Batteries, Music, Autism – PediaCast 213

This week on PediaCast… Join Dr Mike in the studio as we cover News Parents Can Use. Topics include The Wishing Tree Project, battery-related emergency department visits, video games, cerebral palsy, music therapy, baby brain development, schoolyards, autism, and compulsory physical education. All this plus pay-to-play sports policies keeping kids off the team… And could school-based health clinics replace the doctor’s office?


  • Battery Dangers

  • Active Video Games and Cerebral Palsy

  • Music Therapy and Baby Brains

  • Schoolyards and Autism

  • Compulsory Physical Education

  • Pay-to-Play Sports

  • School-Based Health Centers



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, a pediatric podcast for moms and dads. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. I'd like to welcome you all to the program. It's episode 213, 2-1-3, for May 30th 2012. We're calling this one Batteries, Music and Autism.

Of course we have lots more topics coming your way. We'll get to the complete lineup in just a couple of minutes. First, I want to ask you, did you have a fun and safe Memorial Day with your families? I hope you did. We had a great one and I hope you did too.

I also want to thank all of you for sticking with us. This is the time of the year when things get crazy and if your family is anything like mine you're just going nuts right now. We've got a kiddo graduating from high school so they got the graduation parties, summer vacation plans, just seems like everything sort of comes together this time of the year and that your schedule is pretty crazy. So for those of you with the busy schedules who are sticking with us here at PediaCast, I just want to say a word of thanks, of course we appreciate your loyalty.


Things are crazy here at Nationwide Children's Hospital. We are running headlong into our grand opening celebration. June 20th is the big day, so we're just like about three weeks away from that. It's the largest pediatric expansion ever in the history of the United States. I would go out of limit and say maybe in the history of the world. We are adding over two million square feet of additional space with a brand new hospital that's 12 stories tall, each floor the size of a football field, plus we have new research space, a new green certified power plant.

So really amazing stuff happening here in the Midwest and I know most of you aren't in Central Ohio and in fact many of you aren't even in the Midwest, but never fear, we have found a way for you to participate in the excitement and it's something called the Wishing Tree Project. Basically, this is an opportunity for you to go online and share your wishes with the world. And you can also see what others are wishing for and you can share those wishes, whether it's your wish or a wish that you come across.

You can share it through Facebook, Twitter, Google+, YouTube and email. So what can you share? Well of course you can share your thoughts and your wishes. You can also share photographs and videos. You can contribute wishes for yourself, for your family, for your children, for your grandchildren, your nieces and nephews. Maybe you have a student in your classroom that you'd like to make a wish for or someone in your church.

So really it's just boundless opportunities and different things that you can wish for. Perhaps your child has a chronic medical condition or has been in the hospital; maybe you need some hope and healing or maybe you want some prayers or you'd like to see the wishes of others and ponder them, share them and perhaps pray over them.


So what do you do? How do you get involve with this Wishing Tree Project? It's really easy, you just head over to Pretty easy site to remember but if you can't remember it just head over to the Show Notes at for episode 213 and of course we'll put a link in there for you so you can find it very easily.

If you are in Central Ohio, I would invite you to come out on June 10th, so Sunday, June 10th, that's right around the corner. We are going to have a Community Celebration Day and so you're invited to the campus, they're going to have behind the scenes tours of the new hospital. Basically, a big block party with food and music and events and games and it'll really be just lots of fun and a great introduction for you to the new facilities that we have here.

So if you are in Central Ohio, just put the date down on your calendar, June 10th is our Community Celebration Day, it's on a Sunday, so we hope to see you here on the campus of our brand new hospital here at Nationwide Children's.


All right. So what are we talking about today? We've got a great lineup for you – batter dangers, especially with button batteries, more kids are swallowing batteries and being injured by batteries than ever before and we've had some show recently on just how great we're doing with injury prevention and how the number of preventable injuries in kids has decreased by about 30% in the last 10 years.

But when it comes to batteries, especially button batteries and swallowing batteries, we're not doing so great with that. In fact, we've about doubled in recent years the number of injuries that we're seeing related to batteries, so we're going to talk about that.

