Cry It Out, Lonely Gamers, Teen Suicide – PediaCast 240

Join Dr Mike in the PediaCast Studio for more News Parents Can Use. Topics this week include the cry-it-out technique for infants who wake in the night, the effects of screen time prior to bed time, video games and friendships, teenage girls meeting online strangers in real life, and new statistics on teenage suicide.


  • Cry It Out Technique for Infant Sleep

  • Screen Time before Bed Time

  • Video Games & Social Ties

  • Teenage Girls Meeting Online Strangers… In Real Life

  • Teenage Suicide



Announcer 1: This is PediaCast.


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

Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast, it's a pediatric podcast for moms and dads. I'm Dr. Mike, and coming to you from the campus of Nationwide Children's Hospital in Columbus, Ohio.

It is Episode 240 for January 30th, 2013. We're calling this one Cry It Out, Lonely Gamers and A Teen Suicide.

I'd like to welcome all of you to the show. It is a News Parents Can Use edition of the program. And we're going to do a complete rundown of the line-up in a moment.

First, I want to pre-apologize if my voice creaks and crack a little bit. It's really cold here today. I mean, the high is supposed to be like 11 degrees. With the wind chill, the last I heard, 15 below zero. And when it gets that cold, the air gets dry. And I'll tell you, my throat and nasal passages are extremely dry. So I got water here, next to me on the counter, and I may be taking some swigs of that here as we progress because it's dry. And try not to get shocked when I touch anything metal-like.

Quick reminder for you, the 2013 Pediatric Pearls Conference for Clinicians – that means it's for doctors and nurses, pediatricians, family practice docs and the like – Thursday, March 28th, 2013 from 7:30 in the morning until noon, here on the campus of Nationwide Children's Hospital on the agenda health care reform, long-acting contraceptives, vesicoureteral reflux management and cholesterol screening recommendations.


If you like to take part in that, just head over to the registration link in the Show Notes – Look up the Show Notes for Episode 240 and we'll have a registration link. It goes to the Educational portal. Under Professional Courses, just select For Physicians and then click Search For Courses, and the 2013 Pediatric Pearls Conference will be at the top.

Also, a shoutout of the crew of our brand new helicopter here in Nationwide Children's Hospital. Of course, we've had helicopter transport for a very long time provided by the good folks at MedFlight and they'll continue to provide some air transport services for the hospital. But to round out our air transport offerings, we will soon be flying Monarch 1. That's the new bird or butterfly, as the case maybe. And my hope is by giving them a shoutout, maybe, just maybe, I'll get an invite for a little trip, you know what I'm saying. Hey, you'll never know.

Seriously, though, I think they'll be a great interview, the air transport team here in the PediaCast Studio. I can look into that.

If you're interested in knowing more about the very large, EC145 chopper and/or you want to see pictures of Monarch 1, all tricked out with hospital colors and butterflies, I'll put a link in the Show Notes for this Episode 240 over at

And then, finally, I want to remind you, iTunes reviews are helpful. And about once in a quarter, we put this up at the beginning of the show rather than just saving it for talking about it at the end. If you have not written a review in iTunes, I would just ask, please consider taking five minutes to do so. And you know, I make this plea and usually then, we get three or four folks who write in a review in iTunes. You know, I'm looking for like ten new reviews.


And the reason that these are important is, when new reviews come in, it propels us up in the rankings in iTunes, because we get more five-star ratings. And, of course, we want you to be honest in your review, but my experience has been most of them are pretty good. And that does help us to get in front of more moms and dads who are looking through iTunes at various podcasts.

And of course, you know, whenever you check out something new or you're thinking about spending time or money or effort on something, you read reviews. And that's one of the cool things about the online world. At least, I know I do and I'm sure that lots of moms and dads and probably lots of you out there in the audience as well, before you download and listen to PediaCast for the first time, you look through the reviews.

