Insecticides, Physical Discipline, Eye Injuries – PediaCast 224

Podcast: Download

Subscribe: RSS

Join us this week for a Pediatric News Extravaganza! Topics include insecticides and c-sections affecting memory and IQ scores, parental compliance with new car-seat and booster-seat recommendations, preparing preschoolers for college, physical discipline, eye injuries, sugary drinks at school, and labels used to describe overweight kids.

Topics

• Insecticides and IQ Scores

• C-Section and Memory

• Improper Car-Seat Use

• Preparing Preschoolers for College

• Physical Discipline

• Eye Injuries

• Sugary Drinks at School

• Obesity Labels

• A Healthy You and 22q – Conference Information

Links

• Lower IQs Seen In Boys Exposed In The Womb To The Insecticide Chlorpyrifos

• Brain-Boosting Proteins Triggered By Natural Birth — But Not C-Section

• Disturbing Rates Of Improper Car Seat Use Among Children

• 2012 GUIDELINES: Car Seats and Booster Seats

• Preschoolers Who Pay Attention More Likely To Get Degrees Later On

• Getting Physical With Unruly Kids

• Eye Injuries In Young Athletes Can Be Avoided With Protective Eyewear

• Fewer Sugary Drinks At U.S. Schools, But Still Widely Available

• Hurtful vs Less-Offensive Labels For Obese Children

• A Healthy You and 22q – Conference Information

Transcription

Announcer 1: This is PediaCast.

(Music)

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

Dr. Mike Patrick: Hello, everyone and welcome once again to PediaCast, a pediatric podcast for moms and dads. And it seems like we have an increasing number of folks in the audience who are also clinicians. So, we have pediatricians, family-practiced doctors, nurse practitioners, pediatric residents, medical students, undergrad students interested in pediatrics, so welcome to all of you as well. We try to keep balance between information that parents want and what clinicians would want and a lot of times what that means is still going into the depth that pediatricians would want, but in terms of parents can understand. So hopefully, we are achieving that goal of appealing to both audiences. And I know through the iTunes reviews and through emails that I get from you and contacts through the Contact page at pediacast.org that there are more clinicians, but parents out there never fear, we are not going to leave you behind. We'll make sure that everything we talk about that you can understand what it is that we're saying.

So this is episode 224 for August 29th 2012. We're calling this one Insecticides, Physical Discipline and Eye Injuries. It's a little bit of a different program today. I'm calling it a news extravaganza and the reason for this is there have been a lot of news stories that I've been sort of holding off on in order to get to your questions and to interview our wonderful experts here at Nationwide Children's Hospital. But the news stories have been piling up and there's a few of them I really feel strongly about passing on to you so that you know about them because they really are the type of stories that can make a difference in your life and the lives of your children.

02:17

So, for today's show I made the executive decision to dedicate an entire episode to some interesting news items. But never fear. We'll have plenty of opportunities to answer your questions coming up, so keep those questions rolling in. And of course, as always we have plenty of great interviews coming your way down the road as well. But for this week, anyway, we're sticking with the news.

Before I get to today's lineup and tell you exactly what news items we're going to cover, I want to say a word to parents with college-aged students out there, because as you know, you don't stop being a parent when your child goes off to college. Well, I'm kind of with you there because my daughter started college this week and I'll tell you it is tough not having her at home. So I just wanted to put a word of solidarity out there for parents with kids in college, I know it's not easy. And since having a college-aged child is my season in life right now, I have a high school student too, but because I have a college-aged student, you might be hearing a little bit more about the health and well-being of college-aged students.

And by the way, I will put a word in there for, if you have a college-aged student, it is OK to keep seeing your pediatrician, unless your pediatrician tells you they don't want to see you anymore. But I know when I practiced, I did not mind seeing college-aged students. And usually by the time they graduated from college I would say, OK, you need to find an adult doctor now. But most of us enjoy seeing college-aged students and don't get me wrong, we like seeing infants and toddlers and elementary, middle and high school students, but the college-aged population has their own set of issues and problems and pediatricians like dealing with those too. It's kind of refreshing sometimes after you've seen a bunch of babies to take care of a college-aged student.

04:10

So, I'll just put a plug in there, don't feel like you have to transfer out from your pediatrician to an adult doctor too soon, because most of us love seeing college students. So anyway, a good luck shout out to my daughter who just left for college, I just want you to know that I love you and miss you. And I feel a sort of kinship now with other parents out there with kids living away from home.

