Flag Football, Swimming Lessons, Color Blindness – PediaCast 371

Show Notes


  • We have a big show for you this week! Pediatric news covers cat ownership & mental health, congenital heart disease & school performance, and flag football injuries. Then Lisa Armitage stops by the studio to talk about swimming lessons. Finally, we answer listener questions on color blindness, iron intake and vegetarian diets. We hope you can join us!


  • Cat Ownership & Mental Health
  • Congenital Heart Disease & School Performance
  • Flag Football Injuries
  • Swimming Lessons
  • Color Blindness
  • Iron Intake
  • Vegetarian Diets




Announcer 1: This is PediaCast.


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

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

It is Episode 371 for March 22nd, 2017. We're calling this one "Flag Football, Swimming Lessons, and Color Blindness ". I want to welcome everyone to the show.  

First, I just want to give a shout out to my mother. It is her birthday, March 22nd. So, happy birthday, mom. And the rest of you, if there's any others had have birthdays, spring babies, March 22nd, happy birthday. Or really, if you have a birthday in March, happy birthday to you, too.

We have a big one for you this week with plenty of news you can use, an interview with another fantastic guest, as we consider swimming lessons and water safety. Spring is just right around the corner, and later on, it will be summer and swimming lessons and water safety always an important consideration. And there's all those indoor pools, too, they could swim in all winter long. So really important any time of the year. 

And then, we're going to answer a couple more listener questions for you to wrap up the show this week before we go to the specifics of the entire line-up, because we will be covering more topics this week than the title would suggest. Although, I do think flag football, swimming lessons, and color blindness make a nice little collection. I mean, you can end it right there and you'll be fine. But we have more. So, all the details in the moment. 

First, though, I do have a quick favor to ask, if you find PediaCast useful, if you've listen to our program — maybe you told others about it, and very long time listeners — would you please take a couple of minutes and review the show for us? Wherever you find your podcasts — so if that's iTunes, Google Play, iHeart Radio, might be a podcast app or an online podcast community — really, whatever the source, could you take a moment and put some thoughtful sentences together? Maybe words that'll convince other moms and dads to give us a try. 

Now, if you're a first-time listener or you've only listened to a show or two, give us some more time, keep listening, and the next time I put out that call, maybe you could help us out to that point. 

We don't have an advertising budget on PediaCast, so we really do rely on word of mouth. And an effective word of mouth is those online reviews. Of course, we also appreciate literal word of mouth. So when you share the show with your families, friends, neighbors, co-workers as well as your child's provider, their pediatric providers, so they can share the show with other families that they take care of. 

And if you are a pediatric provider, we really do appreciate you advocating for our evidence-based pediatric podcast with the kids and families you serve. 

Okay, that's my little request. I won't take up much of your time compared to the large amount of time it's taking to prepare today's content for you, which is many many many hours. 

So, what are we covering today? What is the culmination of all those hours of work look like? We start with cats. And yes, you heard me right, cats. I know it should have been in the title. We probably would had more people listen if instead of flag football I had said something about cats. But especially when you consider all the YouTube cat videos and how crazy folks go over that. But we're going to start with cats and their connection with mental health. So that's a fun new story. 


And then, kids with congenital heart disease, even mild heart defects that were fixed and seem finished after birth, how did these kids do in school compare to those who were born without any congenital heart defects? It's an important consideration as you advocate for your children and it reveals an issue which could impact kids with any chronic illness, things like asthma, diabetes, cancers, inflammatory bowel disease, juvenile arthritis, really all sorts of diseases. 

How do they affect schoolwork? Even when the disease really seems to be under pretty good control and what can parents do to anticipate and help solve difficulties who have some ideas coming up.

And then a flag football, many parents nudge their kids in that direction thinking it's safer than tackle football. And, in fact, we now have flag football leagues all around the country. But is it really safer? We'll take a look. 

And then, Lisa Armitage is going to join to us. She's a swimming lesson and water safety expert here in Central Ohio. So, we're going to talk swimming lessons including lessons for babies. How young can you start introducing babies to the water? The answer is as young as four months for healthy kids. But we'll put some caveats on that and explain which kids maybe it's not such a great idea and exactly how you go about doing it in a fun and yet safe and sensible manner. Stay tune for that interview.

And then finally, answers to listener questions regarding color blindness, iron intake and vegetarian diets. 

Told you we have a big one for you this week. Don't forget if there is a topic that you would like us to talk about or you have a question for the program that you'd like me to answer, really easy to get in touch. Just head over to PediaCast.org and click on the Contact link.  It's at the top of the page. You'll see a tab that says Contact Dr. Mike. Just click that, fill up the form, send it in. I do read each and every one of those that come through. And we'll try to get your question or your comment on the program with a future edition of PediaCast.


Also, I want to remind everyone, the information presented in our podcast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So, if you have a concern about your child's health, make sure you call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at PediaCast.org. 

So let's take a quick break, and I will be back to talk more about flag football, swimming lessons, and color blindness, plus those  other things I mentioned including cats and mental health — got to love that. It's all coming your way right after this. 


Dr. Mike Patrick: Cat lovers will be relieved to hear that growing up with furry felines in the home does not appear to increase the child's risk of developing mental health problems. 

So say researchers from University College London as reported in the journal Psychological Medicine. The new study casts doubt on previous work which had suggested the children who grow up around cats might have an increased risk of mental illness. The previous study made little sense especially to the dog lovers on the crowd.

Cats, after all, are the primary host of the common parasite called Toxoplasma Gondii and this microorganism has been linked to mental health problems such as the development of the schizophrenia. However, the new study suggest that cat ownership and pregnancy in childhood does not play a role in developing psychotic symptoms during adolescence. 


So what gives? Well, previous studies were relatively small with significant gaps in the data. For the current project, the investigators considered nearly 5,000 millennials born in 1991 or 1992. They are followed until the age of 18 and researchers noted the presence or absence of household cats during moms pregnancy in the years in which the kids grew up. They also looked for the presence or absence of mental health conditions of these children and found no significant association between cat ownership and mental illness. 

Dr. Francesca Solmi, psychiatrist and lead author of the study, says, "The message for cat owners is clear. There is no evidence that cats pose a risk to a child's mental health." "Now, to be transparent," Dr. Solmi adds, "Initial and unadjusted analyses of our data suggested a small link between cat ownership and psychotic symptoms at age 13, but this turned out to be due to other factors. Once we controlled for factors such as household over-crowding and socioeconomic status, the data revealed that cats were not to blame."

She believes previous studies, which reported a link between cat ownership and psychosis, simply failed to adequately control for other possible explanations which is always an important thing to do. 

Previous studies were also retrospective, meaning people with and without a mental illness were asked to look back and answer questions about the presence or absence of cats during mom's pregnancy and a number of years living with one or more cats during childhood. Dr. Solmi says these accounts are vulnerable to errors in recall which can lead to spurious findings. 

