although her mother was able to go home on the same day she was born, little Lexi was transferred to Birmingham Heartlands Hospital and then to Shrewsbury Royal Hospital to receive specialist care and she was eventually returned to Worcestershire Royal Hospital. Seriously, folks, she had three hospital transfers? OK. Government medicine in the U.K. and perhaps coming soon to a city near you. Lexi's parents were very scared that she would not survive. Rowberry said they would get calls from the hospital like, "Lexi needs a blood transfusion and she probably won't make it through the night." Although her baby have been given all clear, Rowberry said she's still scared because Lexi is so tiny. She is the most premature baby ever to survive at that hospital. A premature baby is born before the 37th week of pregnancy and the baby born between 35 and 37 weeks is described as moderately premature.

17:07

If they're between 29 and 34 weeks, they are very preterm; and between 24 and 28 weeks, we call them extremely preterm. A low birth weight baby weighs less than 1.5 kilograms, which is 5.5 pounds. Although, an extremely low birth weight baby weighs less than 1 kilogram, which is 2.2 pounds. Lexi weighed less than half of the extremely low birth weight threshold when she was born. Because they are born too early; premature babies often have health problems because their organs are underdeveloped. And as a result, they can be at a higher risk for a range of problems such as breathing difficulties and serious lung conditions like respiratory distress syndrome, cerebral palsy, life-threatening infections, and learning and developmental disabilities. In the U.K., nearly 8% of live births are preterm with 93% occurring after 28 weeks of pregnancy, 6% between 22 and 27 weeks, and just under 1% before 22 weeks.

18:02

A mid-1990 study of babies born before 26 weeks in U.K. showed 81% of those born at 24 weeks survived, whereas only half of those born at 22 weeks survived. The study also found when it reexamined the children at age 11, that those born earlier than 26 weeks of pregnancy had lower scores for cognitive ability, reading, and mathematics. In the U.S., the incidents of preterm live births appear to have increased. It's been nearly 13% in recent years, which is significantly higher than the 5% to 10% of other resource rich countries. Nice stab there from the Brits.

[Laughter]

All right. Touting their lower rate of preterm babies compared to ours. Yeah? Well, we don't transfer our preemies around from hospital to hospital. If you're born in the boonies, you get one transfer in the U.S. and that's probably going to be it. All right. They do make a point though. We do have a high premature birth rate here in the U.S. and it sounds like a topic for a future PediaCast.

The use of device assisted enteroscopy, a technique that allows complete examination of the small bowel, may be just as successful in pediatrics as it's been in adult medicine.

19:09

That's according to a study from Nationwide Children's Hospital. One of these techniques known as a Double-Balloon Enteroscopy also known as DBE, a procedure readily available in adults, allows doctors to reach parts of the small intestine that cannot be reached using standard endoscopic procedures. Due to access issues and size limitations, DBE is rarely considered an option in pediatrics and as a result, little is known about this technique in children. So, listen up all the G.I. specialists out there who are listening to the program today. Since the introduction of fiber optic endoscopy in the 1950s, gastrointestinal endoscopy has undergone dramatic progress in how it can aid in the diagnosis and treatment of patients. That's according to Dr. Steven Erdman, a gastroenterologist at Nationwide Children's Hospital, a professor of Clinical Pediatrics at the Ohio State University College of Medicine, and one of the study authors.

20:04

"Yet, even with this progress, endoscopic examination and treatment in the small intestine has remained a challenge especially in children. Small intestinal enteroscopy in the pediatric population remains relatively unknown and underutilized", said Dr. Erdman. To shed light on the indications in possible benefits of DBE in children, physicians from Nationwide Children's review the outcomes of DBE cases performed at the hospital during a two-year period. The physicians performed a total of 13 DBE procedures on 11 pediatric and adolescent patients. Prior to the DBE, all patients underwent a detailed diagnostic evaluation including laboratory data and diagnostic radiologic imaging along with upper endoscopy, colonoscopy, and capsule endoscopy tests. Abnormal small intestinal findings or continued small bowel disease symptoms without diagnosis by conventional methods were used as indication for DBE. So, in other words, they really look at this kids by standard ways first.

21:04

OK. I mean, they did the colonoscopy, they did the endoscopy, and well, what we're talking about here just to make it clear, you know, you can put a tube with — and I'm simplifying it. But you can put a tube with a camera so you can inspect the inside of the intestine. You can do it up the bottom, we call that a colonoscopy. You can do it from the top, and that's endoscopy. But you can only go so far if you're doing it from the top. So, this is a procedure where you go – we call it now, instead of endoscopy, enteroscopy because you're going much farther into the small intestine to be able to take a look. So, before they did this procedure, with their going farther into the small intestine – and, you know, there's more complications that can happen because you're going in so deep and the patient has to be more sedate, it takes special equipment — so, this is the reason that it's not been done universally. So — but these kids, they didn't just say, "Hey, let's go deep and see what we find just for the fun of it."

22:00

I mean, these are kids who needed it. They had a problem and the problem was becoming difficult to diagnose. They didn't know what was causing it. So, they did all the conventional things first and if they still couldn't figure it out, that's when they went to DBE. Two of the patients underwent DBE for treatment of small intestinal polyps associated with Peutz-Jeghers syndrome, which dramatically improved their symptoms of abdominal pain and bleeding. So, they not only went to look, they were also able to do something about those polyps that were deep in the small intestine. Another patient's DBE was done to remove a bleeding small intestinal vascular malformation that had caused the years of symptoms in chronic anemia. Two other patients had history of bloody diarrhea, anorexia, and weight loss. Lower DBE provided evidence leading to the diagnosis of Crohn's disease when other medical techniques had been unsuccessful. DBE can be associated with abdominal discomfort following the procedure due to gaseous distension as that was seen in 5 of the 13 procedures. Utilizing carbon dioxide rather than regular air to fill the intestine during this procedure has eliminated this issue.