And so those are important in terms of helping us build the audience. And really, just looking for five minutes of you time to go to iTunes, find PediaCast and just write a review for us. So if we could get ten people – I know we have thousands in the audience – we could just get ten of you to write a review, I'd be happy. If there's more than that, we're obviously ecstatic. So please consider doing that.

All right, what is on the line-up today? The cry-it-out technique for letting babies go back to sleep. Do you let them cry it out or do you go in and soothe them? Lots of people have mix feelings on this. We're going to take a look at an evidence-based study that examines self-soothing in babies.

Also, screen time before bed, does it interfere with sleep? If so, by how much and when should you put away the TVs, video games, and computers? How long prior to bedtime, if at all? And that, we'll let you know.

Speaking of video games, are teenage gamers loners? Do video games disrupt friendships and social ties? We'll take a look at that.

Teenage girls meeting strangers offline – so we're talking about teen girls, they meet a stranger on the Internet and then hook up with them for real. How big is that problem? And what can parents do to prevent it?


And then, finally, teenage suicide, we have a new study to report with the updated numbers. You know, it's a disturbing topic, I know. It's hard to talk about, it's hard to hear. But the numbers are quite high actually. And I think this is going to be great information for moms and dads really to monitor high-risk teens.

And then, we're going to talk about what to do if suicidal thoughts or plans are reality in your family. So we're going to talk bluntly about these things because I think it's an important topic even though it's one that's a little bit difficult to discuss. Because a lot of kids have these thoughts and as a parent, we need to know about it.

So it's all coming your way in this News Parents Can Use edition of PediaCast. We do have plans to more listener shows. It's easy to participate in those. If you have a question, comment for the show or a news story you'd like to point us towards, it's easy to get a hold of me. Just head to and click on the Contact link. You can also email or call the voiceline at 347-404-KIDS. Again, that's 347-404-K-I-D-S.

Also, I want to remind you the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So, if you have a concern about your child's health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination. Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at

So let's take a quick break and I will be back with News Parents Can Use right after this.



Dr. Mike Patrick: All right, nothing like starting out with a divisive issue. There's lot of passions surrounding the cry-it-out technique for infants who wake and cry in the night. Some parents swear by it and others cringe at the thought and equate it with child abuse. Researchers at Temple University have come out with a glowing recommendation of the practice as published in the Journal of Developmental Psychology. They say most babies who wake up during the night should be allowed to self-soothe and fall back to sleep on their own.

Dr. Marsha Weinraub, a professor of psychology at Temple, says by six months of age most babies sleep through the night, awakening their mothers only about once per week. However, not all children follow this pattern of development. If you measure them while they are sleeping, all babies like all adults move through a sleep cycle every one and a half to two hours where they wake up and then return to sleep. Some of them do cry and call out when they wake which we call "not sleeping through the night".

Researchers examined 1,200 infants ranging in age from six to 36 months of age. And they asked parents about their child's sleep and wake habits during the night at 6, 15, 24 and 36 months. And based on the answers to these questions, they divided the infants into two groups – sleepers and what they called 'transitional sleepers'. So I think it's a kind of politically correct term. I mean, I would have called them easy babies versus difficult babies, but that's me.

By six months of age, 66% of the babies slept well through the night, waking up only once per week. Thirty-three percent, so just over third – or no, not just over… That is a third, isn't it? So a third were still transitional sleepers at six months with most of them waking every single night of the week. Now, for some good news, by 15 months, the transitional sleepers were waking only twice per week and by 24 months of age, they have improved to waking only one night per week.


When examined as a group, the transitional sleepers were more likely to be boys or more likely to be breastfed and were more likely to be considered irritable or difficult by their parents. See, I told you. The mothers of these transitional sleepers were also more likely to be depressed or considered to have greater maternal sensitivity.

Dr. Weinraub says babies should learn to fall asleep on their own without help. She says when mothers tune in to these night time awakenings and/or if a baby is in the habit of falling asleep during breastfeeding, then he or she may not be learning how to self-soothe, something that is critical for regular sleep. She adds, "Because the mothers in our study described infants with many awakenings per week as creating problems for themselves and other family members, parents might be encouraged to establish more nuance and carefully targeted routines to help babies with self-soothing and to seek occasional respite. The best advice is to put infants to bed at a regular time every night, allow them to fall asleep on their own and resist the urge to respond right away to awakenings."

