Erythema Multiforme & Electromagnetic Waves – PediaCast 319
Join Dr Mike in the PediaCast Studio for more answers to listener questions. This week’s topics include erythema multiforme, acne and Accutane, baby yoga, infant development, sitting positions, double-jointedness, and the possible hazards of electromagnetic waves.
Acne & Accutane
Announcer 1: This is PediaCast.
Announcer 2: Welcome to PediaCast, a pediatric podcast for parents. 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. This is Dr. Mike coming to you from the campus of Nationwide Children's Hospital. We're in Columbus, Ohio. It is Episode 319 for May 27th, 2015. We're calling this one "Erythema Multiforme & Electromagnetic Waves".
I want to welcome everyone to the show.
We have another Answers to Listener Questions edition of the program lined up for you this week. And thanks to you, the listener, we have lots of topics to cover today.
Now, I've mentioned two of them in the title, and no, they don't go together. We'll start the show with the question on erythema multiforme. I know it's a mouthful. It sounds very mysterious and maybe even a little scary, but we're going to demystify it for you.
And then, we're going to end with a question on electromagnetic waves. In between, we're also going to cover acne and Accutane, baby yoga, sitting positions and double-jointedness. Is that really a thing? I mean, no one believes double-jointed people really have two joints where everyone else has one joint, right? Please don't tell me you believe that. But what is going on, really? And is it a problem? Should it keep your kids from participating in certain activities? That's the heart of our listener's question, and we'll get to the answer in a few minutes.
Sitting positions, I mentioned that as well. Are there any that are bad for kids? Could the way a kid sits hurt their joints or cause problems down the road? That's a legitimate question.
The baby yoga thing, I did a show a couple of years ago and shared a YouTube video of a mother swinging her baby all over the place and calling it baby yoga. I called it dangerous and certainly not recommended. Well, a new listener to the show, she was going through the back episodes and found my comments from two years ago and wanted to share her experience with safe baby yoga practices, so we'll hear from her.
And then, acne and Accutane. Accutane is a medicine you may have heard of. It's related to vitamin A and it can help acne go away like magic, but you may have also been scared away from it after hearing side effects and other potential problems. So we'll do another exercise on risks versus benefits as we help a family in Israel make up their minds about Accutane as a treatment for acne.
Notice I didn't say we'll make up their minds for them. The conclusion you and I reach maybe very different based on our unique situation and risk tolerance so we'll go there again. Of course, it's an important place to go, our risk-benefit meter, because the principles applied all sorts of other health care decisions, not just acne and Accutane.
And then, we'll have our book ends that I'd mentioned. Erythema multiforme, it's a big name for a big rash. Definitely scary sounding to some people, scary looking to others; not quite common, but not rare either. So we'll explore that one.
And then finally, the question you've probably pondered yourself, can electromagnetic waves cause cancer? And if so what about all those power lines and Wi-Fi routers and cell phones that are spewing them out? Should they be a cause for alarm?
Well, according to the French government, we should be concerned. In fact, they took steps to limit exposure to electromagnetic waves in daycares and nurseries. And so a pair of listeners asked a logical question, should we be alarmed about this here in the United States?
Our own federal agencies are relatively silent on the subject, but I did quite a bit of my own digging in the scientific literature, and I'll fill you in on what I found a bit later on the program.
Before we get started, I do want to remind you about our 700 Children's blog which you can find at 700Childrens.org. I read a couple of recent post there, one on listeria, since contamination with that bacteria in ice cream made news, both local and national in recent weeks.
And another on head lice, the American Academy of Pediatrics had some new words to say on an old problem including wise words on treatment and whether or not you need to keep your kids out of school if they have head lice. You can find both of those posts along with many others again at 700Childrens.org.
Also, don't forget PediaCast is your show. If you have a question for me or you want to point me in the direction of a news article or you just want to suggest a topic, just head over to PediaCast.org and click on the Contact link.
You can also call the voice line and leave a message that way — 347-404-KIDS. 347-404-K-I-D-S or 5437 if you need the digits.
Also want to remind you, the information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child's health, be sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.
All right, let's take a quick break, and I will be back with your questions. This is the show that you guys created and we'll get to all of them right after this.
Dr. Mike Patrick: All right. First up, Adrianne in New Jersey. She says, "Hi, Dr. Mike. I've been listening to the PediaCast for about a year now and find it fascinating. Thank you for putting such useful information out there. I'm curious what your thoughts are on a condition that my 18-month-old son came down with about one month ago. He's fine now, but I have taken him to a specialist for a second opinion.
He had thrown up one afternoon and had a poor appetite. Soon after, developed a fever of a 102 degrees Fahrenheit. He became lethargic and just generally sick. His pediatrician recommended we wait 24 hours to see if the fever subsided. In the mean time, I had given him Tylenol and the next day, ibuprofen which he had never had prior.
