Bikes & Babies, Safe Cookware, Adults with Autism – PediaCast 435

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  • This week we answer more listener questions. Topics include traveling with infants, bikes and babies, toddlers who bite, safe cookware, the meningitis B vaccine and adults with autism. Plus we’ll share how to get YOUR questions answered on the podcast. We hope you can join us!

Topics

  • Anesthesia and Kids
  • Traveling with Infants
  • Bikes and Babies
  • Toddlers Who Bite
  • Safe Cookware
  • Meningitis B Vaccine
  • Adults with Autism
  • Balancing School and Work

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Transcription

Announcer 1: This is PediaCast.

[Music]

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

Dr. Mike Patrick: Hello, everyone. And welcome once again to PediaCast. It is a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children's Hospital. We are in Columbus, Ohio. 

It's Episode 435 for June 27th, 2019. We're calling this one "Bikes and Babies, Safe Cookware, and Adults with Autism." I want to welcome all of you to the program.

0:01:00

You can probably tell from the title of today's show that we are answering listener questions this week. And since it's been quite a while since our last listener episode, I have several of them lined up for you. I've said this many times in the past and I'm going to say it again now if you are or become a regular listener of the show, you're going to hear me say it again. And that is that I absolutely love answering your questions.

Now, don't get me wrong. I enjoy interviewing our expert guests on PediaCast but the reason I started the show was to help moms and dads, many of whom have questions about their child's health and parenting. It's not knowledge that we're born with. And if you have a question, it tends to reason that thousands of other parents are asking themselves the very same question.

So by answering your questions in the context of a podcast, your one question, obviously it benefits your family, but it also benefits thousands of other families around the world who are asking themselves the same question. So I love doing these episodes.

0:02:06

Topics this week include the three I mentioned in the title, bikes and babies, safe cookware, and adults with autism. We're also going to talk about anesthesia in children briefly this time. We've covered that in the past and we're actually going to cover it in more detail in the future. More to come on that.

Also traveling with babies, not just on bicycles but also long car rides and airplane trips. We had a listener ask some questions along those lines, so we'll talk about it. 

We're also going to discuss toddlers, and in particular those who bite and hit and kick at home and at daycare. Why did they do it? How should we respond as parents or caregivers? I'll give you a hint. The answer is never to bite them back. I've heard that suggested in the past. No, no, no. They're not a good idea. We'll talk about why and what you can do.

We're also going to cover the meningitis B vaccine. And I have some solicited advice, because you asked me, about balancing school and a full time job. I'll provide some thoughts on that as well.

0:03:12

Now, since I’m answering many of your questions this week, I do need your help because we're going to need to fill the question bank back up so we can do this again with new and different questions down the road.

It's really easy to submit a question. We take all questions even if you think it's silly, there are no silly questions pertaining to parenthood. Some may giggle but that doesn't make them silly question. It's more likely the giggler can relate. So ask away. I love hearing from all of you.

Again, easy to do, just head over to pediacast.org. You can click on the Contact link. That's located up at the top of the page. We have a form there for you to fill out. 

And I do read each and every one of those that come through and I'll do my best to get as many of those on an upcoming show. We'll get your questions answered. That's really important to me. We also have a telephone line. If you would like to call and leave a message that way, 347-404-KIDS, 347-404 K-I-D-S.

0:04:09

All right, we will get started with the answers to your questions in a moment. First though, a couple of quick housekeeping items. You can find PediaCast on all sorts of places. I'm not sure how you're listening now but I just want to remind you, we are in the Apple Podcast app. We're on iTunes, Google Play, Google Podcast, iHeart Radio, Spotify, SoundCloud now, where we have a playlist available for you, kind of package episodes theme. 

For instance, we have some dental ones together. We have sports medicine. We have our Pediatrics in Plain Language Panel episodes. We have another one of those coming up, by the way, in a couple of weeks regarding summer safety. I'm really kind of excited about that one because we have some announcements for you. So stay tune for that, coming up in a couple of weeks.

Also on Castbox, I've been also participating as a guest on a podcast in Castbox that is live every weekday at 1:00 PM called REVIVE!. It's brought to you by The Parents On Demand Network.

0:05:11

And for the summer, every other Tuesday at 1:00 o'clock, I'll be the guest on their program talking more about child health and parenting topics. So you can catch me on the REVIVE! podcast, again, live on Tuesdays at 1:00 Eastern Time, every other Tuesday. So I did that this week and we'll do it again in a couple of weeks.

We're also on social media, Facebook, Twitter, LinkedIn and even Instagram. Not only do we share content from this program but really tried to provide you with material that will help you as you think about the health of your kids and parenting, what sort of in the news right now that parents need to know about. We try to share those things on a daily basis especially in Facebook, Twitter, and LinkedIn.

On Instagram, a little more fun, a little more family-oriented, what's our family up to, what do we do in the summer, what movies have we gone to see, what activities are we doing and then peek inside the studio too as we record our podcast. So please look for us. And in all of those places, just search for PediaCast and we'd love for you to connect with us there.

0:06:15

Also, I want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, always make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at pediacast.org.

Let's take a quick break and then I will be back to talk about bikes and babies, safe cookware, adults with autism, and much, much more. That's coming up right after this.

[Music]

0:07:23

Dr. Mike Patrick: Our first listener comment this week comes from Jill in Minnesota. She says, "I wanted to drop a note to say how much I appreciate your podcast generally but especially the recent episode that discuss general anesthesia. My 22-month-old has had two surgeries under general anesthesia and while I  was vaguely aware of the concerns about developing brains and anesthesia exposure, I had not looked very deeply into those issues myself. I appreciated your interpretation and explanation of the reference to research studies. Thanks again. Jill."

Well, thank you, Jill, for listening to the program, for your kind comments and feedback. I really do appreciate those.

0:08:01

For those of you who are now thinking, "Hmm, that sounds like it might have been an interesting discussion. I wonder what we know about the long-term effects of anesthesia on behavior and development. And there's probably a lot of you out there sort of asking that question as you hear about it because surgeries in kids are very a common thing. 

And for the most part, the benefits of having the surgery outweighs the risks that are associated with anesthesia. But that could potentially change as we know more about what the long-term effects of anesthesia are. So that can come into play as we think about is the surgery really necessary or not? 

