Baby Hearing Loss, Hand Washing, Reading Comprehension – PediaCast 412
- This week we answer listener questions and take a sneak peek into the future of pediatric medicine. Topics include baby hearing loss, hand-washing and family dynamics, reading comprehension, 3D-printed replacement bone, ketamine for teenage depression and a blood test for Kawasaki Disease.
- Baby Hearing Loss
- Newborn Hearing Screen
- Hand-Washing and Family Dynamics
- Reading Comprehension
- 3D-Printed Replacement Bone
- Ketamine for Teenage Depression
- Blood Test for Kawasaki Disease
- When & How to Wash Your Hands (CDC)
- Intravenous Ketamine for Adolescents with Treatment-Resistant Depression: An Open-Label Study
- Kawasaki Disease – PediaCast 203
- Parent Savers Podcast
Announcer 1: This is PediaCast.
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 is 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 Episode 412 for August 15th, 2018. We're calling this one "Baby Hearing Loss, Hand-Washing, and Reading Comprehension". I want to welcome everyone to the program.
We have an Answers to Listener Questions and Pediatric News edition of the program for you this week. Our listener questions are spelled out in the title of this week's show. We're going to cover baby hearing loss, and especially the congenital sensorineural variety. And I'll explain exactly what that means coming up. Suffice it for now to say that this is the reason we like to perform a newborn hearing screen on every baby. It's mandated in some states, optional in others.
So for all expectant moms and dads out there, when your baby is born, make sure you're an advocate and ask that they get that hearing screen done as soon as possible, even if you live in a state that doesn't mandate it by law. It's really important and we'll explain why.
We'll explore exactly how baby hearing test work. I mean, you can't ask a baby if he or she heard the sound right. We'll talk about next steps if your baby fails the initial screen, also what causes hearing loss in babies and how is it treated when hearing loss is confirmed after the initial screen.
Our listener wanted to know, so we'll explore the answers to those questions. And then, hand-washing, of course, it's important. It's the primary way we want to prevent the spread of infection, but can it be overdone? And what do you do when the topic of hand-washing becomes a bone of contention between a father and his in-laws. So that promises to be an interesting discussion coming up.
Also this week, reading comprehension, is there a way to help kids better understand whatever it is that they are reading. I'll have some ideas for you in the reading department, which is an important skill for all children.
So three great questions from you, the PediaCast audience this week. Then, I'll have some interesting pediatric news items for you as we take a sneak peek into the future of pediatric medicine. And this second half of the program will be particularly interesting I think for the pediatric providers in the crowd, because the science is a little thick in these stories. Parents will enjoy it too, especially if you're a science nerd or junkie. And I'll try to explain things as we go so it's easy to understand.
So let's just take a quick sneak peek at what those are going to be. The first one, 3D printed bone. 3D printed bone, just think about that. Making bone with a 3D printer that can be put in a body. It's actually used as a scaffold and that it helps new bone to grow as the 3D printed bone dissolves. And we'll explore that upcoming technique and the promising applications for its use.
And then, IV ketamine for the treatment resistant depression in teenagers. This one is particularly interesting to me because we use ketamine frequently in the emergency department where I currently practice. And we perform sedations for procedures like setting broken bones and applying large burn dressings, especially when the burns need to be cleaned and what we call degraded to get the dead tissue off. It hurts and so we like to sedate kids who have to have that done. And ketamine is a medicine that we frequently use for sedation.
Well, someone thought, "Hey, let's see if this stuff helps severe depression." I'm not sure how this became an idea, probably a very interesting story by itself. I can kind of imagine that there were some kids who, teenagers who had depression that was resistant to treatment. And then they had an injury that was not related to their depression, or maybe it was. And they had sedation to have that injury fixed. Maybe a broken bone had to be set.
And after the ketamine, maybe their depression sometimes got better and someone started to see a pattern. And that's why this became an idea. Or they may be a different story. I'm just not really sure. If you come across the answer to that, please write in and let us all know. But it appears that it works and not just work a little. It appears to work really very well and could offer hope to many teens and their families if validity and safety trials hold up.
So much more on that one later in the show. And then finally this week, Kawasaki disease. We've covered it before on PediaCast, and I'll share that show on the Show Notes for this Episode 412 over at PediaCast.org so you can find it easily. This time, we're talking about the potential of a single, sensitive, and specific blood test for Kawasaki Disease which will help with the early diagnosis, early treatment, and the prevention of coronary artery aneurisms in kids.
So stick around, we have a lot for you this week. First though, quick reminder, we are on social media and we love when you connect with us there. We're on Facebook, Twitter, Instagram. Facebook and Twitter, we primarily share new shows as they come out so you can be notified and listen to us right there in Facebook or in Twitter if you like.
Of course, the shows are also available in most podcasting apps, Apple Podcast, iTunes, Google Play, most podcast apps for iOS and Android. But we let you know about those on Facebook and Twitter.