Two to three hours later, he developed a rash on his legs which slowly spread to his arms, back, stomach, and eventually everywhere. His pediatrician said this was a viral-related rash and would get worse before it got better.
Within 24 hours, he could not step down on his foot and cried in pain. He pointed to his head and hands often. I took him to the emergency room when the rash began turning purple-brown colors out of pure fear that something was terribly wrong. The ER doctor diagnosed him with erythema multiforme minor. That sounded scary, but I was reassured this was time-limited and would go away on its own, which it did within five to seven days.
What causes this? And will my son have this again? Thank you for your time – Adrianne from New Jersey."
Well, thanks for the question, Adrianne. Always appreciated.
So erythema multiforme minor, what is it? What causes it? What are the symptoms? What do you do about it? Can it come back? And if there's a minor form, makes sense that there could be a major form as well. Is this true? And if so, what's that like?
So good questions all around, Adrianne. And we'll add some to it so that we can really get a good working definition and understanding of erythema multiforme.
So let's start with just a simple definition of this. It's not a common problem, but it's not rare either. Pediatricians and many parents see erythema multiforme from time to time. And it's a characteristic rash that falls in the category of a hypersensitivity reaction. So what's that?
Well, a hypersensitivity reaction is one of the ways that our immune system reacts to something foreign that it encounters in our body and the reaction is exaggerated. So that's why we call it a hypersensitivity reaction. It's exaggerated compared to how our immune system normally responds. There's a continuum on which hypersensitivity reactions occur from very mild and minor nuisance to very severe and life-threatening. The exact point on that continuum – or in other words, how severe the hypersensitivity reaction is – depends on a complicated set of factors that we don't always completely understand.
The good news is this, the milder forms of hypersensitivity reactions, those are common ones. The medium in severity forms, they're the ones that are uncommon, but not exactly rare. And then, the severe forms, the life-threatening ones, fortunately, these are pretty rare. But it's good to know what all of these are like so that doctors and parents can recognize them and intervene when it's necessary.
So that all still seems a little bit cryptic, doesn't it? I'm going to throw one more wrench into the works. We can have immediate hypersensitivity reactions, and we can have delayed hypersensitivity reactions.
The immediate hypersensitivity reactions are probably a little bit more familiar to you. Your child may have a food allergy or an allergy to bee stings and whatever the trigger is, the body responds immediately. That's why you called it an immediate hypersensitivity reaction. It could be as mild as a few faint hives at the mild end of the spectrum. More hives and swellings somewhere in the middle and full-blown life-threatening anaphylaxis with hives, possible breathing problems, possible dropping blood pressure at the severe end of the scale. And those are the folks that need an epinephrine auto-injector or an EpiPen available when they're prone to unknown trigger, potentially causing anaphylaxis for them.
So those are immediate hypersensitivity reactions. Now, erythema multiforme is a type of delayed hypersensitivity reaction, meaning, it takes a few days to get started. It occurs by some different mechanisms of the immune system compared to the immediate reactions.
Delay of hypersensitivity reactions also live on a continuum with simple hives and other itchy rashes like the one we see with poison ivy, or poison oak, or poison sumac depending on what area of the country you live in, for example, on the mild end of the spectrum. Things like serum sickness, erythema multiforme minor, erythema multiforme major in the middle of the spectrum, and Stevens-Johnson syndrome and Toxic Epidermal Necrolysis on the severe life-threatening end of that continuum for delayed hypersensitivity reactions.
Again, the exact nature of the reaction and where you end up on that continuum is dependent on a complex set of factors including your genetics.
Okay, so now that we have framed hypersensitivity reactions, let's hone in on one specific type of delayed hypersensitivity reaction in the middle of the spectrum called erythema multiforme. I know, it took us a while to get there, but I think it's important to understand how it relates to other exaggerated responses of our not-always-perfect immune systems. So what sort if things trigger erythema multiforme? What does it look like? What's the difference between the minor and major varieties and what do you do about it?
We'll start with the triggers. So something triggers erythema multiforme, and the most common trigger is going to be infection and in particular, viruses are a common trigger. In particular, the herpes simplex virus which causes cold sores, but other viruses can do it as well.
Certain bacteria can also trigger erythema multiforme. Mycoplasma, for instance, is a common bacterial trigger, but others can do it too. And some fungal infections can also trigger erythema multiforme.
Medications are less commonly a trigger, but they're also possible. In particular, non-steroidal anti inflammatory drug, things like ibuprofen, certain anesthesia drugs like barbiturates, antibiotics like penicillins and sulfonamides and some seizure drugs like phenytoin or Dilantin, these are all medications that are known to trigger erythema multiforme. But again, medication as a trigger is less common than infection as a trigger.