So there you have it, support for the cry-it-out method. I will point out, just to keep things real, and here's where I always get myself into a little bit of trouble. Although the study is built by the authors as support for letting babies cry it out, that's not really what this is. This study merely quantifies the problem by saying a third of babies wake frequently at six months of age but by 24 months of age, these frequent wakers are only doing it once a week. So the study kind of describes the normal transition between six months and 24 months of age of babies who wake frequently becoming babies who seldom wake in the night.


I would have like to see them take the transition sleepers, the difficult babies, and divide them into two groups. Let one group cry it out in some controlled and humane fashion and let mothers in the other group just sort of intervene as they please. And then, look and see if the truly you're-going to-let-them-cry-it-out group would learn to self-soothe faster than the mom-intervenes-all-the-time group. I mean, that would have been a nice edition to the study in my mind. Of course, they didn't ask me for my opinion.

Speaking of opinion, I'm all for the cry-it-out method. We follow that plan for our kids and it worked well. They are now seemingly well-adjusted teenagers with no visible scars of their cry-it-out days. Of course, your mileage may vary. And as always, PediaCast encourages parents to make informed decisions that work best for their family's situation.

Speaking of family situations, children and teenagers who spend time watching television, playing video games and using computers right before bedtime, these kids often take longer to fall asleep which could create a sleep deficit. This is an important observation because sleep deficits may affect daytime behavior in school performance. Researchers at the University of Auckland in New Zealand say reducing screen time in the pre-sleep window could be a good strategy for helping kids go to sleep earlier.

The team looked at children and teens between five and 18 years of age. Specifically, they examined their activity during the 90 minutes leading up to bedtime. What did they find? Well, according to their report, published in the Journal of Pediatrics, those with more pre-bed screen time took longer to fall asleep. Why? Well, because watching television, playing video games, and using computers stimulates the brain plus bright light from these devices stimulates the pineal gland which is responsible for regulating sleep-wake cycles.

But just how much of a problem is this? Well, researchers say that those with the greatest exposure to pre-bed screen time are losing about one hour of sleep each week compared to those with little pre-bed screen time. Now, one hour per week. It doesn't sound like much but consider this – one extra hour of sleep each week equals 52 hours of extra sleep each year. That's what the researchers say.


Now, what exactly does that mean? Well, the researchers don't explain the significance of that. And to be honest, I don't know what the significance of that is either because the accumulative effect of little bits of more nightly sleep over long period of time has not really been studied.

So the take-home, should you ban all screen time during the 90 minutes leading up to bedtime so your child can get one more hour of sleep each week? Well, that depends. If the screen time doesn't appear to affect your child's sleep and your child has gained the proper amount of sleep each night for their age and their daytime behavior and school performance is satisfactory, then you probably don't need to make any changes.

On the other hand, if it takes your child more than a few minutes to fall asleep or if they aren't getting the recommended amount of sleep each night for their age, or they are experiencing daytime behavioral and/or school performance problems and you want to see if more sleep might help correct these problems, then by all means, have your child trade in those devices for a warm bath or shower. Maybe a not too stimulating family game or a little laid back craft time or maybe or a story or some reading time, you get the picture, during those 90 minutes prior to bed.

By the way, you may be wondering what the appropriate amount of sleep time is for a child. According to the National Sleep Foundation, people, including kids vary in their sleep needs. But on average, preschoolers need 11 to 13 hours each night, elementary school-aged kids, 10 to 11 hours, and teenagers 8 to 10 hours.

All right, let's move on to a teenage topic. Many people have the notion that teenage gamers are loners who don't have friends. There's an image of dark circles under the eyes, closed door, poor social skills – you get the idea. But is this image reality or an unfair stereotype? Recent study from researchers in Penn State published in the Journal of Society and Leisure suggest the latter to be true. They say gamers, they connected with friends and gaming activities tend to strengthen teenage social ties.


