Dry-Erase Markers, Hip Pain, Cold Remedies – PediaCast 239

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Join Dr Mike in the PediaCast Studio as we answer more listener questions! Topics include dry-erase markers, toxic effects of carpeting, the newborn physical examination, hip pain, homeopathic cold remedies, and influenza.

Topics

  • Dry-Erase Markers – Non-Toxic?

  • Carpeting vs Hardwood Floors

  • The Newborn Physical Exam

  • Hip Pain

  • Homeopathic Cold Remedies

  • All About Influenza

Links

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's a pediatric podcast for moms and dads. And we're coming to you from the campus of Nationwide Children's Hospital in downtown Columbus, Ohio. It is January 23rd 2013 and we have another listener show for you this week. We're calling it Dry-Erase Markers, Hip Pain and Cold Remedies.

So lots coming your way. Of course, as with all of our show we cover more topics than we put out in the title, just picked the ones that'll I think grab the most attention. We're attention getters. But we do have other topics for you and in just a couple of minutes I'll get to the entire lineup for today's show.

Dry-erase markers. How do we incorporate that into a pediatric podcast? Stick around and find out. Hip pain and cold remedies, OK, you can understand those, but dry-erase markers, we had a listener asked about them. And we're going to share that with you here in just a couple of minutes.

01:30

Another thing I want to share with you, we have a lot of conferences, medical conferences here at Nationwide Children's Hospital. And one I want to tell you about, why this particular one, I have to admit, yeah, I'm being a little self-indulgent because I'm one of the physician coordinators for this conference.

It is the 2013 Pediatric Pearls Conference and it's coming up on Thursday, March 28, 2013, from 7:30 in the morning until noon on the campus of Nationwide Children's Hospital. So it's just a half-day conference.

It's really aimed at clinicians, so pediatricians, family-practiced doctors, nurse practitioners and I know we have a lot of listeners in the audience who would describe themselves with one of those three titles. And so I just want to let the clinicians out there know about this conference.

We're going to be covering health care reform, long-acting contraceptives, vesicoureteral reflux management and cholesterol screening recommendations. So it's going to be a great time. A lot of great information coming at you, just a half-day conference.

Again, Thursday, March 28th, from 7:30 until noon here at Nationwide Children's. And if you're interested, there is a registration link in the Show Notes, so just head over to pediacast.org and you'll find the link there.

You have to follow some specific directions, once you click on the registration link, that will take you to the hospital conferences page and then you click to open the "Education Portal" and there under "Professional Courses" select "For Physicians" and then click "Search for Courses" and the 2013 Pediatric Pearls Conference will be the first one listed.

It doesn't have a website like so conferences have had here in the past. But it's a low budget half-day conference. It's a good one. Great topics and great information, but low budget so it doesn't have its own webpage.

But if you're interested in registering just again head over the Show Notes at pediacast.org and rewind this episode and just listen to those instructions again because I'm not going to repeat them. But you can rewind and listen again and find the conference for yourself.

03:38

And for the rest of you out there and for the clinicians, too, I do want to remind you we are on Pinterest now. We have an Episodes board where you can repin and share the individual episodes. We also have a News Parents Can Use board, which covers news stories that are not included in the show but ones that I think are important for moms and dads to know about.

Also, we have a Blog Post board over at Pinterest. And I do write a monthly blog for iTriagehealth. We have a couple of new posts for you. One was from the holidays, it was called The Best Gift You Can Give Your Kids and it's a free gift and it's not limited just to the holiday season, Christmas time and such.

So if you're interested in the best gift you can give your kids any time of the year and one that's free, just check out that blog post on the Blog board at Pinterest, PediaCast Pinterest site.

And then the newest one, Everything You Wanted To Know About Ear Infections – Part 1. So if you're a parent who's dealing with recurrent ear infections in you kids, you want to check out that blog post because we really kind of go into the nuts and bolts of ear infections, kind of like we do with other topics here on the program, but in a blog format.

And as you can tell, it is a two-parter and part one's up now and part two will be up next month.

