Enterovirus D68, School Lunch, Soda Tax – PediaCast 296

Join Dr Mike in the PediaCast Studio for more news parents can use. This week’s topics include breakfast & type II diabetes, nutritional value of packed lunches, family meals & cyberbullying, soda tax, TV ads & apple fries… plus everything you need to know about the outbreak of Enterovirus D68!


  • Breakfast & Type II Diabetes
  • Nutritional Value of Packed Lunches
  • Family Meals & Cyberbullying
  • Soda Tax
  • TV Ads & Apple Fries
  • Enterovirus D68




Announcer 1: This is PediaCast.

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

Dr. Mike Patrick: Hello, everyone, and welcome once again to PediaCast, a pediatric podcast for moms and dads. This is Dr. Mike, coming to you from the campus of Nationwide Children’s Hospital on Columbus, Ohio. It is September 24th, 2014, Episode 296. We’re calling this one “Enterovirus D68, School Lunch and Soda Tax”. I want to welcome everyone to the program.

So I originally planned to call this episode, “Breakfast, Lunch and Dinner” and make it a clever all-meals-of-the-day episode of PediaCast. You knew that wasn’t going to work out. And I still have all those stories lined up for you, and we’ll get to the specifics in the moment. But my clever plan was disrupted by a little virus called Enterovirus D68. You may have heard about it. It showed up here in the Midwest, in Kansas City and Chicago first. Then it decided to pay us a little visit here in Columbus.


Let me tell you, we’ve been swamped with sick kids, in pediatrician offices, in our urgent cares and in our emergency department. And yes, as you’ve heard in the news, there had been sicker kids than we typically see with respiratory viruses this time each year in the fall. We’re seeing lots more kids wheezing than usual, many who do not have a history of ever wheezing before. And lots of kids had been admitted to the hospital, some do intensive care because of this virus. But of course, many, many, many more who are infected with the virus, just have runny nose and congestion for a few days and then it goes away. It’s really the sick of the sick that we see, and most kids with this virus do well.


But what has really stricken the community, more than the virus I think, is many times, fear — fear concerning where this virus came from, why so many kids are having severe symptoms, fear that your child might be infected, fear that you might not recognize the symptoms in time, fear your child might wheeze or need admission to the hospital or even need intensive care. These are all fears that many families in the Midwest have expressed and families elsewhere, those in communities the virus hasn’t yet visited, we hear fear in your voices as well.

Now, here’s the encouraging part, really, you don’t need to be afraid. Yes, we’re seeing more sick kids, and we’re seeing more kids with severe symptoms. But we also know that the vast majority of children infected with Enterovirus D68 will have mild symptoms and will recover just fine. And the sicker one, well, we know what causes the symptoms and we know how to treat them. So the medical community is not panicking.


Parents armed with knowledge, which we’ll provide for you later in the program, there’s no reason for you to panic either. Why? Because I have all the facts that you need and understanding and dealing with Enterovirus D68. We’ll cover the nuts and bolts of this illness. Including, what exactly is Enterovirus D68? How does this spread? What symptoms does it cause? What causes similar symptoms and how can you tell the difference? Why are so many kids experiencing severe disease? How is Enterovirus D68 treated? When should you go to the emergency room? Is there a shot to prevent it? How can we keep it from spreading to our kids?


That’s all coming your way at the end of the program, in my Final Word segment. Yes, I know, it’s hot news, but look, it’s also an add-on. I had this great idea for a breakfast-lunch-and-dinner show, and this little guy sweeps in and ruins my plan, so he gets added to the end. Just the way it goes. Because the rest of our topics are also very important.

What are they? Well, I’m glad you asked. Breakfast in Type 2 Diabetes – it turns out eating breakfast every day may help prevent Type 2 diabetes. But it’s just any breakfast or do they have to eat the right foods? We’ll let you know.

And then, the nutritional value of packed lunches. As a standards for the National School Lunch Program changed, more kids are packing their lunches. So how are moms and dads doing? Are they packing nutritious lunches or are the homemade meals a train wreck? I’ll give you  a hint. The news is not even close to being good.

And then, family meals and cyberbullying, yes, there’s a connection, and we’ll talk about it.

And then, soda tax. That’s just what we need, right? Another tax. On the other hand, obesity is a public health problem, is it time to implement a soda tax? We’ll look at a study that examines the potential benefits of a soda tax as well as other alternatives.