All right. So let's move on and explore our lineup with our news extravaganza. Here's what we have cooking, insecticides and memory and IQ scores. What is the relationship between in utero exposure, so when babies are inside mom's womb? How does the exposure to insecticides during that time when babies are developing, how does that affect their memory and IQ scores later in life? And insecticides aren't the only thing that can have an impact on IQ and memory; it seems that whether a baby is born by C-section or vaginal delivery might also make a difference on memory and IQ later in life. So, we're going to talk about those two things – insecticide exposure and C-section versus vaginal delivery and how those affect brain development and then have an effect on IQ score and memory down the road.

We're also going to look at improper car seat use. This is really disturbing. There were some new recommendations that came out last year with regard to car seat use and we're going to look at the numbers. Parents as it turns out are not listening to the new advice and are putting their kids at risk. And so there are going to be some kids out there who are seriously injured, hospitalized, possibly in intensive care units and possibly who die because their parents did not heed the expert opinion on how you should advance children through car seat usage. And so we're going to look at the numbers and we'll also review the proper car restraints that you should use for different ages and sizes of kids.

06:16

We're also going to look at preparing preschoolers for college. See, I told you we're going to have a little bit more look at college. This is serious though. Is there something that parents can do when kids are preschool age to make it more likely that they'll not only go to college but that they will finish with a degree? So, if you are the parent of a preschool student you'll definitely want to pay attention, especially if you're interested in your child attending college down the road.

We're also going to look at physical discipline. What are parents really doing? This is kind of an interesting study that was done where the researchers went out into the native environment of parents, at least the public, the public natural environment. So they looked at grocery stores and fast food restaurants and parks and places where parents and kids hang-out and looked at discipline practices in nature rather than surveys or in the lab where they could be observed and just see what are the differences between what parents say they do and what they actually do. So that's going to be interesting.

Also, eye injuries as we get the fall sports season underway. What kind of protective eyewear do your kids need and what should you do if an eye injury occurs?

07:31

We're also going to look at sugary drinks at school. Are we making progress at offering alternatives? We all know that there is an obesity epidemic out there, just seeing more and more of that. And part of the problem is kids getting way too much sugar in their drinks. So, what are schools doing to curb the amount of sugar that kids are exposed to at school?

And then speaking of obesity, what about obesity labels? How do moms and dads want doctors referring to overweight kids? Should we call them obese? Should we call them overweight? Do we say hey, there's a weight issue or weight problem? I mean, how exactly do you address this issue or how do moms and dads want us to address this issue?

So, all of these news stories are coming your way. I do want to remind you if you there's a topic that you would like us to talk about, or you have a question for the program, you can head over to pediacast.org and click on the Contact link. You can also email pediacast@gmail.com or call the voice line at 347-404-KIDS. That's 347-404-K-I-D-S.

Also, I want to remind you the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. So if you have a concern about your child's health, 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.

All right. With all that in mind we're going to take a quick break and we will be back with our first news segment right after this.

[Music]

09:35

Our News Parents Can Use is brought to you in conjunction with a news partner, Medical News Today, the largest independent health and medical news website. You can visit them online at medicalnewstoday.com.

A new study is the first to find a difference between how boys and girls respond to prenatal exposure to the insecticide chlorpyrifos. Researchers at the Columbia Center for Children's Environmental Health at the Mailman School of Public Health found that aged seven boys had greater difficulty with working memory, a key component of IQ, than girls with similar exposure.

On the plus side, having nurturing parents improve working memory, especially in boys, although it did not lessen the negative cognitive effects of exposure to the chemical. Results were published online in the journal Neurotoxicology and Teratology in 2011.

In 2011, research led by Dr. Virginia Rauh, ScD, Co-Deputy Director of the Columbia Center for Children's Environmental Health, established the connection between prenatal exposure to chlorpyrifos and deficits in working memory and IQ at age seven. Earlier this year, a follow-up study showed evidence in MRI scans that even low to moderate levels of exposure during pregnancy may lead to long-term potentially irreversible changes in the brain.

The latest study led by Dr. Megan Horton, PhD, explored the impact of sex differences and home environment on those health outcomes. Dr. Horton and colleagues looked at a subset of 335 mother-child pairs enrolled in the ongoing inner-city study of environmental exposures, including measures of prenatal chlorpyrifos in umbilical cord blood.

When the children reached age 3, the researchers measured the home environment using the Home Observation for Measurement of the Environment criteria, including two main categories: 1.) Environmental stimulation, defined as the availability of intellectually stimulating materials in the home and the mother's encouragement of learning; and 2.) parental nurturance, defined as attentiveness, displays of physical affection, encouragement of delayed gratification, limit setting, and the ability of the mother to control her negative reactions. The researchers then tested IQ at age 7.