I'm not going to rehash all of that here today but I will point you in the right direction if you want to hear more about this topic. It was Episode 428 that Jill is referencing. The episode title was "Anesthesia, Naps, Deaths, and Funerals".

And by the way, that was answer to listener question episode of the podcast which you can always tell because the title usually has things that don't seem related in it.

0:09:09

And it's funny because I would never come up with many of these topics that we cover as we answer listener questions, but I love that. I love that these ideas are generated from all of you. And certainly, the effect of anesthesia in kids are something that a lot of parents are thinking about and are concerned about. There has been some things in the news recently with some research studies. So we kind of break down those studies for you in that particular episode.

By the way, that episode led to an interesting offline conversation with one of our own pediatric anesthesiologists here at Nationwide Children's, Dr. Marco Corridore. And he expressed an interest in sharing his thoughts on anesthesia and kids here on the podcast, not only the risks and benefits of anesthesia in children, what we know, what we do not know, but also how to best prepare your child for the experience of surgery, what they can expect, what can you expect, and how can you best advocate for your kids in a situation where you seem to have a little control.

0:10:16

He's actually scheduled to visit the studio in early September, along with one of his colleagues. I think that will be an enlightening conversation as we all learn more about anesthesia and kids from a pediatric anesthesiologist who is quick to say, "Hey, here's what we know. Here's what we don't know. This is what parents should consider as they think about surgery and the surgical procedures for their children."

It's all coming up again in September. Really excited to welcome Dr. Corridore to the podcast studio. Just a little sneak peek there for you and some insider info, Jill. Stay tuned for more information regarding anesthesia in children in a couple of months.

Next up we have a question from Niurka in Miami, Florida. 

0:11:03

Niurka says, "I love your podcast. I have the following question. We're looking to take a vacation within the United States with our baby. However, we are unsure if it is safe. What are your recommendations for traveling with a nine-month-old baby in an airplane? How long is it recommended to drive with an infant in a car? The road trip will be a whole day of driving with several stops. Thank you. Niurka." 

Well, thanks for the question. I'm sure lots of moms and dads are wondering the same thing. So you're traveling within the United States with a nine-month-old. I just want to say right upfront that if you're traveling to an area where we know there is a lot of measles, nine-month-olds are not protected against measles. 

And we also know that considerable number of kids who get the measles especially young infants can end up with a severe disease. Pneumonia is a possible complication. About 20% of kids with measles will end up hospitalized and about one to two out of every thousand cases could end up in death, particularly from pneumonia. Also, encephalitis is another possibility.

0:12:07

Measles is a dangerous illness and nine-month-olds have not have an MMR yet. Now if you are traveling to an area where there is a lot of measles present, nine-month-old babies can get an MMR, which is measles, mumps, and rubella vaccine, that will give them some protection. However, that will not count as one of the two doses of the vaccine that they need before they enter kindergarten. So you'd still need to get another one of those at 12 to 15 months of age and then again, at around four, five years of age.

Getting one at nine months is fine and will provide some protection but it does not count as the first one. You still have to get the first one between 12 and 15 months of age. 

Something to think about in terms of safety. We didn't have to worry about these sorts of preventable infectious diseases in the United States. We worried more about if you are traveling to an area internationally that had measles present, that we would have to have this discussion. But with so many pockets of measles within the US now, you do have to pay attention to that. 

0:13:11

If you're not sure if where you're traveling does have a lot of measles or not, you can check with the CDC. Their website shows where the measles outbreaks are and also your physician, your child's medical provider should be able to help you determine whether you need one of those.

Now, I realized that Niurka's question really is more about the travel itself, so in an airplane and in a car, how long, what are the guidelines. I do want to point you to a resource I think will be very helpful. The American Academy of Pediatrics has some really terrific information on traveling with kids at their website, their website for parents which is healthychildren.org. 

They have one article called "Travel Safety Tips with Kids" and does have lots of detail about traveling by car, traveling by airplane, international travel. And then, there's another one called "Flying With Baby" that really talks about what if your baby is getting fuzzy in the airplane cabin and they're crying, how do you soothe a fussy baby so you don't bother your neighbors too much?

0:14:15

And it also addresses pressure in the ear. When you're going up and down in an airplane, you get that pressure differential on each side of the eardrum and that can cause some sort of popping and crackling discomfort within the ear and that can make kids fussy. So what are some things you can do to help alleviate ear symptoms in an airplane for babies?

So I'll put a links to both of those articles. Again, "Travel Safety Tips with Kids" and "Flying with Baby". And I'll put those in the Show Notes for this Episode 435 over at pediacast.org. Lots of great information there.

But let's get specific answers to your questions, Niurka. First, is traveling within the United States safe with a nine-month-old baby? Other than the infectious disease aspect of it and measles which I just talked about, generally speaking, sure, it's safe. I mean, there's risk in everything in everything we do, right? 

0:15:07 

But the benefits you get out of travel, spending time with family, visiting friends and relatives, new experiences, making memories, even short-term ones. I mean, your nine-month-old baby may not remember the vacation when they're four or five years old but they'll remember it for a little while. 

And so, just making memories, the new experiences, the stimulation, being exposed to different things, that's all fantastic. There's a lot of benefit to be had. In my mind, traveling is usually worth the risk.

Now, there are things that we can do to minimize risk which is why we have car seat rules and recommendations. And I'll put a couple links in the Show Notes related to that as well, "Car Seats: Information for Families", "The Car Seat Check-Up", all of these from the American Academy of Pediatrics. Just so you can review and make sure that you are using an appropriate car seat and using it the way that you ought to be using it in terms of rules for rear facing, forward facing.

0:16:07

For the most part, the rules are rear facing until kids turn two years of age and then they can be forward facing. Always in the backseat, never in the front. The passenger side airbag can be very dangerous for young children. And then you want to follow the rules that are on whatever car seat that you're using in terms of limits for weight and height. 

Those are the big things. But be sure to check out those links for lots more information about car seat safety. Just brush up on the hose before you leave.

In terms of traveling with the nine-month-old baby on an airplane, the Federal Aviation Administration, so the FAA allows children under the age of two to be held on an adults lap in an airplane. So you don't have to have their own seat if they're less than two years of age. 

However, the American Academy of Pediatrics recommends, and I agree with this recommendation, that all babies and children really ought to have their own seat. And they should be restrained in a car seat that is appropriate for their age, weight and height.