Then, finally, TV ads and apple fries. This is one of my favorite stories of this program. A certain fastfood company is cutting up apple and making the slices look like french fries. Even the container looks like a fry back. Is this a good thing or a bad thing. We’ll take a close look and I’ll share a link to an entertaining YouTube video of the researchers and children in action. So stay tune for that.

Of course, at the end of the show, we’ll explore the ins and outs, nuts and bolts of the Enterovirus D68. So don’t go anywhere. I’ve got a great show lined up for you.

Few reminders before we get started, our 700 Children’s Blog, you’ll find it at 700childrens.org, “Enterovirus D68: Learn the Facts”, written by yours truly, and I’ll put a link in the Show Notes for that one for this episode. Other topics, “Breakfast on the Brain”, which ties in nicely with today’s show, “The Dangers of Caffeine Powder”, “Extending Our Mission: Training Colorectal Surgeons in Africa”, “Is Your Child Abusing Drugs or Alcohol?”, and “Could Your Child Have a Rare Form of Diabetes?” So those stories and more, just head over to 700childrens.org and check out our blog.


Also, if you have a topic that you like us to talk about here on the podcast, or you have a question you like me to answer, or you want to point me in the direction of a journal article or a news story, it’s easy to get in touch, just head over to pediacast.org, and click on the Contact link.

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. If you have a concern about your child’s health, be sure to 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 of course you can find at pediacast.org.


All right, let’s take a quick break, and I will be back with news parents can use right after this.


Dr. Mike Patrick: All right, we are back.

Regular consumption of healthy breakfast may help children lower the risk of developing Type 2 diabetes. This is according to a report recently published in PLOS Medicine. The study, lead by Dr. Angela Donin of St George’s University of London, found an association between children who reported skipping breakfast most days and higher levels of known diabetes risk factors. The researchers reached these conclusions after conducting a cross-sectional study of over 4000 primary care children, nine to ten years of age in the United Kingdom.


The children responded to questions about how often and what they ate for breakfast, and blood tests measured diabetes risk markers such as fasting insulin glucose and glycated hemoglobin, also known as hemoglobin A1C. Twenty-six percent of the children reported not having breakfast every day. Children who reported usually not having breakfast have higher fasting insulin levels, higher insulin resistance, slightly higher hemoglobin A1C, and slightly higher blood glucose levels compared to children who reported always eating breakfast. Additionally, among children who completed a 24-hour dietary recall, those who reported eating a high-fiber cereal-type breakfast had lower insulin resistance than those eating other types of food, such as biscuit-based breakfast.


So I have to pause here, biscuit-based breakfast, maybe one of my listeners from the United Kingdom will be kind enough to write in and enlighten us, Americans in the audience, what exactly is a biscuit-based breakfast? Now, I realize in other parts of the world, what we call cookies here in the USA are called sweet biscuits, so I’m  wondering if a biscuit-based breakfast, which by the way is hard to say three times fast, is like donuts and pastries maybe. Because I would think that what we call biscuits will be more of a high-fiber item and not so much a basis of the meal, but more of a side dish with let’s say bacon and eggs or sausage gravy. See, language barrier still get in the way even when we’re all speaking English.

Anyway, though a limitation of cross-sectional studies is the risk of identifying false associations as a result of confounding factors. This association identified in the study remained significant even after adjusting for potentially confounding factors such as socio-economic status, physical activity, and body fat. Still, the authors note the need for future studies to demonstrate whether increasing breakfast consumption among children leads to improvement in their diabetes risk profile. The authors say the absurd associations suggest that regular breakfast consumption particularly involving a high-fiber cereal could protect against the early development of risk factors for Type 2 diabetes.


So there you have it. Another reason breakfast is important, especially if you choose a non-biscuit-based healthy one, whatever that means. Maybe someone will write in and let us all know.

All right, open a child’s lunch box and you’re likely to find a meal inside fall short of federal guides, says researchers at Tufts University, as published in The Journal of the Academy of Nutrition and Dietetics. Senior author of the investigation, Dr. Jeanne Goldberg, says the study is among the first to examine what children bring to school for lunch and snack. Researchers used digital photography to document the lunches and snacks of more than 600 Massachusetts third and fourth graders in 12 schools in 6 public school districts. Goldberg and colleagues compared students’ lunch and snack items to standards provided by the National School Lunch Program and the Child and Adult Food Care Program.