Also, video games is another topic that we have talked about several times here on the show. Usually, it's in a negative context, you know, we're saying kids play too many video games and you want to get outside and do some things with your hands and be more interactive and not just sitting in front of the screen. But for some kids, video games are a good thing and in particular when they're active video games, so like we're talking the Wii, those kinds of things and it gets you moving, that's a good thing. And then when you have a kid with cerebral palsy or some other chronic medical illnesses, getting them active with video games can have even more benefit and so we're going to talk about that.


Also, music therapy for babies, this has been kind of controversial in recent years. There was a large company, which we'll talk about coming up, a large company that had some products out that claimed would improve your child's brain development if you use them. Well, the American Academy of Pediatrics came out and said nah, there's really no research that shows that and so this large corporation sort of recanted saying that these products could improve brain development.

They actually went so far as to offer refunds for parents who had purchased and used them if you wanted to send them back. Well that was then and this is now. We do have some research now that does show that music therapy can improve baby brain development. But there's some nuances to that and so we're going to discuss that whole recent study coming up in just a little while, tell you exactly how music therapy can benefit your baby and perhaps lead to improved brain development. I will warn you, it's not just a passive thing. Your babies can't just listen to the music. There's going to be more involved and we'll talk about what that is, coming up.


Also, schoolyards, what if you could design a schoolyard specifically for kids with autism? What would that look like? There's been some research in that topic and we'll explore schoolyards for kids with autism.

Also, compulsory physical education. We know that it leads to less obesity and fitter kids, but what about school compliance? Are schools actually compliant with their state requirements and if they're not, why not? And what are the states doing to get school districts in compliance with their physical education policies.

Speaking of policies, a lot of schools are having to kind of switch to pay to play as budgets tighten, they just don't have the funds to pay for athletics and so parents are being asked to foot the bill and how exactly is that affecting kids on the playing field? Do we have less kids actually participating in sports or is it not making a difference? And in particular, what about low income kids, so if the parents can't afford pay to play, what's happening with them? We're going to talk about that.

And then we'll wrap things up with a discussion on school-based health clinics. So kids are getting physicals and vaccines down the hall instead of at their doctor's office. And so we're going to talk about what parents think, what primary care doctors think about school-based health clinics, that too is coming up a little while later in the program.


I do want to remind you that if there's a topic that you would like us to talk about, it's very easy to get a hold of me, just go to, you can click on the Contact link. You can also email or call the voice line at 347-404-KIDS. That's 347-404-K-I-D-S.

Also, I want to remind you the information presented in PediaCast 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.

Also your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find over at All right, with all that mind, we will be back for some news and commentary, it's coming at you, right after this.



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

In today's technology driven world, batteries, especially button batteries, are everywhere. They power countless gadgets and electronic items that we use everyday. And while they may seem harmless, button batteries can be dangerous if swallowed by children. A new study conducted by researchers at the Center for Injury Research and Policy of the Research Institute here at Nationwide Children's Hospital found the annual number of battery-related emergency department visits among children younger than 18 years of age more than doubled over the 20-year study period, jumping from 2,591 emergency department visits in 1990 to 5,525 emergency department visits in 2009. The number of button batteries swallowed by children also doubled during this period.

The study which appears in the June 2012 issue of the journal Pediatrics, found that more than three-quarters of battery-related emergency visits were among children five years of age or younger, with one-year-olds having the greatest number of visits. Of the cases where the batteries intended use was mentioned, only 29% involved batteries that were used for toys and games. The majority of cases involved batteries from products not intended for use by children, such as watches (14%), calculators (12%), flashlights (9%) and remote controls (6%).


"We live in a world designed by adults for the convenience of adults, and the safety of children is often not considered," says Dr. Gary Smith, director of the Center for Injury Research and Policy here at Nationwide Children's.

Products with easily-accessible battery compartments are everywhere in our homes today. By making a few simple design changes and strengthening the product manufacturing standards, including products not intended for use by young children, we could prevent many of these serious and sometimes fatal injuries that occur when children are able to easily access button batteries in common household products.

Among cases that described the type of battery, 84% involved button batteries. Researchers attribute this finding to the increasing number and variety of electronics powered by button batteries and the resulting increased availability of these products in the home.