0:17:12

And again, you can check your car seat to ensure that it is FAA-approved. If it is, you're good to go. If not, then the recommendation would be to get a car seat that is FAA-approved to be used on an airplane and then have your baby in that car seat buckled in to their own seat on the flight.

Belt positioning booster seats cannot be used in an airplanes since there's no shoulder restraint. But they can be checked as luggage for use in rental cars, taxis, Uber, whatever it is you're going to be traveling in at your destination. 

Now, that does not apply, of course, to a nine-month-old. But if you have older kids that usually, they're in a booster seat that adjusts the shoulder strap appropriately, at home, you can pack that and use it on your vacation. Now, once your child is 40 pounds, then it's fine to use the airplane seats lap belt. 

0:18:04

So that's the safest way. Now, I do see lots of babies and toddlers held on airplanes and I always cringe. There's a reason the seatbelt light comes on when the air gets choppy. Flight attendants buckle in when unexpected turbulence is encountered. 

And while I've never witnessed a young child becoming a projectile within an aircraft, it certainly is possible, with broken bones, lacerations, head injuries, all of those things as a consequence of you losing your grip and then hitting the seat in front of them or even worse, spilling out into the aisle.

So best practice is going to be babies and toddlers having their own seat on an airplane and remain appropriately restrained in an approved car seat until they're 40 pounds.

Lots of additional tips in the links that I mentioned -- pack plenty of toys and snacks to keep your little one occupied. This may not be the time to cut back on screen time. Please keep them entertained. Your fellow passengers will thank you.

0:19:08

Sucking can help ease ear discomfort. It can be sucking on a pacifier or on a bottle, that can help. Sort of the equivalent of chewing gum for older kids and for adults to help with ear discomfort. No gum chewing in babies or toddlers. Maybe save a bottle with some formula or milk or juice in it for the descent, that sort of thing. And again, lots of additional tips like that in the links that I mentioned.

In terms of long car rides, frequent stops is definitely the order of the day which you've mentioned, Niurka. If your baby is sleeping, by all means, keep going until they wake up. But when baby wakes up and gets fussy, that will be a great time to take a break and stretch and walk around the car.

As in the airplane, snacks, toys, screens can be very helpful. However, think about poking and choking hazard if baby is alone in the backseat. You don't really want to give them snacks without direct side-by-side supervision. In fact, if someone can sit in the backseat with your baby to try and keep an eye on them and keep them entertained, that's the best way to travel. 

0:20:21

Again, lots more tips in the links and I'll provide those in the show notes for this episode, 435, as we think about traveling with babies.

One final note, very young babies, so we're talking those who are less than couple of months old, just stay home if you can. Those really young babies are more prone to infection which can quickly become serious. Young babies, especially less than two months of age with fever always need medical attention right away when a fever develops.

They have lots more needs too when they're less than two months old. Just stay home, relax, bond with your baby in quiet. Take advantage of that opportunity. There will be plenty of time for travel after the age of few months.

Hope that helps, Niurka. As always, thanks for writing in.

0:21:12

Our next question comes from Anna in Fort Ripley, Minnesota. Anna says, "Hi, Dr. Mike. Minnesota is a lovely area with all sorts of outdoor activities and a ton of lakes. My question today is in relation to bicycle trailers and seats and their safety. I have a nine-month-old and I'm trying to get outside this summer. I was trying to read up on safety of bike trailers versus the seats that can go on adult bikes and wondering your thoughts and recommendations. 

"Also, how old do kids need to be before safely riding in a bike trailer. Thank you so much. Anna."

Well, thanks for the question, Anna. It's a good one and apparently, this is a nine-month-old day on PediaCast since our last listener question also pertain to a nine-month-old. 

First, let me just say like all children and adults, babies should always wear a bike helmet. And yes, they do make infant-sized bike helmet. So always protect that noggin. Your child only has one. Protect it even if baby is riding in a pull-behind bike trailer. Always have a helmet even for babies as we think about bicycles.

0:22:19

Second, never carry babies or children while you're on a bike. Even if it's a bicycle built for two and another adult is doing the driving. No carrying on the arms or in a backpack or a frontpack, none of that. 

So the options that you mentioned, Anna, are the only safe ones, in a child seat that designed for babies on a bike or a pull-behind trailer. So those are really the only two options, no backpacks, frontpacks or holding in the arms. Much too dangerous. You can easily lose your balance or lose your grip. And bad things can certainly happen.

Third, regardless of which one you use, only adults should operate a bike when there is a young child on board. So don't let big brother or sister take baby for a spin. Not only it is a dangerous practice but think about the shame and the guilt that you're setting your older child up for if something terrible were to happen. Even though big brother, big sister may want to do that, don't let them. Only adults should operate a bicycle when there's a young child on board.

0:23:26

Fourth, and this one you may not like what we have to say here, Anna, but my fourth important point is that the AAP, the American Academy of Pediatrics and I agree with this recommendation, they recommend that children less than 12 months of age should really just not ride in a bike or a bike trailer.

And I know that maybe not so much of a popular recommendation for you, Anna. I get that. But the reason is this, babies need good muscle tone and strength to sit unsupported for prolonged periods of time.

Now, I know they're supported because they're strapped in but they really need good neck strength to support even a lightweight helmet. Nine-month-olds may have the proper strength to sit up for a few minutes, but how long is that reliable? 

0:24:22

And are you willing to face the consequence of an unattended baby bending at the neck and suffocating because they couldn't right their head or move away from the strap or the buckles? Or some inside part of the trailer that they get up against and then they can't move, and suddenly they have suffocated.

So, 12 months is really the youngest recommended age for both bike seats, dedicated bike seats made for babies and pull-along trailers. So less than 12 months, if you want to get outside with your young baby, which I would highly recommend. I mean, it's wonderful to get outside and enjoy the great outdoors. But use a stroller instead. It's much easier to maintain constant supervision.

0:25:05

Now, that said, 12 months is a guideline. The important thing here is reliable trunk and neck support with endurance. Some 12-month-olds may not be ready for that. So there maybe kids who even after 12 months is a better time to think about bike riding.

So keep rides short at first for those young babies but only after 12 months. Check in with them frequently. Make sure they are securely restrained according to the seat or the trailer's specifications. And that they are not fatiguing, that their necks are not flopping over and cutting off their airway.

Again, infant helmet is a must even inside a trailer. And stick with dedicated bike paths. Avoid traffic, reduce your speed, and use extra caution whenever you have a baby on board.