23:06

Noting the limitations of the study on the small number of patients from a single institution, Dr. Erdman says that, "DBE appears to hold promise for pediatrics. Our experience suggest that DBE shows great potential and the diagnosis and management of pediatric small intestinal disease without undue risk." Since completion of the original report, eight additional DBE procedures had been completed with similar positive outcomes. Although DBE shows great potential, Dr. Erdman warns that pediatric centers may not be able to devote the necessary resources and time needed to provide this type of service. "DBE remains a resource intensive procedure requiring multiple staff, general anesthesia and extended procedure time in addition to cost outlays for equipment", he said. These instruments were designed for use in adults and size is a limitation that remains to be addressed before DBE can become a more standardized tool in pediatric gastroenterology.

24:00

All right. Moving now from bowels to bullies. More than 30% of children are reported they have been bullied, teased, or harassed because of their food allergy. That's according to a study published this month in the Annals of Allergy, Asthma, & Immunology. Although verbal abuse is the most common, over 40% were reported to have been threatened physically with acts such as being touched with their allergen or having the allergen thrown or waived at them. Food allergies affects an estimated 12 million Americans including 3 million children. "These children face daily challenges in managing their food allergies", said Dr. Scott Sicherer, co-author of the study and a researcher at the Jaffe Food Allergy Institute at Mt. Sinai in New York. Sadly, the study shows they may also be bullied their food allergy, a medical condition that is potentially fatal. In the survey of 353 parents and caregivers of food allergic children and food allergic patients, barely one quarter of individuals in all age groups were reported to have been bullied, teased, or harassed because of their food allergy.

25:00

Of those affected, 86% reported multiple episodes. Additionally, 82% of the episodes occurred at school, 30% perpetrated by classmates, and 21% were reported to teachers or other school staff. I'm sorry. No. No. Let me back up. Sorry about that. 86% reported that they happen multiple times, 82% reported that it occurred at school, 80% the person who did the bullying or classmates — this is crazy. 21%, it was teachers or other school staff that were the bullies. Recent – that's just disturbing; isn't it? Recent cases involving bullying in food allergy include a middle school student who found peanut butter cookie crumbs in her lunch box and a high school student whose forehead was smeared with peanut butter in the cafeteria. That's according to Dr. Christopher Weiss study, co-author and vice president of the Food Allergy & Anaphylaxis Network.

26:01

Bullying, whether physical or verbal is abusive behavior that can have a tremendous impact on a child's emotional well-being. This — the meticulous attention that must be paid to every — more so, a food a child with food allergy eats is challenging enough. Unfortunately, this is not the only stressful aspect of food allergies. The diagnosis of food allergy is life altering in several ways not the least of which is the emotional impact on the children. "Victims of bullying who are food allergic risk losing their sense of security at school, which could lead to a heightened anxiety state because of this emotional abuse", said Dr. Sicherer. Additionally, the bullying of a child with a food allergy is potentially dangerous.

"Educators should develop anti-harassment policies related to food allergy", said Dr. Weiss, "because the public needs to understand this behavior is unacceptable". Managing a food allergy is difficult enough on its own, but add bullying into the mix, and it's downright dangerous. One way the Food Allergy & Anaphylaxis Network helps children manage their food allergies is through its peer education program: Be A PAL: Protect a Life from Food Allergies.

27:06

This program is designed to help and educators teach things about food allergies and how to help their friends who are managing them. The first rule of Be A PAL program says, Food allergies are serious. Don't make jokes about them. And this program teaches children as young as — I'm sorry. This — the program — I'm getting – my mouth is just not moving right this morning. This program teaches children at a young age about the steps they can take to keep their classmates safe. So, if your child has a food allergy, ask them directly, "Is anyone at school bothering or threatening you with your food allergy?" Don't wait on them to tell you because they might not. If your child does not have a foodallergy, ask them directly, "Are you bothering or threatening someone at school with their food allergy?" Don't wait on school officials to inform you of that behavior, again, because they may not. In fact, they may be the ones doing the behavior according to this study. All right. That wraps up our News Parents Can Use for this week.

28:00

We have a brand new listener — we have brand new listener questions since we resuscitated the program. So, if you are one of those who wrote in to us with the questions, since the show restarted a few weeks ago, it's very likely we're going to get to your question. So, we will get to those including the white noise issue, which we'll then kind of bleed into the research segment because we have a nice research study which relates to white noise, but that's all coming up later. I'm getting ahead of myself. First is the Listener Segment [laughter] and we will get to that right after this.

[Music]

29:08

OK. We have lots of new listeners since I last addressed this topic. Some people may be wondering, "OK. Why do you have the interlude music between the segments?" Well, there are several reasons. Number one, I like to record the show start to finish all in one take live. I just — I like to do as little audio file manipulation as possible because really, my love is getting this information into your hands. And so, the smaller amount of production work that I can do, the better. So, I just like to do it all on one take, you know, as if it were like a radio show. Here I am, let's get the information out, that's it. But I get thirsty – you know, my mouth gets dry. So, those interludes actually allow me to get a little drink to wet the old whistle. And also, there are, you know, folks out there who. OK. Right now, I just want to listen to the Listener Segment or I'm just interested in research. And so, it's a little easier to fast forward to the program to when the segments are divided and separated by these musical interludes.