Recent research reports suggest that the number of fatal and severe button battery ingestion is on the rise and this trend is associated with the increasing use of 3-volt, 20-millimeter, lithium ion button batteries. The increased prevalence of these higher voltage 20-mm lithium batteries is concerning because it coincides with an alarming 113% increase in battery ingestions and insertions by young children.

And Dr. Smith adds, "When a button battery is swallowed and gets caught in a child's esophagus, serious, even fatal injuries can occur in less than two hours."

Recommendation to prevent these types of injuries include taping the battery compartments of all household devices closed; storing batteries and products with batteries out of the reach of young children; and being aware of this potential danger when your child is visiting other homes.

Researchers also recommend manufacturers package batteries and products containing button batteries in child-resistant containers. They also say manufacturers should design battery compartments to either require a screwdriver for opening or secure with a child-restraint locking system, regardless of whether the product is intended for use by children or adults. Parents who think their child may have swallowed a button battery should seek medical attention immediately so x-rays can be taken to be sure the battery is not stuck in the esophagus.


So this is great advice and I have to admit, when my kids were young and it wasn't always the case that these battery compartments had child-proof locking mechanisms or they have had a screwdriver. And when companies started putting the little screws on to close and secure the battery compartments, I have to admit to you I was frustrated as I'm sure many of you are, like really, I have to go find a tiny little screwdriver to get this thing opened, I just want to change the battery! And we weren't necessarily even talking about button batteries, even if they had D-type batteries, it's pretty unlikely kids are going to swallow a D battery. But you know you into the C batteries and the AAs and the AAAs and certainly they can put those in places they shouldn't and put them in their mouth and suck on them and the smaller ones they can swallow.

And so I find that frustrating but as I'm reading this research study and just seeing the numbers, kids do get injured with batteries and then when we're talking button batteries, absolutely, those are definitely a problem. And the acid in your GI tract can corrode the surface of the battery and then battery acid comes out, which is even worse than your stomach acid and then that can corrode your intestinal lining and then the esophagus, in particular, that can be a problem because the battery is just stuck and sitting in one place and if that battery acid leaks out it can erode a whole in the esophagus and that can cause a problem pretty quickly once you hit a blood vessel and start bleeding into it. And then also, we worry about infection too, because if you get a little whole in the intestinal wall, the intestine's full of bacteria, then the bacteria can get into a place they're not supposed to be and cause infection and sepsis, so that's another issue associated with swallowing batteries even when they're not and necessarily in the esophagus.


It's an important and so my tolerance on battery compartments that actually require some work to get them opened, even as an adult, I guess I need to be more tolerant of those. It's not being as much of a problem here since my kids are older now and we haven't had the little toys around at home but if opening battery compartments frustrates you as a parent, just be thankful that your kids aren't able to get in and get to those batteries.

All right. Let's move on. Like their healthy peers, children with disabilities may spend too much passive time in front of video screens. For children with cerebral palsy, this leads to a greater risk of being overweight, developing new health issues, such as diabetes and worsening of neuro and musculoskeletal disorders. A group of scientists say, "Active video games, such as Nintendo's Wii, offers an enjoyable opportunity to promote light to moderate physical activity in children with cerebral palsy and may have a role to play in rehabilitation therapy." This research is published online in the Archives of Physical Medicine and Rehabilitation.

"Active video games provide a low-cost, commercially available system that can be strategically selected to address specific therapeutic goals," that's according to lead investigator, Elaine Biddiss, PhD, of Toronto's Bloorview Research Institute at Holland Bloorview Kids Rehabilitation Hospital in the University Toronto. "While our results did not show active video game play to be regarded as a replacement for more vigorous physical activity or muscle strengthening, we did find some games may provide targeted therapy focused on specific joints and movements."

Seventeen children with cerebral palsy were studied while playing four active video games, Wii Bowling, Tennis, Boxing and Dance Dance Revolution. Energy, motion and muscle activity data were captured and the children completed the survey indicate their level of enjoyment playing the games.

