Colds and Flu, TV and Exercise, Suicide Prevention – PediaCast 448

Show Notes


  • It’s cold and flu season! We explore these common viral infections, including the cause, symptoms, treatment and prevention. Less TV time and more exercise are important for families… we explain why. And learn about an intensive crisis intervention that aims to prevent teen suicide.


  • Common Cold
  • Influenza (Flu)
  • TV Watching
  • After-School Exercise
  • Teen Suicide Prevention



Announcer 1: This is PediaCast.


Announcer 1: 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 448 for January 8th, 2020. We're calling this one "Colds versus Flu, TV and Exercise, and Suicide Prevention." I want to welcome all of you to the program. 


Also, welcome to 2020. It is a brand new year and we've been away for a few weeks. As is typical during the holiday season, we took a family vacation down to Florida with my wife and my two young adult children, also my son-in-law, and had a wonderful time enjoying the warm weather in our old stomping grounds of Central Florida.

And then, we flew back up to Ohio just in time for Christmas and the cold weather. Which is much as we love visiting Florida -- and, of course, we still live there and so, it's like home in both Ohio and in Florida -- but when it comes to Christmas time, the cold weather and a little bit of snow still on the ground -- although it melted fairly quickly, definitely cooler than Florida was -- it's good to be back up here. At least until we hit about March or April, then I'll be ready for warm weather again, maybe before that.

Also, as I reflect on a previous New Years on PediaCast -- because we've had several of them -- l remember making a point each and every January to welcome all of our new podcast listeners because the audience always grew this time of year. 


Why? Because people are getting electronic devices around the holidays for the very first time and having a convenient way to unplug from the computer and listen to podcasts on the go. I mean, that was a new thing. You know, there were these newfangled devices like iPads and then iPhones and Android devices.

The good all days, right, when we were just beginning to get connected to mobile electronic devices and being connected was not necessarily all consuming like it can be today. So, there probably are not many of you out there discovering podcasts or PediaCast for the very first time at the beginning of this new year. 


However, if by chance you are new to podcasting or you have recently discovered PediaCast, welcome to our little corner of the podcasting world. We are certainly happy to have you with us. 

And if you're interested in a little background on the program -- how we got started, why this project to inform moms and dads and improve the health of children and families everywhere, why is this podcast important to us here at Nationwide Children's -- sort of a peak into our passion, if you want to know more about that, just head over to show notes page over at for this episode, again 448, and check out the link. It's called City of Pod: Dr. Mike Patrick, the Pediatric Pioneer. 

And it's an article in the Columbus Monthly which is one of local magazines. And my goal here honestly is not to toot my own horn, really. I just want to share the story of our journey. Because you as a listener are part of the story that begin 14 years ago now. 


And this nice article again in Columbus Monthly does a nice job of summing up who we are, what we do here on PediaCast. You can read the online version of the write-up and discover how we got started by following the link in the show notes.

All right, I hope all of you also had a wonderful time with your family and friends over the holiday season. It is back to business now after the break. 

And we're hitting the 2020 road running with lots of information for you this week, beginning with the difference between the common cold and influenza. It's that time of year, right? Cold and flu season. 

We wrapped up 2019 with an episode on fever and illness followed by croup and bronchiolitis, which are always heavy hitters this time of year. But croup kind of stayed late and bronchiolitis hit early, so we're really busy with both of those.

And just like in the blink of an eye, we switched over from lots of croup and bronchiolitis to influenza. So, we're going to talk about that today and along with colds, the common cold virus. We'll talk about the cause of each of these signs and symptoms treatment complications, when to worry, how can you prevent them. 

So that you will be prepared when colds and flu arrive in your community, if they're not there yet. The truth be told, they probably have already arrived like here. But we do want you to be ready.

Then, we're going to talk about TV watching and after school exercise as we cover some news parents can use. Now is the time to make a new year's resolution for the entire family and a really terrific resolution for every member of your family would be less screen time, more exercise, and healthy eating.

We all know this is true but we also know it's easier said than done. And I'm just as guilty of this myself. It requires motivation. So, I'm including some evidence-based news items that I hope will encourage all of us, and including myself, to make healthy changes as we cross the starting line and head into 2020.


And then, finally, we're going to talk about suicide prevention as we consider a model program here at Nationwide Children's Hospital called Intensive Crisis Intervention. And I'll explain exactly what that is and why it matters a bit later on in the program. 

Don't forget, you can find PediaCast in all sorts of places, really wherever podcasts are found, in the Apple Podcast app, Google Play, iHeart Radio, Spotify, SoundCloud, and most mobile podcast apps for iOS and Android. 

Reviews are helpful wherever you listen to podcast. We always appreciate when you take a moment to share your thoughts about the program.

And we love connected with you on social media. You'll find us on Facebook, Twitter, LinkedIn and Instagram, simply search for PediaCast.