30:05

So, anyway, that's the reason. It's not like, you know, we someday have a plan to put all these big commercials or anything like that, so — in case you were wondering. OK. Our Listener Segment, first up is Leslie. She says she was born and raised in Ohio. Go, Buckeyes. And now she's enjoying the Columbia South Carolina winters. She says, "Hi, Dr. Mike, love the show. I'm a new listener and I spend my morning walks catching up on past episodes. My son is four and a half months old and just had his four month shots. I didn't think to ask if the time about flu shots for the upcoming flu season mostly, because it's still 90 degrees here in South Carolina. But now that I see the drugstores are advertising flu shots, I thought I should ask. Should my son get a flu shot or is he too young? Does breastfeeding, if I get the shot, give him any protection if he is not eligible? I got a flu shot last season when I was pregnant with my son. Should I wait until our six-month well baby check up on October 29th to bring this up to the pediatrician or should I schedule another appointment earlier to get a flu shot?

31:05

My husband's company provides all employees and family members with free flu shots every season. Is my son able to participate or does he need a specific dosage only available at the pediatrician's office? Just when is the best time to get a flu shot? It seems early to be seeing advertisements in my area already. Thanks for putting on such an informative podcast." Thanks for the question, Leslie. Flu shots are not licensed for use in babies younger than six months. Now, would they be safe prior to six months? Probably, but they haven't been formally tested for immunogenicity and safety in that age group, although I suspect that could possibly change in coming years. But for right now, six months is the youngest age. So, Leslie, definitely bring it up and get your son a flu vaccine at that six-month old well check up. Incidentally, since it's his first year getting a flu shot, he'll need a second vaccine at least four weeks after the first one, but I wouldn't wait until the nine month well check up to get that one.

32:02

So, you'll — you need to make an extra visit into the doctor to get the second flu vaccine at least a month after that six month well check up when he gets the first one. And I would get this all done at your pediatrician's office, not through a company health clinic. That may be fine for teenagers and adults, but for young kids, you definitely want to have your pediatrician do the vaccine. In case, you're wondering, H1N1 is included in the flu vaccine this year so there won't be two different flu shots like last year. And who should get a flu shot? Well, this year is the first year of universal recommendation. Everyone six months of age and older should get it. A note on timing too, it takes about two weeks for protection to develop and with this year's flu season potentially around the corner, now is the time. Unless your child is less than six months of age like Leslie's, in which case, you should wait until they are six months old. So – you know, to Leslie, let me point this out.

33:00

You know, you're asking about timing. When flu hits, you know, in a big way in and the specific area really varies from area to area and from year to year. For instance, down here in Florida, last October was just terrible with the flu and then things got better in November, December. The first wave was that H1N1 and then the seasonal flu hit around January, February. So, there are years when the flu really hits earlier. Most typically, it is a little bit later, you know, into January, February kind of time range in the country, but there are years that it's earlier. So, now is the time to do it or in your case, as soon as your baby is six months old. Also, to answer your other question, Leslie, does breastfeeding help? It potentially does as long as you had natural infection of the circulating strain or had a flu shot this season that was two or more weeks ago. So, go ahead, Leslie, and get your flu shot now so you can start passing some of those antibodies onto your baby sooner rather than later.

34:03

But still, you know, you get a really small amount of those antibodies through the breast milk as oppose to making your own antibodies with the flu vaccine. So, that's the best way to go once your baby is six months old. All right. Thanks again for the question, Leslie. Let's move on. The next one comes from Ana in Toronto, Canada. "Hi, Dr. Mike. I really like your podcast. I join it when — I joined it when you were away and have listened to the past podcast, not all of them yet. I really like it and your voice is nice, really not everyone can speak on the radio." Oh, that's sweet. "My son had an issue with on and off diarrhea. We have an appointment for a specialist, but as usual, it will take four or more weeks to see the specialist because we live in Canada. Anyways, other symptoms are that he had a red rash on his anus. He is gaining weight and is growing normally. He will have diarrhea for a couple of days then he's all right for a week or two and then again with a diarrhea. So far, we've tried lactose-free diet. He seemed better, only had one diarrhea in five weeks.

35:01

We have him gluten-free at home since my husband is intolerant into it, although he does not have true celiac disease. I was just wondering what other things I should be doing. Is it normal for a preschool boy to have all these? Thanks for reading, Ana." And the parenthetical comments by the way were Ana's, not mine. Like I would know, that her husband doesn't truly have celiac disease. So, that was from Ana. Thanks for the question, Ana. First, let me say, "Sorry to hear it will so long to see a pediatric GI specialist in Canada." Although, honestly, it isn't always better in the U.S., depending on where you're located, not because the government control over the number of pediatric GI subspecialist, but because fewer young doctors choose to become pediatric subspecialist. Pediatric subspecialist must complete general pediatric training first. And fewer medical students are choosing pediatrics in other seemingly primary care fields because there's a huge discrepancy in the pay right now between primary care and specialty fields in light of increasing debt needed to attend medical school.

36:05

So, there is also a big discrepancy in pay between pediatric and adult subspecialist of the same discipline. For instance, adult and pediatric GI docs, with the pediatric folks earning far less, yet carrying the same debt load. So, the bottom line is fewer are choosing pediatric pathways, which ultimately leads to a shortage of pediatric subspecialist, which lead to longer wait time. So, free markets aren't always better, not to say, I think socialized medicine is a better plan. You guys know what I feel about that, but just saying that our system has problems of its own. OK. On to your question, Ana. Intermittent diarrhea is a common problem during the preschool years. And there's really a laundry list of possible causes. We can, sort of, divide it up into infections; so viruses, bacteria, parasites, protozoa, fungal infections, although in the case of infectious causes, you wouldn't really expect the diarrhea to be so intermittent.

37:03

And often, you would have other symptoms like fever, abdominal pain, vomiting, blood or mucus in the stool, things like that. There's also inflammatory causes of intermittent diarrhea, things like Crohn's disease and ulcerative colitis. Those are really complex diseases and beyond the scope of this discussion, but the interesting ones that perhaps we should on the docket for future episodes of PediaCast. Other disease processes such as cystic fibrosis, hyperthyroidism, are just a couple of examples of possibilities and then dietary problems, and probably the biggest example of that is going to be lactose intolerance. And it sounds to me, Ana, like this could potentially be your problem. Now, let's be clear, I am not making a diagnosis on a podcast, by all means, go see your pediatric GI doc when the appointment rolls around. But you said so yourself, when you implemented a lactose-free diet, he only had one episode of diarrhea in five weeks.