And then, every day, I also try to send out just some other things that I think parents would find interesting both on Facebook and Twitter or some other blog posts we're writing here at Nationwide Children's. But not just here, we kind of keep an eye on pediatric blogs out there, follow a few of them. And so, when there's good writings from my fellow pediatricians, we also share those on Facebook and Twitter so you can find us there. Just search for PediaCast, really easy to follow us.
And then also, on Instagram. On Instagram, we try to give you more of a peek into the studio and then also just in my private life with my family and the goings-on and would love to connect with you there and find out what's going on in your life as well.
So Instagram, a little bit more fun, a little more personal. Facebook and Twitter, mostly pediatric stuff.
Just to give you an idea, some of the things we've been sharing on Facebook and Twitter, Why Parents Should Consider The Meningitis Vaccine For Their Kids. That's really important as our sons and daughters are heading off to high school and college. We sometimes do see meningitis sporadically on college campuses and it can kill college students. So It's important to get that meningitis vaccine.
Will standing, okay, standing before they can walk, hurt a baby's feet or legs? Does standing cause bow-leggedness or other problems? So there's a nice blogpost that looks into that.
Back-to-school routines, drug allergies and the importance of getting them right, that was a CME program that we did on our sister podcast, PediaCast CME. That one's for providers and is available for free Category 1 Continuing Medical Education. So we share that on Facebook and Twitter.
And then, how to use nose sprays correctly. Fall allergy season has began and if you use a nose spray on a regular basis, you want to make sure that you're using that correctly, that the nasal steroid is going where you want it to go. So that's a nice article.
Again, all those you'll find on our Facebook and Twitter. And then, you'll notice that we are answering your questions this week. What if you have a question? It's easy to get in touch. Just head over to PediaCast.org and click on the Contact link and ask away. I read each and every one of those that come through. And we'll try to get your question, your topic suggestion.
If you want to point me in the direction of a news article or a journal article and you like some comments on it, we'll try to get your ideas on the program. Again, easy thing to do, just head to PediaCast.org and click on the Contact link.
Also, I want to remind you, the information that's presented in every episode of our program is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So, if you 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.
Let's take a quick break. And then, I will be back answers to your questions and some pediatric news. That's coming up, right after this.
Dr. Mike Patrick: Our first listener question this week comes from Lariana in Massachusetts. Lariana says, "Can you talk about sensorineural hearing loss in infancy? Thank you."
Great topic idea and I really appreciate you bringing this one up. So let's just define what we're talking about. A congenital condition is as we think about it in terms of newborn babies, although it can also be acquired and we'll talk about the difference between those in a minute, but what we're really speaking of is hearing loss that is related to that sensorineural apparatus in the ear.
So when sound waves enter our ear, they have to be first conducted, and they go through the ear canal. They hit the ear drum. The ear drum vibrates, they go through some little bones in the middle ear space, and then those vibrations go to the cochlea in the inner ear space. And the physical sound waves get turned basically into electrical impulses that then are going to go from the inner ear through the auditory nerve to the brain. And then we experience that as hearing when those electrical impulses get to the brain.
So when we have hearing loss, it can be a conductive hearing loss, meaning that there is a physical barrier to the sound waves. The sound waves can't get through, and that can be caused from ear wax or some other foreign body in the ear canal. The ear drum may have a problem and not vibrate correctly.
There could be fluid behind the ear drum. Maybe there's an issue with those bones that then transfer the vibrations to the middle ear space to the cochlea in the inner ear space. So anything that disrupts the travel of those physical sound waves, that would be considered a conductive hearing loss.
Now, a sensorineural hearing loss. Now, there's a problem converting those physical sounds to electrical impulses which is done by sensory cells in the inner ear or there's a problem transmitting those electrical impulses to the brain, so it could be an issue with the auditory nerve.
Now, congenital versus acquired. Congenital just means that you are born with this issue, and acquired means that the hearing loss came along at some point later. And the newborn hearing screen is really designed to catch instances of congenital hearing loss.
And then, we rely on parent and medical provider observations and the school system to catch subsequent acquired hearing loss. So they seem to hear just fine, they pass their newborn hearing screen, but then there some maybe behavioral things that we're starting to notice that would let us know that there is an acquired hearing loss.
Some providers may screen for that on a regular basis, others don't. Probably before kindergarten, just about everybody gets another hearing screen. But at any point, parents are worried about a child's hearing, preschool might be worried about it or a medical provider, the subsequent hearing screen can be done really at any point.
So how often are babies born with hearing loss? So how common is congenital hearing loss? And it's about 1 to 3 of every 1,000 babies that have some degree of hearing loss at birth.
And it's important to pick these kids up because the earlier that you can intervene, the more likely it is that they will first figure out what's causing it and is it correctable? And if not, just getting early intervention, getting speech therapy, just much easier to deal with these kinds of problems the earlier that you know about them.
So it's important to screen all babies because they don't come out with a sign that says "I'm one of the 1 to 3 of every 1,000 babies with hearing loss." You got to figure that out somehow. And so, the newborn screen is really important in terms of hearing.
And so again, if your state does not mandate one of those, as I mentioned in the intro of this program, be an advocate for your child and make sure that they do get newborn hearing screen ideally before they even leave from the hospital.