The American Academy of Pediatrics does have a nice article on this topic. It's called "Baby on Board: Keeping Safe on a Bike". And I will put a link to that in the show notes for this episode, 435.

0:26:09

Thanks for the question, Anna. I know probably not the answer you wanted but, hey, now you have something to look forward to next summer, right?

[Music]

Dr. Mike Patrick: Next up is Amanda from here in Ohio. She has a simple question, "What is the solution for an 18-month-old biter in the daycare? Mom is a little embarrassed." Simple question, not so much of a simple answer. Thanks for the question, Amanda.

0:27:01

The answer, by the way, is really going to be the same and pertain to not only biters but also toddlers who are hitting or kicking or throwing major tantrums, throwing things, throwing objects, whatever the sort of bad behavior is that they do repetitively and whether that's at daycare or at home.

And the answer is this, what you do really depends on the reason that they are biting, or hitting, or kicking, or throwing, or having major meltdowns. There's several possible reasons for this behavior and you really have to kind of get a sense of what the reason is to really address it in the way that's going to work the best.

The first possible reason is just that doing those things gets a reaction. It's not necessarily seen as a good thing or a bad thing. They just enjoy seeing the result. And you can tell that this is the case because often they'll laugh in amusement at the response. 

So they hit, or bite, or kick and there's some response by the person who is being attacked and the toddler laughs. It's because they enjoy seeing the response of their action.

0:28:12

The solution there, number one, is to keep them busy. Try to prevent this from happening in the first place so that they don't have to think, "Oh, hey, I'm bored. Let's see your reaction." Keep their mind focused and busy doing something else. 

And then, react in a fun, exaggerated fashion when they are behaving appropriately. You want to reinforce good behavior and if it's reactions that they love, you can make faces, play peek-a-boo. Do something fun that really causes them to laugh. But don't do it in response to them doing something bad. Give them those reactions which they're looking for when they're doing something good to reinforce the good behavior.

It's still okay to give a firm no when they do those things, but then you don't want it to be too exaggerated. You don't want to amuse them with your response. Just a firm no and then stop and redirect the behavior to something appropriate. Get their mind on something else as quickly as you can so they forget about that bad behavior.

0:29:14 

It does take being persistent, patience, consistency, responding the same way each time with that no and the redirection.

And you probably need to partner with the parents, train them. You're a child care expert. Let the parents know, "Hey, this is how we're dealing with the situation. I want to reassure you. Mom, don't be embarrassed about this. We see a lot of toddlers who do the same things and we have found that the best thing to do is just to give it a firm no and then redirect. And to be consistent with that each and every time."

As I mentioned in the intro to this episode, you do not want to bite them back. No, don't hit them back. Don't kick them back in response because you're just modeling the behavior that you want to erase. It's not going to work. So reward a good interactions. Give them reason to behave the way that you want them to behave. 

0:30:05

That's one reason. It's just the reaction. Now, another reason that babies or toddlers may do these things -- biting, hitting, and kicking -- is that it gets them what they want. Young children are resourceful. If they have a toy and they bite another kid and they get the toy, they've learned, "Hey, If I bite, I get the toy."

One, again, prevention-wise, you want to try to redirect before physical violence occurs. Get their attention on something else if you see him going for something that another kid has and it's not time to share it. It's fairly easy on toddlers. Their attention span is so short, like, "Hey, look at this. This is really fun." 

It does take supervision. Someone has to be watching the interactions that the toddlers are doing. When there's not enough eyes on the kids, then, of course, the other child is going to get bitten. Because this toddlers don't really understand good and bad, right or wrong. They  just know that biting gets them what they want.

0:31:07

Someone has to be watching and really try to redirect, refocus before it gets to that point. 

Once the biting does occur, you still have to say no. They don't get what it is that they were after. Don't let the biting have worked but again, redirect and get them doing something else and be very persistent and consistent with that.

By the way, if they're going for something that another child has and the other child has had it for a long period of time and you catch it before the biting, hitting, kicking occurs, this may be an opportunity to teach both kids that, "Yeah, it is time now to share." The other child has had this toy long enough and so we're going to say, "Hey, it's time to share with this other one who wants it now for a little while." 

Then, the other kid gets what they were after without needing to resort to biting, kicking, or hitting. And then, you're going to have to redirect the first one who's going to be upset that they just lost the toy but quickly redirect them to a different toy, get their mind off of what they just lost, especially if they've been playing with it for a little while.

0:32:06

And so teach, and reinforce, "Hey, we're sharing. This is a sharing thing. And there may come a time when you want to play with something that the other child has had for a long time. And now, you're going to get it because we're all sharing together."

So again, it just takes a lot of patience and persistence. That's another way to go about this and dealing with it.

The third reason and this reason tends to involve more of the older toddlers. And it's just that they act out and display this kind of actions because it's a way for them to express their frustration.

Babies and toddlers have very limited means  of expressing their feelings, right? They can't do it with words. They can't make an argument about why they should be allowed to do something. 

And yet, they still have complicated emotions just like any other human beings. They may be angry about something or frustrated or anxious or disappointed and rather than responding with words or forming an argument, often they just out of frustration act out. They express themselves with actions that are sometimes violent.

0:33:12

And again, in addition to biting, hitting, kicking, this is now where you may see kids throwing objects, destroying property. And your best bet here really is to have a sense that this is what's going on, that this is a communication problem and that a child is frustrated.

And as it becomes a history of this happening, it's going to be important to try to predict when these meltdowns might occur and intervene before that happens.  So have a sense of what it is that the kids you're watching are trying to accomplish. And as they become frustrated, help them accomplish what they want to accomplish within reason or find an appropriate alternative.

And that's a great thing about toddlers. In general, you can redirect them pretty easily. But yet, it takes some insight and constant supervision to see, "Hey, this is a situation that looks like it could get frustrating for this child who has history of acting out in a violent way." And so, this is going to be a great opportunity to redirect things before it gets to that level. 

0:34:12

When it does occur and they do have the meltdown, a brief timeout usually cool things down, although there may be loud screaming and writhing at first but just be consistent with your response. These brief timeouts, we say about a minute for each year of age. Put the two- or three-year-old, two or three minutes of timeout is appropriate. Have a debriefing. Let them know you love them, but this is not appropriate behavior.

