Finger Foods, Bed Wetting, Head Lice – PediaCast 200
Join Dr Mike for more news parents can use and answers to your questions! This week’s topics include finger foods, moving from house to house, second-hand smoke exposure in cars, bed wetting, cool mist humidifiers, head lice, and toddler behavior revisited.
- Finger Foods
- Frequent House Moves
- Second-Hand Smoke Exposure in Cars
- Bed Wetting
- Cool Mist Humidifiers
- Head Lice
- Toddler Behavior
- Finger Foods and Healthy Weight
- Frequent Housing Moves and Adult Health
- Second-Hand Smoke Exposure in Cars
- Bed Wetting and Sleep Deprivation
- Bed Wetting and Constipation
- PediaCast 199 – Hypoplastic Left Heart Syndrome
- PediaCast 182 – Temper Tantrums
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!
Mike Patrick: Hello, everyone, and welcome once again to PediaCast, a pediatric podcast for moms and dads. We're coming to you from the campus of the Nationwide Children's Hospital in Columbus, Ohio.
This is Episode 200 for February 22nd, 2012. We're calling this one "Finger Foods, Bedwetting and Head Lice." Of course, we have lots more topics coming your way and we'll get to a rundown of our lineup here in just a minute, but I want to pause. As I mentioned, it is Episode 200, and I think this is a big milestone, so I just want to give it a little bit of thought here.
We started doing PediaCast back in 2006, so we're going on six years now, and as I thought about this to talk about this with you at the beginning of this show, I did a little reminiscing.
I remember when we first began, I was in the basement of my house. We were on a pretty rickety table. We did get a Skype thing going so we could do some interviews and really just tried to make a commitment to getting patient and parent education materials as pertains to general pediatrics into the hands of moms and dads.
Six years later, we've definitely grown. We've had some good times, we've had some bad times. We almost stopped doing it. My family and I, we were down in Florida living after a few years and got a little distracted and really got burnt out with doing it to some degree because I was trying to do PediaCast on top of a full-time 40-hour-a-week job, plus living in Florida and really dedicating family time to…I didn't want my kids to grow up and I'm spending all my time on PediaCast.
We had the opportunity in 2011, the beginning of the year, so about a year ago now, to come up here to Columbus and bring PediaCast to the campus of Nationwide Children's Hospital, and it's been great. It really revived the program, and here we are, Episode 200. I'm not in a basement on a rickety table anymore. We are in a gorgeous audio studio and we can have guests actually stop by the studio and talk to us, which we did a lot last year and have lots more plans of that this year as well. So it's been great.
And actually, speaking of milestones, in June there's really quite a big milestone for Nationwide Children's Hospital. We're opening up a brand-new building, and it is humongous. In fact, when it's open, we'll be the second-largest pediatric facility in the United States, 12 stories tall, each floor the size of a football field.
If you want to see what the new building's going to look like and just get a sneak peek at our new facilities, in the Show Notes over at pediacast.org, I'm going to put a link to our Building Update page. So if you just want to see, 'Hey, what's this place called Nationwide Children's Hospital like?' what's the new place going to look like, just head over to pediacast.org and we'll have a link, again, to the building update so you can check it out over there.
All right, enough about our 200th episode. Let's go on with it already. What are we talking about today?
Well, first up, finger foods and healthy weight. If you introduce young babies to finger foods early, is that a good thing or a bad thing? Is baby food better or are finger foods better as you're weaning them from milk, from breast milk or from formula, as you're starting solid foods? Do you want to start the solid foods with baby food or with finger foods? And does it make a difference in their health and their weight later on, depending on which route you go?
We're also going to talk about frequent moving, as in from house to house, so kids who move frequently. You'll look at my family and we moved down to Florida, then we moved back up to Ohio. Does moving frequently affect their health, particularly their health as adults? So if you take an adult and you look back at how many times they moved as a child, does that have an impact on their adult health?
Secondhand smoke in cars, not a good thing. We'll talk about why. Also, bedwetting. We're seeing some new relationships with bedwetting, which makes you think or rethink how you treat bedwetting, and a couple of those factors, that there's been some recent studies on, include sleep deprivation, could how much sleep that you're getting affect bedwetting, and also constipation. Can the presence or absence of constipation be related to bedwetting. If you slept better and took care of constipation, could that help bedwetting to go away? We're going to talk about that.
And then we have some listener questions on cool mist humidifiers, head lice, and then on toddler behavior, which, again, that seems to be a recurrent topic here on PediaCast, but I know it's something that lots of you who are out there listening right now deal with on a daily basis, so we're going to help someone talk through some toddler behavioral issues coming up in just a little bit on the program.
I also want to remind you that each episode of PediaCast is really tailored toward you. So if there is a topic that you want us to talk about, you have a question for us, a comment, an idea for a show or a news story you want to point us toward, we really, really like to get the audience involved and participating.
And it's really easy to do. Just go over to pediacast.org and click on the 'Contact' link. You can also email firstname.lastname@example.org or call the voice line at 347-404-KIDS. That's 347, 404, K-I-D-S.
I also want to remind you, the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals, so if you 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.
With that in mind, we will get back to 'News Parents Can Use' right after this break.
Mike Patrick: Our 'News Parents Can Use' is brought to you in conjunction with the news partner "Medical News Today", the largest independent health and medical news website. You can visit them online at medicalnewstoday.com.
I do want to point out that "Medical News Today" has been one of our news partners for many years now, and if you've not checked out their website, you've heard me talk about it but you haven't actually been over there to check it out, tons and tons and tons of news articles that relate to not only your child's health but to your health as well. They cover adult stories, pediatric stories. It's just a goldmine of health-related news. I would encourage you to check them out, again, at medicalnewstoday.com.