So Adrianne, your son had an infection with fever and not feeling well prior to the onset of the rash, and he may have been sick with that whatever caused that infection for a little bit longer. Even then, he had the symptoms, and he had exposure to ibuprofen. Although his first dose of ibuprofen was two to three hours before the onset of the rash, and since erythema multiforme is a delayed hypersensitivity reaction, not an immediate one, I think the ibuprofen is less likely to be a cause in your case compared with infection. But that doesn't completely eliminate ibuprofen as a possibility.
Now with regard to infection as a cause, keep in mind it's not really the infection that causes erythema multiforme, it's the immune system's response to the infection. So it's not only a delayed hypersensitivity reaction, it's also an auto immune type problem. So the immune system is what's actually causing this.
So what does erythema multiforme look like? What are the symptoms? Well, the primary symptom is a characteristic rash. It usually begins on the extremities — the arms, hands, legs and feet — but it can also involve the face, the neck and the trunk.
The rash begins as pink or red blotches of various sizes, which develop over a few days into round shapes that look like targets, with most typically red on the outside margin, kind of pale or pink in the center and sometimes a red dot in the very center. So it really does look like a target lesion or a bullseye kind of lesion.
These range in size from small buttons to silver dollars, and individual lesions can coalesce into some unusual shapes. Areas of lesion may turn a deep red, almost purple color, but if you do see purple, it's important to distinguish these lesions from something we call purpura, which is a different sort of rash caused by bleeding into the skin.
Purpura is a different beast. It can be associated with some mild conditions, but it can also be associated with some life-threatening conditions. It's a difference your doctor will be able to tell. It's not a judgment you want to make for yourself at home. Which leads me to probably the most important point I can make in this discussion, and that's any funny-looking rash, any rash you're uncomfortable with — you know the kind, the one's that make your mommy or daddy radar go off — they should always be seen and evaluated by your doctor right away.
If not in person, give your doctor a call by phone so your doctor can advice you for trip to the emergency department or an urgent care is necessary, or if it's something that can wait till the next day for them to take a look at it. Based on your description, they may be able to give you some advice there.
If you can't get a hold of your doctor and your child has a concerning rash that you're not comfortable with, just go. Go to an emergency room or an urgent care center. It may not end up being serious as is the case with the erythema multiforme or could be life-threatening and you really need to see a medical provider to tell the difference.
OK, so back to erythema multiforme. We have red target lesions which are characteristics, sometimes blue to purple hues, and then finally as they're resolving, they may turn a copper to brown color before fading away. The lesions are frequently itchy, so they do itch a little bit. Sometimes they burn, and they may be associated with hives. Sometimes they blister and become what we call bullous lesions which can rupture and scab, and sometimes the skin becomes dry and scaly as the rash fades.
You'll notice I used the word sometimes quite a bit in this description. The truth is the erythema multiforme has a considerable range of appearances. It doesn't always look like the classic textbook picture, and it's important to have an experienced clinician take a look and provide the diagnosis. That's true for a lot of childhood rashes. There's a range of what they can look like so you really need someone with experience looking at these things and diagnosing them.
So, in addition to the rash, we also can see low grade fever, muscle aches and joint pain are common with erythema multiforme and sometimes mouth sores or blisters occur.
There's a bit of controversy about what to call minor versus major forms of erythema multiforme or you just lump them all together and just call it erythema multiforme. So there's some controversy in terms of nomenclature.
In general, if there's no or very minimal mucous membrane involvement which includes the inside of the mouth, those were the ones we typically call erythema multiforme minor. And if there's more substantial mucous membrane involvement, then we would call it erythema multiforme major.
The presence or absence of a mucous membrane involvement is important because this is seen with the more severe and life-threatening forms of delayed hypersensitivity reactions such as Stevens-Johnson syndrome and toxic epidermal necrolysis.
So if you have mucous membrane lesions that are there, that's more of a cause for concern and that's why sometimes it's called erythema multiforme major versus erythema multiforme minor.
So what do you do for erythema multiforme? Well, unfortunately, there's not much we can do other than help the kid out with the symptoms. Erythema multiforme, as your doctor suggested, is self-limiting, meaning it goes away on its own. But it takes a while to go away and the length of time varies most commonly one to two weeks, but sometimes as long as four weeks.
You can remove the trigger by stopping an offending medication or treating the infection if there is a treatment, but that doesn't necessarily help or shorten the course of the reaction because, again, it's not the infectious agent or the medication that's actually causing the rash — it's the immune system's response to those things. And even if you take those things away, the immune system often will continue to have the full course of that response.
You can treat the symptoms, as I mentioned, moist compresses on the rash, or topical creams to help alleviate the itching. Anti-histamines like Benadryl may also help the itch. Tylenol can be used for muscle aches and joint pain. Ibuprofen would help too, but it's not recommended if that's believed to be the trigger. Sometimes steroids are used for a few days, especially if mouth sores are present. But steroids won't help the rash or joint pain get better any faster, and it won't keep this reaction from getting worse.
Really, the best treatment is what I like to call 'tincture of time'. You just have to wait it out, which is something most parents don't like to hear, but it is what it is. It's the truth and you just have to wait.