Dr. Benjamin Hickerson, Assistant Professor in the Department of Recreation, Parks and Tourism Management at the Pennsylvania State University, says "We're interested in how engagement with video games is related to perceptions of social support based on the common belief that playing video games is socially isolating.To examine the relationship between gaming and social ties, researchers hang out at two video game stores and interviewed teenagers and young adults waiting in line for the night time release of "Call of Duty: Black Ops", a first person shooter game. They asked 175 costumers to fill out surveys which included questions about video game playing habits, attitudes and social ties. The questions were based on a scale experts normally use to assess a person's involvement with recreational leisure activities.

So what did they find? Well, on average, the gamers spent 20.5 hours playing video games each week and spend $200 each year on the games. The range of time invested in games varied greatly, with some participants spending more than 100 hours per week. Seriously, 100 hours per week.

Anyway, regardless of the time and money invested in gaming, there was no significant difference in the strength of social ties, even for the ones who spent a 100 hours per week. Researchers say that gamers were able to reinforce relationships and experience high levels of social ties and support because of the games. Dr. Hickerson says there's a common stereotype that if you play video games, then you're a loner. But it may have more to do with how a person is involved in gaming that determines if their social support is affected. He says video gaming is not always a negative. Players may actually be doing something positive when gaming becomes a means of connecting with friends, especially in the case of network play when those friends are not geographically near by.


And in the case of those 100 hours per week gamers, Dr. Hickerson says "These are people who are thoroughly invested in gaming and people who are organizing their lives around playing video games." He says this information could help video game designers create games that identify problematic behaviors such as excessive centrality and build games with features that help gamers maintain friendships and relationships.

I'm not sure that game designers have the psychological interests of their consumers in mind. Although, maybe socially matured gamers buy more games over the course of their lives. I don't know, the researchers didn't look at that.

Bottom line here, moms and dads, as always, I think moderation is key. We've talked a lot about video games in the past on PediaCast. We have covered research that shows active video games curve obesity and help those with cerebral palsy. Video games improve memory. They improve eyesight; they improve visual, spatial brain development. And now, we have one showing no adverse effect on social ties even when the game is played for hours on end.

So does that mean moms and dads should give their kids a blank check with regard to gaming? No, of course not. Other studies have shown video games to be associated with lower grade point averages and sometimes more aggressive behavior. But look, folks, at the end of the day, the results of scientific studies are just one factor. Really, as parents, we have to look at the big picture. Video games are not the end of life as we know it but they also can't replace other important life activities like succeeding in a job or school. And you know, I don't understand how you can gain 100 hours per week and succeed in school or maintain a job. That doesn't quite make sense to me.

Spending lots of time interacting with family and friends while engaged with the real world is also important. Now, do I have specific study to back me up on this? No. And you know, as my regular listeners know, we do place a premium on evidence-based here on PediaCast. But let's face it, there's still room for common sense. And in my mind, common sense dictates moderation.


Speaking of common sense, it's not a good idea to meet up with strangers you find on the Internet, right? Well, someone needs to inform our teenage daughters of this little chunk of wisdom. Why? Because researchers at Cincinnati Children's reported in the Journal of Pediatrics that nearly one-third of American teenage girls admit to meeting up in the real world with people they first met online. The study followed 250 girls ages 14 to 17 for more than a year and found 30% of them established and developed online relationships that culminated in a face-to-face meeting – a real one, not Skype.

Dr. Jennie Noll, lead author of this study and Professor of Pediatrics at the University of Cincinnati, says the vast majority of these meet-up are benign. Statistics show that in itself the Internet is not as dangerous a place, for example, as walking through a really bad neighborhood. On the other hand, 90% of our adolescents have daily access to the Internet and there is a risk associated with meeting strangers offline and that risk exists for everyone.