So how do these things work? How do you screen the hearing of a baby? And it's interesting, there's a couple of different tests. One is called the automated auditory brainstem response or ABR. In this one, they put electrodes on the baby's head, just like if you're getting an EEG, where you look at the brainwaves. So little electrodes on their head. And then, soft clicks and tones are played through headphones and then electrodes measure electrical activity of the auditory nerve.
And so, this is really going to test them for both conductive and sensorineural hearing. So first, the sound had to be conducted physically, get transferred into electrical impulses and then go to the brain. And as it's going to the brain, those electrodes pick up those signals. And so, we know that the apparatus is intact. You can't say for sure the baby's experiencing hearing, but in all likelihood they are if they pass that test.
And then, the other test is called the otoacoustic emissions test or the OET. And that one measures sound waves that are produced inside the inner ear. Now, this is interesting. A small sound is generated as the cochlea converts those physical sound waves to electrical impulses. There's a sound that's involved in that conversion.
And so, a probe is placed in the ear. It has a speaker on it because it's going to emit those soft tones and clicks. And it also has a microphone. And the microphone is going to pick up the echo of those noises being converted into electrical impulses.
Now, it's not as a good of a test if there's an issue with the conduction of those impulses to the brain. So if there's a problem with the auditory nerve, it's not going to pick that up, but most of these sensorineural hearing losses are from there being a problem with the conversion of those physical sound waves to electrical impulses.
So those are the two screening tests. They're very quickly done, can be done right there in the newborn nursery. Or your pediatric provider may be able to do those as well.
So what do you do if your baby fails the hearing screen? Well, as it turns out, they're not perfect tests. And most babies who fail the initial screening actually end up having normal hearing.
And so, what's recommended is if they fail that test, that a repeat test is done as soon as possible, certainly by three months of age. And your pediatric provider can arrange for that. And then if the repeat screening fails again, then your child is going to need referral to a formal hearing center for a comprehensive evaluation.
And this is going to be done by, usually, it's operated by the ear, nose, and throat doctors. They'll have an audiologist as part of the center. Speech and language pathology is usually a part of it as well. But it's the audiologist who's really going to do then that formal, comprehensive hearing evaluation. Of course, an ear, nose, and throat doctor my look inside that ears as well.
And those are a little more sophisticated. Actually, I should say they're a little less sophisticated, but they're very sensitive. And what they do is they put the baby in a sound-proof room and they have little noises. And they just see as the baby look where the sound's coming from. So you're kind of seeing their behavior. So they want to know for sure. And so it's not something like one tone and the baby looks. They do it over and over and see if they can correlate babies looking at the sound. That's my impression of it anyway.
And again, if there's an audiologist out there, there's more to it than that. But again, it's less sophisticated but more sensitive when they're failing those screens. And so the audiologist really do know what they're doing.
Now, if that comprehensive evaluation also supports hearing loss, then what do you do? Well, it really depends on the type and degree of hearing loss. And they're able to do the degree at that point because they can control how loud those noises are, the standards of when a baby should pay attention to those noise.
And of course, they have to factor in, is there a behavioral issue that they're just ignoring the sounds? That's why it takes so long and you have to be patient and an expert on performing one of these types of exams.
But they can also check for different frequencies. And you can get a lot more knowledge about what sort of hearing loss is going on with this kind of tests where you can really control what the frequencies and how loud the sounds are and watching the baby's behavior.
It's also recommended if babies fail their hearing screen, that they also have a good vision screen. So that's something else you can be an advocate for. If there's a problem with one sense, there could be a problem with other senses. And so with the baby vision screen, you can check to see if they're responding to light. Does their pupil respond? Are they able to follow a target.
And then just like the hearing test with the electrodes, you can also do a visually evoked response test. Electrodes are placed on the baby's head. The baby is shown lights and patterns, and then you just see if electrical impulses are picked up. So are we getting a signal from the eyes that the physical light is being converted into electrical impulses to go to the brain.
And then, when babies have congenital hearing loss, referral to genetics is also a good idea because congenital hearing loss can be present in several genetic syndromes.
Now, in terms of what causes babies to be born with hearing problem, genetic syndromes are possible, but they're actually the less common variety of this. The most common is it's just an isolated genetic problem. It's typically recessive, so both mom and dad have normal hearing, but if the baby receives one recessive gene from each parent, then deafness may result.
And it's a little complex depending on which genes are involved. There's a varying degrees, but for most of these babies, it's an isolated problem. It's just a hearing problem and genetic in nature, but not necessarily related to a genetic syndrome. But if there is a genetic syndrome, you do want to know that so that you can provide the best services and treatment possible. So that's why a referral to a geneticist may be a good idea.
And then, congenital infections can also result in sensorineural hearing loss. For example, if mom during pregnancy is infected with toxoplasmosis, rubella, cytomegalovirus, syphilis. There are lots of infections that can infect hearing as the baby is in the womb. And that can be a life-long thing when they're born with that hearing loss.