The researchers evaluated the intensity of the physical activity, the therapeutic potential of active video game play and the practical considerations surrounding the use of active video games for physical activity promotion. They found children with mild cerebral palsy can attain moderate levels of physical activity during active video game play with games that require full body movements, such as Wii Boxing and Dance Dance Revolution. But the activity is not vigorous enough to build endurance or strength.


Active video games also play an in important role in encouraging repetitive movement and provide feedback to the user through onscreen avatars and game scores which could promote neuroplastic change. The children reported high levels of enjoyments which also enhances neuroplasticity. Researchers found certain games, such as Wii Boxing, may be a good choice for encouraging and training wrist movements, which is important for children with cerebral palsy as they commonly experience a difficulty extending their wrists.

Children with hemiplegia, a form of cerebral palsy that affects the limbs on one side of the body, frequently underutilize their affected limb regardless of their functional abilities. In the study, children engaged both upper limbs when playing Wii Boxing or Dance Dance Revolution. Dr. Biddiss says, "Wii Boxing or similar games may be an effective motivational environment for increasing increased movement speed of the hemiplegic limb, in addition to the bilateral use of the limbs, because in-game success is strongly linked to these two metrics."

She adds, "The range of motion of the dominant limb was well within the typical norms associated with upper limb movements in able-bodied individuals. While further safety studies are needed, results from the current project suggest these video games are relatively low impact activity for participating children."

Dr. Biddiss concludes by pointing out that active video games are not a replacement for structured exercise and physical therapy, but they may encourage children with cerebral palsy to be physically active and to practice complex motor activities. She says, "There are many opportunities for further research and future development and optimization of active video games technologies may usher in a new age in physical rehabilitation where virtual environments provide an arena for neuroplastic change in the comfort of one's home."


So what's meant by neuroplastic change? Basically, we're just trying to get a benefit of the neuromuscular system. So getting kids, especially kids who have disabilities to use their brain and use their muscles in a new way that they're not used to using when they're just sitting and being passive, so that's what's meant by that term.

And I think if your kids are going to play a lot of video games, which of course we don't encourage a lot, I mean kids do need to be playing and using their brain and doing with their fingers and doing other things and socializing and being outside, you know my feelings on this since we've talked about it so many times in the past. But I have played some active video games with my kids and I'll tell you, you do get a workout with some of them, especially the dancing type, the dancing type programs, which I know there have been some YouTube videos floating around of members of my family doing these kind of things, which doesn't always make the parental units of the family happy, but they do exist.


All right. An article published recently in the scientific journals Developmental Science and the Annals of the New York Academy of Sciences reveals that McMaster University researchers have discovered in a first study of its kind that very early musical training benefits children before they are able to walk or talk. The finding show parents who take their one-year-old to participate in interactive music classes have babies who communicate better, smile more often and show earlier and more sophisticated brain responses to music.

Laurel Trainor, director of the McMaster Institute for Music and the Mind, says, "Many past studies of musical training have focused on older children. Our results suggest that the infant brain might be particularly plastic with regard to musical exposure."

But these neurologist-type people like to use that word plastic, don't they? So it just again, new experiences, new things, the brain being used in a new way. In 2008, Trainor and David Gerry, a music education and graduate student received an award from the Grammy Foundation to study the impact of musical training in infancy. In the recent study, Trainor and Gerry studied babies and their parents who participated weekly in one of two types of music instruction over a six-month period.

In one of the classes, the infants were interactive in making music, learning to play percussion instruments and taking turns, as well as singing specific songs and learning a small range of lullabies, nursery rhymes and the songs with actions. The other music class entailed infants and parents playing at various toy stations while Baby Einstein recordings played in the background. None of the infants had previously participated in baby music classes and part of the start of the classes all infants had a similar level of communication and social development skills.


Trainor says, "Babies who participated in the interactive music classes with their parents showed earlier sensitivity to the pitch structure in music. Specifically, they preferred to listen to a version of a piano piece that stayed in key, versus a version that included out-of-key notes. Infants who participated in the passive listening classes did not show the same preference. Even their brains responded to music differently. Infants from the interactive music classes showed larger and/or earlier brain response to musical tones."

