Screen Time, Back Injuries, Night Owls – PediaCast 275

Join Dr Mike in the PediaCast Studio for our final installment of 2013. This week’s topics include managing screen time, skin-to-skin contact in the delivery room, young athletes & back injuries, returning to the classroom following a concussion, big trouble for night owls, and the best gift you can give your kids this holiday season.

Topics

  • Managing Screen Time

  • Skin-to-Skin Contact in the Delivery Room

  • Young Athletes & Back Injuries

  • Returning to the Classroom Following a Concussion

  • Big Trouble for Night Owls

  • The Best Holiday Gift

Links

 

Transcription

Announcer 1: This is PediaCast.

[Music]

Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. And now direct from the campus of Nationwide Children's here is your host Dr. Mike.

Dr. Mike Patrick: Hello everyone and welcome once again to PediaCast, it's a pediatric podcast for moms and dads, this is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio it is December 18, 2013, it's episode 275 and I'm calling this one Screen Time, Back Injuries, and Night Owls. I want to welcome everyone to the program, it's the final show of 2013 and we are going to go out with a bang.

0:01:00.2

I have a News Parents Can Use edition of the show lined up for you. I hinted some of the topics in the show title and I will expand on that list in just a moment. But first a reminder, Christmas and New Year are upon us and you can make a difference in a child's life by supporting nationwide Children's Hospital where we rely on your gifts and our effort to advance ground breaking pediatric research, and to provide the best pediatric care on the face of the planet, so please consider helping us as we help kids from across the United States and around the world. Many of you gave to Nationwide Children's last year and we do thank you again for that because your trust and your support are truly appreciated. This year I would simply ask that you consider including Nationwide Children's in your tax deductible charitable giving and it's an easy thing to do, just head over to the show notes for this episode 275 at pediacast.org and just click on the Every Gift Matters link.

0:02:00.3

You can also call us toll free at 1855-885-5437 and I will include that phone number in the show notes as well. Let's take a closer look at the line-up today, first up is screen time, how many hours do kids spend engaged in screen time for the purpose of entertainment each day, how many hours? I'll let you give your best guest and I'll reveal the answer in the course of the new story. It may or may not surprise you, more than that what's the fall out of too much screen time? How much is actually recommended, and how can families wean down on the screen? That's all coming your way. Speaking of screen time, I also read a blog post regarding the AAP's recent policy statement on family use of digital media. It's over at the 700 Children's blog and you can look for that in the show notes as well, just head over to pediacast.org, click on the show notes for episode 275 and I'll put a link to that blog post there for you.

0:03:03.1

Speaking of the 700 Children's blog, what in the world is that? 700 Children's is a blog for moms and dads from your friends here at Nationwide Children's Hospital. We have lots of pediatrician authors with wise words and timely advice, so be sure to add that to your frequently checked list of online parenting resources. It's easy to find, just type 700childrens.org in your web browser and enjoy. Back to the line-up, after we talked about screen time we're going to cover skin to skin contact between mom and baby in the delivery room. Why is that important? How often does it happen? And what's the consequence of skipping it, stay tuned to find out. Then back injuries in young athletes, they're more common than you'd probably thought, in fact they ranked number three on the It Was Caused By Playing Sports Injury list. I'll explain why they're so common, also detail the long term consequences of not taking them seriously, and give you some helpful hints on how your young athlete can avoid them.

0:04:09.8

Then we're going to talk about concussions, now I know we've talked about concussions many times on this program but most of that conversation is focused on symptoms, how long should concussed athletes stay off the playing field, or court, or arena? We've talked about that. But what about school, when is the best time to return to school or the classroom following a concussion? We've not really covered that and if concussed student can't return to school, how or when does the homework get done? That's coming your way. And then we're going to talk about night owls, lots of teenagers and younger kids stay up late, lots of grownups do too, is this harmful? Is there a health advantage to being a morning person? I approach this one with some caution because the truth be told I'm more of a night owl than an early bird, but you can count on me to report the truth even when it's not exactly what I want to hear or maybe the answer made me feel better, encourage, maybe there is an advantage to being a night owl, be sure to stick around to find out.