38:02

That seems pretty conclusive to me. I mean, most of the listeners out there listening to this podcast right now can probably think back in the last five weeks, "Did you have at least one episode of diarrhea?" A lot of you probably have, you know. Depending on what you ate on a certain day, you're going to have a looser stool sometimes. So, one episode of diarrhea — one episode of diarrhea in five weeks does not a disease make. So, I think since you implemented the lactose-free diet, things are better. Now, I think that's more likely than the – than the gluten explanation. Now, here's a way you can test it though, reintroduce foods with lactose. Does the diarrhea return? Then go back to the lactose-free diet. Does the diarrhea resolve again? If so, I think you definitely have your answer, but again, go see your doctor. I'm not making a diagnosis here. Just, you know, putting the pieces of the together and telling you what I think the big picture looks like. So, let's take a step further and just briefly talk about lactose intolerance.

39:01

Why does lactose intolerance cause diarrhea? Let's go a step further here. Lactose is a sugar. Each molecule of lactose is galactose and glucose. Now, the small intestine can absorb each of those individual components. So, the small intestine can absorb galactose and it can absorb glucose. So, it can take it from the inside of the intestine and bring it into the body, but it cannot absorb the combined products. So, you put galactose and glucose, a molecule of each of those together, and you make lactose. And now, the body cannot absorb that. It can't take it from the inside of the intestine and bring it in to the inside of the body. It — what has to happen is you have to have an enzyme called lactase to break the galactose-glucose bond. And then each simple sugar can be absorbed on its own. So, lactose comes in, body, says, "Hey, I can't absorb this. I need an enzyme called lactase to break it apart into galactose and glucose, its two components, and then those can be absorbed."

40:08

Now, some people are born without the ability to manufacture lactase, the enzyme that breaks that bond down. So, lactose doesn't get broken down and absorbed, instead it travels to the large intestine. Now, you're going to have to think back to high school biology. At the — probably even — it was probably mentioned in middle school by life science, to be honest with you. But it's a concept called osmosis and this just says that water travel across the semipermeable membrane from the side with less particles to the side with more particles. Well, if you have bunch of lactose that couldn't get broken down and absorbed in the small intestine that goes down to the large intestine, guess what? You have more particles in the large intestine. The bowel wall is a semipermeable membrane. So, water travels into the large intestine and "Voila", you got diarrhea. So, what do you do? Well, you can eliminate lactose or you can provide lactase in the diet.

41:01

Let me back up. What foods contain lactose? Well, we're mostly talking about dairy products here, cow's milk, cheese, yogurt, ice cream, et cetera. And then, how do you – so, those are the things you have to avoid. If you wanted to instead provide lactase, you can buy milk that has lactase added, and that's called Lactaid. It's the brand name of it. There's probably other brands out there as well. I just haven't looked in the dairy case for it lately. You can also provide lactase in — for older kids in the form of chewable tablets. And it's basically taken at the same time as lactose containing foods. So, there are Lactaid tablets that contain lactase, which is the enzyme, and you can chew those up with your lactose containing food, so that will help with that issue. One more lactose related issue, often a toddler is not born lactose intolerant, but can become temporarily lactose intolerant and thus have intermittent diarrhea. So, how does this happen?

42:00

Well, think back again the high school biology. The small intestine is lined with millions of little projections toward the lumen or inner tube called villi. And lactase, the enzyme that breaks down lactose, lives on the tip of these villi. So, if child get – if your child gets a virus, OK, they get diarrhea from the virus and – but that lactase gets washed away and they become lactose intolerant until the body can make more lactase. And this is the reason when your kid has diarrhea, we say, "Avoid milk and dairy products" because they're going to be lactose intolerant. Because the lactase, the enzyme that breaks down the lactose, gets washed away with the diarrhea and now you become lactose intolerant until your body can make more of the lactase. So, this is important because sometimes it can become a vicious cycle where kids have diarrhea and now they're lactose intolerant and suddenly the diarrhea is lasting a lot longer than the virus, but it's no longer caused by the virus. Now, it's caused by the lactose intolerance.

43:02

So, what do you do about this? Well, again, you do a lactose-free diet while you have the viral infection and then you continue the lactose-free diet for a few days after the diarrhea resolves. So, that gives you time to build up more lactase again. All right. I think we beat the lactose issue into the ground. Thanks for your question, Ana. Hopefully, you can take away some ideas from that. But, again, by all means, see the pediatric GI specialist and see what they have to say.

All right. Let's move on. Mandy in Utah says, "Dr. Mike, love the show, especially the rants and tangents because it's the little things that count. And gut feelings go a long way to making a person good at whatever it is that they do." Well, see, that's so nice. I appreciate that. "My concern is over my three-year old daughter. It used to be that it seemed like she could go all day without going potty. However, now, within the last month or so, she goes a couple of times an hour. I've taken her to our pediatrician twice because I was concerned. In both times, he had her urine tested. Both times, the test came back regular.

44:01

No urinary tract infection. No diabetes. The last time we went – the last thing he said before he left the room was, 'Ignore her.' I did a double take and said, 'What?' He said again, 'Ignore her. You have a new baby and she just wants the attention.' Well, that's greatly frustrated me. Yes, we do have three and a half month old twins, in fact, in our home and yes, I have noticed situations where attention has been pleaded for, but she's been potty trained since 30 months over a year and a half, goes to the bathroom, completely by herself almost all the time to the extent I don't always know when she goes and she gets no attention from it. Do you have any suggestions about this and should I be worried?" All right. Thanks for the question, Mandy. I agree with your doctor that testing your daughter's urine each time you went in was the right thing to do and that would reveal urinary tract infection and it would also likely reveal sugar diabetes or diabetes mellitus. There's another form of diabetes that is a non-sugar diabetes called diabetes insipidus, but it's very rare and it is unlikely to be your child's problem.