All right, first up in our 'News Parents Can Use' segment, a study published in the "British Medical Journal Open" reveals that infants tend to eat healthier and maintain a healthy weight as they get older if they're allowed to feed themselves with finger foods from the start of weaning. This early introduction to finger foods is known as 'baby-led weaning' and a difference from traditional weaning practices whereby parents feed their infants with a spoon. According to the researchers, findings from the study indicate that baby-led weaning may help prevent childhood obesity.
Findings from the study were based on 155 children between the ages of 20 months and six years. Parents completed surveys documenting their children's food preferences and weaning style. The researchers found 63 parents spoon-fed their children puréed foods throughout the weaning while 92 parents followed the baby-led style of weaning and allowed their infants to eat finger foods early on.
So what did they find? Well, the baby-led group of weaners tended to eat complex carbohydrates such as toast and crackers while the spoon feeders ate sweetened puréed versions of fruits, vegetables, meats and complicated mixtures such as baby food, lasagna. Got to love those mixtures.
How did these trends affect weight down the road? Well, the baby-led group of weaners were more likely to maintain a healthy weight for height and age while the spoon feeders were more likely to trend toward obesity. And these findings held true even after researchers controlled for such factors as birth weight, parental weight, and socioeconomic factors.
According to the authors, carbohydrates such as toast may improve a child's awareness of textures, which are destroyed when food is puréed. Prior studies have demonstrated that presentation is an important factor in food preference.
Of course, baby-led weaning has its critics who point out the possibility of finger food-related infant choking, but researchers say in their study choking did not surface as a problem, and they conclude that baby-led weaning appears to have a positive impact on babies eating healthier foods and has implications for combating the world-documented rise of obesity in contemporary societies.
I'm not going to come out swinging as a die-hard proponent or opponent to baby-led weaning. I'll let parents decide for themselves. But I do think the study and the findings have merit. But I don't want to brush the choking risk under the carpet, either. This particular study looked at only 155 kids, so I do wonder if there would've been some significant choking events if they had looked at thousands of kids rather than just over a hundred.
I think the take-home here on choking is if you're going to jump on the baby-led weaning bandwagon, you have to constantly supervise your baby's meal the entire time they're eating. Actually, even if you're doing baby food, the same advice applies. You don't want to put any kind of food in your baby's hand and then walk away. Be there with them right there. Constant supervision is important while they're eating.
Also, avoid small pieces of food that are the size of your baby's trachea or windpipe. And to give you an idea of what that size is from a diameter standpoint, if you look at your baby's little finger, so their pinky finger, that's about the size of their airway. So it's a small circle, but you want to avoid chunks of food that are about that size or something that could get caught in the airway.
Little chunks of anything like carrots, hotdogs, grapes, these things are definite no-nos. You want to cut them into smaller bits that won't get caught in the airway or larger finger foods that they can take little bites of that are going to be appropriate size. And again, you're going to have to be watching them to make sure that the size of things that they are biting off aren't chokable sizes.
And I've said this before, too, and I'll say it again now, and I'll probably say it again in the future: all parents, moms and dads, should take infant and child first aid and CPR classes so that you are prepared in the case of a choking or other emergency.
All right, let's stick with the United Kingdom for our next story, another British study, this one published in the "Journal of Epidemiology and Community Health". It suggests that moving frequently, as in from house to house, during childhood appears to raise the risk of poor health as an adult.
Researchers looked at 850 Scottish residents taking part in a longitudinal study of long-term health spanning two decades. Participants ranged in age from 15 to 55 years of age and the team evaluated each one's overall health, including a subjective evaluation of general health, documentation of unhealthy behaviors such as illegal drug use, smoking and heavy drinking, physical health parameters such as weight, BMI, blood pressure, lung function, and aspects of psychological health.
They divided participants into 'healthy' and 'unhealthy' groups and then took a look back at how often they moved from house to house as children to see if they could make any connections.
So what did they find? Well, 20% of individuals lived in the same address throughout childhood while 60% moved once or twice, and another 20% moved three or more times. Risk factors for moving frequently included living with a single parent or a stepparent and having two or three siblings at home. Interestingly, individuals with four or more siblings tended to stay put in the same house during childhood.
The team found no clear link between frequent house moves and socioeconomic class. Also, there was no association between physical health measures and the frequency of house moves.
However, the researchers did find an association between moving from house to house during childhood and an increased risk of psychological distress, also smoking during adolescence and adulthood, heavy alcohol consumption, and general feelings of poor overall health.
According to the researchers, some of these effects might be due to changing schools, which can disrupt social networks and turn family life on end. However, this doesn't appear to be the case for a heightened risk of illegal drug use. During adolescence and adulthood, the team found that illegal drug use was independently linked to frequency of house moves during childhood, even after taking into account the number of school moves, parental background, and levels of affluence.
So moving frequently from house to house does not appear to affect physical health of adults, if you look back at their childhood, but it does make a little bit of a difference on psychological health with those who move frequently, having more psychological issues as adults.
Again, as I mentioned in the introduction to the program, having moved from Ohio to Florida to Ohio again, I can see how this is possible.
Moving does have a psychological impact on families, it's stressful, and changing schools is stressful, and these are the kinds of things that do appear to affect mental health down the road. So I think that's a factor that parents, you should consider when making moving decisions.
Now I know many times you don't have a choice. Jobs change, life circumstances change, and sometimes you just have to do it. But in doing so, we should be aware of the stress that this places on our kids and we need to make sure we're doing everything we can to emotionally support them through those changes.
My daughter likes to point out that she has lived in seven houses in 17 years. My son has lived in six. Now we did stay put in one home for 10 years, so that's a lot of moving in the remaining seven years. Once we moved to Florida, we were having a house built, so we were in a different house for a while, and once we moved back to Ohio, we had lived with family for a brief time. So she's counting some soft ones there that weren't necessarily 'you're setting up your own bedroom that you think is going to be permanent, and then it's not.' But it's still a lot of moving.