So what did they find? Well, as it turns out only 27% of the lunches met at least three of the five National School Lunch Program standards, and only 4% of snacks met at least two of the four Child and Adult Food Care Program standards, both of which emphasize fruits, vegetables, whole grains and low or non-fat dairy.

Dr. Goldberg says the findings highlight the challenges associated with packing healthful items to send to school. She adds, “When deciding what to pack, parents are juggling time, cost, convenience, and what is acceptable to their children. Unfortunately, these factors are not always in harmony with good nutrition. Lunches were comprised more of packaged foods than anything else. Almost a quarter of the lunches lacked what would be considered an entree, such as a sandwich or leftovers, and were instead made up of a variety of packaged snack foods and desserts.


“The few existing studies on packed lunches report that children who bring their lunch tend to consume fewer fruits and vegetables, less fiber and more total calories than those who participate in the National School Lunch Program.” Dr. Goldberg says, “Given that over 40% of US schoolchildren bring their lunches to school on a given day, it’s important to consider how nutrition experts and policymakers could help parents meet the challenges of cost, convenience, and child preference and still add nutrition to the equation.”


The researchers also found considerable room for improvement in school snacks. Goldberg and colleagues found that a typical snack consisted of one or more sugar-sweetened beverages paired with a packaged snack food or dessert. Corresponding author, Dr. Kristie Hubbard, says, “Few studies have evaluated snacks from home and our data suggest that classroom-based snacking presents another opportunity for kids to eat and drink high calorie and nutrient-poor foods and beverages. Although water was slightly more common than sugar-sweetened beverages at lunchtime, we saw many children with two or three sugary drinks in their lunchboxes. Replacing sugary drinks with water – the drink recommended by the American Academy of Pediatrics – keeps children hydrated without adding extra sugar to their diet.”

The current study evaluated one day’s worth of lunches and snacks in 12 schools. And Dr. Goldberg acknowledges the need for larger studies of more diverse groups of students over an extended period of time. But she says the study still points to the need to help parents find a way to build nutrition into the packed-lunch routine. Investigators say this is a challenge, one that will require creative approaches to packing lunch boxes with affordable, easy-to-prepare, and healthy options while at the same time creating a demand for these options among children.


So, a healthy lunch is important. I’m somewhat torn here. The National School Lunch Program has drastically changed their standards in the last two to three years. They’re good and healthy standards, but you’ve seen the news stories. You’ve probably heard children complaining. You’ve heard about schools opting out of the program, and you’ve probably heard about children wasting food that is required to be on their trays. So by making drastic changes over a short period of time, the question becomes, “Are policymakers driving more kids to bring unhealthy packed lunches to school?” Personally, I think they are. And here, we see a study showing that those packed lunches tend to lack good nutrition. Almost a quarter were exclusively made up of packaged snacks and desserts. I mean, really, is this helping the problem? No.


So I think some common sense and moderation on the part of the National School Lunch Program is in order. Sure, the standards are great from a nutrition and public health point-of-view. But are they realistic? Are they helping children or are they driving kids to bringing unhealthy lunches from home?

Bottom line here, and this is where the real common sense comes into play. Parents, we have to take the lead. You know your kids, you know what they like, but you also want the best for them. You want them to be healthy. And I think we can all agree that simply packing snacks and desserts is not the right thing to do. But what is? Well, you have to spend some time investigating. You need to invest some time and energy and the input of your kids into this, and you have to make smart and realistic decisions.

And to get you started, I’ll share some links on how to pack a healthy lunch when the kids will actually eat. You can find those links over at pediacast.org in the Show Notes for this episode, PediaCast number 296. What will you find there? “Wondering What To Pack For School Lunches” from WebMD, “How to Pack a Healthy School Lunch” from the American Heart Association, “School Lunches 101” from the AAP News, “School Lunches: You Can Make a Difference” from Healthy Children, and “Understanding My Plate”, also from Healthy Children.


So there’ll be lots of stuff for you there to click on and gather some information on packing healthy lunches. And again, you can find that in the Show Notes for this episode, 296, over at pediacast.org.

All right, let’s move on. Sharing regular family meals with children may help protect them from the effects of cyberbullying. This, according to research from the McGill University and published in the journal, JAMA Pediatrics. Dr. Frank Elgar, with McGills Institute for Health and Social Policy, says because family meal times represent social support that benefit adolescents’ well-being, family communication during the meal can serve to reduce some of the distressing effects of cyberbullying.