45:07

But I still wanted to mention it because even though it's rare, it does happen to some kids; and, you know, it could be your kid, but again, it's very rare. With diabetes insipidus, kids are thirsty and drink lots of water or other fluids, which is why they urinate often. So, with diabetes mellitus or sugar diabetes, you have high blood sugar, which gets into the urine and again, osmosis — our friend osmosis draws water into the urine. And so, you get really large volumes of urine that are being produced. And so, you drink a lot, so you don't get dehydrated because of all these urine that you're making. With diabetes insipidus, it's the other way around. You're drinking a lot because you're thirsty all the time. And because you're drinking all the time, you make lots of pee. And so, it's, sort of, the reverse of the sugar diabetes.

46:00

Now, with diabetes insipidus, kids urinate frequently and each time, it's a large volume of urine. So, they drink a lot. They make lots of dilute urine. Their bladder fills and they pee often and they pee a lot. So, Mandy, this is something to consider, but remember it's very rare. I'll bet that your child pees frequently, but urinates a very small volume of urine each time. Now, why do I think this? Well, because the most common cause of frequent urination in kids is — and drum roll, please. So, I think we need a drum roll in our sound effect files. OK. What is it? What is the most common cause of frequent urination in kids? Constipation. Now, I know you're saying to yourself, "Huh?". But let me explain, and I think it will make sense once I do. But before I explain, I have to say what is the medical definition of constipation. Well, constipation is simply having too much bulky stool filling up the large intestine. And this does not always mean that you have infrequent hard difficult to pass bowel movements.

47:02

You can have a kid who has a soft stool a couple of times a day, but if they're making stool at the same rate that they're getting rid of it, the net result is still too much stool in the intestine. So, what does this have to do with frequent urination? Well, bulky stool filling the large intestine, it equals a swollen bowel, which pushes on the bladder. The bladder stretches and the brain thinks, "Hey, the bladder is stretching, it must be full." You know, it just sends the signal, "Dude, I got to pee." So, the child goes and pees. Only there really wasn't much urine there, so they only pee a small amount, but they do it often and three or four times an hour is sometimes common with this because the brain just keeps thinking, "Wow, you're making lots of urine. You got to go." Because it – the brain, you know, can't see the bladder. It just knows that the bladder was being stretched and it assumes that that stretching came from the inside because it was full of urine. It doesn't consider, "Hey, it's the large intestine pushing on the bladder, that's making it stretch."

48:03

So, what do you do? Well, a stool softener, even if they don't seem constipated, you have to loosen all that bulk and you have to end up passing more stool than you're making. So, you really got to get in there and clean out the large bowel. My favorite way to do this is with an over-the-counter product called Miralax. You just basically mix half to one tablespoon in four to six ounces of water and give it once or twice a day for a few days and that will really clean out the bowel and then often, the urinary frequency magically goes away. OK. Legal disclaimer here. I'm not telling you, Mandy, to go out and buy – that your child has urinary frequency, because of constipation, go out and buy Miralax, is not what I'm saying. OK. Check with your doctor first, but it all make sense when you think about it. All right. So, think about it. All right. We're going to move on. Judy in Doha, Qatar in the Middle East says, "Dear Dr. Mike, I've just started listening to your program since receiving an iPod from my husband a couple of weeks ago.

49:03

It's great. I listen to past episodes every chance I get. I would enjoy hearing an episode on children being tongue tied. At the end of the program on tonsils, you mentioned wanting to discuss tongue tied issues, please do. I have children who are ages 7, 6, and 19 months. The older two had surgery. They cut the frenulum at six months of age. In their case, it was very obvious that they're tongues were tied. The tongue was attached nearly to the tip. They couldn't stick out their tongues; however, the initial position of my son's – the initial position of my son's pediatrician was to wait and see if there were any speech problems as he grew older. I had to slightly push the issue to be referred to an ear, nose, and throat doctor and my pediatrician's view is that if he wasn't having problems eating, then there was – there might not be any need for the surgery. I just couldn't see how there was any chance he would not develop speech problems if it was left alone. I know it was a fairly minor issue a few years ago, but it would interest me nonetheless.

50:01

Thanks for your program, Judy." Well, thanks for the question, Judy. First, let's define tongue tied. The medical term is ankyloglossia. And to understand what this is, let's take a look at fetal development. So, during development, when the baby is inside the womb, cords of tissue called frenula form in the front part of the mouth. And they show up as early as four weeks of gestation. Now, the word, frenula comes from the Latin word for bridle and just as bridle guides a horse, the frenula guide the development of structures inside the mouth. Later in development, the frenula recede, although there are two important remnants that remain. The first is the labial frenulum, and this is a tiny cord of tissue that connects the center of the upper gum to the inside of the upper lip. And you're likely feel it if you slide your tongue way up high across the center of your upper gum. So, go ahead, give it a try. Slide your tongue all the way up across your teeth, up a little bit further across the center and you'll probably feel you'll feel a little ridge there and that is the remnant of the labial frenulum for you.

51:09

Now, when babies are born, this remnant is large, but it recedes over the first years of life. And now, sometimes the babies fall and hit their face, they may lacerate or cut that cord of tissue. And usually, it's not a problem because that cord of tissue is going to recede anyway. So, you don't need to stitch it up or fix it. And that's very common. In fact, my son had a large labial frenulum that separated his two upper teeth and it looked like it would create a wide gap between his middle upper teeth, but by the time he was three or four years old, it receded and you – was no longer even noticeable. All right. So, a lot of you know what I'm talking about with that one at the top. Well, then frenulum number two is the lingual frenula and this one connects the base of the tongue and the floor of the mouth. And if you look at the mirror and lift up your tongue, you'll see it. Like the labial frenula, the lingual frenula extends close to the tip of the tongue in early development and then it recedes to the base of the tongue in later development.