Of course, it did take lots of love and support on our end as parents. It has been definitely required for our family's journey, and I'm sure for your family, too. But in the end, giving opportunities for love and support are good things. You just have to be aware of the stresses as well.
For us, I guess it really helped that our kids home-schooled where we actually did a private online school, and of course with social media these days, it's a little bit easier to stay in touch with friends than it was when I was a kid growing up and had to move. So those are also things to consider as well.
All right, let's move on to secondhand smoke. This is even less of a good thing when you look at it.
Secondhand smoke exposure among middle and high school students in the U.S.A. has actually dropped over the last 10 years, so say researchers from the National Center for Chronic Disease Prevention and Health Promotion and the Centers for Disease Control and Prevention. But in a report to be published next month in the journal "Pediatrics", the authors say too many kids and teens are still trapped with smoke, and in being so trapped, they run significant health risks.
Regularly occurring inside the car, secondhand smoke exposure for non-smoking children and teens dropped from 39% to 22.8% in the past 10 years, but the nearly one-quarter of all kids and teens who still suffer from regular in-the-car exposure are prone to such problems as frequent upper respiratory infections, exacerbations of asthma, delayed lung growth, and frequent ear infections.
Dr. Brian King, lead investigator for the project, points out previous studies have looked at secondhand smoke exposure in the home, but his team wanted to hone in on smoke exposure in automobiles because of the higher concentration of toxic chemicals the cooped-up kids breathe in.
Despite a significant reduction of in-the-car secondhand smoke exposure, the authors point out that nearly one-quarter of American children and teens are still exposed to dangerous and deadly toxins on a regular basis, and they believe jurisdiction should expand comprehensive smoke-free policies to not only include work sites but public places and also motor vehicles occupied by youth.
All right, moms and dads, don't wait for smoking in your car with your kids on board to become illegal. Please, just stop doing it now.
Nighttime visits to the bedroom are generally associated with being pregnant or having an enlarged prostate, but the problem can affect youngsters as well. A new study sheds light on why some children may need to urinate more often during the rest cycle.
Danish researchers have found that sleep deprivation causes healthy children between the ages of eight and 12 to urinate significantly more frequently, excrete more sodium in their urine, and have altered regulation of the hormone important for excretion and they also have higher blood pressure and heart rates.
The study, entitled "Sleep Deprivation Induces Excess Diuresis and Natriuresis in Healthy Children", appears in the "American Journal of Physiology – Renal Physiology" published by the American Physiological Society. Some big words there. 'Diuresis' just means urine production and 'natriuresis' means sodium excreted in the urine. So the title of the study simply means not sleeping enough leads to extra sodium in urine and extra urine volume.
Let's talk about how they figured this out and why they think this occurs, and what it all means to you, the parent, because I am going to bring this home for you. Just hear me out and we'll get there.
Twenty healthy children, 10 boys and 10 girls, were enrolled in the study. The children underwent two consecutive 24-hour stays at the hospital. The first 24-hour period was used to register baseline values including urine data, blood pressure and heart rate and other physiological measures. The second 24-hour period was used to register these values during and following sleep deprivation, and the information was subsequently compared with everyday life records submitted by the parents.
On both evenings, the children were required to be in a supine position, so on their back, in bed in a dimly-lit room at 8 p.m.. Physical activity, food and fluid intake were not allowed between this time and 7 the next morning.
On the second night, the children in the same position on their bed were kept awake as long as possible throughout the night, if they were willing, by telling and listening to stories, doing small tasks such as word and memory games or making crafts, and daytime catch-up sleep was not allowed.
So what did they find? Well, sleep deprivation had a dramatic effect on nighttime urine excretion with an average increase of 68% among the participants. So you make more pee when you're awake. Even if you're not moving a lot and you're still lying in bed, just your being awake and your brain functioning makes you produce more urine.
The amount of sodium in the urine from the sleep-deprived night was almost a third greater than it was during the normal sleep night. The levels of hormone associated with water and sodium excretion had numerous differences after the sleep deprivation, and blood pressure and heart rate were significantly higher as well. These findings were similar for boys and girls.
The authors say sleep deprivation leads to numerous physiological differences in children that ultimately resulted in increased urine output and higher sodium excretion. The authors speculate that the reason for these differences could be the result of changes in the regulations of the hormones responsible for setting water and sodium output in the kidney, which also affects heart rate and blood pressure.
Findings ways to address these factors could stem at nighttime urine production, which in turn could potentially help sleep disruption and bedwetting in youngsters.
So helping your kids get more sleep may curb bedwetting. Now granted this is a small study with a sample size of only 10, but if you're dealing with bedwetting or sleep deprivation because of frequent overnight urination in your home, maybe you should try getting your kids settled down and in bed earlier in the evening. That could possibly help.
Now here's another idea and another thing that could help with bedwetting. New research out of Wake Forest Baptist Medical Center implicates constipation as a common culprit in bedwetting woes, and if it isn't diagnosed, children and their parents must endure an unnecessarily long, costly and difficult quest to cure those bothersome nighttime events.
Reporting online in the journal "Urology", researchers found that 30 children and adolescents who sought treatment for bedwetting all had large amounts of stool in their rectums, despite the majority having normal bowel habits. Following the initiation of constipation treatment, 83% of kids stopped having bedwetting episodes.
Lead author Dr. Steve Hodges, an Assistant Professor of Urology at Wake Forest Baptist, said, "Our studies show that a large percentage of these children were cured of nighttime wetting after constipation therapy. Parents try all sorts of things to treat bedwetting from alarms to restricting liquids, and many children, the reason that those things don't work is that constipation is the problem."
Hodges points out that the link between bedwetting and excess stool in the rectum, which is the lower five-to-six inches of the intestine, was first reported in 1986. However, he said the finding did not lead to a dramatic change in clinical practice, perhaps because the definition of constipation is not standardized or uniformally understood by all physicians and lay people.