So even if just one percent of them end up having a dangerous encounter with a stranger, it's still a very big problem. On top of that, we found that kids who were particularly sexual and provocative online do receive more sexual advances from others and are more likely to meet these strangers who after some time of many months of online interaction may not seem like a stranger anymore.

So the implications are dangerous. Two groups of teenage girls were followed in the study. A 130 who were identified by their local child protection agency as having a history of abuse or neglect and 121 girls who did not have a history of previous mistreatment were included in the study. Investigators collected pictures and information in the girls' social media profiles and surveyed parents regarding their teens' habits in the nature of any Internet monitoring that was used in the home. Teens were also asked to report any offline meet-ups with folks they had met online.


So what did they find? Well, teenage girls with a history of abuse or neglect were more likely to post provocative pictures and information in their social media profiles. And those who posted provocative pictures and information were more likely to receive sexual solicitations online. Those who received sexual solicitations online were more likely to arrange offline meeting with strangers.

Now, what about parental influence? Moms and dads who monitor their child's Internet activity were less likely to have teenage daughters meeting strangers offline. But if that monitoring only consisted of parental controls and filtering software, then there was no difference in the incidence of offline meetings between those with filters in place and those without software filters.

Dr. Noll says, "As parents, you always have the right to observe your kids without their knowing. But I would be careful about intervening in any way that may cause them to shut down and hide because the most effective thing to do is to have your kids communicate with you openly without shame or accusation about what their online lives actually look like."

So the take-home here for moms and dads, teenage girls do meet strangers offline, to the tune of 30% of then. Now granted, many of these girls have a background that involves abuse and neglect, that may describe your daughter or it may not. But not all of the girls who meet strangers have abuse or neglect in their past. So we do have to be concern about this with all of our daughters. And parental control and filtering software isn't enough. Sure, it's a good thing to have them placed but it's not a substitution for having an honest, open and loving relationship with your daughter, one in which you do life together and are in each other's business.

One more teenage story for you this week, and this is another serious one. Researchers at Harvard reported in the Journal of JAMA Psychiatry that one in eight or 12.5% of US teens have thought about suicide and one in 20 which is about 5% have made plans or have actually attempted to kill themselves. Eighty percent of these teenagers were under doctors' care for a mental health issue but 55% hadn't considered suicide until after their treatment had begun.


Researchers interviewed 6,483 teens between the ages of 13 and 18 and they asked them about suicidal thoughts, plans and attempts. They also questioned parents and screened for mental health disorders such as anger, depression, anxiety, panic and bipolar disorders, conduct disorder, oppositional defiant disorder, ADHD, eating disorders, post-traumatic stress disorder, substance abuse and many more.

Prevalence of suicidal thoughts, plans and attempts increase steadily with age and were common in girls compared to boys. Mental health disorders with the strongest link to suicidal attempts include depression, bipolar disorder, eating disorders and post-traumatic stress disorder.

The author stressed the importance of their finding, that suicidal thoughts may begin after treatment for mental health disorder has begun. Often, teens are asked about suicidal thoughts during the initial evaluation, but if they deny having suicidal thoughts or plans, the issue may not be raised again once a diagnosis is established and treatment has begun. Therefore, it's very important for clinicians and parents to closely monitor adolescents with mental health disorders especially during the first year of treatment.

You know, I think a lot of parents are afraid to ask their teens about suicidal thoughts. Like, "I might put that idea into their head." However, there is no evidence that asking about suicide makes a suicide plan or attempt more likely. On the other hand, not asking and not intervening, especially if your teen is having suicidal thoughts or has developed a plan, well, that situation is very dangerous.

So parents, ask away, especially if your child's been diagnosed with a mental health issue. And even if they're undergoing treatment and seem to be doing well on the surface, ask away, especially during that first year of treatment and if when you hit bumps on the road or need to alter treatment.


Again, the disorders with the highest suicide risk include depression, bipolar disorder, eating disorders and post-traumatic stress disorder.