0:05:11.1

Finally I'm going to bring a home with the final word on the best gift you can give your kids this holiday season, it's not too late to find this gift, it's great for every age what could it be? Stay tuned to find out. Another reminder before we get started, I recently had a big listener question marathon show and pretty much exhausted the questions that all of you have sent in so I need more for 2014. Maybe you've had a question in the back of your mind but haven't had the opportunity to send it in, now will be a great time to find that opportunity. Maybe you're a new listener with several questions, that's fine. Maybe you've always thought, we must get loads of questions, he'd never choose mine. Not exactly true, I mean it is true, I do get lots of questions but there's still a good chance I'll choose yours because I also answer lots of questions, in fact I answered 70 listener questions in 2013, so there is a good chance that yours will make the show.

0:06:09.1

If you have a question, or a topic idea, or you want to point me in the direction of a new story, or research article be sure to head over to pediacast.org and click on the contact link and I will do my best to get to yours. Also I want to remind you the information presented in every episode of PediaCast is for general educational purposes only, we do not diagnose medical conditions or formulate treatment plans for specific individuals. If you do have a concern about your child's health, make sure you 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. Let's take a quick break and I will be back with News Parents Can Use right after this.

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0:07:24.8

Dr. Mike Patrick: From TV's, to smart phones, to social media the lies of you as children and families are dominated by 24/7 media exposure. While media itself is not the leading cause of any health problem, it can contribute to numerous health risks, on the other hand digital media score some pluses on the beneficial side, it provides untold educational opportunities and it helps families stay connected. Despite these facts both good and bad, few families maintain rules surrounding media use and this lack of oversight can lead to big problems for many families.

0:08:00.2

That's according to a recently revised policy statement from American Academy of Pediatrics and published in the journal Pediatrics. Dr. Marjorie Hogan, co-author of the statement says, "A healthy approach to children's media use should both minimize potential health risks and foster appropriate and positive media use, in other words it should promote a healthy media diet. Parents, educators, and pediatricians should participate in media education which means teaching children and adolescents how to make good choices in their media consumption. Excessive media use has been associated with obesity, lack of sleep, school problems, aggression, and other behavioral issues…. And that's likely just the tip of the iceberg in an effort to dig deeper, the American Academy of Pediatrics is calling for more and better research on the ways media exposure impacts the lives of our children and teens. One such study recently took a look at exactly how much time kids spend interacting with media and the results may surprise you.

0:09:00.3

The average 8 to 10 year old spends nearly eight hours a day engage with media older children and teens spend even more time approaching 12 hours each day. Now granted some of that media time involves education and appropriate communication, but more than seven hours each day is dedicated to entertainment and kids who have TV in their bedrooms spend even more time in front of the screen. While the total amount of time behind the screen is one thing, the content on that screen is another, and while digital media can help kids learn about empathy, and racial, and ethnic tolerances, and the entire host of inter personal skills, these pros can quickly be over shadowed by repeated exposure to violence, explicit sexual content, and the glorified use of alcohol, tobacco, and recreational drugs. Dr. Victor Strasburger, another co-author of the report says, "For nearly three decades the American Academy of Pediatrics has expressed concerns about the amount of time children and teenagers spend with media and about the content they are viewing."

0:10:07.7

He adds, "The digital age has only made these issues more pressing." So what's a parent to do? How can you make a difference for your home? For your kids? You can start by developing a family media used plan with clear guidelines for each device including how long and how often. Also keep all screens large and small out of the bedroom, don't watch screens during meals, look at each other, talk, limit entertainment screen time to a total of just one to two hours each day, don't allow children under the age of two to watch any screens at all, their little brains are developing rapidly and need lots of human interaction. Watch TV and play video games with your children and teens, when questionable content arises, use it as a teaching opportunity. When advertising persuades, counter it with truth, use a established rating systems to help avoid unnecessary exposure to violence, explicit sexual content, and that glorified use of alcohol, tobacco, and recreational drugs, and finally be a role model, moms and dads should follow these guidelines too.

0:11:14.2

What about the doctors and nurse practitioners in the crowd, how can we make a difference? First, by applying these principles to our own home, we should also ask two questions at the well child visit. Number one, how much time is your child spending with media? And two, Is there a television and or internet connected device in the child's bedroom? We should also take a more detailed media history for children or teens who are at risk for obesity, aggression, tobacco, and substance use, and or school problems. We should work with schools to encourage media education, encourage innovative use of technology to help students learn and establish rules about what content may be accessed on devices in the classroom. We should challenge the entertainment industry to create positive content for children and teens, and advocate for strong rules about how products are marketed to youth.