"The definition for constipation is confusing and children and their parents often aren't aware the child is constipated," said Hodges. "In our study, x-rays revealed that all the children had excess stool in their rectums that could interfere with normal bladder function. However, only three of the children described bowel habits consistent with the traditional concept of constipation."
Hodges explained that guidelines of the International Children's Continent Society recommend asking children and their parents if the child's bowel movements occur irregularly, less often than every other day, and if the stool consistency is hard.
"These questions focus on functional constipation and cannot help identify children with rectums that are still enlarged and interfering with bladder capacity," said Hodges. "The kind of constipation associated with bedwetting occurs when children put off going to the bathroom. This causes stool to back up and their bowels to never be fully emptied. We believe that treating this condition can cure bedwetting."
Children in the study ranged from five to 15 years old. The constipated children were treated with an initial bowel cleanout using polyethylene glycol, also known as Miralax, which softens the stool by causing more water to enter the bowel through osmosis, and children whose rectums remained enlarged after this therapy, enemas or short course of stimulant laxatives were used.
Dr. Hodges cautions parents that any medical therapy for bedwetting, including the treatment of constipation, should be overseen by a physician.
The study used abdominal x-rays to identify the children with excess stools in their rectums and Hodges and radiologists at Wake Forest Baptist developed a specific diagnostic method that involved measuring rectal size on the x-ray, and he said rectal ultrasound could also be used for diagnosis.
Hodges says, "The importance of diagnosing this condition cannot be overstated. When it is missed, children may be subjected to unnecessary surgery and the side effects of medications. We challenge physicians considering medications or surgery as a treatment for bedwetting to obtain an x-ray or ultrasound first."
The study involved reviewing the charts of 30 consecutive patients treated for bedwetting. The authors cautioned that some cases may have improved on their own over time and they said a more accurate measure of the treatment's success would be to randomly assign bedwetting children who have enlarged rectums to either constipation therapy or an inactive placebo treatment, an approach that would differentiate true responses from cases that would resolve on their own over time.
Let's break this down a little bit more, because I think some of you out there may still be thinking, 'OK, now wait a minute. How does constipation lead to bedwetting, for one, and also, what do you mean constipation doesn't mean infrequent hard bowel movement? Can my kid who has a nice soft bowel movement everyday really be constipated?' So let's talk about this.
First, let's talk about why it is that having too much stool in the rectum could cause constipation. Or, I'm sorry, that is the definition of constipation. How could that cause bedwetting?
Well, an enlarged rectum encroaches on the bladder, and this can actually do two things. It can decrease the volume of urine that the bladder is able to hold and it can also stretch the wall of the bladder by pushing into it, and the brain interprets this stretching as you having a full bladder, causing your child to feel like he or she needs to go to the bathroom.
This can also result in the bladder relaxing the valve that holds the urine and the bladder muscle contracting to push urine out, because the brain thinks that you have a full bladder, even though you don't really. The reason the bladder is getting stretched is not because it's full of urine on the inside but because this enlarged rectum full of stool is pushing on it. Not only could this possibly lead to bedwetting, it can also lead to urinary frequency during the day.
So you can have a kid, you go out to eat at dinner and they've got to go the bathroom two or three times in the same meal, and each time they pee they just get out a small amount, and the reason is, again, because they have too much stool in their rectum that's pushing on their bladder and making them feel like they have to go to the bathroom even though their bladder is not really full.
Of course, there are other medical problems that can cause the same symptoms of frequent urination. Diabetes is one example. So it is important you see your doctor and not try to figure this out at home by yourself.
What about the constipation part? How can a kid who has a soft bowel movement everyday really be constipated? Well, for this, you have to look at ins and outs. How much poop are you getting out compared to the amount of poop that you're making? If you're making more than you're getting out, regardless of how much that you do get out, that stool is going to start backing up and creating problems. So we do see lots of constipated kids who aren't necessarily experiencing infrequent hard bowel movements.
However, once you add a stool softener and encourage them to go to the restroom on a regular basis and try to make poop and having them sit on the toilet long enough to get out what they can get out, then you start to have an improvement in their constipation symptoms, which can include intermittent abdominal pain and also bedwetting, as we see here.
So you really do have to get kids…and you may not end up needing a stool softener. It may just take that you need kids to actually sit down and try to get more stool out than they're used to doing. A lot of kids, they go in, they sit on the toilet, they get out one turd. I love being able to talk this way, by the way, but these are the words you understand.
So you have a kid, they're sitting on the toilet, they pop out a turd, it takes them 30 seconds and they're wiping and they're running. But if they had sat there for five minutes, maybe they would've gotten out three turds. So you have the situation where they're not emptying their rectum every time that they sit down.
From the parents' point of view, it's like, 'Hey, they're going to the bathroom once a day, they have a soft bowel movement. There's no trouble here. How can my kid be constipated?' But if they're only getting out one turd when they could've gotten out three, and that happens every single day, it doesn't take long for them to be backed up and still have too much stool in their rectum that can then push on the bladder and can cause problems.
One more thing, and this is interesting, too. When the large intestine is really full of thick poop, new waste coming from the small intestine can slide by and actually come out as liquid stool because there isn't room in the large bowel to form proper turds, and these kids may actually appear to have diarrhea of sorts. When it leaks out into their underwear, we call that 'encopresis'. But the problem isn't diarrhea at all; it's still constipation.
A lot of times parents will say, 'No way, my kid does not have constipation. They poop all the time. In fact, sometimes they poop in their underwear. It's just their poop situation is just a mess.' Well, no. That can be constipation, because all those symptoms come from having too much poop in there and you've got to make things worse before they can better and get all that stuff out.
Again, don't try to figure this out at home. See your doctor. But I will say this: if you do see your doctor and your doctor says, 'Hey, no way your child can be constipated because they aren't having infrequent hard bowel movements,' if that happens, then you may want to get the opinion of another doctor.