There's also acquired sensorineural hearing loss that can be caused by very high bilirubin levels or jaundice. Kernicterus, we call it when it's really bad like that. Bacterial meningitis can do it. Certain medications at particular doses and exposure levels. For example, antibiotic Gentamicin, we monitor drug levels when babies have to have that because it can cause hearing loss if those doses are too high over a prolonged period of time.
Trauma to the inner ear and exposure to loud noises over long periods of time, which is why we say protect your hearing. Those are all sensorineural type hearing losses.
And then, in terms of treatment, it really depends on the degree and type of hearing loss. Hearing aids can help.
Speech and language team early intervention and it's actually free for those with hearing loss for The Individuals with Disabilities Education Act. So again, if you're not getting free early intervention and your child has a congenital hearing loss, be an advocate because your child does qualify for free early intervention services.
And then, cochlear implants can be helpful when there's very severe sensorineural hearing loss and there's a problem with, again, converting those physical sound waves to electrical impulses. There's a device that can make that conversion for you called a cochlear implant. And so that can be a treatment for those babies.
So, Lariana from Massachusetts, hope that answered your question, all about baby hearing loss. I really do appreciate you writing in.
Next up is John from Lorain, Ohio. John says I'm a long-time listener of the show. Thank you for putting time into this. It is a valuable resource. Recently, I've been having an argument with my in-laws, never a good idea, John, about washing my son's hands. He spends about ten hours a day at their house during the week, and they are lax about hand washing.
I asked them to wash his hands after he plays outside because he often digs in the dirt around the house and before he eats. Their house is around 60 years old. There's a train track nearby. And sometimes my father-in-law will take my son to watch the trains travel under a highway overpass. My son plays with the rocks under the overpass and I ask that they wash his hands after doing this.
They've argued I'm being overprotected. I recently brought this up with our pediatrician asking how concerned I should be about lead exposure and general uncleanliness. She told me I was exhibiting OCD tendencies and to seek treatment before I force the same tendencies unto my son. I was disturbed by the response and finding myself wondering if somehow maybe I can't see that I'm being unreasonable.
I feel I got some appropriate request and can't understand which part of it is extreme. Looking for additional input.
Another question, my in-laws frequently take my son on rides on their ride-on mower and golf cart. My wife and I had told them not to do this but it has continued. How worried should we be? Is it something you feel worth finding alternative child care over? Thank you, John in Lorain, Ohio.
So that's a pretty loaded question, John. Since I don't necessarily want to be the catalyst for a family squabble. But I will say this, it does seem reasonable to me to have kids wash their hands after playing outside in the dirt or with rocks near railroad tracks and highway. There's a slight chance of harmful exposure, so I get it.
On the other hand, we do have an immune system and there is a fairly strong evidence that overavoidance of contact with allergens and microorganisms during childhood can increase our risk of developing allergic conditions down the road, including asthma.
So I would take a balanced approach. Playing with rocks near railroad tracks and highways, that seems high risk for chemical exposure compared to playing in dirt in the yard. Especially if your child is playing very close to the tracks in the road which is probably not the best place to be playing for additional and somewhat obvious reasons.
On the other hand, playing in yard dirt, that may actually be a good thing as long as there isn't an exposure to chemicals like insecticides and fertilizers.
So again, balanced approach. I would not say that you need to wash your hands every ten minutes or even come inside every hour and wash up. That sort of things seem excessive, but encouraging kids to wash their hands after coming inside from playing in the dirt all morning or all afternoon, it seems reasonable. Perhaps not entirely necessary, but certainly reasonable.
Now, washing hands before you eat, that's always a good idea. Hands are going to be near or inside your mouth. You're going to be touching your food. And you want to wash away any illness-producing microorganisms before you put your fingers in your mouth and food in your belly. So washing your hands before you eat, very important.
Another important point, I would be careful not to scare kids about germs in the dirt because they may become fearful and not want to go outside and play, which is not necessarily a good thing either. So again, a bit of a balanced approach.
And then, the other important thing is these are your in-laws. So you do have to pick your battles to some degree, just being realistic. And this is probably best brought up with them from your wife rather than you, again for what I hope are obvious reasons.
Now in terms of riding on lawnmowers, that's never recommended. And I explained why in a recent episode we did on lawnmower safety. I think we cover that just about every summer. So riding on lawnmowers, even if the mower deck is off, is not a good idea. I would not have kids riding on lawnmowers. I would put my foot down on that one. But again, maybe it's your wife that needs to put the foot down.
Golf carts, I don't know. I'd use your judgement on that one and perhaps not think in terms of absolutes. It really depends on the age of your child, his or her ability to follow directions, the degree of supervision, how fast is the golf cart going, what's the terrain like. Lots of variables there to consider.
There is some risk. There is risk in everything we do and having fun and family relationships are also important. So in other words, we have to consider risk, yes. But we have to consider benefits as well and having a happy healthy relationship with your in-laws will benefit your kids. On the other hand, boundaries are healthy and important, too.