Also, if you would like to suggest a topic for the show, you have a question for me, you want to point me in the direction of a new story, perhaps, that relates to pediatrics and hear my comments, it's an easy thing to do. Just head over to and click on the Contact link.


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

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

So let's take a quick break. And then we will be back to talk about colds, the flu, TV, exercise, and suicide prevention. That's all coming your way right after this.



Dr. Mike Patrick: So we're going to talk about colds and flu, and there's a lot of colds and flu that go around this time of the year. And it's important to distinguish the two, so you know sort of what to expect, how things are treated. In many ways, they are treated the same way, but there are some slight differences and then how do you prevent these things, and what complications do you watch out for. 

So let's talk about this. Let's consider colds first. Typically, colds are going to be caused by the common cold virus, also known as rhinovirus. Other enteroviruses can also cause colds. There's some other fancier ones -- coronavirus, adenovirus, human metapneumovirus. Lots of them that can do this.

And in fact, there's over 200 strains of various viruses than can cause the common cold. And that's the reason that you get so many of them each year. When you have one, you do get some protection from your immune system for when that particular strain comes along. 


But in particular, the cold virus is really good. It's sort of mutating and changing itself in small ways to evade the immune system. And so, that's why we get colds so often.

As we mentioned in a previous episode, croup is caused mostly by the parainfluenza virus and bronchiolitis in young babies, often caused by respiratory syncytial virus. And both of those can also cause common cold-like symptoms, especially in older kids and in adults. Lots of different causes for the common cold. 

The flu on the other hand is really caused by a much smaller number of very specific viruses. Those will be the influenza A virus, and there are a few different strains of that one, and the influenza B virus and all of those sort of subsets of these viruses, just like the cold viruses. 

Really depend on the proteins on the outer layer of the virus. That's where your immune system is attacking. So when it recognizes specific proteins on the surface of the flu virus, then it's going to be good at getting rid of that virus for you. 


And if they're proteins that your body has not seen before or you've not have a flu shot against, it's going to take a little longer for your immune system to sort of kick in and you're going to be sicker, longer, with bigger chance of complications. 

So, if it's a strain of flu that you've seen before, you're going to have some good protection against it. Or if you had a flu vaccine, which we'll talk about in more detail later, then that's also going to give you a lot of great protection against the flu in a particular year. 

We don't have a shot for the common cold. Although, there are scientists trying to develop one of those, but we do have a flu vaccine and I would encourage everyone to take advantage of that. Even though we are sort of getting into the deeper stages of flu season right now, you can expect it to last several more weeks or months. 


So if you haven't had your flu vaccine, or even if last week, you had the flu and you're feeling better, get your flu shot because there will be likely more strains of flu coming later in the winter and into early spring. And that will offer you some protection against those. 

Now, in terms of signs and symptoms, colds and flu have a lot of similarities and they also have some differences. If you look at the onset of symptoms, colds are usually more gradual onset where flu is very sudden onset. 

Often, fever's with the flu. And a sudden onset of a high fever is very typical with the flu. Whereas the cold, you can get fever with the cold, especially in the first 24 hours or so of the cold. But, typically, it's not as sudden of a really high fever like you get with the flu, but it can be there. 


Also, with the flu, along with that high fever comes aches and chills because your body is feeling cold. You shiver, you put on blankets as your body is trying to increase your fever. We talked about how that happens also in a previous episode at the end of 2019, where we talked about fever specifically.

But with the flu, because of that sudden onset of high fever, you're much more likely to have the body aches, the muscle aches, the chills, the fatigue, and weakness, all common with that. You can also get those things with the cold, but it's usually to a milder degree. 

Stuffy nose is common with both of them. Although, typically with the cold, you're going to have even more a stuffy nose, more mild congestion with the flu. But you can't use that as a differentiating factor. It's a sudden onset of high fever that really is the biggie that helps us tell the difference between the two.


By the way, the stuffy nose can be clear, it can be yellow, it can be green. The color does not really matter, just let you know that your immune system is at work and whether it is fighting viruses or bacteria, it doesn't really matter. It can be any of those colors. 

Sore throat is common with both the cold and the flu. So you may see a little bit of a sore throat, probably a little more severe with the flu compared to the cold. But again, you cannot use the absence or presence or severity of the sore throat to tell you the difference between the two. 

Cough is common with both of them. Again, probably more so with the cold a little bit because there's so much mucus and your body was trying to keep that mucus out of the lungs, and you get that tickle in the back of your throat. But especially if you have a tendency towards asthma, you may get a bad reactive or spasmodic cough associated with the flu, so you can see cough with both of them. 


Headaches sometimes occur. Vomiting, it seems like this flu season... I know this is what doctors would call anecdotal because I don't really have number, it's just my own personal experience, but it seems like I've seen a lot more folks vomiting with the flu this season compared to past season. 