All right. I really meant to keep this discussion on the bedwetting topic and instead we've taken a big long detour into the world of constipation. Sorry about that, folks.
The final take-home here, if you're dealing with bedwetting problems at home, of course see your doctor, but don't discount sleep deprivation and constipation as possible causes.
All right, lets take a quick break and we're going to come back and answer some of your questions right after this.
Mike Patrick: All right. First up in our listeners' segment, we have Lindsey in Calgary, Alberta, Canada. Lindsey says, "Hello. A friend of mine is pregnant with her female fetus, and her female fetus was diagnosed with hypoplastic left heart syndrome. She has a large community of friends and specialists. However, we're all trying to understand what this means for her and her child, and I'm wondering if you could do an educational feature on hypoplastic left heart syndrome. A listener who loves your podcast, Lindsey."
All right. Well, Lindsey from Calgary, thanks for writing in. I think your question and our last podcast must have passed each other in the night. Dr. Ken McBride, a a geneticist here at Nationwide Children's Hospital, stopped by the studio last week and talked about the genetics of congenital heart disease, and in the course of that conversation we did cover hypoplastic left heart syndrome with a fair amount of detail.
So if you haven't done so already, make sure you check out PediaCast 199 at pediacast.org, and I'll bet we get a lot of your questions answered on that. But again, thanks for writing in. It's always appreciated.
Next up is Kate in Chicago, Illinois. Kate says, "Thank you so much for your wonderful information. This may sound like a silly question, but here we go." No silly questions, by the way, Kate. No silly questions on PediaCast. Ask away. So your silly question, which isn't really silly: "With cold and flu season in full swing, is there a proper way to use a cool mist humidifier? I have two babies under the age of two and they're miserable with their colds. Not being able to do much for them, I want to make sure I'm using the humidifier in the most effective way possible."
"Thanks again for your podcast. By the way, I have a link to your show under the parent resource area of my classroom website." Well, thanks for the question, Kate, and thanks, too, for spreading the word about PediaCast. That really means a lot to me. I appreciate you taking the effort to do that.
OK, cool mist humidifiers. The goal with cool mist humidifiers, the goal is to moisturize the nasal passages and to make them less irritated and also to thin the mucus that is obstructing them when your child has a lot of mucus production because of an upper respiratory infection.
Now the best bet on moisturizing the nasal passages and thinning that mucus is saline nose spray, so you're putting moisture directly into the nose. In babies, instead of the spray, you use drops and then suck them out with a bulb syringe, and with older kids and adults, you use the spray. It loosens things up, moisturizes the nasal mucus membranes, and makes it easier to blow your nose and get the mucus out.
But maintaining a humid environment when you're sleeping can also help meet those goals. Now remember, moisture is going to spread out evenly in the room, so having the machine anywhere in the room is fine. It doesn't have to be right next to the crib. But if your baby is sleeping in a large cavernous room, even with the humidifier right next to the crib, it's not going to work well, because remember that humidity is water vapor in the gas form and it's going to spread equally throughout the room. It's not just going to hover over your baby's bed.
So just keep that in mind; you want it to be in a smallish room. And it's going to work better with the door closed because then that moisture is not going to as easily escape out into the hallway.
Smaller room, closed door, humidifier anywhere in the room: that's going to make the most humidified environment for your baby, which may help them to sleep more comfortably to keep their nasal passages less irritated and to help keep the mucus thin so that they can breathe more comfortably.
Now, having said that, I know some parents aren't going to feel comfortable with their baby's door closed, and that's fine. You just have to realize you're not going to get as much humidity. I'm not saying you have to close the door and make sure your baby's in a small room. We're just saying that you're going to get more humidity in a smaller room with a closed door.
But certainly, especially if you're not using a baby monitor or you just don't feel comfortable closing the door, leave it open. Leave it open as far as you're comfortable with. Just realize that you're not going to have quite as much humidity in the air if you do it that way. But safety and your comfort level as a parent is also important. And again, humidifiers help but they aren't really as important as saline drops and using the bulb syringe.
Another hint, you can leave it running with the door closed a couple of hours before a nap or bedtime to pre-humidify the room. Also make sure you rinse out the cool mist humidifier once a day with a little bleach water. You don't want to grow and spray molds and bacteria throughout the room. Cool mist humidifiers can get slimy pretty quickly, so you definitely want to watch for that.
Now here's another question we're often asked: what about warm or hot humidifiers?
Well, hot humidifiers, you can't really find those anymore and they're not recommended because of the burn danger, especially if you have a toddler in the house or a younger child and they're able to trip over or fall into it, knock it over, any of those things. So it's really hard to find the hot humidifiers anymore. And you shouldn't use those; they are definitely a safety concern.
But they do make warm humidifiers now that don't get scalding hot but put out a little bit of heat. In my mind, they're really not worth the hassle. It was the hot humidity that really helped more, I think, than the warm does. The warm one, by the time it actually gets to your child, it's really cooled to room temperature, and I don't think that they offer any advantage over the cool mist humidifier.
So I would just stick with the cool mist. Those are probably the easiest ones to take care of and use and work just fine and are safer than hot ones.
What about additives like Vicks or VapoSteam that you can add directly to the water or VapoPads that can be inserted in line with the escaping moisture? What about these products?
You know, there's something in my mind to be said for aromatherapy. I love the smell of the Vapo stuff when I'm sick. Now, is that really going to help their symptoms? Is it going to help them get better faster? No. But is it going to hurt, and does the aromatherapy add benefit to your child's comfort? In my mind, it may.
Now, there was one study that showed that using VapoRub could increase asthma symptoms, but that study rubbed the VapoRub directly onto the nose of baby ferrets. So the take-home there is don't rub VapoRub on your baby's nose, especially if your baby is a ferret. But it's probably OK in the humidifier.