11:43

While home environment and sex had no moderating effect on IQ deficits related to chlorpyrifos exposures, the researchers uncovered two intriguing findings related to sex differences. First, that chlorpyrifos exposure had a greater adverse cognitive impact in boys as compared to girls, lowering working memory scores by an average of three points more in boys than girls and second, that parental nurturing was associated with better working memory, particularly in boys.

"There's something about boys that makes them a little more susceptible to both bad exposures and good exposures," says Dr. Horton. "One possible explanation for the greater sensitivity to chlorpyrifos is that the insecticide acts as an endocrine disruptor to suppress sex-specific hormones. In a study of rats, exposure to the chemical reduced testosterone, which plays a critical role in the development of the male brain."

Going forward, Dr. Horton will look at how sex and the home environment may influence the effects of prenatal exposure to other environmental toxicants, such as those found in air pollution. "I expect this information will be useful in efforts to develop new interventions to protect children from the potentially negative consequences of early exposure to harmful chemicals," says Dr. Horton.

The insecticide chlorpyrifos was widely used in homes until 2001 when the U.S. Environmental Protection Agency restricted indoor residential use, but permitted continuing commercial and agricultural applications. Since that time, a drop in residential levels of chlorpyrifos has been documented by Robin Whyatt, DrPH, another Co-Deputy Director of Columbia Center for Children's Environmental Health. The chemical continues to be present in the environment through its widespread use in agriculture, wood treatments, and public spaces such as golf courses, some parks, and highway medians. People near these sources can be exposed by inhaling the chemical, which drifts on the wind. Low-level exposure can also occur by eating fruits and vegetables that have been sprayed with chlorpyrifos. Although the chemical is degraded rapidly by water and sunlight outdoors, it has been detected by the Columbia researchers in many urban residences several years after the ban went into effect. Many developing countries continue to use chlorpyrifos in the home setting.

So, I think in that in coming years we're going to hear more about insecticides and their effect on humans. They're great at killing insects but at what cost? On the other hand, what's the cost of not using insecticides? There right there tough questions but ones we'll hopefully be a little easier to answer as we learn more.

14:16

In the meantime, another story related to memory and IQ, vaginal birth triggers the expression of a protein in the brain of newborns that improves brain development and function in adulthood. That's according to a new study by Yale School of Medicine researchers, who also found that this protein expression is impaired in the brains of offspring delivered by caesarean section or C-section.

These findings are reported in the August issue of PLoS ONE by a team of researchers led by Tamas Horvath, a Professor of Biomedical Research and chair of the Department of Comparative Medicine at Yale School of Medicine.

The team studied the effect of natural and surgical deliveries on mitochondrial uncoupling protein 2, also known as UCP2, in mice. UCP2 is important for the proper development of hippocampal neurons and circuits. The area of the brain is responsible for short- and long-term memory. UCP2 is involved in cellular metabolism of fat, which is a key component of breast milk, suggesting that induction of UCP2 by natural birth may aid the transition to breast feeding.

So, let me just stop here for a second. So there's this protein, UCP2 is the name of the protein, and it helps the body to use the fat that is in breast milk and also fats that would be present in baby formula. It helps the body to use those fats to grow the brain, so to speak. So the brain is made up of a lot of fat because each neuron in the brain, the brain's made up of a bunch of neurons, each of those are coated with fat. And so how the body takes fat and then uses it as the brain grows during the first months to a couple years of life is important. And so it seems that in particular, the hippocampal area of the brain, which is responsible for memory, is particularly sensitive to the proper activation of this particular protein.

16:25

So the researchers found that natural birth triggers that protein UCP2 expression in the neurons located in the hippocampal region of the brain. But expression of the protein was diminished in the brains of mice born via C-section. Knocking out the UCP2 gene or chemically inhibiting UCP2 function interfered with the differentiation of hippocampal neurons and circuits, and impaired adult behavior related to hippocampal functions.

Dr. Horvath says, "These results reveal a potentially critical role of UCP2 in the proper development of brain circuits and related behaviors. The increasing prevalence of C-sections driven by convenience rather than medical necessity may have a previously unsuspected lasting effect on brain development and function in humans as well."

So here's another reason C-sections simply scheduled for convenience are not in the best interest of the baby. And having said that, there are plenty of circumstances when C-sections are definitely the safer way to go. So it seems to me the next logical step besides replicating the finding in humans is to see if there is a way to stimulate UCP2 function when C-sections are recommended for legitimate safety reasons. And as always, if you have concerns or you want to know exactly why your doctor is recommending or not recommending a vaginal delivery versus a C-section, be sure to ask them.