So you can have some vomiting sometimes. A lot of times, when folks have vomiting and diarrhea, they'll say they have the stomach flu, that's not really the flu. But you can have some vomiting, sometimes some loose stool. Usually not like really watery diarrhea. But a little vomiting and diarrhea can be part of the flu.

And it can occur with colds with, too, although I think less often. Unless the colds are caused by some specific enteroviruses which can cause more profound vomiting and diarrhea than even the flu would. And have runny nose and congestion and cough along with it as those enteroviruses infect both the respiratory tract but can also infect the gastrointestinal tract. 

So there's a lot of nuance here. I think the biggest thing is that sudden onset of high fever with a little runny nose and congestion. When we know flu is in the area, that is most likely to be the flu.


But you do have to look at the big picture and consider all the data points. And when in doubt, talk to your healthcare provider because they're going to be experienced to really be able to piece together what that big picture looks like and sort of guide you on is this the cold or is this the flu, if you are not sure. 

Now, in terms of treatment for colds and flu, for the cold, there's really nothing that you can do other than supportive care. And by that we mean plenty of rests, lots of fluids to keep yourself from getting dehydrated, treating the fevers, the chills, the aches, the headaches, the sore throats with acetaminophen or ibuprofen. And if you're unsure of doses, make sure you call your child's healthcare provider and get those proper doses. 

You can look at the label for most kids. But if your child is exceptionally small for their age or exceptionally large for their age, then a weight based dosing is going to be more appropriate. So you may need to reach out to your provider for that.


Also, in young babies who have fever, just call your doctor. Because there's so many different things that can be and you don't want to mistake a significant fever for one that's just caused by a cold. 

Then, of course, the other components, I should also mention less than six months of age, we'd use Tylenol or acetaminophen only. No ibuprofen less than six months of age. And again, any fever in babies less than four months age, just touch base with your doctor. And even between four and six months, if you're concerned call your doctor.

And then, humidifier, in the winter time when these viruses go around, typically the inside of the house, the air is dry as our furnaces kick on and dry out that air. So humidifier in the bedroom may help. You want to use... And I don't think there are very many old humidifiers out there, that really heat that water up high, but those can be burning and scalding hazards. So you're going to want a cool mist humidifier or a modern warm humidifier that sort of has a regulator on how hot that water can become. 


And then, lots of blow in the nose. If they're too young to blow, then suck out the snot in nasal saline, non-medicated, just salt water that's commercially available in a spray or drop form. Usually, that can help loosen up the mucus and make it a little bit easier to blow the nose or to suck the nose out.

And as we've mentioned, in previous episodes, those human-powered nose suckers, one of the brand names is NoseFrida, where you put the little tube inside your child's nose. There's a filter in line and then you take the other end of the tube, put it in your mouth, and you suck. 

Those work wonders in terms of clearing out the nose and the mucus, especially for those young babies who are, again, obligate nose breathers. They don't really know how to transition to breathing through their mouth when their nose gets really stuffy. And they will just struggle and work hard to breathe through all that mucus. And so, you really got to get that cleared out so that they don't have difficulty breathing. 

And then, over the age of 12 months, honey can be helpful in terms of coding the back of the throat and helping to take that tickle away, which is causing the cough that's associated with colds and flu. 


But again, less than 12 months of age, there is the risk of botulism with honey. So you want to avoid that in babies. 

Cough and cold medicine, for the most part, they make you drowsy and they help you sleep, which it seems like it might be a good thing, but they can also decrease your breathing, your respiratory rate. They can diminish that, especially if they're given in too high doses or too often. 

And you don't necessarily want to suppress a cough completely because that cough is doing a job. It's protecting your airway. It's keeping mucus and mouth bacteria from getting down into the lungs and causing a pneumonia. So cough is your body's way of healing even when it lingers for a little while. 

So we don't like to use cough and cold medicines especially in young kids. Once you get to be older school-aged, teenagers and into adulthood, there may be a role for some cough and cold medicine. But really, talk to your child's doctor or your doctor about the use of those agents. And definitely, younger than school-aged kids just would not use them because the risk simply outweigh any benefit that you're going to get from those.


So sort of the supportive care that I'm talking about, that's really going to be good for both colds and flu. Now, when we're talking about real flu, which either can be diagnosed clinically when there's lot of flu in your community, if it seems like the flu, sudden onset, high fever with that runny and congestion, little mild runny nose and you just feel achy, it's probably the flu. 

Or you can have a flu test, which are always the best tests. When they come back positive, you know it's the flu. But there's a pretty high false negative rate, meaning there's going to be a lot of folks who test negative for the flu on those rapid tests who really do still have the flu.


There are antiviral medications that can be given, probably the most popular of those that's used goes by the brand name of Tamiflu. There's another single dose one, Xofluza I believe is the name that is just coming out and is only approved for 12 years of age and older. More to come on that one in future flu seasons as we know more about it.