And here's the thing, with any decision in life, whether the decision relates to health and wellness or some other aspect of life, we have to sort out risks and benefits in light of our personal and family risk tolerance. That's an important part of being a human being with the opportunity to make choices.
So I hope that helps, John. You're not going to win a battle with the in-laws. Just saying, a little friendly piece of advice. But there are ways to reach compromise. Except the lawnmower, kids should not ride on riding lawnmowers ever in my opinion. My personal risk-benefit meter swings all the way to risk on that one.
In the end, I do think you bring up good points. I would caution you to consider and prevent other sorts of problems that can impact mental and family health and provide as much as risk as dirt and rocks and golf carts. My two cents anyway for what they're worth.
And thanks so much trusting me with your question, John. I really do appreciate that.
Another resource you may want to check out, especially if you're wondering what is the official word on when to wash your hands and what is the proper technique, the US Centers for Disease Control and Prevention have an excellent guide called When & How to Wash Your Hands. I'll put a link to it in the Show Notes for this Episode 412 over at PediaCast.org.
According to the CDC, when should you wash your hands before, during, or after preparing food. So again, mealtime, really important to wash your hands. Before eating food, especially, they say. Before and after caring for someone who is sick. Again, microorganism exposure. Before and after treating a cut or wound because your skin's lost its natural protection then, things can get inside easier.
After using the toilet, after changing diapers or cleaning up a child who has used the toilet, after blowing your nose, coughing or sneezing, after touching an animal, animal feed, or animal waste, after handling pet food or pet treats and after touching garbage.
In terms of how, the preferred method is soap and running water. Wet your hands with clean, running water, warm or cold. Turn off the tap, apply the soap. And then, lather your hands by rubbing them together with the soap and be sure to lather the back of your hands between your fingers under your nails. You're going to want to scrub your hands for at least 20 seconds. And if you need a timer, hum the Happy Birthday song or the ABC song from beginning to end twice through. And that will get you about 20 seconds.
And then, rinse your hands well under clean running water. And dry your hands using a clean towel or air dry them. Alcohol-based hand sanitizers are also a possibility and maybe more convenient. But they will not eliminate all types of germs and they might not remove harmful chemicals. So if you're worried about lead, especially playing around highways and railroad tracks, again probably not the best place to play. But if you're worried about harmful chemicals, the alcohol-based hand sanitizers aren't going to get those off of your hands like using soap and water will do.
But if you're going to use an alcohol-based hand sanitizer, apply to the palm of your hand. Read the label for the correct amounts for that particular product. Rub your hands together. Rub the product over all surfaces of your hands and fingers and do that until all your hands are dry. Pretty easy.
By the way, there is a scientific evidence to back up these recommendations which you can read at the CDC website.
Our next question comes from Jen in Freemont, California. Jen says, "Dear Dr. Mike, back in Episode 401, you put up the call for listener questions and we are happy to oblige. Over the years, we've emailed you regarding our two boys, Kai, seven, and Bo, four. And I can safely say that we are better parents today because you your wonderful replies and advice."
That's so nice, Jen. Really do appreciate those kind words, thank you.
"Our question today has to do with the studying environment and reading comprehension. Early this year, we were told by the teacher of our seven-year-old Kai that he has a little trouble understanding the main ideas of stories. Academically, he seems fine otherwise. We have tried asking him questions during and after reading a book, like what are the main characters and the main ideas.
"Do you have any other tips and/or suggestions on how to improve a child's reading comprehension? Also, we have often wondered what's the best study environment for kids, slightly noisy versus quite, alone, or with the parent nearby? As always, thank you so much."
Well, thanks for the question, Jen, and the kind words. My best advice on this one is talk to your child's teacher. They love these sorts of questions. And he or she is an education expert with the tips and tricks that I would never ever begin to come up with on my own.
My gut tells me you're on the right track, asking questions about stories as you go, training him to be thinking as he reads, anticipating what questions that you may ask him can help him pay attention a little bit more as he's reading.
And you may want to try this, each of you read a selection and then let him ask you questions about it. That way, he's forced to think as he reads because he's going to come up with the questions to ask you. So that might be fun or ask each other questions and see who answers more of them correctly. Reading games like that are always fun.
The tough again question probably plays a big role, too. We pay more attention when we're interested in what we're reading, which can't always be done with regard to school because you are assigned reading. But by encouraging kids to read what they like to read on off times, so apart from school, if they're encouraged to read what they like, that may help with comprehension of what then they have to read. So kind of train them with books that they find enjoyable.
And then, read to your kids often. They're never too young or too old to gather around for a good book. Listening to stories can cultivate an interesting reading and it can improve comprehension skills because they get more practice thinking about those stories as you read.
So those are my ideas but I suspected the teacher might have additional and probably better ideas than I do as a pediatrician. So definitely use that resource and talk to your teacher about that.
And then, in terms of reading in the studying environment, just thinking about my own practice, I do emergency medicine now, but I did ten years of private pediatrics and talk during those years to lots of families and lots of kids. I think back to my own kids and sort of the way that I study when I need to. And I would say that each kid is probably a little different.