0:12:06.6

And as the media landscape continues to evolve at a rapid phase the AAP calls for a federal report on what is known about the media's effect on youth and what research still needs to be conducted. In addition the American Academy of Pediatrics calls for an ongoing mechanism to fund research on media's effects. Just to be clear these guidelines that I've mentioned for parents and doctors, they aren't just my ideas, they're based on recommendations from the American Academy of Pediatrics and I know what many of you are probably thinking, this sounds a little extreme right? Limit entertainment screen time to just one to two hours each day when kids are really doing seven hours now, how are you going to do that? But we got to do something, screen time is spinning out of control and the reason is because we, parents are just as addicted as the kids.

0:13:01.3

After a busy day at work we want to kick back and escape behind the screen, don't do it. Moms and dads have a second shift, that's what we signed up for, after work get home and get involve with your kids, play hide and seek, read a story, break out the deck of cards in the monopoly board, help your kids with a hobby, go outside, toss a ball, run around, but those screens down and start building relationships with one another, quick before it's too late. According to an abstract presented at the 2013 American Academy of Pediatrics National Conference and Exhibition in Orlando, Florida, "Skin to skin contact between mother and infant in the delivery room is associated with an increase likelihood for exclusive breast feeding and when combined with a mother's intent to breast feed the likelihood is even greater. Researchers looked at skin to skin contact between mother and baby in the delivery room as well as a host of other factors such as maternal age, the number of children previously delivered by that mother, intention to breast feed, gestational age, mode of delivery, the baby's first temperature and blood glucose readings, the number of formula feedings, birth weight, discharge weight and duration of hospital stay."

0:14:12.9

The study found that skin to skin contact and intention to breast feed were significantly related to exclusive breast feeding independent of those other causes or other factors. If skin to skin contact is so important, how many mothers are given this opportunity? The 150 moms surveyed, only 53% were offered skin to skin contact with their babies in the delivery room. Dr. Darshna Bhatt a pediatrician that Cohen Children's Medical Center of New York and author of the study says, "While skin to skin contact is associated positively with exclusive breast feeding, the more statistically significant factor is intention and the center just take effect between intent and skin to skin contact in the delivery room increases the odds that the mother will breast feed….

0:15:05.0

How many of the mothers included on the study indicated an intention to breast feed? That number was pretty high, 72% and how many ended up breast feeding exclusively? Only 28% which leads to a final question, if more of the mothers had been given the opportunity for skin to skin contact in the delivery room would this number had been higher? Dr. Bhatt says, "Breast feeding is one of the easiest things we can do for babies to make sure they're growing up healthy. We have to create a more inter disciplinary approach to increasing awareness and intention. When a mom declares her intent to breast feed, there really shouldn't be a reason why she doesn't have skin to skin contact with her new infant in the delivery room." We've talked about breast feeding many times in the past few weeks, I've said breast milk is best and I've reported encouraging numbers on the numbers of mother who are breast feeding.

0:16:03.2

My audience is also had their say with some heart felt comments from mothers who really wanted to breast feed but for one reason or another, it didn't work out and they were looked down upon and felt much guilt for their failure. Breast feeding is not going to work out every time for every mother and there are plenty of healthy and well-adjusted children who were exclusively formula fed and live to tell the tale. Given a perfect world, breast milk is best and should generally be the first choice of new mothers. When we see a study like this that shows a concrete intervention that can lead to more breast feeding success, then I agree with Dr. Bhatt we should be doing it. Dr. Bhatt says, "There should never be a reason to omit skin to skin contact between mother and baby in the delivery room especially when there's intent to breast feed…. I learned a long time ago to never say never in medicine, there may be reasons why skin to skin contact is not possible in the delivery room like in the case of emergent lifesaving surgery for mom, or resuscitation of an extremely ill or premature baby.

0:17:10.6

But barring these sorts of circumstances, I do agree that skin to skin contact in the delivery room should be offered to a 100% of mothers, not 53% as was reported in this study. Moms and dads, you may have to get vocal to change this, ask for skin to skin contact in the delivery room.

In fact demand it unless of course someone's life is at stake. Here's another story from the 2013 American 1Academy of Pediatrics National Conference and Exhibition in Orlando, Florida, "Lower back injuries are the third most common injuries suffered in athletes under the age of 18…, that's according to Dr. Neeru Jayanthi a sports medicine physician at Loyola University Medical School. Turns out many of these injuries are severe enough to side-line young athletes for one to six months and may lead to even more problems down the road.