17:51

In the United States, car accidents represent the highest cause of death for children above the age of three and are responsible for over 140,000 children's visits to the emergency room each year. Despite this, new research published in the September issue of the American Journal of Preventative Medicine has revealed that only a small percentage of children in the U.S. are using age appropriate safety restraints and many children are seated in the front seat and exposed to unnecessary risk.

In 2011, the American Academy of Pediatrics issued new Guidelines for Child Passenger Safety, which recommends that until at least the age of two infants are seated in rear-facing until they reached the maximum weight or height of their seat. At that point, they should be seated in a forward-facing seat with a five-point harness system until the child has reached the maximum weight or height of that seat. Finally, they should be graduated to booster seats until an adult seat belt fits properly and this is typically not until a child reaches about 57 inches in height, which is the average height of an 11 year old. Furthermore, the new recommendation states children up to the age of 13 should always be seated in the backseat of the vehicle.

Researchers with the Child Health Evaluation and Research Unit at the University of Michigan C.S. Mott Children's Hospital set out to see how well parents are following these new guidelines and to see if any differences in restraint used exist among different ethnic groups. The team led by Dr. Michelle Macy, collected and examined three years of data from the National Highway Traffic Safety Administrations and National survey on the use of booster seats. They also observed, interviewed and recorded data from drivers with child passengers arriving at community sites, such as fast food restaurants, gas stations, recreational facilities and child care centers.

19:31

That's great! I just love that. So these researchers are observing what parents are actually doing in their car.

They collected information such as child restraint type and seat row, driver restraint use, passenger gender and vehicle type. They also noted the age and ethnicity of all drivers and passengers. And overall, the team collected and analyzed data for more than 20,000 children.

So not only did they observe, then they also approached the car and said hey, how old are your kids? Here's what we're doing. So what did they find? Well, Dr. Macy says, "We found very few children remain rear-facing after the age of one. Fewer than 2% use booster seats after age seven and many children between the ages of 6 and 13 still sit in the front seat."

They also found that the use of proper restraints increased with a child's age, which meant parents put infants and young toddlers at the highest risk for injury. Black and Hispanic infants and toddlers were 10 times more likely to be completely unrestrained that white infants and toddlers. And older kids in minority ethnic groups were twice as likely to be unrestrained when compared to white children.

The percentage of rear-facing car seat use for those under the age of two was lowest amongst minority groups, but even in whites only 17% of those under age two were rear-facing. The team also found minority children were more likely to be transitioned to seat belts too soon.

Dr. Macy sums up by saying, "The most important finding from this study is that, while age and racial disparities exist, overall few children are using the restraints recommended for their age group and many children over five are sitting in the front seat. Our findings demonstrate that not all children have been reached equally by community-based public education campaigns and the passage of child safety seat laws in 48 states. Further development and dissemination of culturally specific programs that have demonstrated success in promoting restraint use among minority children are necessary. Further, the findings may help in developing strategies to lower the racial and ethnic disparities seen in children experiencing crash-related injuries."

21:36

So, this is not just the parents' fault, it's also our fault in terms of adequately getting the message out that hey, there've been some changes in the recommendation and here's what the changes are. So, we as a medical community need to find a better way to reach especially minority groups of what these new things are. I think this was an excellent study to really target where the message is not getting and then we can step back and say hey, how can we get that message/where we need it to go?

However, those of you out there who are listening to my voice right now, you have no excuse for not knowing the new guidelines and following them. So let's review what the recommendations are again so that everyone out there is up to speed. So, under age two, you're kids should be rear-facing in the backseat. When do you transition them to forward-facing with the 5.0 harness? Well, you do that when they outgrow the rear-facing seat or when they turn two. Once we have that rear-facing seat, once your child has reached the maximum length or weight for that seat and they're close to the age of two, then you're good and you want to go ahead and turn them around into a forward-facing seat with a 5.0 restraint.

OK. So when do you transition from that to a booster seat? Well, when they outgrow that forward-facing seat. So now they're forward-facing, they're in a 5.0 restraint, they're over the age of two, you'll leave them in that seat until they reach the maximum weight or length for that seat. And then you can transition them to a booster seat when they outgrow the 5.0 restraint seat. But that's not going to be until they're quite a bit older.

OK. So when do you transition to the regular belt? Well, you do that when the belt fits properly. So it should be off of the neck, across the shoulder and across the bones of the pelvis not the sort abdomen and that's not going to be until they're around 57 inches and about 11 years of age. So most 10-year olds should still be in booster seats, moms and dads. And no riding in the front seat until at least age 13.