The new study is significantly more reliable than previous research because the team followed families prospectively or as they grew up documenting the presence or absence of cats in the onset of mental illness in real time. The new study was also much larger than previous studies which boosted its statistical power. 


Dr. Solmi points out the team did not measure Toxoplasma Gondii exposure directly. But the result suggest that if the parasite does cause psychiatric symptoms, then owning a cat must not significantly increase exposure to the microorganism since cat owners in this large prospective study did not demonstrate an increase incidents of mental illness based on cat ownership alone. 

Dr. James Kirkbride, who serves as senior author of the project, reinforces the team's findings by saying, "Our studies suggest that cat ownership during pregnancy or in early childhood does not pose a direct risk for later psychotic symptoms." However, he adds, and this is a really important addition, "There is good evidence that Toxoplasma Gondii exposure during pregnancy can lead to serious birth defects and other health problems in babies. As such, we recommend that pregnant women should  continue to follow the advice of not handling soiled cat litter in case it contains Toxoplasma Gondii."

So, there you go, cat owners rejoice. Cat ownership does not appear to increase a child's risk of developing mental illness and in particular, psychosis and schizophrenia. However, it is still important for families to come together and keep pregnant moms away from the chore of litter boxes scooping. 

Children will all types of congenital heart defects face learning challenges in elementary school but many may not be receiving adequate educational assistance. 

This according to a new study published in Circulation: Cardiovascular Quality and Outcomes, which is a journal of the American Heart Association. Using North Carolina educational records along with birth defect registries and birth certificates, the new research examine whether congenital heart defects were associated with low scores on standard reading and math tests, even at the end of the third grade. 

The research included 2,807 children born with heart defects and 6,355 born with normal hearts. All of the children in both groups completed third grade in public school between 2006 and 2012. 

So, what did the researchers find? Well, children with a congenital heart defect regardless of how severe the condition had 24% higher odds of not meeting standards in either reading or math compared to children without congenital heart defects. And those with critical defects were 46% more likely to get special education support compared to those with less severe defects.

In other words, those with less severe heart defects, they still have problems in school but are less likely to get the help they need. Dr. Matthew Oster, lead author of the study and pediatric cardiologist at Children's Healthcare of Atlanta, says, "Our research is the largest of its kind to examine the impact of potential brain deficits in US children born with heart defects. It's also unique because we accounted for children with less severe congenital heart disease." 

He adds, "It's unclear why children with heart defects struggle in school. Many theories relate to factors that are most important in children with severe defects namely surgical procedures, pre-natal brain development, time in an intensive care unit or degree of hypoxia," or low oxygen to the brain. 

However, children with a milder congenital heart disease do not typically share those risk factors. Yet, both groups of children, those with severe defects and those with milder disease may share genetic vulnerability to problems with brain development. The study also noted that children with less severe defects are less likely to receive special education services.

Dr. Oster says, "We believe this is likely due to a lack of recognition that mild heart defects could be a risk factor for neurocognitive challenges." He adds that doctors should be aware that all children with heart defects, even those with mild ones are at risk for academic problems, and they should ask families how these children are doing in school.


He also advises doctors to consider formal neurocognitive evaluations when appropriate and encourages schools to take action based on their awareness that children with heart defects can have learning difficulties even many years after their heart defect is supposedly fixed. 
Dr. Oster concludes by saying the study findings carry some limitations. It only focused on children in public schools. And there was insufficient information on children unable to take state tests and little was known about each child's medical details. He asked the further research should follow children as they grow to detect similar academic problem beyond the third grade. Future studies should also explore a special education can help improve outcomes and pinpoint the factors that affect how these children fare.

So, for parents out there especially those of you who have a child born with a heart defect, even a mild defect, maybe one that was fixed many years ago, for you this is a call to action. It's okay to be proactive and advocate for your child. In fact, it's essential. 

Make it your business to know how your son or daughter is doing in school. Connect with the teachers often. Don't wait for major problem to develop. Anticipate academic difficulties, and if they occur, ask for additional help early on.

And while we're at it, really any parent who has a kid with chronic illness, whether they seem sick or not — and those with healthy children, too — it's important for all of us to play an active role in the educational process partnered with the school. Sometimes you have to be that squeaky wheel as you advocate for your son or daughter at the earliest sign of difficulty. 

Flag football is no safer than tackle football. This according to research at the University of Iowa as reported in the Orthopaedic Journal of Sports Medicine. 

Concerns about the rate of concussions amongst students athletes and the possible long-term effects of repeated head injuries has lead to discussions about safety and the notion that those under the age of 12 might be best served by avoiding contact sports such as tackle football. With this in mind, some have advocated youth flag football as a safer alternative to its tackling cousin. But is it really safer?


Researchers considered three large youth football leagues with a nearly 4,000 participants and compared the number of mild injuries, severe injuries and concussions among players competing in flag football teams versus tackling football squads.

So, what did the researchers find? Well, it turns out mild injuries were actually more likely to occur with flag football while rates of severe injuries and concussions were similar, when flag football and tackle football were compared with one another. 

Dr. Andrew Peterson, lead author of the study and sports medicine specialist with University of Iowa says, "We wanted to test the hypothesis that not allowing tackling might reduce the risk for injury in young athletes. However, based on our results, we cannot conclude that youth flag football is any safer than tackle football."    

Sports related accidents remain the leading cause of injury among children and adolescents. And with 2.8 million Americans between the ages of 6 and 14 participating in youth football, a significant of the total injuries come from this sport, regardless of the presence or absence of tackles and flags. 

Dr. Peterson says, "We hope this information will help families as they make decisions about a child's participation in youth football whether they choose flag or tackle leagues."

The take-home here for moms and dads, don't let the flag football league give you a full sense of security as you send your young athletes off the play. According to this study, kids gets hurt playing flag football as the same rate or a little higher rate in the case of mild injuries compared to those playing tackle football. 

So if safety is the key reason you choose flag football over tackle football, you may be in for a surprise when your child comes home with a serious injury or a concussion. It can happen. In fact, it does happen in flag football with rate similar to tackle football.


So, does that mean you should keep your child away from football altogether? Not so fast, the over-all incidents of serious football injuries and concussions remains low when compared with all those kids out there playing in various leagues around the country. And they're certainly other benefits to consider especially for children who are enjoying themselves, getting outdoors, competing in a sport with other kids and maintaining a healthy degree of physical activity.

So, sure, there are risks, ones that can be minimized but not eliminated with adequate supervision, following directions, proper technique, and good sportsmanship. 

And there are all those benefits that we previously mentioned about getting outdoors and competing. So at the end of the day, you have to examine the risk and the benefits in light of your family's risk tolerance and your child's skills and passions as you search together for the right answer as it pertains to your family.


Dr. Mike Patrick: Lisa Armitage is a swimming and water safety expert in Central Ohio. She oversees two locations of the Goldfish Swim School, one in Dublin and another in Westerville, both suburbs of Columbus. 