So what's the outlook for a kid who has erythema multiforme? Well, again, it resolves on its own. Sometimes, some hyperpigmented spots can remain, and this is because there's an intense inflammatory reaction in the skin which may stimulate underlying pigment cells to start making more pigment in the areas where the rash and inflammation used to be. And these dark spots may last a few months, but after some time, the pigment cells usually settle down and the dark spots fade away.
What about recurrence, which Adrienne was asking about? Can it happen again? Well, it can especially if your child re-exposed to the original trigger. Sometimes this can be avoided, and sometimes it can't, especially in the case of infections depending on the exact nature of the trigger.
So do you need to see a specialist for erythema multiforme? And if so, who do you see? Well, straightforward cases of erythema multiforme can be diagnosed and managed just fine by your primary care provider. The condition is scary for parents because it has a big strange sounding name, and because it's a rash you've probably never seen before, and because it lasts a long time, and because your doctor is saying there isn't much we can do about it.
But despite these things, your primary doc has most likely seen it still lots before. Remember, it's not rare, not common. It's not something that your doctor's seeing every week, but they see it a few times a year, and your doctor likely feels comfortable helping your child through it.
However, if mouth sores or other mucous membrane involvement become a prominent feature, or if other concerning signs and symptom develop, or your primary care doc is not really sure what's going on or is not comfortable with your child's case , or if erythema multiforme is happening recurrently, or really for any other good reason under the sun, then your primary care doc may want to collaborate with a specialist or a team of specialists — which could include allergists, immunologist, dermatologist, emergency medicine physician, hospitalist, or an intensivist — depending upon the exact scope and nature of the problem at hand.
So there you have it, Adrianne. Erythema multiforme, hopefully, demystified somewhat. There's a lot more complicated science to explore beneath the surface, but I think that's good for now, since we have other questions to answer and this is a podcast, not medical school. I hope our discussion helped your understanding. And as always, thanks for the question. Really appreciate it.
Next up, we have Geraldine at Ra'anana, Israel. Geraldine says, "Hi Dr. Mike. Love your show. Wish you were our pediatrician. My daughter has acne. She's 15 now. We've tried different things, basically, antibiotics like doxycycline and it worked wonderfully. The problem is the acne comes back the moment she stops the treatment. We're now considering Accutane, but when I did research, I read so many side effects. What do you think? Thanks again for sharing your knowledge. Cheerio — Geraldine."
Thanks for the question, Geraldine all the way from Israel. I really appreciate you listening to PediaCast and writing in.
Choosing a particular course of treatment for any medical condition, acne included, really boils down to filtering the evidence of risks and benefits through you and your families, and in this case your teenage daughter's risk tolerance and need for benefit filters.
You're right. Accutane has lots of potential side effects including eye irritation, bone and joint pain, rashes, liver and lipid problems, bone marrow suppression and many others. And a very large concern with Accutane is that it can cause severe birth defects if someone taking it becomes pregnant.
So there are lots of concerns, but let's face it. Most medications do have a longer list of possible side effects. You know this because you hear the ads, you read the labels and you explore the results served up by Dr. Google. At the same time, you understand side effects very tremendously. Sometimes they affect a very small minority of people using the medication. Sometimes they affect nearly everyone who takes the medication. Sometimes there's just a minor nuisance, sometimes they can be life threatening.
So what you really need is a medical provider you know and trust, who will sit down and help you navigate benefits and risks, not only for the medication and question, but also for alternative treatments and for the result of not treating the condition at all.
So let's take acne as an example, since that's what Geraldine is asking about. You have to start with the answers to these questions. How bad is your child's acne? What problems is the acne currently causing? What problems could it realistically cause in the future? What treatments have you tried before? What's worked? What hasn't worked? And what are the risks and benefits of each specific treatment? What's the likelihood and potential outcome of these risks and benefits? And where does your risk tolerance lie? And those are the questions you and your doctor have to answer together.
So let's start down the road for acne realizing the final decision is unique for each patient, and it's a discussion and decision that must take place between you and your child's doctor. You can't get the right answer from a podcast.
So what are the risks of acne now and in the future? So if you just don't treat it at all, what are the risks? Well, one is disfiguring. It can lead to infection. It can lead to scarring which is permanent scarring, and it can lead to mental health issues. Kids already have a fragile self-esteem, and kids can be pretty mean at school. So there's the whole social and psychological aspects of acne. So there really are some genuine risks of not treating significant acne.
There's a difference between mild acne on the one end of the spectrum and severe cystic acne on the other end. There's a difference between acne that's just a little bit of a nuisance and acne that is really interfering with a teenager's quality of life or has the potential to scar their skin permanently.