But don't spent too much time with that. Let them get running again and then really reward them for good behavior and for sharing and for handling their frustrations in a non-violent way. Just heap on the rewards and really let them know, "Hey, yeah, this is appropriate." And that often will help.

And then, when there is meltdown, look back and try to figure out where it went wrong, what could you have done to intervene earlier in a way that would have work.  Learn from that encounter and maybe try a different interventional tactic next time.

0:35:10

So hope that helps, Amanda. I mean, the biggest thing here again is just to be consistent, try to predict, try to redirect, and just lavish lots of the praise and attention when they behave in the way that you want them to  behave. And then, teach those things to the parents. Because, again, it's not always a parent's fault. They don't want their kids biting other kids at the daycare, but there's no manual. There's no training really on how to deal with these things.

And so, as a daycare provider, you can teach kids and you can do it in a way that shows you have empathy for the child and their situation. And just again, say, "This is something that we see. Your child has been doing it. This is how we're approaching it. And we hope you'll continue to do that at home." And really try to teach the parents.

0:36:00

But coming from a place of humility and respect for them as the parents is probably the way to get the best reaction from the parent and get them to buy in to the way that you are handling the situation. 

So again, hope that helps, Amanda. And of course, as always, thank you so much for writing in.

We have a question from Jen in Freemont, California. Jean says, "Dear Dr. Mike, recently, we came upon a YouTube video stating that certain cookware are more dangerous than others. The clip claims that aluminum, non-stick and ceramic coated cookware could leak toxins into food when heated. What's more, even aluminum foil could be unsafe when used to wrap hot food. On the other hand, stainless steel iron and glass cookware are considered safe to use. 

"Knowing that we can't always believe everything we see online, what is the scientific evidence on the relative safety or dangers of different types of cookware. Thank you so much. Sincerely, Jen."

Well, thanks for the question, Jen. This is a tough one. On the one hand, you want to keep your family safe. On the other hand, many of these products are convenient and beneficial and the data on a lot of these is sort of mixed. Most studies that show harm with chemicals, things like BPA and plastic, aluminum cookware, chemical coatings on pots and pans. These studies usually involved animal models and large doses of the chemical in question. 

0:37:30

We do not have studies that look at the long-term effects of small but constant exposures. We don't have those because it would be a very difficult study to design and control and get buy-in from parents who want their kids studied, who are exposed to a potentially toxic chemical in small doses over a long period of time and then see what effects it has. I mean, would you let your child be involved in such a study?

And you'd have to intentionally expose a volunteer group in a meaningful way that mimics real life long-term exposure and then control all the other exposure variables as you compare the study group to a control group. So this is a very difficult study to actually come up with. 

0:38:17

You use aluminum pans for 50 years, let's say. And these guys over here are going to be our control group and they're going to use iron pans. And we're going to ask you to take a 30-minute questionnaire on a regular basis over the course of a few decades. So we don't miss any other sources of exposure. And then, we'll see if one group has earlier onset of dementia compared to the other group. And that's the sort of thing that you would have to design.

And then, since it's a 50-year study, we're going to have to have our younger colleagues finish up the study because we're going to be old and retired ourselves. 

So this sort of thing just does not really lend itself to studying in a way that is very meaningful. But that is what you would really need to do if you're going to try to prove causation of specific outcomes because of cookware.

0:39:06

Now, having said that, it certainly make sense that this could set up a potentially dangerous situation where we know that exposure in sort of larger amounts in animal models is harmful. But there's not enough evidence to ban the sale of this item, sort of say that it's not safe. It's not enough out there.

I can tell you, it's not because cookware companies are paying people in the Food and Drug Administration who potentially could say, "Hey, this is a problem." They're not paying them off in order to keep a business model that could potentially be dangerous over several years. Everybody has folks' health at stake here. 

And we're interested in improving health at large communities. But you have to have evidence that it's really a danger in the way that we're using these products.

0:40:03

Now, having said all of that, is it possible? And would it behoove parents to use glass and stainless steel and iron instead of plastics and aluminum cookware and non-stick surfaces? Sure. I mean, you could say there is potential risk here. We don’t know for sure if there really is associated with specific bad outcomes but because it could be it's not going to hurt anything to use alternatives.

Now, does using the alternatives guarantee healthy outcomes in the future? Not necessarily. And if you don't use the alternatives and you continue to use aluminum cookware and plastics and non-stick surfaces and ceramic surfaces, are you condemned to do and gloomed down the road? Not necessarily because we just don't know.

I mean, ask any spry young-acting 90-year-old the secret of good health and longevity and they're very unlikely to say, "You know what? I avoided plastic containers, non-stick pans and aluminum foil." It's probably not what they're going to tell you.

0:41:13

Now again, that's not to make light of environmental exposures. But I think we can also overdo it really sort of in both directions. Sure, choose glass over plastic when you can. I'm not sure you have to avoid all plastic exposure all the time with all food and drink at all cost. Maybe don't heat a sandwich in aluminum foil everyday of your life but avoiding all contact with aluminum foil, that doesn't really make sense either at least with the data that we have right now in 2019.

My take-home point is this, really, everything is in moderation, right? Pay attention to the warnings. Consider the source, but take convenience and benefit into account as well. I mean, sure, food is easier to clean from a non-stick pan, but you could die next week in a car accident. Why waste time scrubbing when you could have been playing with your kids after dinner?

0:42:07

We have to consider all the decisions that we make from all angles. If danger is clear cut, that's one thing. But very often, danger is not clear cut. There's lots of gray area. And at the end of the day, we still have to live our lives with what we've got.

So, I hope that helps, Jen. I just really try to take a very practical approach to these things. In our house, we use glass containers very often to store and heat food much more than plastic containers. We have a mix of iron and non-stick pans. We use both. 

We cook campfire pies in aluminum cookware, those pie molds, from time to time because my wife's father was one of the original inventors of those. So we do have campfires here and there. We certainly don't do it on a weekly basis. It's occasional. And I'm certainly not averse to using aluminum foil here and there, but certainly not all the time. In our house, I guess, we practice caution but we remain practical as well.

0:43:07

So I hope that helps, Lyn. I know it wasn't a very scientific answer but we just really don't have good data that would support these things being safe or these things being dangerous in the way in which we use them here in the United States of America. Certainly giving large doses of aluminum to animal models is not the same thing. 

So again, thanks for the question, Lyn, and thanks so much for listening to the podcast and for contributing to the program.