For some kids, the slightest distraction may really interrupt their thinking and their flow and being alone in a quiet environment is going to be best for them. For others, if you're alone in a quiet room, you might start daydreaming or getting sleeping. Maybe you need a little of that underlying stimulation. So I would try some different setups and just see what setup produces the best result.
But again, most important of all, ask the teacher the same questions. I'm sure he or she will give you a much better thought for that. Perhaps even evidence-based answers.
Also ask if the school has concerns regarding attention, impulse, or any impulse control or any learning difficulties. I'm not saying that it's going to be ADHD but it's a possibility if there's other things going on, other areas where attention is an issue. Because reading comprehension does take attention to do.
So if that was going along and also some behavior issues with the impulse control, sort of acting out and doing some things that other kids might have a filter for. Those kids might think about it, but then don't it. Or if there any learning difficulties. It doesn't sound like any of that's going on with your previous conversation with the teacher.
But for others out there who are listening, your child may have some reading comprehension issues, those are some other things to pay attention to that could clue you in. Maybe ADHD or attention deficit hyperactivity disorder is coming in to play.
And then, of course, ask for that additional advice on improving reading comprehension and individualizing the study environment from your teacher. And then, if your teacher does share some other things that you find helpful, write back in and let me know. And I'll share what you discover with all of us so we can learn from your experience, if you don't mind.
As a pediatrician, I would also say that making sure that your son or daughter eats a good breakfast. It's important, the brain needs fuel to think and pay attention and comprehend. And the brain also needs enough sleep at night in order to do well the next day, which means bedtime routines and retiring those screens well before bedtime. I think nutrition and good sleep can also improve retention and reading comprehension.
So hopes that helps, Jen. And as always, thanks for the question.
Dr. Mike Patrick: We are going to transition to some pediatric news for you this week. 3D printed ceramic implants that are chemically coated can successfully guide the regrowth of missing bone while steadily dissolving, acting as a scaffold. This according to researchers at NYU School of Medicine and NYU College of Dentistry and reported in the Journal of Tissue Engineering and Regenerative Medicine.
Researchers say the implanted scaffolds were naturally absorbed by the test animals' bodies as new bone gradually replaced the device. Modeled after the bone pieces they are meant to replace, the implants were assembled onsite using 3D robotic printing, a technology that uses a fine-point print head to push out a gel-like ink material.
The material is printed onto a platform, and the printer repeats the process until 2D layers stack up into a 3D object, which is then superheated into its final ceramic form. Available for more than a decade, the technology has only of late been applied in medicine to print out replacement ears, skin, and heart valves.
Dr. Paulo Coelho, senior investigator of the project and a biomedical engineer at NYU says, "Our 3D scaffold represents the best implant in development because of its ability to regenerate real bone. Our latest study moves us closer to clinical trials and potential bone implants for children living with skull deformities since birth, as well as for veterans seeking to repair damaged limbs."
The team reports that ceramics more closely resemble real bone shape and composition than other experimental bone implants in which plastic elasticizers are added to make the implant flex. Although the ability to flex offers some advantages, the plastic does not have the same healing ability as NYU's scaffold.
An important feature of the ceramic devices is that they are made of beta tricalcium phosphate, a compound of the same chemicals found in natural bone that makes the implants resorbable, meaning, they dissolve.
One of the secrets to the rapid growth of native bone with the NYU devices is a coating of dipyridamole, a blood thinner shown in other experiments to speed up bone formation by more than 50%. The chemical also attracts bone stem cells, which spur the formation of nourishing blood vessels and bone marrow within the newly grown bone.
Researchers say the soft tissues give their scaffold-grown bone the same flexibility as natural bone.
Dr. Bruce Cronstein, a co-investigator and professor of Medicine at NYU, adds, "Dipyridamole has proven to be key to our implant's success. Used for more than a half-century to prevent blood clots and treat stroke, dipyridamole has a long-standing safety record. And because the implant is gradually resorbed or dissolved, the drug is released a little at a time and locally into the bone, not into the whole body. Thereby minimizing risks of abnormal bone growth elsewhere, bleeding, and other side effects."
In the latest experiments, researchers used the test scaffolds to repair small holes surgically made in the skulls of mice and missing bone pieces as long as 1.2 centimeters in rabbit limbs and jaws. It's lovely, I know, but it's important. It's important work.
The scientists found that on average, 77% of each scaffold was resorbed by the mammal's body six months after implantation. They also found that new bone grows into a lattice-like structural supports of the scaffold, which then dissolves. Some CT scans of the implant sites showed almost no trace of beta tricalcium phosphate, which is the 3D-printed material of which the original implants were made. So it really does appear to dissolve completely.
Subsequent weight-bearing tests showed that the new bone was of equal strength as original, undamaged bone.
The investigators say their next studies will test the scaffolds, for which they have a patent pending, in larger animals. They caution that clinical trials involving humans are still several years away.
But this is certainly an interesting sneak peek into the future of medicine and the use of 3D printers to make bone.