We worry about the airbag hitting them and worry about them being ejected from the car. So don't let them up there until they are at least 13 years of age. I'm going to put a link, we've done this several times, but I'm going to put a link again in the Show Notes to the current 2012 AAP Car Seat and Booster Seat Recommendations, the official site with all of the requirements and recommendations. Again, that'll be in the Show Notes, so head over to pediacast.org, look for episode 224, which is this one, and in the Show Notes we'll have a link to all of the AAP's latest recommendations.

24:21

All right. Let's move on in a recent study published in Early Childhood Research Quarterly, finding showed that young children who pay attention and can complete tasks have a 50% better chance of finishing college. The Oregon State University study followed a group of 430 preschool-aged children and concluded that social and behavioral skills such as completing a task, following directions, and paying attention can be more crucial than academic abilities.

Dr. Megan McClelland, an Oregon State University early child development researcher and lead author of the study, says, "There is a significant push to teach academics, like reading and math skills, at a young age. However, this study suggests that the biggest predictor of college completion is young children being able to pay attention and follow directions at age 4."

What's more, paying attention and following directions are adaptable skills, meaning parents can teach them to their children. During this study, parents were asked to rate their preschool-aged children on topics such as "plays with a single toy for long periods of time" or "child gives up easily when difficulties are encountered." Later, the same children were assessed at age 7 using reading and math standardization tests. Then at age 21, their reading and math skills were tested again.

Paying attention is a better predictor than academic achievement on whether preschool children eventually get a college degree. And to the authors' surprise, math and reading achievement did not coincide with college completion. Children whose parents rated them higher on attention span and perseverance at age 4 had a 50% higher rate of receiving a bachelor's degree by age 25.

Dr. McClelland says, "Early intervention by parents and educators can help children succeed academically." In her words, "The important factor was being able to focus and persist. Someone can be brilliant, but that doesn't necessarily mean they can focus when they need to and finish a task or job."

The ultimate goal would be to boost a child's self-regulation by increasing their ability to listen, remember instructions, complete a task and pay attention. In previous studies, McClelland has seen simple classroom games, such as Red light/Green light and Simon Says, improving self-regulation as well as literacy.

In conclusion, authors see the ability to listen, complete tasks and pay attention are crucial to achieve success later in life.

26:39

You know, we talked a couple of weeks ago about the father's role in developing persistence in kids and here's another study that shows that persistence is important for later success. So the take home here, moms and dads, if your child starts something make sure they finish the job. Don't give up when the going gets hard. Hang in there, encourage them, help them through the struggle and at the end of the day be sure to reward them for their effort.

All right. We have more News Parents Can Use. I need to take a quick break and we will get back to our next segment of news, right after this.

[Music]

27:51

All right. We are back with more News Parents Can Use, so let's get started. Parents get physical with their misbehaving children in public more often than they demonstrate in laboratory experiments or acknowledge on surveys. That's according to one of the real world studies of Caregiver Discipline.

This project, led by Michigan State University's Dr. Kathy Stansbury, found that 23% of youngsters received some type of “negative touch” when they failed to comply with a parental request in public places such as restaurants, parks and grocery stores. Negative touch included arm pulling, pinching, slapping and spanking.

Dr. Stansbury says, "I was very surprised to see nearly a quarter of caregivers touching their children in a negative way in public places. It's surprising, because I've seen hundreds of kids and their parents in a lab setting and never once that I witnessed any of this behavior."

Dr. Stansbury is an associate professor of Psychology in Michigan State University's Department of Human Development and Family Studies. She embarked on her study to get a realistic gauge of how often parents use what she calls positive and negative touch when confronting a child with non-compliant behavior. And she wanted to collect her data in real world settings rather than a behavioral lab.

A group of university student researchers anonymously observed 106 disciplinary interactions between caregivers and children. The kids were between three and five years of age and all disciplinary actions occurred in public places.

So, it's kind of like the whole observing what kids are doing in their car, are they properly restrained or not and then you find out what ages the kids were and let them know they were involved in a research study. In this case, the researchers are observing public displays of discipline and then approaching the families and saying, hey, how old are your kids/this is all part of a research study. I wonder how well that interaction goes.

29:42

The student researchers recorded their observations; they confirmed the ages of the children and analyzed their findings. The results were recently published in the journal Behavior and Social Issues. So what did they find? Well, Dr. Stansbury says, "Male caregivers touch their children more often during discipline settings than female caregivers, but the majority of the time, these fatherly touches were positive and included hugging, tickling and patting.