The researchers observed the infants' non-musical differences between both groups were even more astonishing with infants from the interactive classes demonstrating better early communication skills, such as pointing at objects that were out of their reach, or waving goodbye. The researchers observed that these infants also smiled more or easier to soothe and were less distress when things were unfamiliar or didn't go their way.

Even though the infants listened to music in both classes and all infants also listened to a similar amount of music at home, the biggest difference between the two groups was that one experienced interactive exposure to music, while the other had a passive experience.

Study coordinator, Andrea Unrau, concludes by saying, "There are many ways that parents can connect with their babies. The great thing about music is this, everyone loves it and everyone can learn a simple interactive musical game together."


So there you have it. There was some controversy a few years ago when a large American entertainment company which happens to be headed up by a certain mouse was selling products that claim to improve baby brain development. The American Academy of Pediatrics sort of put up a stink about that claim and the large American entertainment company not only retracted their claim but actually offered refunds for parents who had purchased and used the products.

Well it turns out according to this study, music can have an impact on baby brain development but you can't just play the music in the background and expect it to have an effect. You have to get down on the floor with your kid, play the drum, sing together, do hand motions and use music as the vehicle to socially interact with your children. That's what seems to make the difference.

Speaking of making a difference, a Kansas State University graduate student is creating a schoolyard that can become a therapeutic landscape for children with autism. Chelsea King, a master's student in landscape architecture is working with Dr. Katie Kingery-Page, assistant professor of landscape architecture, to envision a place where elementary school children with autism feel comfortable and included.

King says, "My main goal was to provide different opportunities for children with autism to interact in their environment without being segregated from the rest of the school. I didn't want that separation to occur." She adds that the schoolyard can be an inviting place for children with autism if it provides several aspects, here they are: clear boundaries, a variety of activities and activity level spaces, places where children can go when they're overstimulated, opportunities for a variety of sensory input without being overwhelmed and a variety of ways to foster communication between peers.


The biggest issue with traditional schoolyards is that they are completely open but also busy and crowded in specific areas. And King says, "This can be overstimulating for a person with autism."

So she researched ways to create an environment where children with autism would be able to interact with their surroundings and their peers, but where they could also get away from overstimulation until they felt more comfortable and could re-enter the activities.

King says, "Through this research, I was able to determine therapies and activities geared toward sensory stimulation, cognitive development, communication skills, and fine and gross motor skills, which traditionally occur in a classroom setting, but these could be integrated into the schoolyard."

She designed the space with both traditional aspects, such as a central play area and additional elements that would appeal to children with autism, including a musical garden where children can play with outdoor musical instruments to help with sensory aspects; an edible garden/greenhouse that allows hands-on interaction with nature and opportunities for horticulture therapy; a sensory playground, which uses different panels to help children build tolerances to difference sensory stimulation; a butterfly garden to encourage nature-oriented learning in a quiet place; and a variety of alcoves, which provide children with a place to get away when they feel overwhelmed and want to regain control.

King created different signs and picture boards around these schoolyard elements, so that it was easier for children and teachers to communicate about the activities. She also designed a series of small hills around the central play area so children with autism could have a place to escape and just watch the action around them.


"It's important to make these children feel included in the schoolyard without being overwhelmed," King said. "It helps if they have a place, such as a hill or an alcove, where they can step away from it and then rejoin the activity when they are ready.

King and Dr. Kingery-Page see the benefit of this type of schoolyard as an enriching learning environment for all children because it involves building sensory experience and communication.

They say, "Most children spend seven to nine hours per weekday in school settings and designing schoolyards that are educational, richly experiential and with the potential for children to have restorative nature contact should be a community concern."

The researchers collaborated with Jessica Wilkinson, a special education teacher who works with children with autism. King designed her schoolyard around Amanda Arnold Elementary School in Manhattan, Kansas, which is a magnet school for children with autism.

Dr. Kingery-Page says, "Although there are no current plans to actually construct this schoolyard, designing for a real school allowed Chelsey to test principles synthesized from literature against the actual needs of an educational facility. And Chelsey's interaction with the school autism coordinator and school principal grounded her research in the daily challenges of elementary education for students with autism."