He adds, “One in five adolescents experience cyberbullying. Many teens use social media, and online harassment and abuse are difficult for parents and educators to monitor, so it is critical to identify protective factors for youths who are exposed to cyberbullying.”

The study examined the role of frequent family meals in reducing the impacts of online bullying on adolescent mental health. The researchers surveyed over 20,000 teenagers in the state of Wisconsin. They measured exposures to cyberbullying and traditional face-to-face bullying and a wide range of mental health outcomes, including depression, anxiety, substance use, self-harm, suicidal thoughts, and suicidal attempts.

Dr. Elgar says, “We found that emotional, behavioral, and substance use problems are as much as 4 1/2 times more common among victims of cyberbullying. And these impacts are not due to face-to-face bullying. They are specific to cyberbullying.”


The authors found that cyberbullying victimization relates more strongly to these problems in adolescents that have fewer family dinners, which suggests that family contact and communication during family meals reduces some of the distressing effects of cyberbullying.

Dr. Elgar says, “The results are promising, but we do not want to oversimplify what we observed. Many adolescents do not have regular family meals but receive support in other ways, like shared breakfasts, or while traveling to school.”  Elgar adds that parental involvement and supervision may go a long way to helping victims of cyberbullying, “Checking in with teens about their online lives may give them tools to manage online harassment or bullying that can easily go undetected.”

So this is what I mean when I say, “Stay involved with your kids” at the end of every PediaCast episode. You want to know what’s going on in their lives, and this includes cyberbullying victimization. Or maybe your child is doing the cyberbullying maybe because he or she was bullied by someone online in the past. So be sure to check in on your child’s online life. It’s important, because cyberbullying is associated with depression and anxiety, substance use, self-harm, suicidal thoughts and even suicidal attempts.


How do you stay involved with your kids? Well, one way — and of course, there are many ways, but one way when they seem to be slipping out of our grasp — is the family meal.

Childhood obesity in the United States remains high, but a tax on sugar sweetened beverages such as sodas, energy drinks, sweet teas and sports drinks would reduce obesity in adolescence more than other policies such as exercise or an advertising ban. And it would generate significant revenue for additional obesity prevention activities. This according to researchers at Partners for Prevention in Washington DC, and published in The American Journal of Preventive Medicine.

But more than a soda tax, the study demonstrates that increased physical activity would have the greatest impact on obesity for children in the 6 to 12-year-old age range. Nearly one in three kids, between ages 2 and 19 were overweight or obese in 2009 to 2010, and there are significant disparities in obesity prevalence among racial and ethnic groups, and by socio-economic status. Overweight adolescents tend to become overweight adults making childhood the ideal time to change habits and prevent obesity.


For these reasons, policymakers are interested in effective programs and policies to reduce this widespread problem. States and localities are increasingly using laws, regulations and other policy tools to promote healthy eating and physical activity. However, federal policies can reach a larger populations and fund more programs that benefit populations at risk for obesity and thus play an essential role in improving public health.

In order to evaluate the potential long-term impact of federally recommended policies, investigators use a set of criteria to select three policies to reduce childhood obesity from among 26 recommended ideas. So, what three policies did they select to study? Number one is an after-school physical activity program. Number two is a one cent per ounce excise tax on sugar-sweetened beverages, and number three was a ban on child-directed fast food television advertising.


To reach policy, the literature was reviewed from January 2000 to July 2012 to find evidence of effectiveness and to create average effect sizes. The investigators then used a Markov microsimulation model to estimate each policy’s impact on diet or physical activity, and then BMI, in a simulated school-aged population in 2032, after 20 years of policy implementation.

The model predicted that all three policies could reduce the prevalence of childhood obesity, particularly among Blacks and Hispanics, who have higher rates of obesity than whites, thus demonstrating that federal policy could alter the childhood obesity epidemic.

Afterschool physical activity programs would reduce obesity the most among children ages 6 to 12 and the advertising ban would reduce obesity the least. The soda tax fell in the middle overall but promised to reduce obesity the most among teenagers in the 13 to 18-year-old range.


Lead investigator of the project, Alyson Kristensen, says, “Although the model predicts that each of these policies would reduce obesity in children and adolescents, the one cent tax on sugar sweetened beverages has other characteristics that make it the best option. The tax,” she says, ” reduces obesity while at the same time generating significant revenue for additional obesity prevention activities.”