This positive approach contradicts the age-old stereotype of the father as the parent who lays down the law. "When we think of Dad," Dr. Stansbury says, "we think of him being the disciplinarian, and Mom as the nurturer, but that’s just not what we saw," Stansbury said. She believes we are shifting as a society and fathers are becoming more involved in the daily mechanics of raising kids, that’s a good thing for the kids and also a good thing for the dads.

Researchers also found positive touch caused the children to comply more often, more quickly and with less fussing than negative touch and physical punishment. Dr. Stansbury goes on to say, "When negative touch is used, even when children comply with parental wishes, they often pout or sulk and are more likely to return to the non-compliant behavior. She says, "If your child's upset and not minding you and you want to discipline them, you should use a positive, gentle touch, because our data found that negative touch doesn't work."

30:58

So this is an interesting study. It sounds like a lot of the witnessed events were minor infractions, you know, probably kids being annoying by adult standards. They need a little distraction, big bear hug, tickling, etc., to sort of reset the child's focus and distract them from the annoying or non-compliant behavior. And you know the kind of things I'm talking about.

Now, on the other hand, if your child's running out on traffic, their non-compliant behavior is now dangerous, in my opinion, that's probably not the time to hug and tickle them. I think you have to consider when you provide positive touches for unwanted behavior, you are to some degree providing some positive reinforcement for your child's non-compliant action and it may be that your child down the road will repeat the non-compliant behavior in order to obtain your positive touch.

So, the observers with this study were looking to see what kinds of touches were likely to stop a behavior and in with the child not pouting or sulking and then the child not immediately repeating the behavior. But what they don't tell us is what kind of discipline is going to prevent your child from engaging in the non-compliant behavior the next time that you go to the grocery store. And of course the importance of that question depends on the exact non-compliant behavior that we're talking about. Do you know what I mean?

I'm trying to make this practical for you. If your child's begging for Froot Loops and you don't really want to buy Froot Loops and they're throwing a fit in the aisle then by all means give them a big hug, maybe a tickle, tell him when you get home you're going to play Lincoln Logs with them; whatever it takes to distract them from the Froot Loops so you can get out of the cereal aisle, keep the peace and move on. OK? And I think those kinds of disciplinary actions with the positive touch, hey, great! Fantastic!

On the other hand, if your child's running out on traffic or they're tripping a little lady or they're spitting at a stranger's kid as they pass by in a stroller, as a parent, my reaction to that might make my child pout and sulk for a little while. And you know what, I'm OK with that. I'm obviously not saying that you need to physically hurt and abuse your children. But I am saying as a parent, you may have to get firm with them and let them know that that is not acceptable behavior and when it's a dangerous thing or something that's just totally socially unacceptable, giving him a positive touch and some positive reinforcement for what they just did might not be in your family's best interest.

Do you know what I'm saying? If in a long run, because of my reaction, my child refrains from the dangerous and/or totally inappropriate impulses, that's great. But that's me. Just trying to put a practical spin on it for you there, folks.

33:51

All right. Let's move on to eye injuries. With the new school year upon us, pediatric eye specialists from the Johns Hopkins Children's Center and the Wilmer Eye Institute are offering advice on sports related eye injuries that can easily be prevented, yet still occur all too frequently. August is Children's Eye Health and Safety month and pediatricians are being advised to educate parents, coaches and young athletes about the dangers of eye injuries, urging them to wear protective goggles when they participate in sports and in particular for high-risk sporting activities, including fencing, boxing and ball sports, such as soccer, basketball, soft ball, lacrosse and baseball.

Pediatric ophthalmologist Dr. Michael Repka, M.D., from the Johns Hopkins Wilmer Eye Institute, who is also deputy director of ophthalmology at the Hopkins Children's Center explains, "As training season begins and as children resume practice, emergency rooms across the country may see an influx of eye injuries from sports – yet most if these injuries are highly preventable by wearing protective goggles."

In fact, safety eyewear can prevent nine out of 10 injuries when worn consistently. Mild injuries like bruises to the eyelid and corneal abrasions usually only cause short-term damage, but serious eye trauma can have lasting effects. High-impact injuries may cause internal bleeding or fracture the bones around the eye, which may require surgery.

Dr. Repka says "Eye injuries at an early age can have serious and life-long consequences for the young athlete that go beyond missing a game or two and can sometimes lead to permanent eye damage and loss of vision."

35:18

In the U.S., eye injuries are the leading cause of blindness in kids. According to the National Institutes of Health, most eye injuries in school-age children are sustained during sports. Each year, around 100,000 people sustain sports-related eye injuries and almost half of these are children. According to The Centers for Disease Control and Prevention, a third of all eye traumas requiring hospitalization occur in kids.