04:50

OK. And a final piece of housekeeping for you and here is a little bit of a reveal, Ask Dr. Mike is going to debut soon on the Nationwide Children's Hospital Facebook page. So basically, what will happen is readers of the Facebook page for Nationwide Children's, now this is not the PediaCast Facebook page, this is the Facebook page for Nationwide Children's, we're going to have the opportunity for readers to ask questions and then we'll have video answers with yours truly in the studio.

And to help us get ready for this we produced a little influenza video segment, sort of what can I do if my child has the flu. So you can check that out in the Show Notes, there'll be a link for it so you can watch the video.

And speaking of influenza, stay tune to the end of this show and I'll share my thoughts with you on the current influenza outbreak in the USA. We'll talk symptoms, diagnosis, treatment, complications and prevention, so be sure to hang out until the end of the show to catch everything you ever wanted to know about influenza.

And again, you'll find that YouTube video answering the question, what can I do if my child has the flu, with yours truly and that's going to help us just prepare for our Ask Dr. Mike section or segment, I should say, on our Nationwide Children's Facebook page which is coming soon.

That's one of the things I told you we'd have new for you in 2013. There are more things and we'll reveal those as we're able.

06:14

In the meantime, what are we talking about today? As I mentioned in the intro we have listener questions. Dry-erase markers. Are they really non-toxic or could they be a problem? Carpeting versus hardwood floors. Should you choose one over the other for the health of your kids?

We're also going to discuss newborn physicals. Docs do some seemingly crazy stuff to newborns, twirling their hips around, shining bright lights in their eyes, cradling their body and making baby feel like he or she is falling, so their arms flail out and they start to cry. There's actually a reason we do all these things and we're going to help demystify that for you.

Also, hip pain in kids. Lot of possibilities for the cause of hip pain in children. Some are serious and some are not and we'll help you tell the difference.

And then we have a question on homeopathic cold remedies, things like elderberry extract. Could it help? Is it safe? I will explore those answers.

And then as I mentioned we'll wrap things up with nuts and bolts on influenza.

As usual we have a jampacked show for you today and most of comes from you the listeners, so thanks. If you like to participate in the show by asking a question it's an easy thing to do, just head over to pediacast.org and click on the Contact link.

You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. That's 347-404-K-I-D-S.

Also I want to remind you the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for a specific individual. So 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 and you can find at pediacast.org.

All right. Let's take a quick break and we'll be back to answer some of your questions, right after this.

[Music]

08:36

All right. First up we have Tamara in California and Tamara says, "Dr. Mike, I absolutely love this podcast. I'm a registered dietician and work in a pediatric HIV and infectious disease out-patient clinic. I love being able to look up past topics and become educated for work-related issues. I'm also a mother of three and your show is very helpful. I am sharing your podcast with friends and coworkers. Thank you for this great podcast and current information."

Well thank you, Tamara. Thanks for listening and also thanks for the service you provide children in the pediatric HIV and infectious disease clinic there in California. And also thanks for helping spread the word about PediaCast. That is always appreciated.

Like our conference, our advertising budget is slim pickings and so we really rely on word of mouth for getting the word out about the program. So Tamara, we appreciate it.

All right. Next up is Beth in Seattle and Beth is our dry-erase marker person. Beth says, "Hi, Dr. Mike. My two-and-a-half-year-old loves to practice writing. He has a couple of dry-erase books and a set of flashcards that came with black pens. He's pretty good about keeping the ink off the furniture but it gets all over his hands and face. It washes off easily but he often puts his hands in his mouth while he's writing. Is this safe? The markers are intended for children and they say non-toxic, but I'm not sure I believe them. I also bought a set of Crayola colored markers which I have not given to him yet. I would appreciate your perspective as I am sure some dry-erase markers are not safe, but I don't know how to tell which ones are safe. Thanks – Beth in Seattle."