So you have to have a clear understanding of where your child lies on the severity scale and how likely they are to experience current and lasting physical and emotional complications of their acne. That's the first thing. Because if it's mild nuisance acne, then the risk of Accutane is going to overshadow the benefit. Better to use something with less side effects if it's mild nuisance acne, right?
On the other hand, if the acne is more severe and skin infection and scarring, and then health issues are coming into play, then it's important to find something that's going to work, and your tolerance for risks gets larger because you're looking for a greater benefit.
Now, not knowing all the specifics of your case, Geraldine. I can say, in general, if you find a treatment that works such as a topical medication like salicylic acid or benzoyl peroxide or topical antibiotics or Retin-A type medication or a topical combination of these things — or let's say you add an oral low-dose daily antibiotic to the topicals like the doxycycline, your daughter has been taking — if whatever you're doing is working and it's well tolerated, but when you stop, the acne comes back, maybe not stop it unless side effects or other concerns arise.
If other concerns arise, do those concerns rise to the level of concern we have for something like Accutane? If the risk of treatment is lower than it is with Accutane and the current treatment is working, why stop it? And, again, that's a question only you and your doctor can answer together.
On the other hand, if nothing else is working or there are serious concerns that rise above the level of concern for the Accutane, and there is risk of concerning of recurring infection and risk scarring, and/or mental health concerns, at that point, the benefit-risk analysis for Accutane starts to favor benefit-over-risk rather than risk-over-benefit.
Of course you want to know what the risks are. You want to understand them. You want to monitor for them. You want to know what you can do to minimize them, and you want to follow your doctor's recommendation for monitoring and minimizing those risks. But at the end of the day, you also have to accept the risks. That's the price of seeking the benefit. There isn't a right answer for every family. It really has to be an individual decision between you and your doctor.
So I hope that helps, Geraldine. Accutane has helped and changed the lives of many teenagers with severe acne. It's also caused more trouble than it might be worth for a few others. But I will say this, it's helped more people than it has hurt. Otherwise it wouldn't be approved.
If you go that route, don't be surprised if your provider requires that your daughter be on birth control while taking Accutane and be sure to follow through with recommended blood tests while taking it. I know that sounds scary.
On the other hand, there are plenty of adults with scarred faces who wished they and their parents had taken the risk. And there are some, although I guess the number is much smaller who took the risk and wished they hadn't. But that's life, isn't it? A series of decisions fraught with benefits and risks. Sometimes we make the right choices, sometimes we don't.
But the two things we should always do — first, we should make an informed decision and that starts with an honest and genuine conversation with your doctor. And second, we move on after our decisions without regret because we made the best choice we could given the circumstances and the information we had at the time and we go on to make more informed decisions down the road. That's what we do.
Again, Geraldine, thanks for the question and get talking with your child's doctor. I should also mention, if it's your primary care doctor who wants to use the Accutane, it makes some sense to get the opinion of a dermatologist who treats lots of teenagers with acne. If you're already seeing a dermatologist and you're not clicking, maybe that's why you're asking my opinion on this. If that's the case, there's nothing wrong with finding another dermatologist, maybe someone you click with a little better.
So I hope that makes sense, Geraldine. And again, thanks for the question.
All right, next up is Megan in Indiana. Megan says, "Hi Dr. Mike, I'm a new mom that was looking for a great pediatric resource and I found you on iTunes three months ago. I've been hooked ever since. I just went to visit family in Georgia and while spending 11 hours in the car, I listened to past episodes the whole way."
Wow. That's quite impressive, and thank you. Thank you very much, Megan, for your interest in PediaCast.
"I caught your episode on baby yoga. Although I do agree the mother practicing baby yoga in the video is quite disturbing, I was hoping you would also talk about the good kind of baby yoga. I got a great book while pregnant called, Itsy Bitsy Yoga by Helen Garabedian. When my little guy was one month old, we started implementing it into our daily routine, and he loves it. Now, it doesn't involve swinging him around or standing him on his head. We simply sit on the floor and do some stretches and poses gently, but we have found it really suits him, relieves gas and makes him super happy.
"I taught both his grandmothers how to do some yoga poses, too, in case they need to calm him, and both have said it really helps when they're babysitting. I hope you can share with your audience because it's a great way to interact with your baby.
"I'm also wondering if you have any recommendations on developmental classes for infants and toddlers such as swimming, music, reading, groups, et cetera. I've looked at doing a swim class, but I heard you have to dunk them underwater. I know it's really quick and obviously, he won't drown, but it still seems scary. Any thoughts you have on the subject would be really appreciated.
"I'm a huge fan of the show. I think it's wonderful how you get so much great information out to parents. Thanks so much, Megan from Indiana."
Well, thanks for your comments and your questions, Megan. And thanks for listening, again. Eleven hours straight. That definitely takes dedication. My family won't even listen to me talk for 11 hours straight. I at home, more than an hour I'm talking about something, and they're like, "Can you just shut up for a little while?" So I really do appreciate the dedication of listening for an entire car trip across half the country.