Now, if adding Vicks or any other additive or Vapo-type substance into the humidifier and your child seems to be getting worse, then stop adding it and see your doctor. Just common sense there, folks. But again, for most kids, it's not going to really make a difference one way or the other, but the aromatherapy may help provide them some comfort.
So thanks again for the question, Kate. Hope that helps. And thanks again for spreading the word about PediaCast.
Next up we have Jamie in Pennsylvania. Jamie says, "Hello. Love your podcast. A few months ago, my daughter and her cousins had head lice. My niece visited us from Oregon and she had an infestation, and we didn't realize it until several of her cousins were exposed. I tried everything including a prescription from my doctor. Neither the over-the-counter or the prescription killed the lice. We picked out the nits and cleaned all the linens and furniture diligently."
"Finally, we found a remedy on the internet that worked: Listerine. We kept it on for two hours then rinsed it off, followed by more nitpicking, laundrying and cleaning, and finally we got rid of them. Can you explain why only the Listerine worked and why our pediatrician may not have recommended this? I heard certain regions have lice that are resistant to pesticides. If we have this problem in the future, do you see any harm in using Listerine again? Thanks for your time. Jamie from Pennsylvania."
Thanks for the question, Jamie.
Head lice, there's basically three goals when you approach head lice. The first is you want to kill the adult lice that are moving around on your child's head, or your head. If you live in the same house, it's likely. You want to get rid of the nits or the eggs because the medicine that killed the adults typically don't kill the nits, so you have to get rid of them or you'll just kill the adult stuff and then the nits will hatch and you'll have a new crop of live adult lice to deal with.
You have to kill the adult live ones, you have to get rid of the nits, and you have to do these things without hurting your child.
Now, there's several drugs that are available. I'm going to run through the list here just to give you some background.
The first one that was traditionally used for a long period of time was called Lindane, with the brand name of Quell. But we don't use this anymore because of possible neurotoxic effects, including seizures and sometimes death, especially if the medicine is swallowed by your child. There are safer drugs out there now, so we typically don't use Lindane or Quell much anymore.
Then you have the permethrin drugs, and these are the pesticides that you're talking about. Nix and Rid are two over-the-counter examples of permethrin products. Elimite cream is another one that is prescription-strength. There is sometimes some resistance to these medicines, although most of the time they work. And you have to realize that these also only kill the live adult lice. They don't take care of the nits at all.
Now there's another pesticide called Ovide, and it's called Ovide because it not only kills the live lice but it also is partially ovicidal. Ovide is ovicidal. 'Ovicidal' means that it kills…just think ovicide, ovary, kills the eggs. It kills some of the nits as well.
Now, it doesn't kill 100% of the nits or the eggs, but it does kill some of them along with the live lice, and some of the adult live lice that have become resistant to the permethrin drugs are sensitive to Ovide.
Now the problem with Ovide, there's a couple of problems with it. One is it's expensive and the other is it's flammable. You have to be really careful when you're using that that you don't light your kid's head on fire because you're smoking a cigarette or you're doing something else that's not smart. So you do have to realize that when you're using it.
There is another type of product out there that contains benzyl alcohol; Ulesfia is the brand name. This one also only kills the live adults, not the nits. It's also expensive and it can be irritating to the skin and the eyes, so it has its pitfalls as well.
So when you're looking at medical treatment for lice, these are the options that are available out there for doctors and for parents. Now, there's some other strategies for getting rid of lice that I've heard of through the years, which oftentimes do work. One is Vaseline.
Basically, the idea with Vaseline is it suffocates the lice, the adult lice. It's not going to kill the nits, you still have to pick all those out, but the Vaseline is in the hair, it's hard to get out, and because of that, it's there long enough and it suffocates the live lice.
Now, it takes forever and a day to get this stuff out and your kids are going to have greasy-looking hair for a long time, and that may get them into a being-made-fun-of situation at school. The reason that it works is because it stays in the hair for so long, it really does suffocate the lice, and oftentimes even as the new nits that you don't get out hatch, they get suffocated, too, as soon as they emerge because the Vaseline is there for such a long period of time.
I've also heard of people using vinegar and mayonnaise and these kind of things in the hair. I'm not a big fan of using food products in the hair. I don't know, just the thought of covering my kid's hair with mayonnaise, it just turns my stomach. So I'm not a big fan of these. But those are also strategies that have been used in the past.
Now what about Listerine? Well, classic Listerine contains a host of chemicals including menthol, thymol, methyl salicylates, and a high concentration of ethanol. These are the chemicals that are in classic Listerine. Those are chemicals that actually can be dangerous to your kids, and not enough is really known about the potential harmful effects for me to recommend it, how much of those chemicals get absorbed through the skin.
Salicylate use in kids has been implicated in Reye syndrome, for instance, and Reye syndrome can be deadly. So I think not enough is really known here to be able to recommend it.
Remember, all these drugs that we talk about and the chemicals that are used in the treatment of lice, they're all scrutinized and tested before the FDA approves them. And that's one of the reasons why the drugs are so expensive when they first come out is because it's an expensive process to prove that they're safe.
Listerine may be safe and approved and fine to use as a mouthwash when it's being gargled in your mouth, but to slap it on your kid's head and the possibility of those chemicals getting absorbed through their scalp is a possible concern. I would not be quick to recommend Listerine as a treatment for head lice.
Now I imagine Jamie's next questions are, why didn't the lice go away? Why did it take the Listerine to get rid of this problem? And what do we do next time?
Let's talk first about why lice might not go away the first time you treat it, and this includes Jamie's case. Of course, it could be resistant to whatever product that you started with, but this is what Jamie's assumption is, that the other products didn't work because the lice was resistant to those pesticides. But that's really the least likely reason the head lice treatment fails.