But those antiviral medications, it's not quite like an antibiotic. So antibiotics, you pick the right one, match it up with the right bacteria and you have a pretty good clue that that's going to work for you. The antiviral medications are a little more finicky. Sometime, they work, sometimes they don't. 

They're most likely to work if they started soon, like within the first 24 to 48 hours. And probably even more like 24 to 36 hours. So right at the beginning of that sudden onset of high fever, that's when it's most likely going to help. Once you get out past a couple of days, those antiviral medicines are much less likely to help with the flu. 


But that's not a 100% thing. Your case may vary. And especially when you're in a higher risk of complications from the flu -- and we'll talk about what those complications are in the moment -- but that's going to be kids who are under two, maybe under five. Two to fives kind of gray zone in terms of your complication risk and how severe the flu may be for you. 

And, of course, those with chronic illness, if you have asthma, diabetes, heart disease, immunosuppression, if you are on cancer drugs or you have an immune system problem that's been diagnosed, then even for those high complication risk folks, then using an antiviral like that Tamiflu, it may be helpful. 

And maybe even if it's after 48 hours, just sort of depending on the situation. And that's why you really just want to talk to your medical provider about that, especially early on in the course of what you think might be the flu. And especially if your child has a high risk for complications from the flu -- again, young age, especially under two years of age, or asthma, chronic disease, immunosuppression. 


In terms of those complications, what exactly are we talking about? The biggest one that we worry about really is pneumonia. And when your body is fighting off a virus, and you got all this mucus and they're invading the cells of the line of the respiratory tract, the virus itself can cause pneumonia. And you can also get mouth bacteria, just normal bacteria that you can't get rid of migrating down into the lungs and causing a pneumonia.

So when you have any difficulty breathing, wheezing, just a worsening cough that may be interfering with breathing, you definitely want to have your child seen. If you have a fever that's lasting more than three days or so, then you would want to have them seen.  


Prolonged fever with the flu could mean that it's kind of transitioning from flu to a pneumonia. Or if that fever goes away and then it comes back, that can also be a sign that there's a secondary infection that's complicating things like pneumonia. 

Also, ear infections and sinus infections can occur. Ear infections more in the littler kids, sinus infections in the teens and adults, although anyone can get either of those.  And then, if you have a bacterial infection and the ears, pneumonia down in the lungs, sinuses, the bacteria can potentially turn into a blood infection, sepsis. Meningitis is possible.

So all of these things, if you have a prolonged course, you're worried, have someone take a look and make sure that it's not progressing to something more serious, especially when it's the flu. 

Dehydration is possible. Kids typically don't eat or drink as well when they're not feeling good. And vomiting and diarrhea can be associated with the flu at times, and so dehydration is always a concern. That's why we say keep pushing all those clear liquids. 


And then, urinary tract infections, especially in girls. Girls have very short urethras and so it's easy for skin bacteria to migrate up into the bladder. You're usually protected against that just by the act of peeing. You eliminate urine from the bladder, you eliminate the bacteria with the urine so that prevents urinary tract infection from setting in. 

But if you're not drinking very well because you don't feel well because of the cold or the flu, and you're not drinking as much, so you're not urinating as much, then you can have sort of lower level of urine that just sits in the bladder. You don't feel like you got to go, the bladder's not stretching. So you hold it, you just don't go, and you have this residual of urine, and the bacteria in there can start to grow.


So it's not uncommon to see urinary tract infections kind of on the heels of the cold or flu especially in girls. So again, when you have that prolonged fever or recurrence of fever or abdominal pain or vomiting that's sort of out character for what it had been, then you might want to get the urine checked out. 

Again, all of these complications are more common with the flu compared to colds, which again why it's important to differentiate between the two and know what to be on the lookout for. 

So when do you worry? Really, with both of these, anytime that your parent radar goes off. You're like, should we go see a doctor? Should we call someone? Don't second guess yourself. 

If that crosses your mind, call your doctor. Take your child and have him seen. And if we say, "Hey, it's just a cold," no harm done. But at least, you have peace of mind. And so, I always say, if you are worried, call or see someone. That's going to be important. 

In particular, kids that you think may have the flu who are under two years of age, have them seen sooner rather than later. Same with those who of any age, who have a chronic illness like asthma, diabetes, heart disease, any problems with their immune system or cancer therapy. 


Prolonged fever that's lasting more than two or three days, again, return of fever after that fever seemed to have resolved, any worsening cough, coughing a bunch of times in a row that's sort of taking your breath away, coughing to the point of vomiting. Especially when we see a lot of that, we worry about whooping cough or pertussis, which we used to not see so much because of routine childhood vaccines. But with some folks not getting their kids vaccinated, we are seeing a little rise in pertussis as well. 

And any difficulty breathing or wheezing, again, anything that sets off your parent radar, take your child in. 