10:14

Well thanks for the question, Beth. In my mind, the key here and it really holds true with any product that has the potential to get on your child's skin or inside your child's mouth, the key, I think, and I'll kind of explain why I think this as we go along, but I think the key is to purchase the product from a reputable source, choose a reputable brand and make sure the label that the product is non-toxic.

Now having said that and I think you bring up an excellent point here, Beth, what exactly does non-toxic on a label mean? Well unfortunately, there's no set standard for non-toxic. So the Consumer Product Safety Commission and they are the federal agency charged with administering the Federal Hazardous Substance Act and while this commission does maintain a list of toxic and hazardous substances, it does not maintain a list of non-toxic substances.

So basically, that means that a manufacturer can slap non-toxic on the label as long as there are no ingredients considered to be toxic or hazardous as set forth by the Consumer Product Safety Commission.

Now, does that mean that any substance that is not listed as toxic or hazardous, can you assume those substances are absolutely safe? No. The answer is no, not necessarily. And the reason why is because we're finding out new information all the time because new substances are produced, things happen, we see toxic effects.

And so sometimes things just haven't been around long enough, some chemicals and substances. They haven't been around long enough to necessarily show their true colors. I mean, every time a substance is added to the toxic and hazardous list, it's a substance that the day before it was added was considered non-toxic, right?

I mean, nothing changed. It was just as toxic then as it is now. We just didn't know it. Also, folks can have sensitivities and allergies to a particular chemical that other people might not have. So it is possible that your child could have a problem when most other kids don't have a problem.

12:21

And then we also have to look at what's the effect of prolonged exposure. And what happens if your child has a life-threatening anaphylactic or severe allergic reaction to a supposedly non-toxic substance, what then?

So manufacturers do fool us a bit with the term non-toxic. And this brings me back to the logic behind my advice. Stick with a reputable store and a reputable product. Why? Well, stores and manufacturers have an incentive to keep you healthy. They want you coming back. They want you to keep buying their product.

They don't want you to get sick from using their product, unless of course it's something you can become addicted to and then the sickness is OK because you have to keep buying it. But that's a different problem all together.

And you know they don't want lawsuits because their supposedly non-toxic product is harming children. So this is one instance where capitalism really kind of works for you in a circuitous fashion. It's not a guarantee, but if a reputable store is selling a reputable non-toxic product, especially when it's been around for a while, you're most likely OK.

Again, it's not 100% but as a parent if something bad does happen you'll at least feel like you made a good choice based on the available information. But I'd still be prudent. If a product gets on your child's skin, clean it off as well as you can and as soon as possible even if it's supposedly non-toxic.

Now that doesn't mean use something more toxic to get the product off. Use soap and water, not necessarily something like paint thinner. OK? Not a good idea. And if your child always makes a total mess with a particular product maybe they're not quite ready to use that product.

14:04

Also teach your kids to keep products, body parts and chemicals and such out of their mouth. And guess what, this advice does require parents supervise their children while they play.

Now does this mean kids should never get messy and that parents should avoid all products even the non-toxic ones that has the potential to get on their skin or in their mouth? I'm not saying that either. There's a middle ground here, folks, where we let kids be kids.

We supervise them. We protect them as much as we can, but we also accept some risks in life. Again, it's our ever popular benefit-risk meter rearing its head. There's a creative benefit that comes when kids use non-toxic erasable markers.

There may be risk, too. It's a probably a very, very small one. And you have to decide how much risk tolerance you have for your own family. But that's how I'd decide. You've to make the decision for yourself.

Incidentally, if your child is exposed to any supposedly non-toxic substance, really, if they're exposed to any substance, and they begin to have symptoms – rash, itching, eye watering, drooling, breathing problems, anything concerning – if you think it's life-threatening, call 911.

And the parent should take a basic CPR class from the American Red Cross. I think that's an important thing that all responsible parents should have under their belt. I mean, you should know how to do CPR just in case.

Otherwise, call your doctor or go to a pediatric urgent care facility or a pediatric emergency department, if you're really concerned. If you're really concerned call 911.