So, I'm picturing this place in my mind, which I suppose many of you were doing as well and at first I'm thinking, how are they going to keep the non-autistic kids out of these school places, you know what I mean? They've got musical instruments and the butterfly garden and the horticulture stuff going on and alcoves and hills. I'm thinking it's going to be mayhem everywhere. Kids are going to want to really be a part of this and these spaces and cool things.

And so I'm imagining some undermedicated kids with ADHD sort of spoiling the place for the kids who need the quiet time, if you know what I mean. Then I discover, OK, they're creating this space at a special school that focuses its attention on kids with autism, so cool and this place sounds great and then they add, we're not actually building this. What? Seriously? Well, Chelsey, you need to have a bake sale or something, I mean, get out there and wrestle up some donors. There must be foundations out there eager to jump on something like this. So don't let your dream die on paper, Chelsey King. Go for it.


A study published in the American Journal of Preventive Medicine reveals children are more likely to have better fitness level if physical education at their school is mandatory. The researchers examined fitness levels in fifth graders in public school districts in California that comply with the state's mandatory physical education requirement and those that don't. Lead author, Dr. Emma Sanchez-Vaznaugh, assistant professor of health education at San Francisco State University, explained, "Even though California has a physical education law and monitors its compliance, our study revealed many school districts are not providing the required physical education and too many children go to school districts that do not comply with physical education laws."

According to the researchers, educators have an opportunity to influence life-long health habits given that grade school children spend a large portion of their day in school. Children who do not take part in regular physical activities are more likely to be obese and have poor overall health. In California, physical education is mandatory by law for children in grades one through six. The law states, "Each student should receive 200 minutes of physical education every 10 days."

However, the researchers found only half of the 55 school districts for which compliance data were available complied with the law. The others conducted a one-mile run or walk test and found children were 29% more likely to be physically fit if they attended schools in compliant school districts.

According to the researchers, individual schools might be more willing to comply with the law if there was sufficient funding for physical education and if there was better monitoring of school compliance. Dr. Sanchez-Vaznaugh says, "Parents, educators, policy-makers, schools and the people involved in children's health need to figure out how to help schools adhere to physical education laws, so that children can get the needed physical education while in school."

So in my mind the moral of this story is parents, don't rely on governments and schools to get your kids active. They mean well, but ultimately it's up to us, moms and dads, to model and encourage physical fitness and for great ways to do that be sure to tune in to last week's show, episode 212, entitled Physical Fitness and Resistance Training.


In an era of tight fundings, school districts across the country are cutting their athletic budgets and many schools are implementing athletic participation fees to cover the cost of school sports. But those fees have forced kids in lower income families to the sidelines. That's according to a new poll that found nearly one in five lower-income parents report their children are participating less in school sports.

The University of Michigan C.S. Mott Children's Hospital national poll on children's health recently asked parents of middle and high school aged children nationwide about participation and cost of school sports. Overall, 61% of children playing middle or high school sports were charged a pay-to-play fee. The average fee was $93 according to the poll respondents but 21% of children faced a pay-to-play fee of $150 or more.

Of course, pay-to-play fees are only one component of the cost of participate in school sports, many parents also pay out of pocket for such things as equipment, uniforms and travel fees, bringing the average cost for a child's sports participation to $381 for each sport played. Researchers found 12% of parents report the cost of school sports caused a drop in participation for at least one of their children.

However, that number varied substantially based on income. Among lower-income families, defined as those earning less than $60,000 per year, 19% said their children's participation decreased because of the cost. Compare that the families earning more than $60,000 per year were only 5% reported the decline in participation because of costs.


"As pay-to-play becomes the norm, nearly one in five lower-income parents reported their kids decreased their sports participation and that's significant," says Sarah Clark, associate director of the Child Health Evaluation and Research Unit at the University of Michigan and associate director of the National Poll on Children's Health.

The poll found only 6% of participants received a waiver of pay-to-play fees. "Perhaps," Clark says, "schools need to look at their waiver policies and consider options like partial waivers, installment payments or other means to provide flexibility for families." Ms. Clark says, "We know that participating in school sports offers many benefits to children and teens, higher school achievement, lower dropout rates, improved health, reduced obesity and the development of skills like teamwork and problem solving." And she adds, "There's not an athletic director, school administrator or coach out there who doesn't want every kid to have a chance to participate. But there are no easy answers, especially when budgets are expected to get tighter and tighter."