In terms of prevention for the flu, that yearly flu shot is really important for kids who are six months of age and older. Again, it's not too late to get one. Even if you had the flu last week, get your flu shot. There are going to be more strains of flu that come to your community and you want to be protected. So that you aren't one of those who has a complication from the flu.


I tell you, I used to have of a different look at this. When I was a young doctor, I thought, "Well, okay, fine, I'll get the flu. I'm healthy, I've got a good immune system. And then, when I'm an older doctor, I've had all of these flus and have good natural immunity." I'm sure there are other folks out there who thought the same thing. This is 20 years ago. 

And then one year, I didn't have my flu shot and I got the flu. And I got the flu badly, I was really sick for a week. And then, I got pneumonia from the flu. And I was sick for another week after that with the pneumonia. And I've had a yearly flu vaccine every year since then. That's been many, many, many years ago. 

But my point is, it's really true stuff here. The flu shot can... If it doesn't, even if it doesn't prevent the flu, you're much less likely to have prolonged flu with high fever and severe symptoms for a long time, and much less likely to get complications like pneumonia, much less likely to end up in the hospital with your flu/slash pneumonia, and much less likely to die from the flu. So these yearly flu shots really are important. 


And then, also, stay home when you're sick with the fever. Don't send your kids to school. Make sure that babies and those with high risk of complications, kids less than two, all kids if you have high risk and complications kind of stay away from sick people as much as possible. And that may mean, especially with those young babies, avoid the doctor's office waiting room if you can. 

If you do for the well checkup, hopefully, your doctor has maybe a separate waiting area and they get you right back and get you out. But if your child is two to five, it's a yearly well checkup, maybe wait till after the flu is not in abundance anymore before you head to the office if your child is otherwise well and doing good and not due for immunizations or something. Talk to your doctor about that. 


Also, teach your kids to cover their coughs and sneezes. Inside of the elbow works great. Frequent handwashing, really important, either with the alcohol-based hand sanitizer or soap and water for 20 seconds. Sing the ABC song slowly and that will get you to 20 seconds. And do that often, and especially, after going to the bathroom, before eating, if you've been coughing and rubbing your nose a lot. 

Teach your kids to keep their hands away from their face, too. All important things to help prevent colds and flu.

If you're interested learning more in-depth information even than I covered here on influenza and flu shots, be sure to check out PediaCast Episode 443. That was with Dr. Fatima Dawood. She's a pediatrician and medical epidemiologist with the Influenza Division of the CDC or Centers for Disease Control and Prevention, really a smart person when it comes to thinking about influenza and flu shots.


Again. that was an interview in Episode 443. I'll put a link to that in the show notes for this episode 448 over at


Dr. Mike Patrick: If you're looking for a new year's resolution, one that will impact the entire family as we ring in 2020, you cannot go wrong with watching less TV and exercising more. 


A team that was lead by the Barcelona Institute for Global Health has carried out a study to identify lifestyle habits that influence the risk of overweight and obesity in children. Of the behaviors analyzed in the study, television watching had the strongest associating with overweight and obesity.

The study, published in the journal Pediatric Obesity, was based on data from 1,480 children from Spain who were previously enrolled in the Environment and Childhood Project, which is a Spanish research network that primarily studies the role of pollutants during pregnancy and their effects on children after they are born and while they are growing. 

The researchers analyzed five lifestyle habits of these children -- physical activity, sleep time, television time, plant-based food consumption and ultra-processed food consumption. Parents were asked to complete various questionnaires on the child's lifestyle habits at four years of age. To calculate the health impact of these habits, researchers measured the child's body mass index, waist circumference and blood pressure at four and seven years of age.


Dr. Martine Vrijheid, co-leader of the study and researcher with the Barcelona group, says, "Most research to date has focused on the impact of individual lifestyle behaviors rather than cumulative effects. However, it is well known that unhealthy behaviors tend to overlap and interrelate. Our aim in this study was to examine the whole set of lifestyle behaviors associated with overweight and obesity, which will help us develop future interventions capable of targeting these determinants of obesity, from a broader perspective." 

So what did the researchers find? Well, children who are less active and spent more time in front of the television at four years of age were at a greater risk of being affected by overweight, obesity, and metabolic syndrome at seven years of age. 

Researchers also measured the time spent by the children on other sedentary activities, such as reading, drawing and doing puzzles. However, these activities did not appear to be associated with overweight or obesity.


Dr. Dora Romaguera, another co-leader of the study, says, "When children watch television, they see a huge number of advertisements for unhealthy food. And this may encourage them to consume these products." Ultra-processed foods, such as pastries, sweet beverages and refined-grain products, are high in sugar, salt and saturated fat and low in nutritional value. The study went on to show that high intake of these products at four years of age was indeed associated with a higher body mass index at seven years of age.