The most likely treatment is that as hard as you try, some nits get left behind. Those hatch and you have a new crop of adult lice. So it wasn't really a problem with the agent that you were using to treat. The problem was that the nits hatched, so you have new adults, and that's the reason that you're having this problem again.
Also, remember that nits can be left on clothes, in bedding, on stuffed animals, and they can stay alive on those substances or those places for up to two weeks. You may get rid of kid's head lice, but if you leave nits on their pillow case and you didn't take care of that or it's on a stuffed animal that they sleep with, they can re-infest themselves pretty easily.
Also, you can catch it again from the original source. If you take care of the head lice and your child gets it again in short order, maybe the kid they got it from at school still has not been treated. So that can be a problem as well.
It's important that all clothes and linens be washed in hot water and then a high-heat dryer cycle, and anything that can be washed, stuffed animals and the like, you want to put in sealed plastic bags for two weeks where your child will not have any contact with it and where it's isolated in a plastic bag for two weeks, and then that will also kill the nits.
Next time you're dealing with head lice, after the initial treatment isn't working, make sure that you get out all the nits. You just need multiple nit-picking sessions. Take care of all the clothes and linen, hot water and hot dryer cycle, vacuum carpets and sofas and throw out the vacuum bag, and again, plastic-seal all your other stuff for two weeks to avoid re-exposure.
Of course, if you're using those plastic bags and you have young kids, remember you don't want kids to suffocate in plastic bags, so not only put the things in sealed plastic bags, put the plastic bags out of the reach of your young children. If that doesn't work, then you may need to use a more expensive remedy like the Ovide or the Ulesfia.
But don't take matters into your own hands. Don't try something that's not approved, like Listerine. Instead, see your doctor, trust your doctor. In that way, you won't have a bad outcome that's nobody's fault but your own.
All right. Hope that helps, Jamie, and again, thanks for writing in.
All right, finally we have 'Anonymous' in Idaho. Anonymous says, "Dear Dr. Mike, thanks so much for your podcast. It's entertaining and informative and I love listening to it."
"Recently, I read about a study, I think on everydayhealth.com, about preschoolers' behavior when they missed a nap. The study had the children trying to complete puzzles, including an impossible one," I know how I would react to that, "when they had slept and then when they had not slept. The article reported the children's reactions, but it went on to say that behavioral problems noted with lack of sleep could lead to behavioral problems as adults."
"I'm interested in your take on this study and the leap to comment on potential adult behavior. My daughter has trouble getting to sleep, most notably keeping us up to 2 am when traveling over the holidays, so this study interested me. My doctor has since suggested melatonin for her to help her get to sleep."
"Along with that, I have another behavior question. When do you know when bad behavior is just bad behavior and when is it something more serious? My daughter has had a rough time lately. She frequently hits and kicks other children at daycare, often for no reason. She sometimes hits or kicks adults when she's being disciplined, such as being put in timeout."
"Recently, she threw a 20-minute-long tantrum at daycare, during which time she seemed confused as to how something she threw ended up on the floor. Her teacher said she honestly appeared to not remember having done the deed and simultaneously calmed down very quickly, only to then get upset again. This bothers me for many reasons, and I'm not sure if we need professional help. She just turned four and I thought that by done she would be done throwing tantrums."
"When I brought this up with the doctor, he thought it was largely due to her lack of sleep. She's been taking melatonin for about a week. I don't know how soon I could expect to see results. She exhibits similar behavior at home and at daycare. Thank you very much. Would rather remain anonymous from Idaho."
All right. 'Anonymous', thanks for writing in. Let's break this up.
First, lack of sleep leading to behavioral problems. I don't think this is a mystery to many of us who have experienced being parents or for many of us who have experienced being adults. We need sleep for a reason, and there are lots of consequences to not getting enough sleep.
We've seen a potential one earlier in this show when we talked about sleep deprivation leading to changes in hormones that lead to higher blood pressure and increased sodium excretion by the kidneys and increased urine production, which could possibly lead to bedwetting. And that's the effect on one particular hormone.
What's the effect on scores of other hormones and neurotransmitters? We're talking about complex relationships in the brain, and there's every reason to believe that sleep deprivation leads to or can lead to behavioral problems in children and adults. In adults, we don't call them behavioral problems, but at the end of the day that's often exactly what they are.
I didn't read the study you're referring to, but it certainly makes sense to me and probably to most of you out there that sleep and behavior can definitely be related to one another.
What about melatonin? Well, melatonin is another hormone that plays a role in the regulation of sleep-wake cycles and it can be helpful for kids who have a melatonin deficiency.
The problem is that you can't test to see if you have a melatonin deficiency because levels of melatonin fluctuate throughout the day and there's really no standard of what a melatonin level ought to be in kids. Doctors will sometimes try giving it, and if it works, great. Maybe you had a melatonin deficiency and you added some and it helped. On the other hand, if you try the melatonin and it doesn't work, then melatonin deficiency probably wasn't the problem in the first place, so you stop using it.
Now, one of the issues with treating with melatonin is what kind of dose do you start with, and there's lots of recommendations out there. There's not really a standardized dose.
You start somewhere where you have experience starting. This is why you want to do it with a doctor who has experience using melatonin, and then you have to adjust from there, keeping in mind that too much melatonin can cause other problems, including sleepiness, lower body temperature, vivid dreams, morning grogginess, and changes in blood pressure.
So it's a trial and fail or trial and win process. There's not a lot of science to it with melatonin. But you said you've given it to your child for a week? That may not be quite long enough to know if it's going to work. How long should you give it? Probably somewhere between a week and a month. I know that's a wide range, but it is what it is.
And if it doesn't work, it may be that it's not going to or maybe you need a higher dose, but then if you start getting into side effects and it still hasn't helped, then probably melatonin wasn't the issue to begin with and it's not going to help.