Each year, millions of children and teens play competitive sports in middle school and high schools. Clark says she hopes this study will spur conversation among school officials about how to make sure children in low income families are not left out.


And finally, in our new segment, new researchers from the University of Colorado School of Medicine showed that school-based health centers are highly effective in delivering comprehensive care, especially vaccines to adolescents. The study published in the journal Pediatrics, highlights the value of a captive audience in a school setting where students can be easily reminded to get recommended vaccines.

"School-based health centers can provide comprehensive care to children and adolescents who are hard to reach," so says Dr. Allison Kempe, MD, MPH, a professor of pediatrics at the University of Colorado and lead author of the study. She adds, "I think it's a very important model especially in underserved and low income areas. School-based health centers are not prevalent across the United States, but I think they should be."

Dr. Kempe points out the scope of immunizations for adolescents expanded markedly over the last few years, prompting discussions about a platform of inoculations for this population similar to those given to infants. Immunizations recommended for adolescents include the meningococcal conjugate vaccine, also known as Menactra; tetanus-diptheria-acellular pertussis vaccine or Tdap and the human papillomarvirus vaccine, better known as HPV.


While new vaccines targeted for adolescents certainly hold great promise, they also face certain challenges. Adolescents are in age group that is less likely to access healthcare and only 9% of all healthcare visits by adolescents are for preventative care. Several other issues come into play, including parental consent, lack of health insurance, missed chances for vaccination during routine doctor visits and the scattering of immunization records among multiple providers.

Dr. Kempe and her fellow researchers funded by the Centers for Disease Control studied vaccination outcomes among sixth graders of four school-based health centers in Denver. They began with the demonstration study of 265 females needing at least one vaccine with all the girls getting reminders regarding needed immunizations. Researchers then completed a second study designed as a randomized control trial of 264 males needing vaccines. Half of these males received reminder calls or notes to get immunizations and half just received their usual care.

After six months, 77% of the females in the first study had received at least one vaccine and 45% received all the necessary vaccines. The randomized control trial of males found that 66% of those getting reminders ended up receiving at least one vaccine, compared to 45% in the no reminder group. And 59% of reminded males had obtained all study vaccines compared to 36% who did not receive reminders.

Dr. Kempe concludes by saying, "Our data reinforce the notion that school-based health centers are very viable in providing healthcare to kids who are uninsured, come from poor backgrounds or are just plain adolescents." She says, "Reminders work in school, they're effective, easy and cheap."


So what do you think about this, moms and dads? Do you want a health center down the hall from the classroom where your kids can get comprehensive healthcare including vaccines? And do you want the schools sending you reminders about your child's health, including reminders about vaccines? And what about the primary care physicians in the crowd, do you want your patients receiving healthcare at school?

It sort of does destroy the concept of the medical home, doesn't it? Unless the medical home becomes the school, which doesn't really sound like a great idea to me. On the other hand, teens and especially low income teens frequently skip yearly well-checks and they are at risk from missing potentially life-saving vaccines. So I do understand Dr. Kempe's concern, but here's my idea, because you know, we don't want to criticize without offering a suggestion, how about if parents take charge even of their teenagers, moms and dads, it's our responsibility to get teenagers in to see their doctors once a year and to make sure they're up to day on life-saving immunizations.

So ultimately, this is a parent problem, not a teen problem and certainly not a school problem. So, I'd rather see schools spending the little money they have on teachers and sports programs. Comprehensive healthcare, vaccines at school, really?

Now I realize Dr. Kempe, disagrees with me. Her quote again, "School-based health centers are not prevalent across the United States but I think they should be." My questions to you, Dr. Kempe, how do we pay for this? Would you have the support of parents? Would you the support of primary care doctors? If you are a parent or a primary care doctor, we'd love to hear you opine on this by commenting in the Show Notes over at


All right. That wraps up our News Parents Can Use. We're going to take a quick break and we'll be back to wrap up the show, right after this.