Silvia Fernandez, a post-doctoral researcher with the Barcelona group adds television viewing discourages physical activity and interrupts sleep time. Adequate sleep time in early childhood is essential for weight control later in childhood. Previous studies have shown that 45% of children are not sleeping the recommended number of hours per night, which is worrying because shorter sleep time also tends to be associated with obesity.


Dr. Rowaedh Bawaked, researcher with the Hospital del Mar Medical Research Institute and another lead author of the study, says, "Identifying habits linked to overweight and obesity in the early stages of life can help us define preventive strategies against other conditions, such as cardiovascular and metabolic diseases during adulthood."

The study concluded that adult health depends on the establishment of healthy lifestyle habits during childhood, including less television time, more sleep, eating lots of vegetables, avoiding ultra-processed foods and getting more exercise. All of which can be incorporated into your family's new year's resolution plan. 

Now, speaking of exercise, eight months of daily after-school physical activity in previously inactive 8- to 11-year-olds with obesity and overweight improve key measures of their cardiovascular health such as good cholesterol levels, aerobic fitness, and percentage of their body fat. But it did not improve other measures like blood pressure, insulin resistance, and arterial stiffness. More on that in a moment. 


All of these is according to researchers at the Medical College of Georgia and published in the International Journal of Obesity.

Researchers examined two groups of children, those who exercise daily after school and those who did not. The exercise group experienced twice the improvement in fitness measures and body fat levels compared to the non-daily exercising control group.

Dr. Catherine Davis, clinical psychologist with the Georgia Prevention Institute and corresponding author of the paper says the kids who exercise could do more, breathe better, their heart rates were lower when they were pushing themselves, which is another key measure of fitness. 


The active children also experienced an increase in the protective HDL cholesterol levels, the good cholesterol, a full five milligrams per deciliter which likely resulted from sustained months of physical activity. 

The children who exercised did not lose weight or reduce their body mass index or their waist size, but Dr. Davis says that's okay because with exercise, growing children are replacing fat with muscle, which is a healthy response. 

And muscles, it turns out weighs more than fat does. So when you replace fat with muscle, you may not lose weight but you are going to be healthier. 

She notes that focusing on weight loss is often not the right goal for children because they are growing and, in fact, may ultimately grow into their weight. 

She adds reducing sugar and processed foods in favor of fresh, home-cooked meals is good for children, but weight-loss diets are not necessarily helpful because children need plenty of nutrients to grow. As an example, children in the study grew about two inches during the school year.


Gradual reductions in body fat, like that experienced by the children who exercised, is more beneficial. Dr. Davis says, "They should be growing. With exercise, you can allow their body to develop in a more healthy way." 

The researchers say that healthy diet and exercise together might be a more effective way to address arterial stiffness before it happens, which is important, because prevention is always the best strategy.

One hundred and seventy-five boys and girls participated in the study. Most were black, three quarters had obesity, and a majority had pre-diabetes, meaning their glucose levels or the blood sugar levels were already higher than normal, probably due to insulin resistance, which is  a major risk factor for diabetes. Three percent had early signs of high blood pressure and 5% were diagnosed with hypertension or high blood pressure.


All the children came to the Georgia Prevention Institute each afternoon. Both groups did homework for about a half hour, had a healthy snack, but no specific nutrition education. And they got redeemable points for good behavior like playing well with others, keeping their heart rates up in the exercise class, or putting away their supplies in the non-exercising group. 

Those in the exercise group participated in instructor-led aerobic activities like jumping rope and playing tag for 40 minutes every day and wore heart rate monitors. So both they and the investigators could see how their pulse responded to the exercise. The non-exercising control group also participated in instructor-led activities, but sit-down ones like crafts, music and board games.

Dr. Davis says, "We were looking at cardiovascular health comprehensively but the focus was actually on arterial stiffness or how stiff are the big blood vessels that supply the body." 


Now, this was important to investigators because the impact of exercise on arterial stiffness which can then go along with high blood pressure and hypertension has not been well studied. 

Investigators measured other cardiovascular health indicators before and after the study, including blood pressure, insulin resistance, and blood levels of glucose or sugar. Also lipids and inflammatory or inflammation markers as well as arterial stiffness. 

Now, none of these were affected by exercise. The authors were surprised find an increasing insulin resistance or pre-diabetes was the most closely associated with arterial stiffness, more so than blood pressure, which is thought to be the main cause of arterial stiffness. 

And then, arterial stiffness results in increasing blood pressure. So blood pressure leads to arterial stiffness which can further increase blood pressure, kind of a loop there with one affecting the other around and around we go. 


Also, reducing insulin resistance then might be the best strategy to prevent arterial stiffness in children, which should in turn prevent the high blood pressure. So if it all starts with insulin resistance and pre-diabetes and then that leading to arterial stiffness, which leads to the hypertension which leads to more arterial stiffness. Then, really, the cutoff point would be preventing insulin resistance or pre-diabetes in the first place and that can be done with diet and exercise. 