52:08

But sometimes, when a baby is born the lingual frenulum hasn't receded yet and it still extends close to the tip of the tongue. And that can sometimes interfere with the baby's ability to extend the tongue out and sometimes, it interferes with the ability to touch the roof of the mouth with the tip of the tongue. And that is the condition that we call tongue tied or ankyloglossia. Now, here is the deal, like the labial frenula, the lingual frenula will often recede on its own during the first few years of life. So, often, babies who are born tongue tied, if nothing is done, they're no longer tongue tied by the time they go to kindergarten. OK. So, if it goes away on its own, why is it a big deal? Well, the truth is, most of the time, it's not a big deal. And it's absolutely fine to leave it alone, but of course, there are exceptions. Rarely, tongue tied babies who have trouble latching on to a breast or the nipple of the bottle, and this can result in feeding problems, which leads to growth problems and possible dehydration.

53:08

So, if your infant is tongue tied and having feeding problems that are severe enough to cause growth delay or hydration issues and these feeding problems are felt to be related to the tongue tied condition, then it's time to see a pediatric ENT doc to have the condition fixed surgically. Now, I have to say, if you see a pediatric ENT doctor for this, they're going to fix it. OK. Surgeons cut. That's what they do. Sorry. If, you know, you're going to go see them, that's what they're going to do, but it doesn't mean it was the right thing to do. Now, if your child is having growth issues, but they're feeding well, then fixing the tongue tied condition is not going to help them grow. It's only going to help if the tongue tie is directly related to feeding problems, which are directly related to the growth issues. And your pediatrician is going to be the best judge of that. Now, how often does this perfect storm occur where you have a kid who's tongue tied and it is causing feeding problems which is causing growth problem?

54:08

Well, let me put it to you this way. In ten years of general pediatric practice that I did, I could count the number of times that that happened on one hand. So, it's not very common. Most kids who are tongue tied eat just fine. And again, it goes away on its own. OK. Another potential issue is speech problem. So, in order to form some sounds properly, the tip of the tongue must be able to touch the lips to the roof of the mouth. And the truth is, that most kids who are tongue tied can do those things. They may not be able to extend the tongue very far out pass the lips, but they can at least, touch the tip of the tongue — the lips and touch the tip of the tongue to the roof of the mouth. And that's all that you need. There are no sounds in the English language that require your tongue to be outside of your mouth. So, let's be clear on that.

55:00

Now, by the time most kids have reached talking age, almost all of them who are tongue tied at birth have had enough recession of the lingual labia, so as not to interfere with speech. Now, lots of kids have speech issues. Some of them will be tongue tied. Some of them will have speech improvement if that condition is corrected. But many of them will continue to have speech problems even after the tongue tie is fixed. Why is that? Well, either because their tongue will need to be retrained to move properly or more likely because the tongue tie wasn't the cause of the problem to begin with. So, your best bet here is to wait until your child is speaking age to give time for the lingual frenulum to recede and then if there are speech issues, consult a speech pathologist and if the speech pathologist believes that tongue tie is the problem, then see a pediatric ENT doc to have it fixed. OK. So, why not just have it fixed from birth? That way you don't risk, even though it's a small risk, you're not risking any feeding or speech problems later on.

56:06

Why not just have it fixed? Well, here's why, the area below the tongue is highly vascular and clipping the lingual frenulum often leads to lots of bleeding that can be difficult to control. And to complicate matters, this bleeding is in the airway. So, the procedure actually carries a relatively high risk and complication rate. So, if it's not really medically necessary and you do it anyway and there's a problem with the, you know, the bleeding or airway and aspiration and choking on the blood, if you do it and you have problems and complications and it wasn't even really medically necessary in the first place because your child didn't have feeding or speech problems, then suddenly, everyone wishes that they hadn't done it. So, as with everything in medicine and life, you have to look at risk versus benefit. And in the case of tongue tied, which usually goes away on its own, and which usually does not cause feeding problems, and which usually does not cause speech problems, the risk of fixing it is more than the potential benefit of fixing it.

57:09

However, if your child does experience actual feeding or speech problems that pediatric health professional really do feel is coming from the condition, then the needle swings from the risk side to the benefit side, and I'd say, "Go for it." But again, you really want the opinion of your pediatrician and possibly the speech pathologist because if you go to the ENT doctor, they likely are not going to give you their opinion. They're going to do the surgery. Just a little FYI. All right. Thanks again for the question, Judy. Always appreciated. All right. Let's move on to white noise here as we wrap the program. And I'm looking at the time and I've ran longer than I thought on some of the other stuff, so we may have kind of squeeze this in. Sorry about that. All right. Let's first go to the question. Kim in Houston, Texas says, "Thanks for the podcast. My question has to do with using white noise to help drown out other noises while sleeping.

58:01

Our 20-month old son seems to be a light sleeper. Dogs bark outside, and he wakes up. A helicopter flies over, he's up. There's only so much sound proofing we can do. My husband and I have tossed around the idea of having a white noise machine in our son's room, but we're concerned there could be hearing damage or some other kind of developmental damage resulting from the use of white noise. Obviously, we wouldn't want it to be too loud and it wouldn't cover every noise. We just thought it might help mute some of the noises that seem to wake him up each night. He's coming up on two years old and still rarely sleeps through the night. If you have any other tips on getting a toddler to sleep through the night, my husband and I would be grateful. Thanks, Dr. Mike. Regards, Kim." And the second question came from Erica in Foothill Ranch, California. "Hi, Dr. Mike. I discovered your podcast several months back while looking for entertainment on the long walks I was taking during the last months of my first pregnancy and I am so glad I did. As a registered nurse, I really do appreciate your reliance upon evidence based medicine for the content in your podcast. And I'm having a blast catching up on all your past episodes now that I found you.