Lisa joins me today to talk about swimming lessons including when kids are ready to start swimming and taking lessons. The benefits of swimming and the all-important consideration of water safety. So, let's give a warm PediaCast welcome to Lisa Armitage. Thanks for stopping by today.

Lisa Armitage: Thank you so much for having me, Dr. Mike.


Dr. Mike Patrick: Really appreciate it. So when can parents begin thinking about swimming lessons for their kids? When is the good age to start thinking in that direction?

Lisa Armitage: That's a really good question. We have parents asked us that all the time. Well, you really can start around four months old. Once children have independent head and neck control.

And a perfect way to begin that introduction would be in the bath. So, obviously, the water in the bath is warm. We don't want it hot. But, to get them comfortable with water on their face, we can have a little cup and start pouring water gently on their face just so they're used to having that exposure. 

Also, when we start lessons with our four-months-old, we focus a lot on safety even at that young age. And a lot of times parents will ask us how can a four-month-old learn how to be safer in and around the water. And we work a lot with them on if they were to accidentally fall in to a pool or river or lake. We teach them how to roll over on their back to breath. 

So, in that event that that happen, they could cry out for a parent. They will be able to breathe. We also start working with them on when they come in, we condition them to turn around to the nearest point of the water. So use something like a little rubber duck or something that's pleasing to them. And we start to condition them to turn back around, so that they can see the nearest point of safety.

Dr. Mike Patrick: Yeah. When you're talking about kids as young as four months of age — and I think it's a great idea to start that at home — but if the child that young did have any medical concern obviously, you want to talk to your pediatric provider.

Lisa Armitage: Yes. Absolutely.    

Dr. Mike Patrick: If it was a kid with any kind of chronic underlying disease or illness or pre-mature babies, that sort of thing, make sure you talk to your doctor first.

Lisa Armitage: It's always so important to have those conversations with your doctor if there's anything outside of the norm, to make sure that we're covered there.

Dr. Mike Patrick: Now, when I think about babies and swimming lessons, one of the first things that comes to mind are those YouTube videos where someone just throws their baby in the pool. That's not a good idea, right?


Lisa Armitage: Yeah. That's not what we suggest.


Lisa Armitage: Obviously. 

Dr. Mike Patrick: And I cringe when I see those.

Lisa Armitage: I know. I'm the same. As a mom of three, I feel the same. I think one of the really benefits of our program is that there's a lot of nurturing and bonding time with the parents. It's really a time where we sing songs, we play games. But all of the things that we're doing are all to help the child learn how to swim and be safer in and around the water.

We're not just playing a game just to play a game. When we're kicking the balls, we're moving our feet. We're practicing keeping those legs straight. When we're scooping and pulling, trying to get closer to some of our phone toys, it's to encourage the children to start moving and kicking their arms. 

When we sit down on our big rubber duck mats and we're splashing and singing, yes, the children are having fun, but it also is even helping with their core muscles and helping with stability. Also helping them with independence, so mom or dad or caregiver are right here but baby is independent also on their own. 

A lot of those things, there's a whole process in theory why we do what we do to make it a lot more gentle and not as nerve-wracking for the parents or for the child. 

Dr. Mike Patrick: Yeah, yeah. I mean, if you get the baby to the point where they really are enjoying the water and it's a little bit of an older baby now, that's different than first-time exposure. And I love the idea of just starting that at home, just with exposure to water. 

And we're going to talk about water safety, but I think this will be a good time to point out that with babies and, really, kids of any age, doing swimming lessons does not guarantee that they're going to be safe. And so, even though you may condition a baby to roll over on to their back or to search for that point of entry, still you want constant supervision is going to be extremely important with these young kids.

Lisa Armitage: A 100%, and even with children up to 12 or 14 years old, we'd like to say that children are safer, not that they're safe, because we feel that children are never a 100% safe when they're around the water. We can share a couple tips. I don't know if you want to…

Dr. Mike Patrick: Yeah. Sure.


Lisa Armitage: Okay. Perfect. When we're considering talking about pools, obviously, our number one suggestion is always have a designated watcher. So you are your child's first lifeguard. There might be other lifeguards at the pool, but you are responsible or somebody that you designate in your group of people, for watching the children. 

So being on your phone, sending a text message, on Facebook, whatever it is, that taking's time away. It only takes a couple of seconds for child to drown in the water. And it is crucial that somebody be designated to watch those children. 

And that's as same at home in a bath tub. I know we talk about that a lot, but when the phone rings or if some of the doorbell rings, you never leave your child alone. It can only literally take a couple inches of water for a child to drown. 

So, number one is always being or having a designated watcher. Obviously, respecting the water. Children, when they're 10, 12, 14, a lot times, they're more confident even if they're not strong swimmers. They see their buddies playing or splashing around the water. They see all the fun that people are having. But they necessarily don't always have a respect for the water. So we always encourage parents to teach that respect for the water starting at the young age and then carrying all the way until when they're a little bit older. 

Also, safety equipment, making sure that there is lifejackets, life preservers, available for all swimmers. So, if you're hosting a party or if you're somewhere at a facility where there are swimming, making sure that those things are available for all children to have.

And for the older children, we tell them no rough housing. I know that sometimes takes the fun out of things in their mind, but I think there's really a safe way to play. Trying to dunk each other into the water or throwing things at each other, being aggressive, it will only takes a moment, and someone can slip under the water or be into a position where they're not comfortable. 

And then, obviously, swim lessons are vitally important to start at a very young age. 


Dr. Mike Patrick: Yeah, absolutely. I want to mention that last summer, we did a water safety episode with Dr. Lara McKenzie. She's with the Nationwide Children's Center for Injury, Research and Policy. And it was a whole hour just on creating and maintaining a safe swim environment, pool rules, water supervision tips. We also went in to hot tub safety, bath safety.

Lisa Armitage: How nice.

Dr. Mike Patrick: How to prevent drowning. We talk a little bit about a secondary drowning as well. 

So, folks who are interested in hearing lots more about water safety, make sure you tune in to PediaCast 348. And I'll put a link in the Show Notes for folks for this episode, 371, over at PediCast.org. 

One of the things that we had mentioned in that one is that it's a great idea for parents to be CPR certified. And they can find the class with the American Red Cross in order to really learn CPR, on how to use an AED, that sort of thing. And we'd also put a link to American Red Cross Find The Class webpage because you can just put in your location and find the nearest class to become CPR certified. So something else that we'd recommend for parents. 

And I love the idea of you saying that you ought to have a designated person to watch the pool. Reminds me when my daughter was five. She wanted a pool party for her birthday, and we had a backyard pool, invited all of her friends, great time. We thought, "Okay, we got five-years-old in the pool. We got to a certified lifeguard there who is watching."

And he got there and still had his street clothes on, and my two-year-old son decided that he was going to get in the pool with the five-years-olds, went straight to the bottom. And the poor guy jumped in, pulled him up, and he's still got his street clothes on. I would definitely say it's a great idea to have someone designated just to watch the pool.