At the start, investigators thought exercise might improve arterial stiffness and high blood pressure, but that did not prove true. 

However, over time, the blood vessel stiffness in children who exercised held steady, while arterial stiffness in the children who did not exercise trended upward. So in other words, you may be able to prevent progression of arterial stiffness through exercise but may not be able to reverse the process.


So again, while exercise was not associated with improved blood vessel stiffness, it was associated with a smaller progression of that stiffness that was already there. 

In a follow-up assessment of the children eight to ten months after the study, investigators found improvement in fitness and levels of body fat gained by the children in the exercise group were lost. So you got to keep it up, just within eight to ten months, they lost all the benefits that they got if they didn't keep up those exercise routines. 

Dr. Davis says just as individuals with high blood pressure need to continue taking their medication, continue eating healthy and exercising, continued exercise is also needed to maintain the gains that these children experienced.

The bottom-line is that children need access to fun aerobic, get-your-heart-up moving around activities that encourage them to stay physically active. And children need options that they consider fun and not necessarily just competitive things. She adds children need to feel encouraged to participate in physical activity even when they are not winning. That means having a variety of programs to choose from that are not targeted to only the fastest or the most coordinated of children.


This is really important and this is where parents can just make such a huge difference, not only encouraging your children to eat well and to exercise but also modeling that behavior and doing it ourselves. So that we can also be healthier and also hopefully be around a little longer to see our kids grown up and our grandchildren and all those things.

Now, you may be wondering, how did the investigators measure arterial stiffness? That was one of the things that first came to my mind, like how do you do that? Well, they used painless ultrasound to obtain carotid, which is in the neck, and femoral, which is in the groin area, pulse wave velocity, which is a fancy way of measuring how long it takes blood to travel through major arteries such as the aorta in the chest and abdomen. And then, these numbers were used to estimate arterial stiffness at the start and end of the exercise program.


Dr. Davis explains that a faster speed is worse because it means the blood vessels are stretching less. And it's a vicious cycle, faster blood velocity results in increased blood pressure which causes furthers stiffening of those blood vessels, as I had mentioned. Which further increases blood velocity or how fast it's going and blood pressure and around and around we go. 

Stiffness leads to faster, which leads to more pressure, which leads to more stiffness. And over time, worsening arterial stiffness and higher blood pressure sets the stage for a heart disease and damage to other organs like the kidneys, which can further cause high blood pressure. 

Arterial stiffness is considered an independent predictor of cardiovascular problems and deaths in adults. Black children tend to have stiffer arteries than their peers. And pulse wave velocity has been shown to be faster and increase more quickly in young black children compared to other races. Children in the study who had more body fat or a higher BMI already had stiffer arteries compared to their leaner peers.


In the United States, rates of obesity among children and adolescents have more than tripled since the 1970s, affecting about one in every five children, and that's looking at all races as accumulative, according to the Centers for Disease Control and Prevention. Factors contributing to obesity include TV watching as we previously mentioned. Also genetics, metabolism, eating and physical activity, sleep duration and adverse childhood experiences, like family dysfunction and violence.

Obesity is a major risk factor for cardiovascular disease and both obesity and cardiovascular problems tend to have their origins in childhood.


So there you have it, plenty of reasons to cut down on screentime, increase physical activity, pay attention to what we're eating with fewer processed foods and sweet beverages and more whole grains and vegetables and non-sweetened beverages. Now is the time to do it. And it could be a very important part of your family's new year resolution. 


Dr. Mike Patrick: When a teenager is acutely suicidal and cannot safely remain at home or in the community, in-patient psychiatric hospitalization is the traditional intervention. But a lack of appropriate facilities across the United States combined with an increasing demand for in-patient psychiatric services means many young people who are at critical risk often cannot get the help they need.


That very concern led the Alcohol, Drug and Mental Health Board of Franklin County Ohio, also known as ADAMH, to partner with us here at Nationwide Children's Hospital to create the hospital's Youth Crisis Stabilization Unit in 2011. With funding from the ADAMH board, the unit's doctors and mental health professionals developed a new therapeutic model called Intensive Crisis Intervention.

Now, in what appears to be the first study of its kind and recently published in the journal Child and Adolescent Mental Health, clinicians and researchers at Nationwide Children's have shown that Intensive Crisis Intervention is a promising alternative to a lengthy hospitalization. Findings also revealed significant reductions in suicidal thought at a three-month follow-up.


Dr. Sandra McBee-Strayer, lead author of the study and a research scientist in the Center for Suicide Prevention and Research at Nationwide Children's Abigail Wexner Research Institute, says, "Many communities are searching for other options, and what we have found is that this model holds a lot of promise."