All right, so baby yoga — forgive me if I came across as too negative when I covered baby yoga in the past because I really was addressing that specific video, which if it was a real baby and the jury's still out on that one, then it really was quite ridiculous and not safe at all.
On the other hand, the kind of baby yoga that you are talking about, Megan, with reasonable positions and gentle stretches, that's great. And if it suits the fuzzy baby and it lowers adult stress levels in the process, I'm all for it.
Again, please forgive me for lumping the two together if that is what I did. I don't remember exactly because the discussion was a couple of years ago. PediaCast 248 was the episode. And for those who are wondering what in the world we're talking about, I'll put links in the Show Notes for this show, Episode 319 over at PediaCast.org, I'll put links to that episode, 248, along with the link to the crazy-not-recommended baby yoga video and the much more appropriate book, Itsy Bitsy Yoga.
So go to Show Notes at PediaCast.org. Look for this Episode 319, and we'll have links to all those things for you.
Although I do have to provide a little bit of the side note here. The subtitle of that book, Itsy Bitsy Yoga, reads poses to help your baby sleep longer, digest better and grow stronger. I doubt the author provides convincing evidence that these statements are true. So I'm not endorsing that your baby will really sleep longer or digest better, or grow stronger if you buy the book and follow it's advice.
On the other hand, Megan vouches for its effectiveness with her child. Well, I believe her. Still it's anecdotal and your mileage may vary. At the very least, you and your baby will have fun and maybe those other things will happen, but if you buy the book and they don't, you've been warned.
OK, so check out those links if you're still inclined.
With regard to baby development, I really think anything you do with your baby that is stimulating and fun and safe, whether be in an official class or an activity you concoct yourself, go for it. The more interaction and stimulation, the better. Reading, music, art, splashing in the water, it's all good. Just keep in mind, improved development is not guaranteed. There's a whole bunch of genetics, in addition to environment that takes its toll on where development ends up.
There is research to suggest that just being with your baby, doing anything is probably more important than what you're doing. So plunking on piano keys at home with baby in your lap, that's better than your baby listening to Mozart lying there by his or herself. And the social time that you, as the parent, gets in a baby development class, that improves mom and dads mental health, which improves baby-parent interactions.
So these kind of classes where parents and babies are all together, it's not just about baby development, it's also about you. And that's OK because in the end, it benefits everyone. Having a little bit of a support network with the other moms and dads is important when you have a little baby at home.
So do what you like and do it together. Don't look at it as improving development. Look at it as just being together and having fun. I think that's what really counts. And by some of the research we've covered here on the show in the past, that's what works. So turn off the screens, get down on the floor or up on a piano bench and have some fun together.
Now, with regard to swimming lessons, remember, those will not make your baby safe in water. Always supervise your children 100% of the time around any depth of water, including a little bit of water in a bath tub.
Swimming lessons provide a false sense of security and plenty of excellent child swimmers drown every year. So supervision and fences and alarms and locking doors and gates, those are always a must. So baby pool time has nothing to do with safety. However, it is a fun experience. Nothing wrong with splashing around together in a safe and supervised way. And if you don't want your baby's head going under the water, just don't do it. Just say, no, thank you. You're paying for this experience, right? Don't succumb to bullies or peer pressure in the class. Have fun your way, provide the experience, and above all, keep it safe.
When you're paying the bill for this swimming class, if the instructor says it's time for baby's head to go underwater and you don't want to do it, just don't do it. You have that option. They probably not going to really kick you out of the class if you don't do it. If they do, you probably don't want to be in that class to begin with.
All right, let's move on. Crystal in Gatineau, Quebec, Canada says, "Hi, Dr. Mike. I really appreciate you taking time to answer my previous question on CHARGE syndrome a few years back. Here's another one for you. My three-year-old daughter often sits in a W position when sitting on the floor. Her knees are together, but her bottom is on the floor with her legs to each side. I've heard that this is not an ideal sitting position, but couldn't find any recent information out there that wasn't anecdotal."
So you guys are catching on to the terminology.
"Is it really a bad position to sit in? Should I correct her every time she sits like that? Is it something she would just grow out of? Thanks once again for taking listener questions. Keep up the great work — Crystal."
Well, thanks for asking the question, Crystal. I'm sure plenty of parents have questions about this and other sitting positions. So here's the deal — first, kids are way more flexible than you and me. We used to have that kind of flexibility, but no more. So I wouldn't advice you trying that or other seemingly painful sitting positions because you might have a really hard time getting out of it, and you'll probably spend a good deal of time wishing you hadn't tried.
Second, most kids are pretty smart about pain. If it hurts or they experience pain afterward, or their legs are going numb and they can't walk for awhile afterward, then they generally won't do it or they stop doing it. And notice I did say most kids. You'll have a few here and there that aren't quite as in tune with themselves, or they're impulsive and forgetful about their previous experience.