Lisa Armitage: And even to take turns. I know a lot of times when we're out with our children, the adults want to mingle and they want to have fun. And so, we kind of take shifts. So someone will watch the kiddos for 10, 15 minutes. And then, you tap the next person and they take over. So that way, you can still enjoy yourselves, but making sure that their safety is at the forefront at all times. 


Dr. Mike Patrick: Yeah, absolutely. What are some of the benefits of getting kids involved in swimming lessons? Obviously, there is that safety issue of we want kids to be comfortable in the water and learn to swim. But we're still going to supervise them, even when they have that experience. But what else do you get from swim lessons that make this really great thing for families?

Lisa Armitage: Well, I think, first and foremost, obviously, the safety aspect that we talked about. I think secondly, it really instils a lot of confidence in children when they're able to overcome a fear or learn a new skills, something that they didn't know how to do before. It's tremendous, the amount of enjoyment and satisfaction they get. 

Our ten-year-year old daughter, she's been in some lessons since she was little. And she just had a personal best recently in one of our swim meets and she dropped a bunch of times. And the look in her face was something that I'd never seen before with any of the activity that she's participated in. 

And so, I think even our young swimmers that are two and three, up until if a child decides to be competitive, just the amount of confidence that the children gain from swimming as a sport, I think it's also wonderful because it is something that they will carry with them for the rest of their life. It's not just something that they going to learn and use it for couple of years. It's something truly that they will carry with them. It's a lifelong skill that they'll have.

And with so much water around the world, obviously, but in Franklin County alone, I think there was 3,000 retention ponds. And so, children are around water a lot. I think just having the confidence to be around it and having that respect and knowing the rules is really important. You can learn all of that from swim lessons. 

And obviously, the physical part of it. Swimming is a great exercise. It's wonderful cardiovascularly. And there's really an opportunity for children to set their own goals, whether when they first come to us putting their face in the water or if it's be able to swim a hundred yards. 


Just the benefit of keeping them moving all year round even when it's cold outside, it's the great thing about having our indoor pool. They're able to practice those skills all year. And really, keep physically fit is another benefit. 

And then, in our group classes, we love that the children learn a lot of social skills. They'll learn how to follow rules from their teacher. They learn how to take turns. They learn how to cheer each other on when their buddy's in the class is learning how to do something new. They're learning how to cheer for each other and how to celebrate. 

And I think there's a lot to be said for small group activity where children are getting a lot of instructions from their teacher but then also working together with their group to celebrate all the wins.

Dr. Mike Patrick: Yeah, absolutely. 

What about older kids? You may you have an older child who does not necessarily know how to swim or isn't comfortable in the water but they're showing an interest. But a lot of the beginner lessons are going to have the littler kids. Do you have beginner lessons for older kids as well? 

Lisa Armitage: Absolutely, yeah. We really group the kids by their age and by their ability. And it's never too early or too late to learn to swim. Every day, about 10 people die from unintentional drowning, and of these, 2 are children — 14 years old or younger. Even at that older age, it's very important for children to have that experience and that exposure.

And we do, we have classes where we group them by age and ability so that they're not feeling like they're out of place. We also have very small class sizes. We really look to place children with other children that are around their age. So with the maximum of four students in a class, there's really that a nice opportunity for them to be around children of the similar age. 

Dr. Mike Patrick: Yeah. And you're talking about Goldfish Swim School that you have here in Central Ohio, but there are other places around the United States as well.

Lisa Armitage: Absolutely, yes. There are Goldfish Swim School nationwide right now, but there are other great learn-to-swim programs in communities where people don't have a Goldfish Swim School. Looking online, doing a quick Google search, they can look for a swim lessons that are available in their communities.


Dr. Mike Patrick: Yeah. A lot of YMCA program around the country. But I love this. So, four kids for every instructor at your facilities, that's really great.

Lisa Armitage: We really believe in small class sizes. It gives the opportunity for the children to practice a lot, to get a lot of individual attention, and like I said, really form those friendships. We've had so many families that have said that they've met these families at their classes and then they've gone out for play date after. They've stayed and packed a lunch or snack and they've scheduled play date. So it's really a great way for families to get to know each other in a really small welcoming environment.

Dr. Mike Patrick: Talk a little bit about the kids who are interested in competitive swimming. How do you get involved in that and what kind of training programs are necessary?   

Lisa Armitage: Yeah. Well, we have this great program at the Goldfish called the Goldfish Swim Team. And it's for children that have completed our levels and are ready for something like an introduction into more of a competitive swim program.   

So, our daughter went through it. And it really prepared her for where she's at now with a more, like a club team where she's travelling a little bit more. And at our Goldfish Swim Team, one of the huge benefits is that we've got a coach in the water with the children. 

In that, the children are swimming the length of our pool. There's never more than seven, at that point, swimmers to one coach. But again, all their coaches are in the water. They're hands-on. They're working with the children on all four strokes. 

We've got meets quarterly. It's non-competitive. It's just fun introduction for children. And a lot of the children will gain a lot of confidence here and learn the rules of a swim team and how they work. And then, they'll move on maybe to a competitive program. 

And then, some kids, they're not interested in the competitive program. They're not interested in big swim meets or traveling or anything else. So, they'll stay with us for quite a while just to have that great experience, that really close-knit the family feel, but then they're still getting a lot of exercise, making a lot of new friendships, and really learning how to be strong confident swimmers.


Dr. Mike Patrick: For the folks who may not have swim program affiliated with their school, and maybe there's also not a Goldfish School around, is it going to be difficult to find competitive swim programs? Or they're pretty much everywhere?

Lisa Armitage: I feel like from what we've look there's really everywhere. I think if you log on to like USA Swimming. It's an international group but they're obviously focused in the United States. And they've got swim teams listed for all different parts of the country. 

And it's been such a great experience for our family. I would really encourage families with children that have an interest to explore that.

Dr. Mike Patrick: But you have to be realistic as well. 

Lisa Armitage: Right. 


Dr. Mike Patrick: That your child is unlikely to be the next Michael Phelps or Katie Ledecky, right? 

Lisa Armitage: Right. Yes. 

Dr. Mike Patrick: But that's true of course with any sports, that really to put the focus on having fun, exercising, being around kids your age, that sort of thing.

Lisa Armitage: The great thing about swimming is that they can set personal goals. So, we always encourage our swimmers at Goldfish, whether if their personal goal is to put their face on the water, or when they're more competitive, to beat their own times, or to learn one of the strokes a little bit better.

I think that's a wonderful thing because if you're strictly in a group sport, you're dependent on your team a lot more. Swimming can be a team sports, but it can also be individual as well and really allow a child to get better, to be more confident, but against themselves and what's realistic for them and how that they should be improving.

Dr. Mike Patrick: Yeah. What about diving? It seems there'd be a lot of kids who that's what they want to do. That's the golden thing.