And finally, a fantastic terrific resource for exposures of any kind, even those from supposedly non-toxic substances, is your local poison control center. You can always reach them, at least in the United States, at and we can all sing it now all together because we've done the jingle a couple of different times on PediaCast. 1-800-222-1222.

You can reach your local poison control center by calling that number. 1-800-222-1222. So I hope that helps, Beth, and thanks for the question on dry-erase markers.

16:03

Next up we have Haley in St. Louis, Missouri. Haley says, "Dear Dr. Mike, I've been a loyal listener to your show since my son was born back in July 2010 and consider it an enviable, not to mention entertaining, resource. I appreciate that. I recommended it to my son's pediatrician who still thanks me at every visit for the recommendation. My question today is about the toxicity of new carpeting. We recently bought an older home and we'll be doing extensive remodeling. I was debating the pros and cons of carpeting versus hardwood floors when a friend of mine told me that absolutely do hardwood floors because new carpeting is extremely toxic. I haven't had a chance to discuss this issue with my pediatrician, but I though it would be a perfect question to let Dr. Mike tackle. Any information will be greatly appreciated. Thank you. – Haley in St. Louis."

Well thanks for the question, Haley. There are actually several hazards commonly associated with remodeling old homes. But whether you choose hardwood floors or carpeting is not one that would have come to my mind.

So let's start by talking about what hazards you definitely will face when remodeling an older home and then we'll wrap it up with a talk on carpets versus hardwood floors.

First, when you're remodeling an old home you have to be concerned about lead exposures. Houses built prior to 1978 are the ones most likely to contain lead, especially in the pain. So you have to identify lead-based paint and deal with that appropriately and we'll talk about how you deal with these things in a moment. Right now we're just identifying what you may come across that could potentially be dangerous.

Another is asbestos and you've all heard of this. It was used as an insulation material in older homes and buildings and it's now known to be associated with cancer caused by inhaling the fibers. So asbestos is something else you want to be careful with.

Mercury is a possible exposure. Heating systems and thermostats in old homes often contains this dangerous heavy metal.

And then we also have PCBs or polychlorinated biphenyls. These are chemicals that were used in paints and electronic devices prior to 1977. They are now known to damage the central nervous system, suppress the immune system and cause cancer.

And by the way, all of these substances at their time of use back in the day when they were used in your home as a building material, they were considered non-toxic. I mean, we know better now, but back then we didn't. So it kind of brings us back around to Beth's question about non-toxic erasable markers.

18:28

We do need to be aware of supposedly non-toxic materials. Now that's not to suggest that dry-erase markers are going to be some evil thing down the road, but I'm just making a point that things that were ones non-toxic some of those things are now toxic.

Non-toxic doesn't mean absolutely positively safe. In some cases it means it's just not yet known to be toxic. OK. Another thing you have to worry about is formaldehyde, which is still used extensively today in insulation, particle board, plywood material, hardwood and fake wood floors.

Now, we know when adults are exposed to high concentrations of formaldehyde it can cause burning eyes, sore throat, coughing, nausea. And some studies link significant long-term exposure to formaldehyde to respiratory problems and cancer.

So there are lots of possible toxic exposure dangers with remodeling an older home. And of course that danger is magnified for kids who may become exposed to those substances.

So what should you do if you're remodeling an older home? I would say the first thing is to get professional help. Just factor that into the cost right up front. You really want a reputable abatement team to come in, survey the project and remove or remedy any toxic substances before you move forward.

And you don't want your kids in the house while the process is being done. Now I say reputable because you don't want a shady fly-by-night service that's going to overstate the problem and maybe charge you for more than what really needs to be done.

So check around your local area. Touch base with the Health Department, the Better Business Bureau, Angie's List, that sort of thing.

20:08

OK. So now you have the toxic materials out of the house. You've paid for the cost to have an abatement team come in and do it professionally so it's done in the safest manner possible for you and your family.

The sub-flooring is exposed and you're trying to decide between hardwood or fake wood and carpeting. Tile and linoleum are other options and there are still other, rubber flooring in exercise rooms, for instance.