[Music]

0:44:08

Dr. Mike Patrick: Next up is Becca from Marblehead, Massachusetts. Becca says, "Hi, Dr. Mike. Really enjoy your podcast. I would love to hear your thoughts on the meningitis B vaccine. Do you routinely recommend it for healthy teenagers? I understand it received a Category B recommendation from the CDC's Advisory Committee on Immunization Practices. And I have read that there is no data available on vaccine effectiveness or duration of protection against clinical disease. Thank you. Becca."

Well, Becca, you are very well informed. And I want to thank you so much for asking this question. The quick answer is yes, I definitely recommend the meningitis B vaccine especially if there is a chance a teenager is going to be living in close quarters with other young adults in the near future, such as college dormitory, for example, as that sort of living situation poses an increase threat of meningococcal disease.

So what is that? What is meningococcal disease? The meningococcus is a bacteria. And it sometimes lives in the nose and just stays dormant there. It's not really causing disease. It's just there in the nose.

0:45:21.6

However, if it becomes active, so if it goes from being dormant to actually actively dividing and invading tissue, and it gets into the bloodstream, quickly devastating disease can result. And I'm not overstating this. I mean, death is possible within hours. And it causes a really nasty disease, sepsis which is your body's response to overwhelming infection that causes low blood pressure and can result to death. 

It can lead the meningitis, something called DIC or disseminated intravascular coagulation, where you bleed all over and have problems clotting. It can cause petechiae, loss of limbs. It has a high mortality rate. It is a bad disease and it becomes very bad very quickly.

0:46:10

And by the way, so you  just say, "Why don't we just test everyone's noses and if meningococcus is there, treat it?" Well, the way antibiotic works, the organism has to be sort of dividing and active and not dormant in order for most antibiotics to work, to kill them. 

Also we can get lots of false negatives where that maybe there's just a few, just a handful of the bacteria and the test that you do does not demonstrate that they're there. Or you can also have a positive test that, "Okay, it's there." And then, we're going to give an antibiotic to try to kill it and you have a reaction to the antibiotic. And here, if you just left well enough alone, nothing ever would happen.

It's not quite that easy. And really, in fact, it's so rare that you're better off just monitoring a population. And if these sort of symptoms occur, getting treated immediately is going to be very important. And try your best to prevent it.

0:47:10

And again, because we can do so with the vaccine, that seems like it would be a good idea to have a vaccine against a disease that can be so deadly and so quickly.

Fortunately, meningococcal disease is rare even for people who have the organisms sort of dormant in their nose. But it does happen from time to time, sort of like winning the lottery. Except this is a game that you don't want to win but the chances are like that of this happening.

But we do see it every year. We hear about college students who die very quickly from meningitis and it's usually the meningococcal bacteria that causes this. Just handful of times in the United States, but it's such a big deal you hear about it. And college students are increased risk because they're in close living quarters with others. 

0:48:01 

They begin to share nose bacteria, so colonization with the meningococcal bacteria in the nose becomes more likely because you're in close contact with someone who might have it there. You may start out with one college student who has that in their nose and the next thing you know, the whole dormitory has it. And then it's more likely that one person is going to have invasive disease and have a very bad outcome.

If we can prevent that with the vaccine that will keep that organism in check and if it does invade, you have antibodies that's going to attack it right away. That's a good thing. 

Now, why is the meningitis B vaccine Category B? What does that even mean? Category A recommendation from the folks who recommend vaccines means do it. Please, get vaccinated. This is an important one for everybody.

Category B really just means think about it. It may be a very good idea for you. Talk to your doctor about it. This is vaccine that we think would be helpful but we're not going to say that everybody needs to do it because the people who are most at risk are those living in close quarters with other people especially large numbers like in a college dormitory.

0:49:17

Personally, I think it's a good idea for all teenagers and especially if you're going off to college. And because meningococcemia is a terrible disease and there really are no safety concerns with this particular vaccine other than allergic reaction to ingredients, which we can expect about one in a million doses. From a risk versus benefit, this vaccine would give teenagers way more benefit and tiny, tiny risk.

Now, effectiveness as you pointed out, that's something that's really difficult to establish. Because it's a rare disease and when a vaccine prevents something, that something does not happen, right? So, you don't have a mark to tally. It's a bit hard to keep score at what you're preventing if something doesn’t happen very often. You don't know whether it would have happen or not.

0:50:09

And because there's vaccine fatigue among parents and because people want choices and because HPV vaccine is also a big sell at the time you're trying to sell the meningitis. And by sell, I mean, talk to someone about it and convince them. I'm not saying we need to sell it to make money. Most physicians do not make a large profit off vaccines at all.

But we're trying to get people to do the HPV vaccine and the HPV vaccine impacts far more people than meningococcal disease. If we can prevent cancers and way more people get cancers that can be prevented by HPV, then end up developing meningococcal disease.

Scientist don't want to be accused of introducing vaccines for this whole purpose of selling them. We want to give some people some choice and say, "Look, the HPV vaccine is we really want you do this one. The meningococcal one is a great idea too but let's not put a category A on everything. Let's be reasonable about this."

0:51:09 

They put a Category B on the meningitis B vaccine instead of an A and I get that. But in my mind, we have something that's safe that will probably prevent a very nasty disease. I'm not afraid of vaccines, so I would do it. But that's me. And I understand if there are parents and teens who would rather try their luck without it, knowing that meningococcal disease is more of a possibility, then that's the decision that folks have to make.

For those who are interested in learning lots more about the thinking that went in to the Category B recommendation for the meningitis B vaccine, there's an article that I'm going to put a link to in the show notes for this episode, 435, over at pediacast.org called "Understanding the Category B Recommendation for Serogroup B Meningococcal Vaccine".

This is an article that really addresses everything that you want to know, Becca, and it is from the American Academy of Pediatrics. Really good reading. Maybe a little dry but if you are into science reading, I think you'll love it, especially if this is a question that is on your mind. 

0:52:16

Again, "Understanding the Category B Recommendation for Serogroup B Meningococcal Vaccine". And I will put a link to that in the show notes for this episode, 435.

Hope that helps, Becca. Thanks for listening and as always, thanks for asking your question.

Next up, we have Molly in Greenwich, Ohio. Molly says, "I have a question. Can a child with autism ever outgrow it or is this something they have for life?"