Dr. Mike Patrick: Do you encourage that? Or do you do diving at your swim school?

Lisa Armitage: We do not offer diving at Goldfish just because our water's four feet deep. So, we have purposely a four-foot-deep pool. That way to really facilitate training for these young swimmers, to allow our teachers to be able to stand at an appropriate level, to really have a hands on work with them. 

But I know a lot of swimmers go on to diving, I think it's so fun to watch. I think that they have a great time with it. I know there's a lot of dancers, a lot of gymnasts that have a passion for the water that incorporate that into diving. And I know that a lot of places around the country have opportunities for diving. I know here at Ohio State, they've got a lot of different levels platforms. And I've seen a lot of young kids working out down there, learning how to dive.


Dr. Mike Patrick: Yeah, it's fun to watch.

Lisa Armitage: It is. It's nerve-wracking, though, as a mom. I don't know how I could watch that, but they're very well-coached and trained. And I know they're working to keep them very safe.

Dr. Mike Patrick: You talked about retention ponds and there are a lot of those around. In fact, not just here in Central Ohio. I'm sure that folks listening just about anywhere know what we're talking about, any housing development. I think a lot of fire codes want that so that they have this body of water to take could suck water from if there's a house fire. 

What are some of the safety measures that we should be thinking about with regards to the natural environment? There's retention ponds, lakes. Kids swimming in the ocean. What should parents be on the lookout for in terms of the keeping their kids safe around natural bodies of water.

Lisa Armitage: That's a really great question. First and foremost, just because the season right now. It's very important to keep children off of those retention ponds in the winter. I think there's a lot of false sense of security. People see that they're frozen or there are small bodies of water, and they think, "Oh, my child can go ice skate," or play hockey or do whatever. 

We actually had one of our swimmers couple of years ago fell through a retention pond. He was 10 years old. The mom actually called and said the skills that he learned at Goldfish Swim School saved his life. She said that he knew how to swim, how to be a stronger swimmer. 

He knew to turn around — even at 10-years-old — to turn around for the nearest point in that pond. So, often if somebody falls in the middle of the pond, they think just to swim straight ahead, not realizing that the nearest point is likely behind them. 

So we've been talking as much as we can to people about the winter water safety part of it and making sure that we keep them off of those retention ponds when it's cold outside. 


And then, just you know, when it's not cold and we're just thinking about the rest of the year, always having a US coastguard approved lifejacket around water is very important. We really like to emphasize the US coastguard approved lifejacket. There would be a little like a stamp label on the inside of the lifejacket that would say that it's US coastguard approved. And there's also weight limit on those lifejackets. 

So, making sure that not only you have a lifejacket, but that it's the appropriate one, that it's been tested and that it fits your child's weight. So, that a little one isn't wearing a lifejacket that is way too big for them. 

Also, always swimming in the designated swimming area that's supervised by lifeguards and, like we talked about, having that designated watcher. 

Staying close to the shore so that they can be seen and rescued quickly in the event that there is an issue. We don't want children — or adults, for that matter — swimming in the bodies of water that are not safe for swimmers. 

I know that community did really do a good job of labeling those places, but I would say if there's not something that says safe for swim, it's probably not. Probably better to air on the side of caution and staying away from certain bodies of water. 

Daytime, obviously, is the safest time for swimming in lakes and oceans, just because the visibility. Visibility is usually lower in the morning early hours and at the dusk. Sometimes, there could be predatory animals. We don't really face that in Ohio, but in all parts of the country, there is alligators and snakes and other types of animals that wouldn't be safe. 

And never leaving — like I said, I can't say it enough — never leaving your child unattended in any body of water, whether it's a pool or hot tub, or the ocean. 

Dr. Mike Patrick: Yeah, it's going to be so important. And those currents, you really have to be careful with those. We have relatives that live on the coast in North Carolina. Every year, there's some drownings there, usually from riptides. So it's really important to be on the lookout and just be there with your kids. 

Lisa Armitage: Yes, be present. 

Dr. Mike Patrick: And don't let them swim out far for sure.

Lisa Armitage: Yes.

Dr. Mike Patrick: Great. We really appreciate you stopping by and sharing swimming lessons with us, the importance, and what kids get out of it. The Goldfish Swim School, again two locations here on Central Ohio — Dublin and Westerville — but also 65 locations in 17 states.

We'll a put a link in the Show Notes, so you can find one near you. But also, really, there's swim lessons anywhere, whether it's the YMCA, the community pool, with the school program. Just really get your kids out there on the water, right?


Lisa Armitage: Absolutely. Education is the most important thing you can do.

Dr. Mike Patrick: Great. Lisa Armitage, thank you so much for joining us today.

Lisa Armitage: Thank you. I appreciate you having me. Thank you, Dr. Mike. 


Dr. Mike Patrick: I have couple listener questions for you this week. The first one comes from Lauren in Indiana. Lauren says, "I'm not sure if it's been covered on your show before but I have a question regarding color blindness. My husband is color blind but as far as we know, there is no history of color blindness on my side of the family. 

We are wondering what this might for our daughter? She is 20 months old and knows the names of some colors, but like most young toddlers, she's still calls many things blue or green or whatever her color of the day seems to be. I've heard this is rare for girls but was wondering what this could mean for her and any future children we have, like a boy where I hear color blindness is more common?"

Well, thanks for the question, Lauren. So, let's talk about color blindness. I want to begin with a couple of foundational points that I think will help us understand exactly what's going on and how the condition is passed from one generation to another. 


So, I want you to think back to high school biology class. And you'll recall that the retina is the light sensing portion of the optic nerve that's located at the back of the eye. So, light comes into the eye through the pupil. It passes through the lens, and it gets focused on to the retina, where the light is converted into electrical impulses and then send to the brain where the sense of sight is actually processed and experienced. 

And you'll also remember that there are two types of light-sensing cells in the retina, rods and cones.

Rods are the ones critical for low-light vision or night vision, and those are not able to discriminate color, which is why everything appears greyscale when the lights are off. And the cones are responsible then for day vision and color discrimination. 

And just as a palette of primary colors mixed to create millions of additional colors, the same sort of thing is happening at the back of the eye. There are three types of cones, one that senses blue light. Another for green light and a third for red light. So, we have blue cones, green cones and red cones.

In the exact manner in which a particular color of light stimulates each of these three cones, that will determine how the signal is processed and set to the brain and processed by the brain. And the results ends up being at the human eye can distinguish at least hundreds of thousands of colors, if not as many as 10 million colors. Although, nobody has counted them all reliably to give us an accurate number but somewhere between hundreds of thousands and maybe as many as 10 million. 

Suffice it to say, that's a huge number of colors. And it's really just those three sets of cones working together to give all of those to us. Of course, the key here is the three sets of cones have to be working well together. If there's a problem with the cones or problem with one set or two sets of cones, then the manner in which color is processed and the way that the color then is experienced becomes altered  compared with those who have all three sets up and running in the back of the eye. 