Let's see. In our house, we have carpeting, tile, hardwood, concrete in parts of the basement. So which should you choose? I don't know. Yes, carpeting has some potentially toxic chemicals. You have stain-resistant chemicals, fire retardant chemicals, but look, how much of these chemicals come off of the carpet and onto or into your child's body it's probably pretty minimal.

And wood floors, hardwood and fake wood, as I mentioned before contain formaldehyde and potentially other chemicals as well, on the other hand, these chemicals tend to be locked up in the flooring so you're more likely to become exposed to them if you are removing, especially chopping stuff apart and pulling it apart, breaking the material up as you're removing it, that's more of a concern.

When it's packaged up nicely and just on your floor, really those chemicals like formaldehyde and other things are pretty much locked up in the flooring and really it's unlikely that you child's going to have any significant exposure.

And that brings me to another thing. I think the risk is so low both with carpeting and hardwood flooring, especially from a reputable source. If you're worried about those things harming your child, you probably ought to avoid cars and playgrounds and the great outdoors in general.

Look folks, I'm not picking on you, Haley. I do appreciate the question. But for me, I'm picking carpet versus hardwood based on what I'm going to be doing in the room. There are just too many things in life to worry about.

22:10

And things that I know can hurt me are the ones I'm going to be more really concerned about. But that's me. Let's see, other issues with carpet, other than just toxic chemicals. Carpet stains, even the stain-resistant kind, especially if you have pets or young kids.

Who am I kidding? I have stained our carpet probably more times than our my kids have, spilled coffee drinks, etc. Carpet may also be a problem for those with allergies, dust, mites and all.

Hardwood, it's hard and cold. It looks nice. You may have to wax it depending on the type of floor that it is, which is another potentially toxic exposure.

So which is safer? Which should you pick, wood or carpet? I really don't know. Tile seems like a good option. I'm sure there are problems with that, too. I'm sorry, Haley. I feel I'm kind of like failing you here.

Bottom line, be careful with the removal of toxic substances when you're remodeling. Let a professional do it. With regard to your choice of flooring, go with something you like, something that fits your budget and the needs of your family.

And don't let the fear mongers sway your opinion because there are no evidence-based studies to suggest you should choose one type of flooring over another, at least not at this time.

23:28

All right. Let's move on to Jennifer in Long Island, New York. Jennifer says, "Hi, Dr. Mike. I'm a pediatric physical therapist and I definitely get some good information from your podcast for myself and the parents I work with. So thank you for your well-researched topics. I do home care as well as work in a school for special needs children. When I first get a home care case, usually children under three years, I do my own assessment such as screening for torticollis, neurological science, hip issues, etc. However, I was wondering if you could speak about what a pediatrician's exam should look like for a newborn. I don't have any of my own children yet so I'm curious and I think it would be very helpful. Thanks so much for reading my email and keep up the great work. – Jennifer in Long Island"

So thanks for the question, Jennifer. So the newborn examination is definitely an animal of its own. And I'm going to expand this out a bit and talk about the newborn history and physical, because history is just as important as the physical at this age.

And I think this will be some interest to parents, too, because if you have kids you've been through a newborn exam and there are some specific things that doctors do at that exam that I think we can help you understand.

So what does a pediatrician ask and do at the newborn check-up? Well in terms of history, we're interested in birth history. We're interested in their growth. So what's their weight and length, what were those things when they were born? What are they now at two weeks? And as we move forward we'll continue to plot those.

Some kids lose weight at the two-week check-up and that can actually be normal and then they slowly start to regain it back after that. And the reason for that is because kids tend to be born sort of fluid overloaded and from a nature's standpoint you're waiting on mom's breast milk to come in; the baby may not learn to latch right away and so being born fluid overloaded can help protect you from dehydration if there are some feeding difficulties, both from mom's milk production and from the baby's intake in the first couple weeks of life.

Now obviously, those problems can be extreme and even being born a little fluid overloaded you could still get dehydrated. And so how much weigh a baby's lost and when they gain it back are an important part of the history.