59:03

My question is what is your take on white noise for babies? I was given a book called Baby 411 by Denise Fields and Dr. Ari Brown, which claim a study done in the journal of science showed rat pups exposed to white noise ended up with developmental delay in the hearing center of the brain. I find that hard to believe, white noise can be all that bad given the volume and intensity of sound babies hear in the womb and I sometimes find these baby books misleading when it comes to recommendations for newborns since they aren't always sighting journal references like this book did. We want an air purifier for our three-month old baby because it's crazy loud where we live and she does seem to sleep better with the noise. Is this really a big deal? Thanks and keep up all the great work." All right. So, I'm going to hold off in answering Kim's question, but don't worry. We'll get back to it. And I'm going to do more than just a simple answer to Erika's question. We're going to take a little break and we'll come back with our Research Round Up Segment.

1:00:01

And we'll just – the study that she cited in this book, Baby 411 from the Journal of Science, we're actually going to look at that study and pick it apart together and figure out if it was a good study or not. So, why the white noise in baby hearing development delay research article, which Erika brought to our attention – we are really going to delve into it. On the flip side of the break, we'll figure out together if this was a good study or should Denise Fields and Ari Brown be ashamed of themselves for including it in their Baby 411 book.

[Laughter]

All right. As usual, we'll let you be the judge. And we'll do all that right after this.

[Music]

1:01:21

OK. Our Research Round Up today is inspired by Erika's question. Erika, again, from Foothill Ranch, California. And she wants to know if using white noise to help baby sleep is safe or might it lead to hearing and possibly language and developmental delays. Her concern stems from a research article cited by Denise Fields and Dr. Ari Brown in their book Baby 411. So, let's take a look at the study that they are referring to. The study itself, the authors are Edward Chang and Michael Merzenich and it was published in the Journal of Science on April 18th, 2003. The question before the researchers, what effect does an environment of continuous moderate level noise of mixed frequencies, so white noise what effect does that have on the auditory cortex of infant rat pups?

1:02:07

And they hypothesized that continuous moderate level white noise will delay the emergence of normal auditory cortex topography. So, what does that all mean? Well, first of all, let's just talk about the sound neuron map. Basically, the thought here is that there's a physical area of the brain that is involved in interpreting each frequency of sound that you hear. So, in other words, if you were able to see the brain and each frequency would light up a different color when you listen to a frequency and then look to see what area of the brain lights up, you're going to see an organized pattern. Almost – if you kind of picture piano keys superimposed on the brain, and when you hear a specific note, then the picture of that note on the brain is going to light up.

1:03:05

So, there's an area of the brain responsible for each individual note. So, how does that look on the science level. Well, if you do find electrophysical monitoring of each neuron in the auditory cortex of the brain and then you expose the rat pup to a specific frequency of sound or a specific tone, then you see which neuron lights up for that frequency and you create your color-coded map. So, you can see where each frequency lives on the cortex of the brain. Now, some established facts based on previous studies, we know the onset of hearing in rat pups occurs around post natal day 12. So, at about 12 days of age after they've been born, that's when little rats start to hear. In the next two to three week period is a critical time for auditory cortex development. OK. Now, let's talk about white noise.

1:04:01

Again, it's a mixture of all frequencies, and in this study it was – so, think of a fan running. OK. It's just a hum. It's – all the frequencies mixed together. And for this study, it was presented at 70 decibels of loudness. Now, the control group, what do they do with the control group? The control group of rat babies had no white noise exposure. They were reared in standard housing conditions, so no restrictions. They were just reared with a family of other rat puppies and with rat adults around. And then they did this sound neuron map to map where the frequencies were located on their brain and they did it on post natal days. So, after they were born –16 days of age, 26 days, 50 days, and 90 days. So, they did it four different times. Now, the experimental group, these puppies were exposed to continuous moderate intensity 70 decibels white noise. Again, white noise, mixture of all frequencies.

1:05:01

Exposure began on post natal day 7. So, it's prior to the commencement of hearing. And the exposure continued for three to four weeks. So, past that critical period. And exposure was paused, but less than 24 hours, so that the auditory cortex map could be done. And this was done at post natal days, again, 16, 26, 50, and 90. So, the control group and the experimental group were mapped on these same days. So, what did they find? Well, the control group – so, these are the group that did not have the white noise exposure. The frequency representation started out smudged. Now, this is my term, and in a podcast, I can't show you the picture of what it look like. But basically, hatched, overlapping areas where tones sort of bleed from one to the other. And this was most noticeable on day 16. It was somewhat improved by day 26, and by days 50 and 90, the frequency representation was crisp, complete, and regular.

1:06:01

So, you had nice color representation that were – for the brain, like this is the section that sees tone a, this is the section that sees tone b, this is the section that sees tone c. So, everything was crisp, complete, and regular; whereas, in the beginning of development, on day 16 and 26, it was more smudged and the brain, sort of, one area would be responsible for more than one frequency and they kind of overlap. Now, what about the experimental group? This is the group exposed to white noise. Well, day 16 looked similar to the control group. So, it was smudged and there was lack of discrete correlation. Day 26 did show some improvement, but days 50 and days 90 still had that primitive appearance that was seen at day 16 for both groups. So, in other words, you didn't get to that crisp, complete, and regular frequency representation. It's still – it got a little better as time went on, but even at day — at 90 days of age, the oldest one that you — where you did the mapping, it's still was, sort of, smudged.