Let me say the numbers again, because I think it's important for parents to know them. One in eight or 12.5% of US teens have thought about suicide and one in twenty or 5% have made plans or have actually attempted to kill themselves.

A final note, as a parent, what do you if your teenager says "Yes, I have thinking suicide or I have a plan." What then? This is a medical emergency. It's not something to put off. Unfortunately, there are some teens who use this information as a form of manipulation. But you still need to take the thoughts or the threats seriously.

First step is to call your child's doctor. Preferably, their mental health professional but their primary care doctor is fine if you can't get in touch with the other. They may not manage their mental health issue and may not be comfortable dealing with suicide themselves but they can direct you to the appropriate local resources. If you can't get in touch with the doctor right away, look up your local mental health emergency network; most communities have that in place. And finally, if all else fails, take your child to an Emergency Department. They're open 24/7, 365 days of the year and they are in the position to help.

The most important thing is to ask and not ignore or put off.

All right, that concludes our News Parents Can Use this week. I'll be back with the final word right after this.



Dr. Mike Patrick: All right, we are back with the final word from PediaCast.

Another way to get your questions answered is the brand new Ask Dr. Mike feature which is coming soon to the Nationwide Children's Hospital Facebook page. So if you haven't liked that Facebook page yet, make sure you do so. Just go to Facebook and do a search for Nationwide Children's Hospital and you'll find it there.

I do want to make a note; this is different than the PediaCast Facebook page. So we have our own Facebook page which, of course, I also encourage you to join if you have not done so already, as we have a community forming there.

But the Nationwide Children's Hospital Facebook page is going to have a special tab called Ask Dr. Mike. And it will feature a way to get your questions into my hands. Then, we'll have video answers. Actually, they're on the Facebook page. So, that is coming your way very soon. It's one of those exciting new PediaCast features I told you we'd have this year. And now, you know.

But still, stay tuned because we have more exciting news coming your way regarding the direction of PediaCast in the coming weeks.

And that's my final word. I want to thank all of your for taking time out of your week to participate in the program. I appreciate it whether you're just listening or whether you're heading over to the website and checking out our links in the Show Notes, or using the Contact page to ask your questions or checking out Nationwide Children's Hospital on Facebook. All the ways that you can connect with us, we really do appreciate that.

I want to remind you that reviews in iTunes are helpful as I mentioned at the beginning of the program.

Also, we're on Pinterest and I've really kind of taken a little bit more time to develop that part of PediaCast because I know so many people are in Pinterest these days. So we have several boards for you. One is our Episodes board. We will pin up each episode with the topics that are involved. In that way, you can re-pin and share.


Actually, that's been going fairly well, we're reaching some people who would otherwise would have known about the show. And they maybe following someone else's board on a particular topic – for instance, 22Q. I know we had another one related to congenital hip dysplasia or developmental dysplasia of the hip with an active board that the episode was then pinned on that board.

So there's lot of opportunities to kind of share and get the word out about the various topics that we talked about here in the program. That's on the Episodes board. We also have a News Parents Can Use board, which has news stories on it and product recalls, that sort of thing, that we don't talk about on the program. So the stories that didn't make the show but they're still important, you can check those out on the News board over at Pinterest.

And we also have a blog board. I do write a monthly blog for iTriageHealth and my blog posts are on the Blog board for you, again, over at Pinterest.

Also, I want to remind you, word of mouth is so helpful. So be sure to tell your family, friends, neighbors, co-workers, et cetera about the program. And the most important of all, tell your child's doctor. So the next time you're in for sick office visit or a well-child check-up, just make sure you drop my name. [Chuckle] Let them know about PediaCast and where they can find us. We also have posters available under the Resources tab that they can hang up in exam rooms to help spread the word about the show – evidence-based and trustworthy.

The easiest way to get hold of me to ask your question again is the Contact link over at but you can also email And we have a Skype line, 347-404-KIDS, 347-404-K-I-D-S. That's again to leave a message and ask a question that way.

All right, that wraps things up for this week. Until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long, everybody.


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

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