An earlier study estimated that a national one cent per ounce soda tax would have generated $13.25 billion in 2010. Other advantages, the soda tax would reduce obesity among adults. It does not require substantial federal funding to implement, unlike the afterschool physical activity program, and it would not face the legal hurdles that new regulations often encounter.

Investigators say, “Implementation of any of these policies in the near term is extremely unlikely. However, this may change as the evidence base for these policies grows and changes in public knowledge increase calls for stronger governmental action. Research showing the harms of consuming sugar sweetened beverages continues to grow and the need for new revenue sources may spur Congress to consider a national soda tax,  such as the recently introduced SWEET Act.”


Researchers say, “In the meantime, the findings support state and local level action to enact soda taxes, promote physical activity in afterschool settings, and reduce marketing and advertising of unhealthy foods and beverages in public schools.”

So, here’s another plea on my part for action on the part of parents. Do we need one or want another tax? I personally say no. But, on the other hand, do we need or want parents making good decisions? Yes. Please, less sugar sweetened beverages for your kids. Now, if only it were that simple.


Attempts by fast food companies at depicting healthier kids’ meals frequently goes unnoticed by children ages three to seven year-old age range. This is according to a study by the Dartmouth-Hitchcock Norris Cotton Cancer Center. The research, published earlier this year in JAMA Pediatrics, found that one-half to one-third of children did not identify milk when shown McDonald’s and Burger King children’s advertising images depicting that product. Sliced apples in Burger King’s ads were identified as apples by only 10 percent of young viewers. Instead, most reported they were french fries.

Other children admitted being confused by the depiction, as with one child who pointed to the product and said, “And I see some… are those apples slices?” The researcher replied, “I can’t tell you… you just have to say what you think they are.” The child responds, “I think they’re french fries.”

To view a video of this encounter, along with other responses from children participating in the study — and I do recommend you take a look because it is particularly entertaining — simply head over to pediacast.org and look for the link in the Show Notes for this episode, 296.


Dr. James Sargent, principal investigator of the project says, “Burger King’s depiction of apple slices as ‘Fresh Apple Fries’,” see, they’re even calling them fries, “was misleading to children in the target age range. The advertisement would be deceptive by industry standards, yet their self-regulation bodies took no action to address the misleading depiction.”

In 2010, McDonald’s and Burger King began to advertise apples and milk in kids’ meals. Sargent and his colleagues studied fast food television ads aimed at children from July 2010 through June 2011. In this study, researchers extracted “freeze frames” of Kids Meals shown in TV ads that appeared on Cartoon Network, Nickelodeon, and other children’s cable networks. Of the four healthy food depictions studied, only McDonald’s presentation of apple slices was recognized as an apple product by a large majority of the target audience, regardless of age. Researchers found that the other three presentations represented poor communication.


This study follows an earlier investigation conducted by Sargent and his colleagues, which found that McDonald’s and Burger King children’s advertising emphasized giveaways like toys or box office movie tie-ins to develop children’s brand awareness for fast food chains, despite self-imposed guidelines that discourage the practice.

While the Food and Drug Administration and the Federal Trade Commission play important regulatory roles in food labeling and marketing, the Better Business Bureau operates a self-regulatory system for children’s advertising.

Again, it’s self-regulatory.


Two different programs offer guidelines to keep children’s advertising focused on the food, not toys, and more specifically, on foods with nutritional value.

Dr. Sargent says, “The fast food industry spends somewhere between $100 to 200 million dollars a year on advertising to children, ads that aim to develop brand awareness and preferences in children who can’t even read or write, much less think critically about what is being presented.”

So, this study makes a good point. How much easier would it be on us parents if children saw and recognize healthy food on fastfood advertising, especially in homes where parents are really trying to get their kids to make better choices? Instead of offering healthier food because they have to, what if fast food companies created a demand for healthy food by presenting it in a way that is attractive to children and in a way that would encourage children to choose it. It’s a win-win. They offer healthy food for kids and they make money in the process.


Now, let’s face it. Sometimes you got to eat out. And for some of us, it’s more than sometimes. So parents need a fast food partner, not a deceptive advertising campaign that lures children in by making them think that apple slices are french fries.

It’s an eye-opening video. Be sure to check out the link, and again, we’ll have that for you over at pediacast.org in the Show Notes for this episode, which is 296.