And by the way, the problem could lie in the cone itself or along the pathway between the cone and the brain or in the brain where the colors are processed. We don't really know where things go wrong, we just know that somewhere in that pathway there's an issue. And then, color blindness, it appears to affect just one set of cones or two sets of cones.

So, what sort of things can go wrong? Well, anything that affects the retina in the pathway to the brain or the visual part of the brain has the potential to affect color. And in particular, for thinking about the retina in the cones, that would include trauma. So, eye injuries, also diseases of the eye, things like diabetes and glaucoma. 

But these are unlikely to affect the single set of cones or just two sets of cones. They're more likely to affect all the cones, all three sets. So, trauma and eye disease can affect color discrimination to varying degrees, but they aren't likely to equally affect just one or two sets of cones. Usually, those are going to affect all of them. What is likely to affect a single set of cones or just two sets of cones is a developmental issue. 

In other words, there's a functional problem that's present as the eye develops and present from birth. So we would call that a congenital condition. And this is the case with classic color blindness, which brings us to our second foundational topic, and that is a reminder of some basic genetic principles. 

So, again, think back to high school biology. And in addition to those rods and cones that you remember learning about, you also learned that genes reside on chromosomes and babies get a mix of genetic material — one set of chromosomes for mom and another set of chromosomes from dad. 

And then, we also have the sex chromosomes, so an X and a Y. And if a baby gets two X chromosomes, so one from mom and one from dad, then she'll be a girl. And if a baby gets an X chromosome and a Y chromosome from dad, then he'll be a boy. 

One final reminder, we can talk about dominant traits, which require only one gene to express itself. And we have recessive traits which requires two genes, one from mom and one from dad to express itself. Or in the absence of another chromosomes, if you only have one, in the case of boys who get an X and a Y, then the recessive trait will only need one gene to express itself, because there's not another X chromosome. 

So, when we look at the pattern of color blindness, we can start to make deductions as we think about this facts that I've mentioned and that you learned in high school biology. If look at the pattern of color blindness, we see that lots more boys are affected, as Lauren suggested, compared to girls. 

When we think about this, then we can deduce that the genes responsible for the defect, whatever that defect is — again, we still don't know — but it's something that only affects one or two of those three sets of cones or the pathway those cones take to the brain, or the interpretation of that set of signals inside the brain. Whatever it is that's going on physically, whatever it is, the genes responsible must be associated with the X chromosome, and it must be recessive in nature. 

So, how do we make that deduction work? If there were on any of the non-sex chromosomes, so any of the other ones, then we'd expect to see closer to an equal number of affected boys or girls. Maybe not exactly equal, because there can be differences in genetic expression when we compare boys and girls, but with expected breakdown to be fairly close equal between boys and girls being affected.


Well, it turns out, in a 2014 study of just over 4,000 children from three to six years of age — kids who could reliably be tested as to whether they know the colors or not — of those 4,000 children, if you look at all the children, 1.6% of them were affected with color blindness. But if you broke them down into boys and girls, 3% of the boys were affected, but only 0.02% of the girls were affected. So if you break that down in the numbers of the 4,000 kids, 120 of the boys were color blind but there was only 1 affected girl. 

So, lots more boys. So that lets you know that we're dealing with a sex chromosomes trait rather than a being on any of the other chromosomes. So, it's going to be they're on the X or the Y. 

Now, if it were on the Y chromosome, then no girls would be affected since girls don't have a Y chromosome. So that means it's going to be on the X. And we think it's recessive because if it were dominant, then every single girl of a color blind father will be affected since every girl gets her dad's one X chromosome. 

On the other hand, an X-linked recessive gene which is what we think is going on here, it would affect every boy who inherits it because boys only get one copy of the gene. And that exactly what it looks like, that any time a boy gets the color blind gene on the X, they are affected. 


So that's how we deduced that it's an X-linked recessive trait. Now, I do want to mention that in the case of boys, they're getting this X, so this X-linked trait, actually from their mom, not from their dad. So even though we think, "Oh, this is only in boys. It would sort of make sense to think, "Oh then, the child must get this from their dad, since we're just seeing it in boys." But remember, if it's on the X, boys get their only X from their mom. So just to throw a little bit more confusion into the mix for you. 

Anyway, color blindness, if we think about it, is a classic genetic disorder. It's one that is X-linked and can only be passed to a son from a mother because that's the only person who can donate the affected X. All sons again get a Y from their dad. 

So we can stop right here and answer one of Lauren's questions. And by the way, if I confuse you as we went through and you're really interested, just rewind and listen again. It may take a couple of times listening to it for it to sink it. Because it did, it's confusing language especially on a podcast where we can't draw a diagram and show you. 

So Lauren's husband is a color blind. So he has an affected X chromosome. What is the chance that a son would then be affected? Well, as we've mentioned, that really depends on Lauren herself. Now, I assume Lauren is not color blind, since she didn't mention that she was. I think she would have. 

So we know that Lauren does not have two affected X chromosomes. Now, she could have one affected chromosome. So she could be a carrier. And if that's the case, then a future boy would have a 50% chance of being color blind. Not because dad is color blind, that has nothing to do with it. Future boys have a 50% chance of being color blind only if Lauren passes the gene… 

Well, actually, if Lauren's a carrier and she passes her one affected gene, then that son has a 100% chance of being color blind because that's the only X he's getting. But there's 50% chance of that happening because Lauren could also pass her unaffected gene, the unaffected X chromosome to the son. 


So if Lauren's a carrier, future boys of that family have a 50% chance of being affected by color blindness. And again, the fact that dad's color blind has nothing to do with it. On the other hand, if Lauren has two normal X chromosomes, then the chance of a future boy being color blind is 0%. 

So right there we can answer Lauren's question about future boys. It really depends on Lauren, not the fact that Dad is color blind. 

Now, what about their 20-month-old daughter? Lauren wants to know, is she color blind? Well, she definitely inherited dad's affected X chromosome. No question there. 

So, if Lauren has two normal Xs, then their daughter is a carrier. So she's not color blind but that means a future son for her has a 50% chance of being color blind. 

Now, let's say Lauren is a carrier — just for the sake of saying that she is, we don't' know if she is or not — but if she is a carrier, then her 20-month-old daughter has a 50% chance of being color blind, since we know she inherited dad's affected X chromosome. 

And if she is color blind, which only time will tell — because there's not a blood test at this point, there's no way to tell by examining the eye, diagnosis relies on self-report — but if it does turn out that she is color blind, Lauren's daughter, then all of Lauren's grandsons would be affected with color blindness. Because all of them are going to get Lauren's daughter's one affected X chromosome, if it turns out that Lauren's daughter is color blind, which again, time will tell. 

And Lauren's granddaughters would have a 50% chance of being carriers. Unless, Lauren's daughter has a child with a color blind man in which case, all of her sons and all of her daughters would be color blind. 