So if you notice the correlation between a specific sitting position and a complaint of pain or not being able to walk for awhile after getting up, then your child might need some help remembering. And that sitting position's probably not going to be recommended if it causes pain or disability, however short-lived. On the other hand, if it doesn't hurt now or later, and it doesn't cause any functional problems, then… their flexibility.
It's like the old tales of getting too close to the T.V. or crossed eyes getting stuck, it's not really a problem. Of course, there are exceptions to every rule. So if your child has a known orthopedic or muscular or connective tissue problem, or you have any other concerns about a specific sitting position, ask your child's doctor. But for most kids, if it doesn't hurt and it doesn't cause a functional problem, they're probably fine. Just leave it and let them go.
Next up, Jamie in Fleming Island, Florida, "Dr. Mike, I love your podcast. I love hearing your advice and/or opinion on multiple subjects. I would love your advice about my daughter. She's nine years old and is double-jointed. She's very active. She dances three to four hours a day seven days a week and is on a competitive dance team.
"I never really gave it much thought that she might be limited in some activities. It wasn't until recently when I was talking with her dance teacher about putting her in gymnastics. He told me this was a bad idea because she is double-jointed. So I began wondering what problems we could face as she grows up.
"Could her being double-jointed cause complications with her development or restrict her from doing certain activities? I don't know if this helps but she also underwent discoid meniscus surgery when she was seven. What is your advice for parents with children who are double-jointed? Thank you, Jamie."
Well, thanks for the questions, Jamie. So double-jointed is not really a medical diagnosis. Some kids and adults have increased flexibility of certain joints, which is probably genetically determined. Some folks have increased flexibility of all of their joints, or so it seems like Houdini. Sometimes this is caused by an atomical variations, and sometimes it's caused by disease. But double joints? That's not really a thing. So that's my first point.
My second, are you sure the dance teacher doesn't want to lose your child to gymnastics? Is there an ulterior motive here? I'm not saying that's the case, but could it be a possibility? As with most questions I get, the first place to check is with your child's doctor. Let your doctor examine your daughter and advice on her worthiness for gymnastics. Don't live it up to the dance coach.
If your child has already seen an orthopedic doctor, which I suspect is the case given the history of the discoid meniscus, then ask him or her about it. If the orthopedic doctor says no, then no. But again, don't leave that decision into the dance instructor.
Another option, you could see a pediatric sports medicine physician and their athletic trainers that work with them. They may be able to provide insight on strengthening and conditioning injury prevention given your daughter's flexibility and helpful ideas on what specific activities are safe and which ones are more risky for your daughter.
Bottom line, don't take the dance instructor's opinion as the final word especially when he has something to gain by the outcome of the decision. Talk to your doctor and go from there.
All right, finally, I have a pair of questions on electromagnetic waves. First up, Terra in Pennsylvania, "Dr. Mike, I'm really concerned about exposure to electromagnetic waves. How concerned should I be with this? It is becoming almost impossible to avoid them with all the increase in technology especially when it comes to our homes. I heard it could potentially cause cancer."
And Nate in Forest Grove, Oregon says, "Hi Dr. Mike. I'm reading about the new French regulations on Wi-Fi and getting a little freaked out. We have cellphones in the home and also heavy wireless router. I have two sons, one eight months and another five years old in the house. What are the dangers? What is the FDA and FAA saying? I don't know if you've already addressed this in another podcast and here's a link to an article about the restrictions of Wi-Fi in nurseries in France. Thanks. I'm learning a lot from your show."
Well, thanks to both Terra and Nate for the questions. And I'll put a link to the article that Nate submitted regarding the ban of Wi-Fi use in daycares and nurseries in France. I'll put those in the Show Notes for Episode 319 over at PediaCast.org.
So a year ago, my mother was moving back up to Ohio from Florida, and our job — my wife and I — was to find a place for her to move up to. We found a really cool old farmhouse in a revitalized uptown area of a suburb of Columbus, Hilliard to be specific, that used to be the outskirts of a small railroad town. Things changed in a big way over the course of a hundred plus years. And while it was a cool old farmhouse, it also have high tension power wires close enough that you could hear the faint buzz from the front yard, and the buzz was a little more prominent on the wet Ohio day that we took a look at the house.
So before I even offered this up as a possibility to my mother who was a nine-year stage three ovarian cancer survivor, who's been in and out of remission and knows the chemo and radiation routines all too well, before I even suggested it I wanted to do more than a little research because I have heard the same sorts things that you are hearing.
One interesting thing I read as I was doing my research… And I have no idea if this is true, I sort of doubt it. I don't know, maybe it is. I read a story of someone with power lines very close to their backyard who could take a fluorescent tube bulb, stand in a yard with it and the light would glow with a very faint green color. Sounded more like a ghost story to me, but it caught my attention. It's one of those thing you doubt is true, but on the other hand, you kind of hope it is because it's kind of a mean, neat little trick, definitely amazing. But it's a neat little trick and amazing in a home you visit, maybe not so much if you live there.