1:07:08

Now, finally the experimental group was returned to standing housing conditions. So, they got rid of the white noise and then both groups were remapped at 10 weeks of age. At that point, the control group at ten weeks still exhibited crisp, complete, and regular sound map. But what about the experimental group? So, in other words, now you get them pass that critical period of development, you take away the white noise and at ten weeks of age, you map them again. Well, now the sound maps resembled the control groups. Now, there was still occasional smudges, but these did not reach a level of statistical significance. So, basically from a statistical significant point of view, the experimental group, development did go to near normal compared to the control group once the white noise was taken away. OK. So, what was the conclusion of this study? The conclusion was that continuous white noise exposure causes a delay in normal auditory cortex development.

1:08:07

But removal of the continuous white noise beyond the critical period results in near normal auditory cortex development by age ten weeks in rat puppies. And the authors go on to say that their study suggest environmental noise, which is commonly present in contemporary child rearing environments can potentially contribute to auditory and language related developmental delays. All right. In my mind, this conclusion is a big leap. First, we're dealing with rat puppies, not human babies. And the human brain – and thus hearing development is much more complex in humans than it is in rats, just saying. One big difference in human hearing is that it commences prenatally. So, this critical period they speak of occurs inside the human womb. This is a big difference and it should not be ignored.

1:09:00

Also in this study, white – again, in the human womb, there is white noise. And you've got, you know, lots of different frequencies coming in all together inside the body. And of course – OK. Maybe it's not true white noise, but it – how are you going to expose your child to continuous white noise when they're inside the womb? It's going to be difficult. And I think it's probably designed that way. OK. One big difference in human hearing, OK, commences prenatally. OK. That's a big difference. Also, in this study – this is also a big difference, white noise exposure was continuous. Now, how many parents expose their babies to continuous white noise 24/7? If they're doing that, there's lot of reasons why the baby may be developmentally delayed. OK. The parents may have been developmentally delayed if they're exposing [laughter] their kids at 24/7 white noise. So, it – can we correlate this study to human hearing? No.

1:09:59

Because, again, the rat pups – all of this was happening during a critical period, which for humans, happens inside the womb, and they did it 24/7. But also, let's point out, near normal development commenced even after the critical period once that noise, the 24/7 white noise, was removed. So, is this study proof enough for parents? Is the perceived risk, as presented here, significant enough to change your behavior? Does this study make you worried enough to remove white noise from young babies when they're sleeping? You have to decide that for yourselves. But here's my take on it, if your baby sleeps well without white noise, don't use it. But if white noise does help your baby sleep better, which means that you sleep better, which means you have more positive energy to create an appropriately stimulating white noise free environment when you're baby is awake, then I say, "Go for it." Incidentally, I love sleeping to white noise and my instrument of choice is a floor fan in the corner of the room. All right. And finally to answer our listener question, specifically, Kim in Houston, Texas wants to know, can she use white noise to help her 20-month old sleep and do I have any other tips on helping her baby sleep through the night?

1:11:10

I'm not going to go with the other tips, Kim, only because we're really pressed for time, but that would be another good topic for a future PediaCast. But the answer to your question about the white noise, by 20 months, which is how old your baby is, Kim. By 20 months the auditory cortex is way, way past the developmental stage. Now, I haven't seen or heard any research that suggest it would be harmful at that point. So, again I say, "Go for it", especially if it helps your baby sleep better. Of course, if you've heard of a study that says something different, send it my way and we'll take a look at it together. And Erika in Foothill Ranch, California wants to use white noise for her three-month old. Well, three months is a little closer to that time of development, but I still don't think the study is any real cause of concern. Now, I don't want to tell you what to do, Erika, but if I had a three-month old at home and they slept better with white noise than without, I'd be inclined to do it, and that's my opinion.

1:12:01

You, Erika, have to form your own. And by the way, thanks to both Kim and Erika for asking the questions and providing such great fodder for our research round up this week. So, the other question is should Ari – Dr. Ari Brown and Denise Fields and their book, Baby 411, should they have even mentioned this study? Sure, mention it, but tell the whole story, please. Don't just say, "Well, there could be a problem so you better not or you better think twice". I mean, at least, tell us what the study showed and be honest about it. I wonder if they even read the study? OK. Just me. Sorry. All right. One study is not exactly a round up, but we are pressed for time, then – plus, I like the alliteration, so cut me a break, you know. Research round up, it just sounds nice even if it is only one study. All right. We're going to be back and we will finally wrap up the show [laughter] right after this.

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1:13:17

All right. Thanks go out to Nationwide Children's Hospital for providing the bandwidth for our program this week; also Vlad at Vladstudio for helping us out with artwork; Medical News Today, Wizard Media, my family, and of course, listeners like you, and thanks, in particular, to the folks who asked the questions. If you have a question that you'd like us to talk about, let us know. We'll do it. We'll get it on the air. Just go to pediacast.org, click on the contact link, and submit your question that way, or your comment; or you can also email in pediacast@gmail.com; or call the voice line, (347) 404-5437, that's (347) 404-KIDS. Don't forget about iTunes reviews. We have lots and lots and lots of old ones, but it would be nice to get some more recent ones up there.

1:14:02

And iTunes reviews do help when people are looking into the program to say, "Hey, is this worth my time?" So, if you could, if you haven't done so, it won't take you long, just go into iTunes and write a little review. It would be most helpful. And, you know, the program is free. So, all we're asking is a little time of your — to do a review, that's it. So, thanks again for everyone. I'm really excited to be back and doing the shows on a regular basis. We've had lots and lots of comments through the email on people who were happy that we're back. And I'm happy we're back. We're in a good place, so I'm and really excited about what the future holds for PediaCast in terms of being able to get the information into your hands that is good information. Information based on research and evidence, that's what we're all about. All right. Until next time, which won't be too long, this is Dr. Mike saying stay safe, stay healthy, and of course, stay involved with your kids. So long, everybody.

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