This is a terrific question, Molly. Autism is not a single disorder. We can't say everyone with autism, "This is what's going to happen." It's a large group of individual disorders that are alike but they're also different, which is why we refer to autism as a spectrum.

0:53:02

Some forms of autism tend to remain constant throughout childhood and adulthood while others present with milder symptoms that may not impact adulthood much at all. How you grow up, your environment, the counseling that your family may get, the support that you get within your family and within your family and within your school, coping skills that you learned, ways to live your life that take your autism into account and sort of change your environment to work more with your personality type with how you engage the environment, all of those things are going to play a role as to function later in life.

And we know that the earlier that we diagnose autism and support kids and families who are impacted by it, the more likely it is that we can adapt to social situations. That support will be there in the home and school that will make it more likely that an individual will be successful in social situations, in school, higher education, having families of their own, having successful careers.

0:54:15

The more that we know about something support, kind of adapt to the environment to fit in with the way a person engages their environment, the more likely it is that they're going to have success.
 
There really is a wide range of possibilities that not only depend on the underlying sort of autism that you have but also how early it's diagnosed, how supportive structures around this person are. The wide range of possibilities ranges from extremely functional to those requiring significant support even in adulthood.

Molly, I would not say that folks outgrow autism but many who are challenged by it live very satisfying lives as adults. In that sense, it may appear that they outgrow it because they are living with it and they are living with it successfully.

0:55:11

On the other hand, I do want to mention -- because I kind of set this up for this to become sort of the next question I think in a lot of people's heads -- the best support systems in the world and starting at the very young age do not guarantee a future of sort of independent living. I'm not saying that outcomes as adult are dependent upon an early diagnosis and support throughout. You can have all of that and still have problems and really need a lot of help with living independently as an adult with autism.

On the other hand, if autism doesn’t get diagnosed until later and there aren’t much in the way of supports, that's not to say that those folks will end up living a very fantastic independent life. 

0:56:01

We do the best we can. We want to try to identify autism early. We want to try to provide the best support we can at home and at school in social situations. But to some degree, what ends up in adulthood is a little bit out of our control. We can try to make it as best as we can by offering support and diagnosing it early but doesn't guarantee. And if we are able to diagnose it early and there's not much support, that also doesn't guarantee anything. Just a wide range of possibilities.

I love the organization, Autism Speaks. They are really terrific group. And if you're looking for more information about autism in general, education about it, the different forms and what the spectrum can look like, if you're looking for a community of support, it's a fabulous website that they have, Autism Speaks. And they have an entire section of their websites dedicated to supporting adults with autism. And resources include ideas on housing and community living, tips on finding a job, information for employers who are interested in hiring folks who are challenged by autism.

0:57:10

There's terrific educational materials for parents and family members and other people who wish to be supportive of folks who have autism. So lots of really good stuff there. I'll put a link in the show notes for this episode, 435, at the Autism Speaks website to their page Adults with Autism which has lots of resources there.

I hope that helps, Molly. I wouldn't say that they, because autism is not a disease like an infectious disease, right? It's a result of our genetics and the way our brain is put together and the way that we respond to our environment.

And so, you wouldn’t' really outgrow autism. It's not something that comes and then goes. Yeah, you do have it for life but that does not mean that folks with autism have a less of a life. 

0:58:05

Through support and through love, and through having an environment that is adapted for the way that your body and your brain works, folks can have a very productive enjoyable functional life as adults. And those around them may never know that they have autism. And so it would appear that they outgrow it but they have adapted so very well.

So that's the best way that I can put in. I am not a developmental and behavioral specialist, by the way. I'm a general pediatrician. This is how I think about it. Certainly, if there is an expert out there that has some other insight for the audience, I would be happy to pass that along.

Thank you, Molly, very much for the question. As always, much appreciated.

Our final question of the day comes from Alicia in Virginia. Alicia says, "I just applied for a phlebotomy program and I’m scared to death because I have not been back to school since I graduated high school in 2003. I also have a full time job working in a hospital. Do you have any advice for me? I'm going into the medical field and working a full-time job. Any advice would be very helpful. Thanks. Alicia."

0:59:20

First off, congratulations, Alicia, on your decision to become a phlebotomist. For those wondering what that entails, phlebotomists work with blood. They typically draw blood in a hospital or an outpatient setting. And they have to know how to enter a vein safely and collect the blood in a sterile manner. 

They need to know how much blood is needed, which tubes the blood goes in because they're not all the same and the knowledge regarding safe transportation of the blood samples to the lab. Some blood has to be run right away. Some samples can wait. Some need to be transported on ice. Room temperature's fine for others.

1:00:00

They need to develop technical skills in terms of drawing blood and acquire lots of new knowledge which is why there are training programs for phlebotomy jobs.

Now, in terms of advice, and by the way, before we get to the solicited advice portion of my answer, I just want to say phlebotomists also tend to be people person. The phlebotomist has an opportunity to engage and talk to patients. It's always great to distract folks when you're drawing blood. You're doing something that is stressful. And so being a people person is very helpful for phlebotomist because you get a chance to just chat with people and talk about any number of things and try to put them at ease.

So you get to meet a lot of people. You're going to work in a hospital, so folks who are phlebotomists, in my experience, are typically very friendly, engaging folks and very important in the healthcare setting.

1:01:04

In terms of advice for going to school and working full time in a hospital, the advice that comes to mind is this. And it's work hard to do a good job because you're going to put in a lot of hours. You're going to put in a lot of hours in your schooling. You're going to put a lot of hours into your full-time job. 

So this is going to be very consuming for the amount of time that you have to do phlebotomy school. But you want to work hard and you want to work hard both in your job and continuing to do a good job there but also to do a good job in school.

Now, some programs lend themselves to that sort of setup better than others. If you have a phlebotomy program that is used to working with folks who have full-time jobs, they're usually more accommodating. You do, to some degree, want to match the way the program is designed with your full-time job.

1:02:04

One benefit is oftentimes, if you work on a hospital setting, that full-time job may give you a discount on your school. Or they may pay for your school or guarantee you a job after you're done schooling. Just depends on the hospital that you're working for and what the benefits are. 

So working a full-time job and going to school, definitely possible, but you're going to have to work hard to do it.

But then, here's where my advice comes in. Work hard but then give yourself an opportunity to play hard when you can. Seek balance. Work hard at your job, study but then give yourself even if it's just 30 minutes a day to do what you want to do. If you can make an hour a day, hey, terrific. But try to give a little bit of time in there. Save some time to do what you want to do. Try to take at least one day a week for yourself if you can.