All right, that does wrap up the main portion of our program, but stay tuned and I will be back with a final word on Enterovirus D68. That’s coming your way right after this.



Dr. Mike Patrick: Runny nose, cough and congestion are sweeping across central Ohio. You know this because you’ve seen it in the news, on social media feeds, and if you’re like me, in your own home. It happens this time every year. Ragweed counts and mold spores rise, asthma and allergies act up, and virus-sharing kids return to school, get sick, and lovingly transmit their germs to moms and dads and the rest of the community.

But this year is different. Here at Nationwide Children’s Hospital, we’ve seen a larger number of patients with respiratory complaints compared to a typical September. We’ve also seen more severe cases than usual, with many children wheezing and requiring admission to the hospital. Some need intensive care. And we aren’t alone in this observation. Reports from Alabama, Colorado, Georgia, Illinois, Iowa, Kansas, Kentucky, Michigan, Missouri, Oklahoma, and Utah tell similar stories.


In early September, the Center for Disease Control and Prevention identified Enterovirus D68 in Kansas City and Chicago. And soon after, the Iowa Department of Public Health reported the virus in their neck of the woods. Samples from central Ohio are still pending as of this reading, but none of us should be surprised to hear the official announcement that EV-D68 has arrived. In fact, if public health officials are correct in their prediction, and I believe they are, this virus will eventually make its way across the entire country.

So what is Enterovirus D68? Until now, EV-D68 was an uncommon — and let me say that again — an uncommon member of the enterovirus family of microorganisms. You know a few of its relatives: Rhinovirus, culprit of the common cold, Coxsackievirus, famous for hand-foot-mouth disease, and the once-feared still-respected Poliovirus. Discovered in 1962, EV-D68 has kept a relatively low profile, causing only six small outbreaks between 2005 and 2011 in the Philippines, Japan, the Netherlands, and the United States. Because it was rare, few laboratories are set up to test for EV-D68, which explains why it took awhile to figure out which virus is making so many kids sick.


So how is EV-D68 spread? Although it has not been thoroughly studied, EV-D68 likely spreads through respiratory droplets and oral secretions. Enteroviruses are also know to infect the GI tract, so transmission through stool is also possible. Bottom line: the virus appears to spread easily through close contact with an infected person, and prevention strategies include staying away from sick people, covering coughs and frequent hand washing.

What symptoms does Enterovirus D68 cause? The current outbreak of EV-D68 appears to be isolated to the respiratory tract. This means it causes runny nose, mild sore throat, cough and congestion. Children with asthma have a high risk of wheezing with this virus, as they do with all respiratory viruses. In addition, there have been many cases of children wheezing who do not have a history of asthma. Wheezing, by the way, is caused by inflammation in the small airways of the lungs, and swelling in these passages restricts the flow of air. The result is a soft, high-pitched sound, especially heard when breathing out.


EV-D68 has the potential to cause fever, abdominal pain, vomiting, diarrhea and rash, but so far these have not been prominent in the current outbreak. EV-D68 has also been implicated in past outbreaks of polio-like paralysis. This is extremely rare and has not been reported in any state at this time.

What causes similar symptoms and how can you tell the difference? Infection with any one of the many common respiratory viruses can result in similar symptoms. Allergies are another cause of runny nose, cough and wheezing this time of year. Since there is no universally available test for EV-D68, there is no sure way to differentiate it from other possibilities. Public health officials will send samples to the CDC in an effort to track the spread of the virus, but they won’t test everyone.


Since there is no specific treatment for EV-D68 and since respiratory symptoms, regardless of cause, are treated the same, there is no reason to test everyone for this particular virus. If an outbreak of EV-D68 is identified in your area, and your child has symptoms typical of EV-D68, there is a good chance your child is infected with the virus.

Why are so many kids experiencing severe disease? At this time, we don’t have a definite answer to this question. There are many possibilities. One likely explanation is that children in affected areas have not had previous exposure to this virus and do not have immunity against it. Scientists will continue to investigate the current outbreak, and future research will likely focus on the biology of EV-D68 infection. Until then, we only know what we see, that lots of kids are getting sick with severe respiratory symptoms, and the likely culprit is EV-D68.