All right. We are back to wrap up the show and I want to thank all of you for again taking time out of your busy summer schedule, which is just getting started now, to make a PediaCast a part of your summer. We have listener questions coming up again next week. We're going to be talking pin worms, shingles and there's another one, scoliosis is also coming up on our next show. So those questions and we're going to talk about pink slime.

There's been a lot said about pink slime in the news in recent months and in social media and McDonald's and Burger King and Taco Bell pulling pink slime out of their burgers. But schools are still including pink slime in their school lunches and the USDA and the FDA say that's just fine. So I'm going to weigh in on the topic of pink slime in our next PediaCast, so make sure you join me for that next week.


Also I want to remind you the Columbus Wishing Tree Project. Share your wishes, maybe you need a miracle. Read the wishes. Some of them will just touch your heart and some of the wishes will be encouraging as you find others in your shoes. Then support those other wishers by reading what's on their heart, sharing the wishes and perhaps offering up some prayers.

You can find that pretty easily, just go to and we'll have a link in the Show Notes for you as well. Also I want to remind you that iTunes reviews are very helpful to this program. We really rely on word of mouth to get out the news about PediaCast and obviously this is something that the folks here at Nationwide Children's Hospital and myself feel pretty strongly about that we want parents to have access to pediatric information that is evidence-based and something that you can trust.

We're going to look at the facts, we're going to do our research, do our homework before we offer any of this to you. And of course, it's also an opportunity for you to ask questions and really to interact with this program. And so we want to make this the best program it can be. And to help us to get the word out about the show, just head over to iTunes and make sure you write a review. It doesn't take long and it really does make a difference for people who are searching through iTunes when they come across your reviews. It helps them to give us a chance.

So if you haven't done that yet, please do. It's very much appreciated. We have had some new reviews in the last couple months based on this request and to those of you who have taken the time to write a review on iTunes, I just want to let you know that I'm really thankful for that, so thanks. And those of you who haven't, please consider doing it, we'd really appreciate it.


Also mentioning us in your blogs, on Facebook, in your tweets and on Google+ is very much appreciated. You can also join our community by liking PediaCast on Facebook and following us on Twitter. If you want to get the word out just tweet with hashtag #pediacast and you can also hang-out with us on Google+ as well.

And be sure to swing by the Show Notes at to add your comments on today's show. We also appreciate you telling your family, friends and neighbors about PediaCast and don't forget to talk us up with your child's doctor at your next well check-up or sick office visit. That's another or one of the big things you can do to help out the show is just next time you're at doctor's office just say hey doc, have you heard about PediaCast? And that way they can be familiar with the program and they can certainly tell their other patients about the show as well.

If you really want to spread the news, we have posters you can download and hang up wherever moms and dads hang-out, whether that be, really anywhere, in daycare centers, at doctor's offices, in the breakroom at work, church nurseries, the YMCA, wherever moms and dads are and you want to get the message out, we'd appreciate it. We have those posters under the Resources tab at


I also want to remind you, it is easy to get a hold of me, just go to, click on the Contact link and of course as I've mentioned before I read every single one of those contacts or the messages that you send in. You can also email, those all come directly to me and can call the voice line 347-404-KIDS. 347-404-K-I-D-S. No, we don't answer that one. It is a Skype line, so you just have to leave a message, but just leave your audio question or comment and we can get your voice on the program with that mechanism.

So we got a big summer ahead of us. We got lots of interviews coming up. Let's see, we're going to do inflammatory bowel disease, we've got one coming up on migraine headaches, I think that'll be a good one; cystic fibrosis is also coming up. So we got lots of interviews and of course we'll have plenty of news and listener type shows for you as well. All coming up this summer. So stick with us. We know your summers get busy and you got lots of things going on but when you're exercising or you're riding your bike or you are driving your car, heading to the pool, those kind of things, consider having PediaCast be your friend and go on doing those things with you.


I will say, please do not listen to PediaCast while you're paying attention to your kids doing something that you really need your full 100% attention, so you know, get young kids were swimming in the pool, if they're climbing up on a play equipment. I mean, if there's something where your kids really need your undivided attention, please turn off this program and focus all of your attention on your kids. That's the most important thing.

All right. Until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long everybody.


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

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