So got to love genetics. I know it sounds so confusing. If you're really interested in this, just go back and relisten. It may take relistening more than twice for it to sink in, especially if you're new to genetics. 


Now,  everything I mentioned does assume a simple pattern of inheritance, which classic color blindness does seem to follow, but it does not take into account random mutations which can occur. 

So now, how can Lauren then tell is she's a carrier? Because that would be the next question if you want to know the chances of your future kids and your grandkids, Lauren really needs to know if she's a carrier or not since that affects all of these progeny. 

Well, if her father is color blind, which Lauren said, to her knowledge, color blindness does not run in the family. But if father is color blind then we know for certain that Lauren is a carrier because she received her father's one affected X chromosome. If he's not, then we would have to consider Lauren's mother. Could she be a carrier? 

If her father was color blind, then yes, Lauren's mother would be a carrier. So Lauren would then have a 50% chance of also being a  carrier. If Lauren's maternal grandfather was not color blind, then you have to consider her maternal grandmother, and her maternal grandmother's father. 

So it can get pretty complicated in a hurry trying to figure this all out. And again, since there's no test besides the color chart and no treatment, at the end of the day, all Lauren can really do is wait and see if her child is color blind. 

So there you have it. Again, go back and listen if I lost you and you're interested few times through, it should start to tract. 

I do want to circle back to those set of cones one more time. So  as it turns out, most common blind folks, so the most common form of color blindness, they appear to have  a fault with their red cones and their green cones. And we call this red-green color blindness. 


But other colors are affected, too, because remember, those two cones are going to involved in lots of colors. So many colors rely on the activation of those faulty red cones and green cones, in addition to the person's normal blue cones. 

So if you want to learn more about color blindness and see what a variety of colors look like to someone affected by various types of color blindness, or you want to test yourself or your children for the presence of color blindness, then I'd highly recommend a website. It's called colourblindawareness.org. And you have to spell color with a U after the O. So C-O-L-O-U-R, colourblindness.org. It's a British site, that's why you got to put the U after the O. 

But it's definitely a worthwhile visit and is chockfull of useful information written in terms parents can understand, including the genetics  part. And I'll make it easy for you to find that particular website by putting a link to it in the Show Notes for this Episode 371 over at PediaCast.org. 

So that helps Lauren, I know it was a lesson in genetics, but hey that's what color blindness is about.

Thanks for the question, really do appreciate your writing in. 

Our final listener question this week comes from Yani. Yani says, "Hey, I wanted to suggest topics for your show, following up on the recent picky eaters segment which was great as always." Thank you, Yani. 

His follow-up questions which many others out there may also have, "Number one, how do I make sure my child is getting enough iron in his diet. And number two, is it possible to provide my child with a healthy vegetarian diet. If so, how?" 


Well, thanks for the question, Yani. They are great follow-up points to our picky eaters episode. Now, some of you are saying "Picky eaters episode? I didn't know you did that. I want to hear it," because picky eaters is such a common issue for many families. 

And we did cover picky eaters a couple of shows back, Episode 369 to be exact. And we had a fantastic guest, a child psychologist and picky eater expert, Dr Lauren Garbacz. I'll put a link to that show in the Show Notes for this episode, 371, over at PediaCast.org. So you can find it easily, although it's not too hard to find. It was just a couple of episodes back. 

All right, so a couple of great follow up questions here. Number one, how do I make sure my child is getting enough iron in his or her diet? Let's start there. 

First, you want to make sure that you offer plenty of iron-rich foods. And that's going to include red meat and also white meat. So steaks, pork, poultry, hamburger, bacon. Really, any meat is going to have lots of iron. Red meat is going to have the most. But white meats have plenty of iron, too. Fish and other forms of seafood also contain iron. And then, as we move away from sort of the meat category and think about vegetables, dark leafy vegetables. Things like spinach, kale, greens, they all contain a fair amount of iron. Beans and peas also contain iron. 

And then, as we think about fruits, couple of dried fruits, raisins and apricots in particular have a good amount of iron in them. And then, many cereals, breads and pastas are fortified with iron. But you do want to check the label because not all of them have iron added. 

So lots of different food groups there. Breast milk for little babies, cow's milk, dairy products, also contain iron. However, introducing cow's milk before the age of 12 months, or using a different type of milk like goat's milk for instance, or drinking too much cow's milk even after the age of 12 months in some people can actually lead to iron deficiency, which is sort of counterproductive to getting iron inside the body.

So dairy does have iron in it. But with the caveat, not all dairy does and too much milk — except for breast milk in babies — sometimes can end up ultimately resulting in iron deficiency. 


Also, another important point when we think about iron is the intake of Vitamin C. Because if you take Vitamin C at the same time that you eat iron rich foods, that helps with absorption of iron into the body through the intestinal wall. So things like orange juice and oranges, tangerines, strawberries, melons, tomatoes, grape fruit, kiwi, all things that are high in Vitamins C. As it turns out broccoli and peppers also have Vitamin C. And leafy greens, those are that being the great source of iron and Vitamin C. 

And of course, a multivitamin containing iron and vitamin C. One that is geared for kids that will help boost iron. However, most kids, even many, many picky eaters get plenty of iron because our food are so supplemented with it and fortified, that they don't require a daily vitamin supplement for either the iron or the Vitamin C. So, lots of picky eaters out there who are not iron or Vitamin C deficient because what they are eating is still enough. 

Now, you're child may cruising along, maybe they eat plenty of these foods, maybe they don't. And you want to know. Like how do I know that they're getting enough? I mean you tell me even picky eaters may have enough iron and getting enough Vitamin C, enough iron, how do I know? 

Well, the best way to screen for that quickly is a quick finger stick and a blood count from your child's doctor. Now, this does not measure iron directly. But the red blood cell count and the hemoglobin and the hematocrit, which are part of a complete blood count or CBC, those components of the blood count — the red blood cells, the hemoglobin and hematocrit — they're great indicators of the amount of iron the kid is getting in a diet. 

Because, in order to properly make red blood cells, you have to have hemoglobin. And iron is a key part of hemoglobin. So, if you're not getting enough iron, you're not getting enough hemoglobin and then you're going to be anemic. 


If you do a blood count, and a child's red blood cells count, their hemoglobin, hematocrit, those are normal, then that's a great indicator that your child's getting enough iron for sure. If you really want to know for sure. 

Now, if those things are low, we say a child has anemia. And then, further exploration can begin. We're trying to figure out why that is. Is it just dietary lack of iron or is there some other disease process going on? So then, we can further explore if they are anemic. 

By the way, you can also check iron levels and iron stores, but that's usually something that we only do if a child is anemic. If we really think there is an iron problem and we're trying to get to the bottom of why it's low and design a plan for bringing it back to normal. Those things can be helpful to know. But we don't usually check an iron level without first just doing a blood count. 