How is EV-D68 treated, and when should we go to the emergency room? The vast majority of children will only experience mild upper respiratory symptoms similar to the common cold. These symptoms last about a week, and treatment is supportive: remove mucus from the nasal passages, ensure plenty of rest and encourage fluids. Children who develop wheezing, difficulty breathing, unusual rashes, persistent vomiting or prolonged fever should see a doctor. Really, if you have any concern at any time, it’s always a safe bet to touch base with your child’s primary care provider.

Children with severe respiratory symptoms — wheezing, difficulty breathing — need to be seen right away. If your child is experiencing severe distress, call 911. Otherwise, call your doctor or have your child seen in an urgent care center or emergency department with special skill in treating pediatric patients.

If your child only has cold-like symptoms — just a runny nose and a mild cough — it really is best to touch base with your regular doctor first. By filling urgent care centers and emergency departments with children who have minor symptoms, it becomes more difficult to care for those who need immediate attention.


Should we panic? Of course not. Runny nose, cough and congestion are common symptoms in the fall. You know this. And most kids with EV-D68 will do just fine and feel better in a few days. However, there is the potential for severe disease. Other than those with a history of asthma, there is no way to predict which children will have an escalation in symptoms, so keep a close eye on your child. You’re going to do that anyway, right?

If he or she begins to have severe wheezing or difficulty breathing, call 911. If the symptoms are mild to moderate, call your regular doctor. If you are unable to reach your regular doctor or if your regular doctor instructs you to go, then visit an urgent care center or emergency department with experience treating children.

Is there a shot to prevent this? Not at this time. But the rapid spread of a potentially-dangerous virus should serve as a wakeup call for all of us. There was a time when viral-mediated diseases like smallpox and measles and polio wrecked havoc on American children. Thanks to immunizations, those days are largely behind us. However, if we let down our guard, the rapid-fire spread of EV-D68 is a clear example of how fast and furious infectious disease can roam through an unprotected community.


And that’s my final word. Actually, I’m going to add one final word to my final word. So I guess this would be a final, final word. Flu season is rapidly approaching. So this would be a fantastic time for you and your children to get your annual flu shots if you haven’t done so already. And really, truth be told, influenza is a much more dangerous virus than EV-D68. As of now, there haven’t been any deaths reported from Enterovirus D68.

Yeah, there had been kids who wheeze, and some of them with severe wheezing, they end up in the hospital. Some of them even end up in the intensive care unit. But the good news is it does appear that this virus, when kids wheeze with it, they respond very nicely to usual asthma and wheezing type treatments.


On the other hand, influenza, and in particular for kids with underlying lung disease like asthma and allergies, and kids with underlying chronic conditions like heart disease, diabetes, that sort of thing, and really just kids in general, influenza can cause complications like pneumonia and can be life-threatening. In fact, each and every year, influenza does kill a number of  children in the United States. So, if you’re worried about Enterovirus D68, you should be more worried about influenza and I would definitely encourage you and your kids to get your annual flu shots.

And that’s my final final word.

By the way, if you like to read and/or share my thoughts on Enterovirus D68, you’ll find  a text version over at 700childrens.org. That’s our hospital’s blog. I’ll also put a link to that post in the Show Notes for this episode, 296, over at pediacast.org.


All right, we’d like to thank all of you for taking time out of your day to make PediaCast a part of it. This does wrap up our time together.

PediaCast is a production of Nationwide Children’s Hospital. Don’t forget, PediaCast and our single-topic short format program, PediaBytes, are both available on iHeartRadio Talk which you’ll find on the Web at iHeart.com, and the iHeartRadio app for mobile devices.

Our show archive, which includes over 250 programs — actually, we’re really approaching 300 now — as well as our Show Notes, transcripts, terms of use and our contact page are all available at our landing site, which is pediacast.org.

We’re also on iTunes, under the Kids and Family section of their podcast directory, and of course, we do appreciate reviews in iTunes. You’ll also find PediaCast on Stitcher, TuneIn, Downcast, iCatcher, Pod Bay and most other podcasting apps for iPhone and Android.


We’re also on Facebook, Twitter, Google+, and Pinterest. Of course, we really appreciate you connecting with us there, and sharing, retweeting, re-pinning our posts so you can tell your own online audience about our little show.

We also appreciate you talking us up with your family, friends, neighbors and co-workers, anyone with kids, and anyone who takes care of children. And as always, be sure to let your child’s doctor know about the program next time you’re in for a sick office visit, or a well-child checkup, or an ADHD recheck. Let them know about PediaCast, and the posters are available under the Resources tab at pediacast.org.

And 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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