Young children who are having trouble sleeping, improving sleep hygiene is often very effective, so you want your kids to have routines, you want to have a settle-down time well before bedtime, go through the same routine whether it be a bath or reading stories, the same kind of 'let's dial down the stimulation and get ready for bed.' No TV, no stimulating music.
The other thing that can help, too, is positive reinforcement programs. I'm not going to go through this again because we have talked about this on many occasions, but the basic thing is, you do come up with something like a sticker chart and you say, 'OK, you're allowed to get up and bother us a couple of times, you need a drink, you've got to go to the bathroom, but once you've bothered us three times, that's three strikes you're out, and you don't get to put a sticker on your sticker chart in the morning. But if you go to bed nicely, you only bother us once or twice in the morning, you get to put a sticker on your sticker chart, and once you get so many stickers, you're going to get a reward,' whether that be a certain toy, going shopping for something, whatever that your child's currency is, whatever is really going to make them want to succeed is what you want with your sticker chart positive reinforcement-type program.
And each kid is different. There is some trial and error with this as well in trying to figure out exactly what kind of plan is going to work for your child.
Now, in terms of the temper tantrums, we've talked about these before, too, and there's lots to say about them, but we're running short on time. If you search the archive, you'll find a lot about temper tantrums in past shows. I did a quick search of the archives and PediaCast 43, 96, 150, 157, 158, 182, 192, all of these mentioned temper tantrums.
Probably the best discussion, though, is in PediaCast 182, so I am going to put a link in the Show Notes for you for that one where we really go in detail about temper tantrums and how to deal with them.
I'll give you a summary here in order to deal with temper tantrums. One, I think, is to maximize sleep. Again, that was not mentioned in PediaCast 182, but I do think it's important, and in my own family, and it's different from kid to kid and from adult to adult. In our own house, my wife and my daughter are particularly prone to having easy meltdown when they're sleep-deprived, and you can just observe that and see it, whereas my son and I don't have to get as much sleep and, in our opinion, don't have temper tantrums or behavioral problems. Maybe if my wife were the one doing the show, she would disagree.
But again, it's something that, make sure your kid is getting enough sleep if you're dealing with temper tantrums.
You want to anticipate their needs and try to head off the temper tantrum when you can. Really focus on communication. Tantrums often result from frustration because your young kid's having trouble expressing complicated feelings, so you want to try to focus on improving communication, trying to anticipate your child's needs so they don't have to resort to the tantrum.
And one really important thing is you can't let temper tantrums work. Whatever it is that your kid's after, you can't give in once the temper tantrum has started. Otherwise, that gives positive reinforcement to the temper tantrum itself, and then you're going to have a lot more trouble getting rid of it.
You've got to let them get through the temper tantrum, let them have it out, ignore it, and then when all is said and done, big hugs, 'We love you. Now let's talk about what it is that you wanted or why you can't have it,' or whatever.
It's also important to make sure that there isn't an underlying medical issue. Certain seizures could look a bit like temper tantrums, and for those who work with kids, temper tantrums and acting out can be a sign of abuse or neglect. So there's lots of things to think about here.
In the end, you have the right people involved, your doctor, the daycare workers, and you. You're engaged at figuring out what's going on with your kid and being a loving advocate for your child getting them through this spell in their life or when they're having temper tantrums. Being a loving advocate, I think that's a good descriptor for a parent.
So hang in there, 'Anonymous', and sooner than you think, this trial will be behind you. But of course, you'll have a new one to face, because the trials of parenthood are definitely ongoing and sequential.
All right. Well, that wraps up our listeners' segment this week. We're going to come back and wrap up the show right after this.
Mike Patrick: All right. Welcome back to the program.
I want to remind you, if there's a topic that you would like us to discuss or you have any idea, comment, suggestion, question, anything, it's easy to get a hold of me. Just go to pediacast.org, click on the 'Contact' link. I do read every single contact request that comes through, so you definitely have my attention when you use the Contact page at pediacast.org.
You can also email email@example.com or call the voice line, 347-404-KIDS, 347, 404, K-I-D-S. And if you go those routes, make sure you let us know who you are and where you're from. That's asked for specifically on the Contact page, but not necessarily if you email or use the voice line.
One final thought. I want to really thank Kate in Chicago again for helping spread the word by including a link to PediaCast in the parent resource area of her classroom website. That made my day.
Is there any way that you are helping spread the word about PediaCast, whether it be through your classroom, through your school, through your kid's school, the preschool, the nursery, your church, your local YMCA, your doctor's office? If there's any way that you are helping spread the word about PediaCast, write in and let us know about it.
And if you find PediaCast because of the efforts of another listener, let us know that, too, just to start sharing some more of these stories. Our best marketing strategy really is you. So please get involved and help spread the word about the program. It's just really, really important and the best way that we get the word out about PediaCast.
I want to thank each and every one of you for making PediaCast a part of your day and sticking with us through an hour of information. I know it's tedious at times, but we try to have a little bit of fun with it as well.
We do have an opportunity for community participation at the website. If you go to pediacast.org and you have something to say about a topic that we cover in any of the individual episodes, please leave a comment. The Show Notes are a blog of sorts and there's a place for you to be able to write down your thoughts, and as a community of supporters, we can help one another. So I would encourage you to head on over to pediacast.org and utilize our Show Notes area as a community group as well.
I just really appreciate your time. We do have lots more shows coming your way this year. We have lots of interview shows still lined up, and of course we'll get to all of your questions as they come in each and every week. As you've probably figured out, we've pretty much gone to the pattern of releasing a new show every Wednesday and will continue to do that into the foreseeable future.
I also want to remind you, we do have transcripts now available of each show as well, so if you don't get the opportunity to listen, you can read the information online. It also makes it easier to search through content for each episode as well.
We're working on getting some of the back episodes, particularly with some of the more requested topics in the past, so some of those shows we're getting transcribed as well. I don't know that we'll get every single episode transcribed, but I'm hoping to get lots of them done.
All right, 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.