Protective eyewear includes safety glasses, goggles, shields and eye guards, these offer adequate protection for most sports. Regular prescription glasses do not offer adequate protection and you should keep in mind that some types of protective eyewear are sports-specific. If your child wears regular prescription glasses and has a need for protective eyewear, prescription safety goggles specific to the sport and for your child's visual requirements can be made and parents should talk to their child's eye care professional to see about having this done.

Serious eye damage can be prevented by following some guidelines – take your child regularly for eye screenings and exams; ask your eye doctor to help you choose the best type of protective glasses suited for a particular sport, and be sure your child always wears the protective eyewear during practices and games.

If your child experiences any of the following, seek immediate medical attention – redness, itching or irritation of the eyes; swelling of the eye or the area around the eye; discharge or excessive tearing in one or both eyes; eye pain, pain behind the eyes and/or unexplained headaches; also, cuts or punctures to the eye; and floaters or flashes in the field of vision or partial loss of vision, which could all be a sign of possible retinal detachment.

You should never rub the affected eye and should not try to remove any splinters or objects that are stuck in the eye because doing so may cause further damage. What you should do in those situations is seek help in an emergency room right away.

37:11

A study published in the Archives of Pediatrics and Adolescent Medicine showed that in comparison to four years ago, 50% less students or one in four U.S. public high school students could buy regular soda in school during the 2010-2011 school year.

Researchers examined the availability of sodas, fruit drinks, sports drink, high-fat milk, low-fat milk and water at schools and this included availability in the school lunch program and school stores and snack bars, in vending machines and in the a la carte lines of U.S. middle and high school cafeterias. They collect data from four academic years between 2006 and 2011, 1,400 middle schools and 1,500 high schools from all regions of the United States participated. So what did they find?

Well, during the 2006-2007 school year, 27% of middle school students could buy a soda. But by the 2010-2011 school year, this figure had dropped to 13%. However, before we get too excited, other sugary concoctions, such as sports and fruit drinks were still widely available. In fact, 63% of middle school students and 88% of high school students were able to purchase these just as bad as soda options during the most recent years studied.

So, the schools are listening to our message but they're just replacing the soda with drinks that contain the same amount of sugar. Now clearly, they're listening but they don't understand the message. OK. And then these are my words – look schools, it's not the soda, it's the sugar. OK? You don't take away the soda and replace it with something that has just as much sugar in it. You are really not understanding the problem.

38:51

Researchers from the University of Michigan say, “Our study shows that, although schools are making progress, far too many students still are surrounded by a variety of unhealthy beverages at school. We also know the problem gets worse as students get older."

Sports drinks make up the majority of sugary options with 55% of middle schools and 83% of high schools making them available during the 2010-2011 academic year. Sports drinks contain unhealthy amounts of added sugar and salt and are design for serious athlete that train exceptionally hard, they're not recommended for daily consumption in schools.

So what about milk? Well, access to 2% in whole milk dropped slightly in middle schools and high schools, but, this high-fat milk still had considerable availability with over a third of middle school students and almost half of high school students still able to buy them.

What about healthier alternatives, like water and low-fat milk? Well, they remain widely available for high school students, but for middle school students, their availability dropped slightly from 96% to 89%.

See now that is crazy to me. So, availability for middle school students of water and low-fat milk is only 89%? I mean, seriously folks, 100% of all kids should have access to water if they want it to drink with their meal or low-fat milk as an option. I mean, really that — that's nuts. So moms and dads, make sure that at your school your kid can have water or low-fat milk. My words.

The research team cites other studies which indicate sweetened beverages continue to be a student's main source of dietary sugar and that selling these drinks at school considerably contributes to the daily calorie intake of our children.

They conclude by saying the progress being made to remove sugary sodas from our nation's middle schools and high schools is encouraging, but we're not yet where we want to be. It's critically important for the USDA to set strong standards for competitive foods and beverages to help ensure that all students across all grades have healthy choices at school.

40:59

And finally, this week if doctors want to develop strong rapport with parents of overweight children, it would be best if physicians use terms like "large" or "gaining too much weight" as opposed to the term "obese." That's according to researchers at the University of Alberta in Canada.

Dr. Geoff Ball and colleagues reviewed several articles about the important relationship between families and doctors as they address concerns about children's weight and their findings were recently published in the journal, Pediatric Obesity.

You know, maybe the journal needs to be a little more sensitive about their name. Maybe instead of Pediatric Obesity, they should be pediatric largeness or the journal of kids who gain too much weight. I'm sorry.

Researchers found a delicate balance in this relationship, a balance affected by such things as the language used to describe a child's weight and the tone in which doctors talked about weight. They also consider how delivered care compared to the parents' expectations.