If you can only fit in one day every couple of weeks, knock yourself out on that day. Go shopping, go bowling with friends. Those may not be interest to you but you get the point. Do something that you find fun. I'm not saying you have to go bowling but something that just you really enjoy, do it. Work really hard but then play hard when you have the opportunity.

1:03:22

For me, after working really hard during a flu season. And I can easily work 50 hours in a week for weeks on end between producing podcasts and teaching healthcare communications and practicing clinical medicine, it doesn't leave a lot of free time. But when I have free time, I sure do make the most of it, which is why our family travels to see Mickey Mouse either in Florida or California on a fairly regular basis. For me, visiting Disney World is the playing hard part of work hard, play hard. 

That may not be true for you at all. Maybe playing hard for you is visiting Vegas or Nashville for the weekend. Maybe it's hiking through a Metro Park or a National Park or the Appalachian Trail. Maybe it's feet up with a fabulous book in your hand.

1:04:06

Whatever it is, don't just dream it, do it. Play hard, or work hard and then play hard. But make sure though that you're showing up to work on time and getting good grades. That's it. That's the Dr. Mike philosophy of living. Work hard, do a good job, put in the hours, learn what you need to learn, and then relax. And play hard and just completely disconnect and just have some fun with your friends and family.

That's my advice and I really do thank you for the question, Alicia. Good luck with your studies.

[Music]

1:05:07

Dr. Mike Patrick: We are back with just enough time to say thanks once again to all of you for taking time out of your day and making PediaCast a part of it. We really do appreciate that.

We answered a lot of listener questions over the course of this episode. And I want to thank all of you who contributed and wrote in. We had lots of great topics this week.

Don't forget, if you would like to contribute, if you have a question that you would like to ask or you want to suggest a show topic, easy thing to do. Just head over to pediacast.org, click on the Contact link and ask away. I do read each and every one of those that come through and we'll try to get your question or your topic suggestion incorporated into the program if we can.

We also have a Skype line at 347-404-KIDS. That's 347-404-K-I-D-S. If you just want the digits, it's 347-404-5437. If you call, you can leave a message that way too, if you want to ask your question and we'll play the audio of your question on the show.

1:06:08

Thanks to all of you. We have lots and lots of links in the show notes for you this week which you can find over at pediacast.org. Just look for the Show Notes for Episode 435. This includes a link to the episode we talked about first thing on this edition of the podcast. We talked about anesthesia and kids and PediaCast 428 called "Anesthesia, Naps, Deaths and Funerals".

That was our last episode that just had exclusive answers to listener questions. And I'll put a link to that in the show notes. You can find it easily if you want to hear more about that.

Also, traveling safety tips with kids, flying with babies, car seat information for families, the car seat checkup and baby on board, keeping safe on a bike. All  of those from the American Academy of Pediatrics and their site healthychildren.org. And we'll put links to all those things in the show notes. 

1:07:03

And then, "Understanding the Category B Recommendation for Serogroup B Meningococcal Vaccine" also from the AAP. We'll put a link to that in the show notes, and then Autism Speaks and their site Adults with Autism. You will find all of those links in the show notes for Episode 435 over at pediacast.org.

Don't forget you can find us in all sorts of places. We are on Apple podcast app, iTunes, Google Play, Google Podcasts, iHeartRadio, Spotify, SoundCloud, Castbox, most mobile podcast apps.

If there is a place where you get all your other podcasts and PediaCast is not there, please use the Contact page to let me know and we'll do our best to get our programs added to their line-up as well.

And, of course, there is the landing site which you'll find at pediacast.org. We have our entire archive, 435 episodes for you there. Also all of our show notes, all the links we talked about, resources, references, our transcripts of some of the programs so you can read through the content if you don't want to listen. We don't have that for all of the episodes but we do have transcripts for several of them.

1:08:08

Our Terms of Use Agreement is located at the landing site and, of course, that Contact page to ask questions and suggest topics for the program. Again, that's at pediacast.org.

Your reviews are always helpful wherever you listen. Everything that our family does it seems, we read reviews first because there's so many options and choices whether it's listening to a podcast, choosing a television program to watch, going to a movie, eating dinner out, going to a vacation spot, buying products, having services or service folks coming to your house to work on something. Reviews are helpful.

And so, we don't charge anything for PediaCast but if you find it useful, please do consider taking couple minutes out of your day and leaving us a review. We'd really appreciate that.

We also love connecting with you on social media. Facebook, Twitter, LinkedIn are the places where we provide not only announcements for the program, letting you know what we're talking about each week. But we really try to put some useful material into the hands of parents as you think about taking care of your kids from a health perspective, in terms of parenting, in terms of what pediatric news is going on out there to what's happening in the news that affect kids -- whether they're your kids or someone else's kids or kids from another country like the migrant children and the conditions that we're seeing, hearing about in terms of care at the border.

1:09:34

So those are the kind of things, stuff that would be of interest to parents that we try to share with you in addition to the podcast itself on Facebook, Twitter, and LinkedIn.

We're also on Instagram. There, it's a little more personal, what's going on with the family, what are we doing today or this week, what do we have for dinner, what movies do we see and where we go on vacation. Just sharing family pictures. I love connecting with listeners there and seeing what you're up to as well. 

Just search for PediaCast and again Facebook, Twitter, LinkedIn, and Instagram. 

1:10:03

We also appreciate it when you tell others about the program, your family, friends, neighbors, co-workers, babysitters, daycare workers, folks who are dealing with those biting, kicking, hitting, throwing things, toddlers. Let them know about the program. It can be helpful for them. 

And that includes, by the way, your child's pediatric healthcare provider.  Please let them know about PediaCast so they can share the show with their other patients and families. And while you have their ear, let them know we have a podcast for them as well. It's called PediaCast CME. That stands for Continuing Medical Education. 

It's similar to this program. We turn up the science a couple notches. We offer free Category 1 Continuing Medical Education for those who listen. And the shows and details are available at the landing site for that program, which is pediacastcme.org.

Those programs are also in Apple Podcast, iTunes, Google Play, iHeartRadio, Spotify, most mobile podcast apps, wherever podcasts are found. Simply search for PediaCast CME. 

1:11:05

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, everybody.

[Music]

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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