We also talk about feeding and well that's going and what we can do to help mom and baby out. We talk about peeing and pooping and sleeping and really answering lots and lots of questions that parents have. And that all goes kind of into the history part of the newborn exam.

25:59

In terms of the physical, with any physical exam we do a primary survey, just look at them from head to toe. Do we see anything obvious or is the parent pointing out anything obvious that they're worried about? Check their vital signs.

And then let's focus on the head, sort of some interesting things that we do in newborns that might get a little bit overlooked at later check-ups. One is to look in the eyes and look for what's called a red reflex.

And so this is if the eye is glowing red in the pupil when we shine the light in that let's you know that the light is shining all the way through the eye reflecting on the retina and bouncing back. And that red that you see are all the blood vessels on the back of the retina.

But if a kid has a cloudy lens like a cataract or they have a tumor in their eye, you might not see a red reflex. So that's a quick check that we do in newborns to make sure that their eyes are normal.

Also we look in front of their ears to see if there's an ear pit. Sometimes those can be associated with hearing difficulties or deafness. And we look at the back of their throat or the top of their mouth to make sure they don't have a cleft palette.

Most large cleft palettes are pretty obvious and get diagnosed right away, right after delivery in the newborn nursery. But sometimes kids will have a more subtle cleft palette that just involves the very back and sometimes those are picked up at the two-week check-ups, so we always want to check those.

We check the neck, make sure it's supple, it turns easily, that they don't have a stiff neck or a tight muscle on one side, which we call torticollis. We listen to their heart. We're listening specifically for heart murmurs that shouldn't be there or maybe a sign that there's a heart problem.

We also listen to the lungs, check out the abdomen. Is it soft? Make sure that there's not a big liver, that there's not a big spleen, that everything feels normal there. We look at their private parts. Is their circumcision healing well? Is the urethra in boys in the right place or does it not come out of the tip with the holes somewhere down the shaft, which we call hypospadias.

27:55

We want to make sure their testicles are descended. For the girls that they have a normal vaginal opening and a normal urethral opening when they pee. And we do a rectal exam, really just an external inspection to make sure that everything is hooked up the right way and that there aren't any little sinus tracts.

We also look at their back to see if there's any dimpling in the sacral region, which could go along with something called a tethered spinal cord. And then we look at their extremities, inspect their five fingers, their five toes. These are little things that can sometimes get overlooked in the joy and enthusiasm of having a new baby at home.

So we really try to inspect every little piece's part. Move all their joints, pay special attention to their hips and check out to see if they have any hip clicks or clunks or anything that could point us toward the developmental dysplasia of the hip, which we've talked about in a previous PediaCast.

We look at their skin. Baby's skin, we say like 'oh, you have skin like a baby' or 'your skin is baby-soft'. Really baby skin can be pretty troublesome to parents. They can have dry skin, baby acne and they could be jaundiced. So there are a lot of things that can go wrong with the skin that we would want to look at and address.

29:06

And then from a neurologic standpoint we check out their tone. Are they floppy or flaccid or are they too stiff? That could point us toward a neurological problem.

We look at the newborn reflexes, things like the rooting reflex when you stroke their cheek they move their head toward that side. So for instance, if their cheek is going to brush up against mom's nipple then their head turns that way so they can latch on. That's the root reflex.

The suck reflex if you put something in their mouth they start to suck. The moro reflex that's the one where we kind of let them drop and then their arms flail out and they start to cry. If they do that that lets you know that they're neurologically normal.

There's also one called the tonic neck or fencing reflex. We check out their grasp, something called the Babinski, the step reflex. A bunch of newborn reflexes that we do. Those are always kind of fun to do.

I'm not going to detail them all here, but you can look them up, Jennifer. They are definitely fun to elicit and show parents OK, look at what your kid can do. So there's a lot that goes on at the newborn check.

It's an important one. It's kind of a fun one. I did primary care pediatrics for 10 years and the newborn well-check was one of my favorite tasks and I do miss that now that I do more emergency medicine and urgent care kind of stuff.