A new study has shown a significant average decrease in the children's depression rating scale. In fact, a decrease of 42.5% which is significantly significant among adolescents with treatment resistant depression who were treated with intravenous ketamine.
So in other words, these are kids who their depression was resistant to treatment with typical antidepressant medicine, but when they were treated with intravenous ketamine, their depression got much better as reported on the Children's Depression Rating Scale before and after the treatment.
So what is ketamine? Quick note, this is a drug that is widely used to perform sedation in the emergency department and outpatient settings, for things like fracture reduction, setting a broken bone that's angulated or displaced, extensive burn, cleaning and debridement and dressings, complicated foreign body removals, incision and drainage of sensitive abscesses.
If you really want to provide sedation in an emergency department setting, ketamine is a good drug for that. And we have lots of experience with this medicine in teenagers but not in treating depression. So this is an interesting development.
The study demonstrates the tolerability and potential role of ketamine as a treatment option for adolescents with treatment resistant depression. It's published in the Journal of Child and Adolescent Psychopharmacology.
Researchers on the project represent the University of Minnesota Medical School, Hennepin County Medical Center, and Mayo Clinic.
The study participants were young adults aged 12 to 18 years who had failed two previous trials of antidepressants. They received six ketamine infusions over a two-week period. The treatment were well-tolerated. Based on the Children's Depression Rating Scale scores, 38% of the participants met the criteria for clinical response and remission of their depression.
Dr. Harold Koplewicz, Editor in Chief of the Journal of Child and Adolescent Psychopharmacology and President of the Child Mind Institute in New York, says, "The field is excited about a potential new agent for adolescents with treatment resistant depression. We look forward to additional studies of ketamine to validate this treatment."
So, more studies are needed but the results have been good, with the 42.5% improvement in their depression rating scales and 38% showing remission of their depression. And again, these are kids that nothing else was working.
They had counseling and then… Well, we don't know that for sure, but I would assume if they have pinned on two different antidepressants that were not helping, that they likely had counseling that was going on at that same time.
So if these results are validated in larger trials and ketamine is shown to be safe and effective for treatment resistant depression, it really could change how treatment resistant depression is treated, the ones that don't get better with psychotherapy and our standard antidepressant. It could really change how this complex and severe cases of depression are treated and then offer hope for many patients and families.
So time will tell. I think the story of how this came together will be a particularly interesting one. Why did we try ketamine for depression in the first place? I can imagine someone making the observation that these kids with severe depression got better following an unrelated procedural sedation. I don't know. Or maybe someone hypothesize that it would work based on the mechanisms, the various mechanisms of action that ketamine plays in the brain.
So I don't know, but I want to find out. If I do, I will be sure to pass that information on to you. And if you find out, pass that on to me and I will share it with all of us.
In the meantime, if you are interested in reading the article, which is called Intravenous Ketamine for Adolescents with Treatment-Resistant Depression: An Open-Label Study, the authors and the publisher have made the full-length reading available for free. So you do not need a subscription to the journal to read the entire article. And I will put a link to it in the Show Notes for you, for this Episode 412 over at PediaCast.org.
For the first time, researchers at University of California San Diego School of Medicine and Imperial College London, with international collaborators have determined that Kawasaki disease can be accurately diagnosed on the basis of the pattern of host gene expression in whole blood. The finding could lead to a diagnostic blood test to distinguish Kawasaki disease from other infectious and inflammatory conditions.
Results of the international study are published in JAMA Pediatrics.
Kawasaki disease is the most common acquired heart disease in children. Untreated, roughly one-quarter of children with Kawasaki disease develop coronary artery aneurysms, which are balloon-like bulges of heart vessels, that may ultimately result in heart attacks, congestive heart failure or sudden death.
So this story is really going to be of interest to the pediatric providers in the crowd. If you want a refresher on Kawasaki Disease, whether you're a provider or a parent, we covered it in quite a bit of detail back in Episode 203 of PediaCast. And I'll put a link to that in the end of our program in the Show Notes for this Episode 412, so you can find it easily, over at PediaCast.org.
Dr. Jane Burns, pediatrician at Rady Children's Hospital-San Diego and director of the Kawasaki Disease Research Center at UC San Diego School of Medicines says, "As there is no diagnostic test for Kawasaki disease, late diagnosis often results in delayed or missed treatment and an increased risk of coronary artery aneurysms. We sought to identify a whole blood gene expression signature that distinguishes children with Kawasaki disease in the first week of illness."
Researchers used a case-control approach, including children recruited in hospitals in the United States, the United Kingdom, Spain, Netherlands, and all of these kids had Kawasaki disease or similar illness. The majority of study participants with Kawasaki disease came from Rady Children's Hospital-San Diego.
The overall study group comprised 404 children with infectious and inflammatory conditions. In the end, 78 had a diagnosed Kawasaki disease and 84 had other inflammatory illnesses. 242 had bacterial infections or viral infections, and 55 were healthy controls.
The researchers looked for tell-tale transcription in blood samples. Transcription is the first step in gene expression, in which information from a gene is used to construct a functional product, such as a protein.