0:18:02.4

Dr. Jayanthi looked at a 127 back injuries and found 39% were serious including stress fractures and complications of stress fractures which is why he says, "It is imperative for young athletes to be evaluated by a sports medicine physician if they have lower back pain lasting more than two weeks." He adds, "Serious injuries like stress fractures can put young athletes at risk for a lifelong back problem if they aren't properly treated." What is it exactly that puts young athletes at risk? Dr. Jayanthi says, "Children and teens have insufficient strength of abdominal and back extensor muscles which increases the risk of back injury from hyper extension or arching of the lower back. This may result in pulled muscles, stretch and torn ligaments, and stress fractures of the spine all of which are frequently seen in young athletes undergoing intense training…. How can parents and coaches keep young athletes safe?

0:19:02.0
Dr. Jayanthi offer some practical tips to reduce the risk of back and other injuries in young athletes, first if there's pain in a high risk area such as the lower back, elbow or shoulders, the athletes should take one day off, if the pain persists, take a week off, if symptoms last longer than two weeks, the athlete should be evaluated by a sports medicine physician. For racket sports, athlete should evaluate their form and strokes to limit extending their backs regularly by more than a small amount, about 20 degrees. Young athletes should enroll in a structured injury prevention program topped by qualified professionals, kids should not play sports for more hours per week than their age because younger children are developmentally immature and maybe less able to tolerate the physical stress. Athletes should not spend more than twice as much time playing organize sports as they spend in gym class in unorganized play. Kids should not specialize in one sport before late adolescence as single sport specialization increases the risk of overall injury even if they're spending an appropriate amount of time per week playing sports and that is no more hours each week than their age.

0:20:13.0

Young athletes shouldn't play sports competitively year round, rather they should take a break from competition from one to three months each year though not necessarily consecutively, and finally athletes should take at least one day off per week from training in sports. There you have it moms and dads and coaches, and student athletes great advice for keeping those backs and other body parts safe by training and playing in a responsible manner, and if I went too quickly through those for you, take advantage of that rewind button and listen again. A concussion should not only take a student athlete off the playing field that may also require a break from the classroom. This observation also comes from the 2013 American Academy of Pediatrics National Conference and Exhibition in Orlando, Florida and the clinical report offering guidance to pediatricians caring for children and adolescents who suffer from a concussion.

0:21:06.1

Relatively a little research has been done on how concussions affect students learning so the report is primarily based on expert opinion and adopted from a concussion management program developed at the Rocky Mountain Hospital for Children's Center for Concussion in Denver, Colorado. Lead author Dr. Mark Halstead says, "Students appear physically normal after a concussion so it may be difficult for teachers and administrators to understand the extent of the child's injuries and recognize the potential need for academic adjustments. But children who suffered a concussion may have trouble learning new material and remembering what they've learned, and returning to academics may actually worsen concussion symptoms." How long should school age children spend recovering? That depends on the symptoms, research suggest students usually recover from a concussion within three weeks, if symptoms are mild or tolerable parents may consider returning their child to school but perhaps with some adjustments.

0:22:04.6

However if symptoms are severe some kids may need to stay home from school and students with prolong symptoms lasting more than three weeks may require more formalized academic accommodations. The symptom check list can help evaluate what symptoms the students are experiencing and how severe those symptoms are. Dr. Halstead says, "Every concussion is unique and symptoms will vary from student to student, the goal is to minimize disruptions to the students life and return the student to school as soon as possible, and if the symptoms improve, to increase the students social, mental, and physical activities. The American Academy of Pediatrics has recommended a collaborative team approach to help a student recover from a concussion and return to a full schedule of academic and athletic activities. Does team should include the child's physician, family members, teachers, coaches and school administrators? The AAP calls for further research on the effects and role of cognitive rest after suffering a concussion in order to improve understanding of the best ways to help a recovering student.
0:23:08.2

This is an important report because it gives some credence to something that many of us have been saying for a long time that kids need brain rest following a concussion and it's hard to get brain rest when you're in school. The problem has been that concussion research is focused on symptoms of concussion, how long those symptoms last, and when young athletes can return to the playing field. When kid should return to the classroom that research has been lacking but I think we will see more of it in the near future. In the meantime this report from the American Academy of Pediatrics gives doctors and parents a leg to stand on when we advocate for keeping kids out of the classroom while they're recovering from a concussion. I should really use the word classroom here because kids shouldn't be doing school work at all at school or at home when they're recovering from a concussion, they need brain rest that's the point here, they need to let their brains chill, no video games, no movies, no strenuous activities and no home work.