So I hope that helps, Jennifer, and as always thanks for writing in.

30:33

All right. Next up we have Dee in Tampa, Florida. And Dee says, "Thanks, Dr. Mike, for putting on such a great podcast. Like many who have written in, the news you can use and listener question shows are my favorite, but I can appreciate the value of your interview shows for parents who have a child or children with the condition discussed. I love the detailed information and your candid commentary on all of your shows. I'm writing today because my four-and-a-half-year-old daughter has had a few intermittent episodes of strong pain in her left hip. A week ago, she started crying and limping out of the blue after getting off the floor from a kneeling position.

After giving her an ice pack and a few minutes of TLC she was fine and able to walk up the stairs to her room for bedtime. She had been completely fine for a week. Very active on the playground, dancing around the house, taking swimming lessons. But last evening she fell over in our garden crying in pain again and pointing to her left hip. She won't put weight on it for about an hour including our walk into the pediatric urgent care center. About an hour after the incident she started walking again but with a limp.

By the end of the night she was walking fine. The X-rays examined both by the pediatrician and the radiologist didn't show anything to be concerned about. And when the doctor was examining my daughter's hip and leg my daughter's only reaction was that the exam tickled. Because my daughter had no fever or other illness in several months the pediatrician didn't seem to be too concerned or to think that any other tests were necessary at this point unless the problem persists or other symptoms appear. She did mention that she ruled out aseptic hip, avascular issue or fracture based on her exam and X-ray results.

This morning I informed her preschool teacher about the issue and she suggested that it could be a nursemaid's hip where the joint pops and causes temporary pain and that she has seen several students with that issue over the years. My daughter was diagnosed with the nursemaid's elbow at 18 months of age with a second recurrence at age two, so I understand that condition, but I can't find anything about a similar condition for the hip. The theory seems plausible but I'm curious why if such a condition existed the pediatrician would have suggested it as a possibility.

Do you know of any other conditions similar to a nursemaid's elbow for the hip in a small child or whether there could be another condition that presents with intermittent temporary pain of the hip in this age group. At what point would you recommend heading toward a pediatric orthopedic specialist? Thanks for all you do. This podcast is an amazing resource."

32:54

Thanks for the question, Dee in Tampa, Florida. So I've been a pediatrician for about 18 years now and I have not heard of a nursemaid's hip. It doesn't exist to my knowledge and I've been around the block a few times.

So a hip pain in kids, let's talk about the possibilities. Not for your child specifically, Dee, but hip pain in general in kids. And I think as we go through this there'll be a couple that stand out that based on the description would be more likely for your child, Dee. But again, you definitely want to see your doctor in determining this for sure.

But we can give a little guidance here. Hip pain in general in kids, we worry about the hips in kids. It's a ball and socket joint and the ball, also known as the femoral head, so the long bone there in the upper leg is the femur and the head of the femur is the ball of a ball and socket joint.

And the problem with the head of the femur is it only has one blood vessel going to it. And so if this blood vessel is disrupted it compromises the blood supply to the bone and that can actually result in bone death if it gets compromised. Something that we call avascular necrosis.

And that can then lead to chronic pain, hip dysfunction limping and the possible need for an early joint replacement down the road. So we take hip pain seriously because if there's anything in the hip that could compromise that blood vessel and result in avascular necrosis we really want to prevent that if possible.

42:19

I would like to remind you if you have a question of your own we're going to make a commitment to getting to more of those in 2013. And it's easy to get a hold of me, just head over to pediacast.org and click on the Contact link.

You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. That's 347-404- K-I-D-S.

All right. We're going to take a quick break and I'll be back with the final word and again, we're playing a little bit more meat into our final words this year. So stick around. I'll have more for you, right after this.

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44:23

All right. We are back with a final word. This week's final word stems from Natalie's question and this idea of diet. I guess it's not a further answer to her question but it got me thinking about this.