As Dr. Burns explains, "A 13-transcript blood gene expression signature," so for the rest of us, it's a highly complex and specialized blood test, "distinguished Kawasaki disease from the range of infectious and inflammatory conditions with which it is often clinically confused. A test incorporating the 13-transcripts might enable earlier diagnosis and treatment of Kawasaki disease, preventing cardiac complications and reducing inappropriate treatment in those other diseases. Our findings represent a step toward better diagnosis based on molecular signatures rather than clinical criteria."
Dr. Burns says there is currently no point-of-service test for Kawasaki disease. Engineers will have to devise a blood testing method that can be adapted to the emergency department or hospital lab setting to help bring these research findings into practice.
Dr. Michael Levin, professor of Pediatrics and International Child Health at Imperial College London, says, "We are already in discussions with the number of biotechnology companies that might help us turn our gene signature into a clinical test, which is important because an accurate test for Kawasaki disease could prevent many children worldwide from being diagnosed too late to prevent coronary artery damage. If we can develop a test based on our gene signature, this could transform diagnosis and enable earlier treatment of children affected by this disease."
Prevalence rates of Kawasaki disease are increasing among children in Asia. Japan has the highest incidence rate, with more than 16,000 new cases per year. One in every 60 boys and one in every 75 girls in Japan will develop Kawasaki disease at some point during childhood.
Incidence rates in the United States are lower, 19 to 25 cases per 100,000 children under age of five. But it is rising, at least in San Diego County. Predictive models estimate that by 2030, 1 in every 1,600 American adults will have been affected by the disease at one point or another.
So another sneak peek into the future of medicine. This time with the possibility of an accurate, single blood test for Kawasaki disease hopefully coming into the not-too-distant future.
Dr. Mike Patrick: We are back with just enough time to say thanks to all of you for taking time out of your day and making PediaCast a part of it. Really do appreciate that.
Don't forget, you can find PediaCast in all sorts of places. We are in the Apple Podcast App, iTunes, Google Play, iHeart Radio, Spotify, and most mobile podcast apps for iOS and Android. If there is a place that you listen to your podcast and PediaCast is not there, please let me know and we'll try to get the show added to their line-up.
We are also a part of the Parents On Demand Network at parentsondemand.com. It's a collection of podcasts for moms and dads. It includes PediaCast along with many other terrific podcast for families, including a show called the Parent Savers podcast, with the hosts Johner, Erin, and KC. They're all seasoned parents and communicators. It's a round-table style show and they host expert guests covering a wide variety of topics aimed at empowering new parents, providing practical tips, and preserving your sanity which new parents definitely need. That's how they put it.
Recent topics include Internet safety, overexposing our kids, so sharing photos and stories online. They had a guest, a law enforcement officer, Detective Damian Jackson. So that was an interesting episode. And they have other episodes talking about picky eaters, speech development in toddlers, baby rashes, baby names, and baby name remorse. What if you want to change your baby's name?
And they talk about newborn screening tests on their program as well. So be sure to check them out. And I'll put a link to the Parent Savers podcast in the Show Notes for this episode, PediaCast 412 over at PediaCast.org.
Don't forget, reviews of podcasts are extremely helpful, whether it's PediaCast, whether it's another one of the ParentsOnDemand, whatever podcast it is that you listen to. Podcasts are becoming very popular, but there's also more and more and more out there. So parents have choices on which podcast to listen to.
And I don't know about you, but I always check out reviews for anything I'm getting ready to do or buy, whether it's a product, something on Amazon. If we're going to have someone in the house doing some work for us, we're going to look at Angie's List. If we're going out to a restaurant, we'll look at Yelp. We read movie reviews.
And so, reviews are very helpful as parents are deciding what to spend their time on. And so, if you have not written a review for PediaCast, wherever you get your podcast, so please consider doing so.
We also really appreciate when you link up with us on social media. We're on Facebook and Twitter. We do try to share pediatric stories and blog posts and just helpful resources for parents in those locations. And of course, let you know when we have new shows that come out.
And then, on Instagram, a little more personal, a peek into the studio and what's going on in my life and I'd love to connect with you there and see what's going on in your life as well. So be sure to check us out on Facebook, Twitter, and Instagram. Just search for PediaCast.
We also appreciate it when you tell others about the program, especially face-to-face, your families, friends, neighbors, co-workers, baby sitters. Anyone who has kids or takes care of children. And that would include your child's pediatric healthcare provider. Please let them know about the program so they can share it with their other families.
And while you have their ear, let them know we have a program for them as well. It's our sister podcast, PediaCast CME, which stands for Continuing Medical Education. It is similar to this program. We do turn the science up a couple of notches and offer free Category 1 Continuing Medical Education Credit for those who listen. Shows and details are available at the landing site for that program, PediaCastCME.org.
And that show is also on Apple Podcast, iTunes, Google Play, iHeart Radio, Spotify, and most mobile podcast apps. Simply search for PediaCast CME.
Thanks again for stopping by and until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everyone.
Announcer 2: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.