Intensive Crisis Intervention relies on cognitive behavioral therapy, focusing on responses to stress that can lead to suicidal behavior and working with these adolescents and their families to develop better ways of coping with stressors. The model places a particular emphasis on family engagement, and family members are encouraged to stay in the Youth Crisis Stabilization Unit overnight with their children.

The therapy takes place across three phases. In the first phase, a psychiatrist and crisis clinician conduct assessments, determine what led to the crisis and what occurred during and afterward and then develop a treatment plan.


In the second, the young person participates in as many as two family sessions and three individual sessions every day to develop successful responses to stressful situations. When families and clinicians agree the adolescent can safely return home, the third phase includes time for safety planning and linking the family to community care. The three phases are designed to take place in three days.

Ericka Bruns, director of Crisis Services at Nationwide Children's and a co-author of the study, says, "We know this will not be enough time to solve all of a young person's issues. But we can work to help the patient and family understand the crisis, and help build coping mechanisms. The family involvement is so important, because communication in the home and learning  the signs of suicidal thought is an important part of safety planning."

The pilot study considered 50 young people, ages 12 to 17, who entered the Youth Crisis Stabilization Unit due to suicidal thoughts and/or behavior. All participants had to score within the clinical range, which was a score of more than 31 on the Suicidal Ideation Questionnaire-Junior. And the average score for the adolescents in the study was 54.3. More than half of the participants had previously attempted suicide.


Approximately one month after undergoing Intensive Crisis Intervention, the average score had decreased from 54.3 to 20.9. Three months later, the score was 20.1. Again, worrisome score is over 31.

Four participants did report a suicide attempt at the three-month follow-up. The authors note that rate is too small for statistical comparison, but it is in line with rates reported in other studies of suicide prevention treatment programs. 

The Youth Crisis Stabilization Unit and its Intensive Crisis Intervention are important components of behavioral health services at Nationwide Children's and are part of a larger system of care within the community.


For more information on teen suicide and its prevention, a really terrific past episode of PediaCast would be Episode 315. And I'll put a link to it in the show notes for this episode, 448. Sort of a sneak peek of that episode, really, I think the bottom-line of that episode is that it's okay to talk about depression and suicide with your kids. 

So don't avoid or be afraid of that conversation because of the fear that you might somehow increase the risk of your child having suicidal thoughts or actions, because you talked about it. Suicidal thoughts and actions have not been shown to increase when families talk about these things. So talk about it, normalize that conversation. 

And then, what do you do is you suspect or find out your child is having suicidal thoughts or plans? You get help right away. First, by calling your child's healthcare provider to get advice and stirring in the right direction and going to an emergency department or calling 911 if there's an immediate life-threatening concern.


If it's not an immediate emergency and you're just not sure where to turn, you can also always call the National Suicide Prevention Lifeline at 1-800-273-TALK. That's 1-800-273-8255 and I'll include that number along with the link to PediaCast Episode 315 on teen suicide, again, over in the show notes for this episode, 448, over at 



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. Really do appreciate that. 

Don't forget, you can find our program in all sorts of places, pretty much wherever you find podcasts, so the Apple Podcasts app, Google Play, iHeart Radio, Spotify, SoundCloud and most of those mobile podcast apps. You can also listen at the website, 

We are a proud member of the Parents on Demand Network, which you can find at Lots of great shows for parents there. 

And then, that landing site I mentioned with the audio players,, also our entire archive of past programs, show notes for each of the episodes, transcripts for many of them, and of course our important Terms of Use Agreement, and a handy contact page if you would like to suggest a topic for a future program. 

Reviews are helpful wherever you listen to PediaCast. We always appreciate when you take a moment to share your thoughts about the program. 

And we love connecting with you on social media. You'll find us on Facebook, Twitter, LinkedIn and Instagram. Simply search for PediaCast.


Also, we appreciate it when you tell others about the program face to face. Let's unplug once in awhile and have some time with other people just interacting and engaging in person in the same room. And if you happen to be doing that and you're talking to someone who also has kids -- maybe it's your family, friends, neighbors, co-workers, babysitters, really, anyone who has kids or takes care of kids -- please do let them know about this podcast. We really don't have much of an advertising budget at all and depend on word of mouth to spread news about the show. 

And that includes, by the way, your child's pediatric healthcare provider. Please tell them so they can share it with their other families and patients. 

And while you have their ear, let them know we have a program for them as well. It is called PediaCast CME. That stands for Continuing Medical Education. It is similar to this program. We do turn the science up a couple notches and offer free Category I Continuing Medical Education Credit for those who listen. 


Shows and details are available at the landing site for that program, And those shows are also available in Apple Podcasts, Google Play, iHeart Radio, Spotify, and most mobile podcast apps, even SoundCloud. Simply search for PediaCast CME.

Thanks again for stopping by. And until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long, everybody.


Announcer 1: This program is a production of Nationwide Children's. Thanks for listening. We'll see you next time on PediaCast.

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