We all know there's an obesity problem in this country. OK. We know that. Let's just take that fact and set it aside here for a minute. We also know that with the coming changes in our healthcare system that we have opened up more access. So more people are going to have health insurance than have had in the past, which is a fantastic thing.

Obviously, we want people to have good medical care. But we also have to realize that with that improved access comes increased healthcare cost. And the cost of providing healthcare in this country is going to get worse.

When we look at the obesity problem and we combine that with increased access and we combine that with increased cost, we could have a very real fiscal problem in this country. We already have a very real fiscal problem, but it can get worse. And in fact, it probably will get worse.

And so my final thought today is just really taking a look at what doctors and parents can do with the health of our kids, which then corresponds to the health of our country, which then corresponds to the fiscal position that we're in, because we want to decrease that cost of healthcare and be healthier and have healthier kids.

So what is the doctor's role and what is the parent's role? Well, we really need, I think, to train doctors with some common sense who aren't necessarily ordering invasive and expensive tests for no other purpose than protecting themselves from lawyers looking over their shoulders and parents demanding work-ups that make no sense.

46:25

I kind of alluded to this, too, when we talked about abdominal pain in kids and trying some things and seeing what works and making a diagnosis based on what works for that individual child. And again, that kind of goes to let's not do the big, huge, expensive workup right out of the gate.

Let's use some common sense. Let's use our clinical skills more. Let's rely on technology a little less. Let's rely on it when we need to, but we don't need to with every single case. And if we do rely on technology and invasive tests and labs the cost just gets to be staggering.

So I think that's the job of the doctor with the coming changes in our healthcare system is use that technology when you need to. Absolutely. But you don't always need to. And hopefully, we're training doctors to have some common sense and rely on our clinical skills and critical thinking about how we're going to approach things.

So what about you the parent? What is your job in saving the physical health of our country and ultimately the fiscal health of our country as well? And this is where Natalie's question really got me thinking about this with the diet.

We have a childhood obesity problem. We know that overweight kids become overweight adults. Let's just say it for what it is, they become fat adults. And fat adults have all sorts of very expensive and life changing health problems that cost lots of money and shorten your life. So by changing your child's diet now, you can help prevent that.

Your child will have the potential to live longer. They're going to have a healthier life and you'll save the country a boatload of money in the process. And you'll save your child a boatload of headache and suffering down in the road in the process as well.

48:14

So how do you do that? How do you change your child's diet? Well, a very child it can be difficult because they can be stubborn. But how do you go about changing your child's diet? There's a number of things you can do.

Eat together as a family. Model good food choices in your own life. Eliminate after-dinner-TV-watching-snacking. Encourage physical activity over screen time. Offer a balance healthy diet. Get all the food groups in there.

Cut back on the fat. Push more the veggies. Choose healthy snacks over chips. Choose water over soda. And do it now while you still can. It's common sense but many of us and myself included, I am not on a soapbox here at all.

I need to exercise more. I need to watch what I'm eating more. I need to encourage my children to snack less just like you do. We're not always making the smart choice. We make the easy choice. So I think we need to start making not just the easy choice but the smart choice as really where we need to go.

So change your diet, get more exercise for yourself, for your kids and for the health of our country. And that's my final word.

50:25

All right. I want to thank all of you listeners out there for making PediaCast a part of your day. We really appreciate it. I do want to remind you iTunes reviews are helpful if you've not taken a few moments to write an iTunes review for PediaCast we would definitely appreciate you doing so. It really helps us to spread the word.

Also links, mentions, shares, retweets, repins, all those things in the social media world are very helpful. We're on Facebook, we're on Twitter, we're on Pinterest. And so if you just like us, join our group and all that business that'll definitely help and help us to spread the word.

And then also be sure to tell your family, friends, neighbors, co-workers and your child's doctor about PediaCast. We do have posters available under the Resources tab over at pediacast.org.

One last time, best way to get in touch if you have a topic idea or a specific question for the program, just go to pediacast.org and click on the Contact link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. That's 347-404- K-I-D-S.

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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