So anyway, I came across that one.
But I also scoured the literature, the scientific literature on this, and I could not find any convincing evidence that electromagnetic waves, which power lines produce in much greater quantities than Wi-Fi routers and cellphones. I could not find any convincing evidence that electromagnetic waves cause cancer.
There are some studies that showed an association awhile back. They were done a long time ago and they were fraught with confounding variables that weren't really accounted for. A lot of power lines were placed in old railroad right of ways. So utility comes along, and they want to put in a high-tension power line. They need a big long area to put it in, and rather than buy a property from individual owners or try to get government to take over the property, if they can get a railroad right of way, then they got a long linear plot of land over a large distance that they can put up their power lines.
The problem is these old railroad right of ways had chemical spills in the soil. And so then, you got to ask, "Well, is it really the power lines that are causing increased cancer? Or was it the chemicals in the soil that was causing the increased cancer?"
And the better designed follow up studies that really tried to isolate out electromagnetic waves as a cause rather than confounding factors, those really have showed no association at all. At least the ones that I've come across.
My mother did not choose the old farmhouse close to the power lines. She cited other reasons, not the power lines, as the reason for not choosing it, but I'm sure the cancer thing was in the back of her mind, and I get that. Still she has Wi-Fi routers in the condo she did choose and a smartphone near her person most of the day. I don't really feel uncomfortable with her exposure to these things, at least not after doing the research myself.
Now, apparently, the French government feels differently, but that's not to say they're basing their policy on the consensus of well-designed evidence.
They admit that their action is precautionary based on the World Health Organization classifying electromagnetic waves as "possibly carcinogenic, and the French National Agency for Health Safety of Food, Environment and Labor recommending to limit exposure of the population to radio frequencies especially from mobile phones especially for children and heavy users."
And yet the basis for these organizations and agencies making these claims is not based on credible evidence, at least that I've seen and at least at this point. Now maybe someone out there will point me in the direction of evidence that changes my mind. Maybe there's something when I scour the literature that I just did not come across that is a well-designed large study.
But I kind of doubt it. If you have proof, show me. That's how we judge risk versus benefit. And right now, on my mind, from what I've seen for me and my family, the benefit of Wi-Fi routers and cell phones and electrical energy far outweigh any risk.
Now, your evaluation and decision may be different, but please look at the evidence and try to steer clear of political pressure and political agendas.
Where do you start? PubMed is a fantastic tool to look up research, but you have to do more than just look at the results. You have to look at methods and the possibility of confounding factors and numbers and statistical significance. And as I consider these things, I just don't see evidence of a conspiracy or a cover-up really, any significant concern with electromagnetic waves.
So hope that helps, Terra and Nate. As always, thanks for the questions. Really do appreciate it.
Don't forget if you have a question for me or you want to suggest a topic idea for PediaCast maybe for one of our interview shows, or you want to point me in the direction of a news article as Nate did, it's easy to get in touch. Just head over to PediaCast.org. Click on the Contact link, I do read each and every one of those that come through.
You can also call the voice line, 347-404-KIDS. 347-404-K-I-D-S or 347-404-5437 if you need the digits.
All right. Let's take a quick break, and then we're going to wrap up the show right after this.
Dr. Mike Patrick: All right, we are back with just enough time to say thank you to all of my listeners who took time out of your day to sit down and write a question. Really appreciate that. And if you have a question for me, again, just head to PediaCast.org and click on the Contact link.
Also thanks to the rest of you. Those of you who didn't ask a question, thank you too for being a part of the audience and for making PediaCast a part of your day, and for listening to our show and sharing it with other moms and dads. We really do appreciate that.
It's all the time we have today. PediaCast is a production of Nationwide Children's Hospital. Don't forget, you can find PediaCast in all sorts of places. We're in iTunes and most podcasting apps for iPhone and Android, including the Apple Podcast App, Downcast, iCatcher, Podbay, Stitcher and TuneIn.
We're also on iHeart Radio, where we not only have this program, but also PediaBytes, B-Y-T-E-S. Those are shorter clips from this show, and they can be weaved together with other content providers to make your own custom talk radio station.
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And, of course, we always appreciate you talking us up with your family, friends, neighbors and co-workers, anyone with kids or those who take care of children, including your child's healthcare provider. Next time you're in for a sick office visit or a well-check up or sports physical, or a medicine recheck, whatever the occasion, let them know you found an evidence-based pediatric podcast for moms and dads. We've been around for nearly a decade, with lots of great content, deep enough to be helpful, but in language parents can understand.
And, while you have your providers' ear, let them know we have a podcast for them as well, PediaCast CME. Similar to this program, we turned up the science a couple notches and provide free Category 1 CME Credit for listening. Shows and details are available at PediaCastCME.org.
This one is in the can. 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.