Again, all of these is a journey that you want to take with your child's doctor. Express your concern to them and figure out what the plan is going to be that you and your doctor come together and make those determinations.

Now, Yani's second question in many ways relates to the first. "Is it possible to provide my child with a healthy vegetarian diet? And if so, how?" So, yes, it's possible. 

The main issue that you're going to face though is getting enough iron by way of the non-meat options that I mentioned previously. So you really do want to push dark leafy vegetables, spinach, kale, and greens — which can be difficult in kids — beans and peas, dried fruits especially apricot and raisins, and then those fortified cereals, breads and pasta. And plenty of Vitamin C with iron containing foods will help. 


So, as we're thinking about not eating meat, you just kind of think about all the other places where you can get iron, as we've mentioned, and really kind of push those foods. 

Now, kids who don't eat meat, they're not only missing iron, but you can also have some problems with Vitamin B12, zinc and other minerals that will be less abundant in the diet if you remove meat. Now, depending on what level of vegetarian we're talking about, if you take away dairy — so you take away milk  and dairy products — then you'll have to make an effort to get  calcium and Vitamin D from another source, and preferably together, like the iron and the Vitamin C, because Vitamin D is important for the proper processing of calcium. 

So, you're getting foods that are rich in calcium and Vitamin D, iron and Vitamin C. And getting these nutrients is doable with the vegetarian diet. But it may take us some creative alternative sources and supplementation but it's something that you want to do in consultation with your child's doctor. 

So, if you are planning on going with the vegetarian diet, regardless of what degree a vegetarian were talking about, you definitely want to partner with your child's healthcare provider in figuring out a good plan and intentionally watching for deficiencies. And partnering with a dietitian if you have access to one, that's just ideal. And your regular provider may have a resource in terms of getting you connected with a dietitian who can really help you plan and to watch for problems. 

By the way, healthychildren.org from the American Academy of Pediatrics has several great resources for parents and kids pursuing a vegetarian diet, as you think about iron and calcium and Vitamin C and Vitamin D, and trying to decide whether your kid needs supplements. They have some great resources. One's called Vegetarian Diet for Children, another, Pump up the Diet with Iron and another called  A Vitamin a Day to help you determine if your kid really need a vitamin or not.

I'll put a link to all these resources in the Show Notes for this episode, 371, over at PediaCast.org, so you can find them easily.


So, hope that helps clear up iron and vegetarian diets, Yani. And as always thanks for the question. 

Don't forget if you have a question for me that you'd like me to answer on the program or you have a topic that you just like to discuss or suggest that we talk about, maybe we can get an expert in to talk more in depth about the topic that you have an interest in, any of those things — or you want to point me in the direction of a news article or a journal article — easy to get in touch, just head over to PediaCast.org. 

Click on the Contact link. There's a form, fill it out, send it in. I do read each and everyone those that come through. And we'll try to get your question or your comment on the program.


Dr. Mike Patrick: All right, we are back with just enough time to say thanks to all of you for taking time out of your day and making PediaCast a part of it. We really do appreciate that.

Also thanks to Lisa Armitage from the Goldfish Swim School. She's a swimming and water safety expert. Really appreciate her sharing her knowledge with us. 

Lots of links for you this week. So I really would encourage to head over to PediaCast.org, click on the Shows and Notes tab at the top of the page and find Episode 371. And you'll find those links. 

So a link to the water safety podcast that we did last summer, which is all still accurate and up to date and definitely worthwhile for you to listen to. That was PediaCast Episode 348. We'll have a link for it in the Show Notes for today's episode. 


Also, the American Red Cross find a class site, that's important. And, of course, the Goldfish Swim School, the national site, also the Dublin and Westerville site for those of you in Central Ohio. 

Colour Blind Awareness, that's a great site with lots of information about color blindness. You can test yourself and your family. And you can just experience what is like to be color blind by visiting that site. 

Also, Picky Eaters and Pet Medication, that was Episode 369. And since one of our listeners had a question about iron intake and vegetarian diets. It's going to pertain to picky eaters. That episode maybe helpful if you have not listened to that. That's Episode 369. And we'll put a link to that one in the Show Notes for this episode as well.

And then, there's resources I just mentioned Vegetarian Diets for Children, Pump up the Diet with Iron and A Vitamin a Day, all from American Academy of Pediatrics and healthychildren.org.

Don't forget, you can find us in all sorts of places. There might be an easier one, an easier way to listen than however you found us today. We're in iTunes, also Google Play, iHeart Radio, Stitcher, TuneIn, really most mobile podcast apps for iOS and Android. If you just search for PediaCast inside the app, you should be able to find us. 

If you do come across a podcast app and we're not in it, you can't find us, use our contact page and let me know, and I'll try to get the program added to their line-up. 

And, of course, we have the landing site. If you don't know about that, it's PediaCast.org. We have our entire archive of 371 podcasts, Show Notes, transcripts, written transcripts of the episode if you'd rather read the content rather than listen to it. Although, I recommend listening. But you know, that's just me. You can read it, that is an option. 


Also, our Terms of Use Agreement, which is very important, and our contact page if you do want to get in touch — all of those are available at PediaCast.org. 

We're also part of the Parents On Demand network of podcasts. You can learn more about them at ParentsOnDemand.com. They actually have an app coming out that will have PediaCast as part of it. That should be out within the next couple of months. We'll keep you posted on when that's available. You'll be able to find us there as a new location, easy place to connect with us. 

We're also in social media. PediaCast is on Facebook, Twitter, Google+, and even Pinterest. We really appreciate you connecting with us on those places and then sharing our posts and our tweets and just helping to get the word out and around with other parents and folks who take care of kids. 

And then, of course, face-to-face recommending of the show is just so helpful. We really don't have an advertising budget on PediaCast. We really rely on parents sharing the show with others. So we do appreciate you telling your family, friends, neighbors, co-workers, grandparents, baby sitters, anyone who either has kids or takes care of children, really appreciate you talking us up with those folks, so that hopefully they can gain information, evidence-based information that can help them as they take care of kids. 

And by the way, that does include your child's doctor. Be sure to let your child's pediatric provider know about PediaCast so they can share the show with the other families that they take care of.

And we also have a program for them, PediaCast CME. CME stands for Continuing Medical Education. It's similar to this program, we turned up the science a couple of notches and offer free Category 1 Continuing Medical Education Credit. Shows and details are available at the landing site for that program which is PediaCastCME.org. 


And PediaCast CME is also on all those other places that I mentioned. So it is also in iTunes, Google Play, iHeart Radio, Stitchery, TuneIn, most podcast apps for iOS and Android. So just let them know, wherever they can find podcasts, they should be able to find PediaCast CME. And on the show itself are the directions for how to claim Category 1 Credit for listening. 

All right, that is all for today. Thanks again for stopping by. And until next time, this is Dr. Mike, saying stay safe, stay healthy, and stay involved with your kids. So long, everybody. 


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

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