0:24:11.9

I can hear the kids that cheering in the background, they love that piece of advice and while we don't have great studies yet to back it up, we do have expert consensus and that should be enough to get the whole team on board, physicians, family members, teachers, coaches and those school administrators. Late bed times for teenagers can negatively impact academic performance as well as social and emotional development, this according to a study from researchers at the University of California Berkley and recently published in the journal of Adolescent Health. Study show by the time they graduate high school night owls had lower GPA scores and were more vulnerable to emotional problems than teens with earlier bed times, and these adverse effects aren't just prominent during school years but can cause difficulties throughout young adulthood as well.

0:25:04.0

Lauren Asarnow, the lead author of the study and a graduate student in UC Berkley's Golden Bear Sleep and Mood Research Clinic says, "Academic pressures, busy after school schedules and the desire to finally have free time to connect with friends at the end of the day make this problem even more challenging,… but the factors aren't all social, some are biological. The humans are circadian rhythm which regulates physiological and metabolic functions typically shifts to a later sleep cycle at the onset of puberty, pair this with an early school start time and most teens don't get the recommended nine hours of sleep a night. Researchers have also found that using electronic gadgets before bed can further hinder a good night sleep, the bright lights on laptops, smartphones, and other electronic devices have been found to suppress melatonin, a hormone in the brain that helps regulate the sleep cycle. Let's think about this, if teenagers have heavy academic pressures which they do including a lot of homework and they have busy after school schedules when did they get the chance to connect with their friends later in the evening?

0:26:10.3

And how are they going to communicate with their friends when they finally get home and are done with all their responsibilities electronic devices? For me I do understand their desire to stay up late and stay connected but this leads to less sleep, tiredness during school, and an inability to pay attention in class which makes homework more difficult if they don't understand the subject, which means more time spent on completing it, which means if they want to chat with their friends they have to stay up even later to do so, and the cycle repeats. How do we reverse this night owl tendency? Berkley researchers suggest using dim lighting and limiting technology before bed time to help teenagers prepare for sleep as well as better parental monitoring and involvement in their children's schedules. And I would add one more in there, I think that the school's need to be more in tune with this problem and if we're saying that there's a biological basis for this that the humans are circadian rhythm really moves to a later sleep cycle as puberty starts, why is it then that the high school kids have to be the ones there first?

0:27:16.5

The kids who have this tendency to want to stay up late not only because of pressures and what they want to do but also because of a biological reason with shifting circadian rhythm, why are they the ones to have to go first? Maybe they should be the ones who start later during the day. Until we get the schools on board with that though which I think that's going to be difficult, in the meantime here's a deal moms and dads, you have to get into your kids shoes, you have to really see what they're up to and you'll likely find that they're over extended, they're involved into many things, academic activities, homework, music lessons, after school clubs, sports, homework, jobs, socializing with friends, all of these things are important but there isn't enough hours in the day to get it all done especially when you also factor in all those hours of entertaining screen time that we talked about earlier in the show.

0:28:11.7

We have to make choices, we have to live well rounded lives that take moderation into account, and as parents raising kids in the digital age, we have to help them make good choices, we can't do that if we don't stand in their shoes, so as I always say get involve with your kids on the ground level, experience life as they experience it and I'll bet you'll come out exhausted. Sure there's a time for academics and music, and sports, and clubs, and jobs, and homework, and friends, but there comes a time to power down and get some sleep. That does wrap up our show for today and as it turns out that's going to wrap up 2013 as far as PediaCast is concerned. I'm going to be back with a final word of the year in just a moment, we're going to talk about the best gift you can give your kids this holiday season and I know it's December 18, we're already right up upon Christmas but this is a gift, it's not too late to give so stick around and I will be back with more details on that right after this.

0:29:17.8

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0:29:56.1

Dr. Mike Patrick: We are back, are you still looking for the best gift to give your kids this holiday season? One that won't cause an arm and a leg or be obsolete by the time next December rolls around when your child would cherish forever and pass on to his or her children. What is this fantastic gift, and where can you find it? Well the gift is persistence and you can find it within yourself. Researchers at Oregon State University say, "Persistence is a great indicator of academic achievement. Their findings published in Early Childhood Research Quarterly shows young children who pay attention and complete tasks are 50% more likely to obtain a college degree. Investigators enrolled 430 pre-school aged children and rated them on ability to pay attention, follow directions, and complete tasks, then they followed the children through young adulthood to see which ones obtained the college degree and which ones did not. Each child also took standardized reading and math test at 7 and 21 years of age.

0:31:00.3

And what are the researchers find? As it turns out persistence during the pre-school years is a stronger predictor of college completion than academic test scores. The good news for parents is that persistence can be modelled and taught to young kids, how? By persisting through difficult adult projects because your children are watching, and by encouraging your kids to pay attention, remember instructions and complete tasks. This isn't easy, start by choosing activities likely to interest your child, pick something simple, encourage them and heap rewards for completion of the task then build on this experience by introducing more complicated but ultimately more rewarding projects. What if your children are beyond the pre-school years? What if they're in high school? Is it too late? Not according to researchers at Brigham Young University, their study published on the Journal of Early Adolescents followed 325 families and looked at the end result of persistence gained through fathers. Bottom line, fathers who encourage their teenagers to stick with tasks and finish projects set a foundation for their children to cope with the stress and pressures of life.

0:32:11.0

Their kids have lower delinquency rates and higher engagement in school. Although this project looks specifically at fathers, the researchers believe their findings would hold through for moms as well. We've all been there even at point when it feels like failure is just around the corner that point when it's easier to quit than to push through to the end, but it's those who push through who succeed even when the path they take is winding, and rocky, and seemingly impossible to traverse. Moms and dads of children of all ages, if your child starts a project encourage them to finish it, don't give up when the going gets though, hang in there, help them through the struggle and when all the said and done reward them greatly for their effort, and that's why teaching persistence is one of the best gifts you can give your kids this holiday season, and that's my final word.

0:33:02.1

I want to thank all of you for taking a time out of your day to make PediaCast a part of it, we really do appreciate it. I want to wish all of you a Merry Christmas, a Happy New Year, a Happy Hanukkah, what do say for Kwanzaa? Is it Merry Kwanzaa? Happy Kwanzaa? Whatever it is, whatever you're celebrating I sincerely hope that it's a happy one. Don't forget PediaCast and our single topic short format programs PediaBytes are both available on iHeart Radio Talk which you'll find on the web and the iHeart Radio app for mobile devices. Our reviews and comments on iHeart Radio and in iTunes would be most helpful as our links, mentions, shares, re-tweets, re-pens all those things, we are on all the major social media sites. PediaCast is on Facebook, Twitter, Google Plus, and Pinterest, also this holiday season as you have get together with family and friends, could you please just mention PediaCast to those who have kids at home including teenagers and college age students, also those who are expecting babies, because word of mouth is pretty much our only advertising mechanism here at PediaCast.

0:34:11.3

We don't have a big advertising budget, we really rely on word of mouth and each and every one of you spreading the word. However it is that you found out about PediaCast I would just encourage you to help. For instance if you found out about us through iTunes, write an iTunes review because someone came before you and paid forward, if you could do that for the next parent that's going to come along that would be great. Another fantastic way to help spread the news about the program is to talk to your child's doctor. The next time you're in for a sick office visit, or a well check-up, or an ADHD re-check just let your doctor know, there's an evidence based pediatric podcast aimed at moms and dads that doesn't dumb things down, that answers questions, interviews, pediatric experts, covers news stories that parents might find useful and just point them at the direction of PediaCast.

0:35:05.6

We do have posters available that they can hang up in their exam rooms, those are available under the resources tab over at pediacast.org. Once again we do need more questions for 2014 because I pretty much exhausted the question bank, if you have a question you like to ask, topic you like us to talk about, do you want to point me in the direction of a new story or journal article, easy thing to do just head over to pediacast.org and click on the contact link. I do read each and every one of those comments that come through, I take them seriously and I'll do my best to get your question or comment on the program. Once again I hope everyone has a fantastic holiday with your families and until next time this is Dr. Mike saying stay safe, stay healthy, and stay involve with your kids, so long everybody.

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Announcer 2: This program is a production of Nationwide Children's, thank you for listening. We'll see you next time on PediaCast.

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