According to the team's findings, Dr. Ball says, "Health professionals probably shouldn't use terms like fat, chubby, overweight or obese, instead, terms that are more neutral, less judgmental and less stigmatizing should be used."

"Families want that sensitive language and that's what doctors should want because that's what families want," according to Dr. Ball. Some parents felt blamed for their child's weight issues, while others found health professionals to be rude and judgmental or inattentive.

42:23

When it comes to discussing sensitive issues around the child's weight, parents feel it is the role of doctor to spearhead that difficult conversation, especially if there are health concerns. However, researchers found health professionals are somewhat reluctant to do this because they don't want to offend families and negatively affect the physician-patient relationship – especially when it comes to raising concerns about weight during a medical appointment about an unrelated medical issue.

Researchers say families want doctors to talk about weight, but if parents feel ostracized during the discussion, they are less likely to follow the doctor recommendations. The research team says physicians need guidance on how to address sensitive topics like weight and they need more feedback from parents about the issue. They also encourage families to put their pride aside and work with doctors as a team to find solutions for their children. Using more sensitive language about weight can ease a parent's anxiety and encourage team effort.

If these changes are made, researchers say, it could lead to better compliance with families actually following the doctor's advice; better follow-up with families actually returning for follow-up weight checks; and better interactions between doctors and parents and an increased satisfaction for families and for their doctors. Dr. Ball says, "You want to have a positive rapport with families so they stay engaged. That's the outcome you want."

43:38

So, this one is a tough one for me and I know it's tough for a lot of other doctors out there and I know that because I talk to a lot of other doctors out there. And of course we want to use sensitive language. I kind of made light of a little bit in my delivery of the news article. But it is true, we want to use sensitive language, I get that. But we also risk minimizing the problem if we go too soft on it.

And one of the things that stuck out for me with this article is that parents feel blamed for their child's weight issue. And the hard reality is that in many cases, the parents are partially to blame for their child's weight issue. Now, obviously this is not the case in every family. But look moms and dads, you buy the food, you have control over your child's food intake, you have control over your child's activity schedule and you have a responsibility to set an example of healthy nutrition and physical activity within your home.

Now, of course it's easy for me to say this here because I'm talking to a group and I'm not pointing my finger at any individual. You know, I understand. And it's different when you are a doctor with a family, one on one in a room. And if you go too tough on it, the family's going to feel offended. I totally get that. But if you go too light on it, then the family doesn't get the idea that you're really concerned about this.

So there's a middle road in there somewhere. And the truth is also this, I'll be honest, if I'm going to point a finger, it's going to be pointed at myself as much as it is in anyone else, because to be honest with you, I'm guilty of not setting a good example all the time in my home. I'm guilty of sometimes buying junk. I'm guilty of not encouraging enough physical activity with my kids. So let's all work together to set an example and be healthy and eat the right things, get enough exercise. Let's pledge to do these things and be intentional about our weight in our family.

So doctors, don't point your finger in the exam room. I understand sensitivity is necessary. But parents, if you don't want doctors pointing their finger at you in the exam room, please, start pointing your finger at yourself and wake up to your involvement in your child's weight issue.

Otherwise, this obesity problem we have in America is not going to change. Unless you want the government to step in and ration your groceries and dictate your daily activity schedule, which is not going to happen in America, I hope.

46:09

All right. I better stop there before I create more trouble for myself. We're going to have an upcoming show here. In fact, I think it's next week where we're going to have the director of our Center for Healthy Weight and Nutrition and also the director of our Pediatric Bariatric Surgery Program. We're going to be talking about the medical and surgical management of obesity and that's coming up, I think next week. We're going to have two doctors here in the studio and we're going to kind of have this out and talk about why kids gain weight, what parents can do, what does the medical management of obesity look like and when do you resort to a surgical management like bariatric surgery and what does that look like and what are the risks and complications of that and when does the benefit outweigh those risks and complications?

So, it's going to be an interesting show next week. We'll try to use sensitive language, but I encourage you to tune in. All right. Let's take a quick break. We'll be back. I want to tell you about an upcoming conference for parents that's going to be here at Nationwide Children's Hospital. We're going to talk about that and we will wrap up the show, right after this.

[Music]

47:53

A Healthy You and 22q, that's the name of our upcoming conference for parents and caregivers and if you have a child with 22q or you know a family who does. This conference will definitely be of interest to you.

It's a day-long conference, funded in part with support from the Dempster Foundation and its target audience is parents, caregivers and patients affected by 22q. The conference will cover general medical concerns, genetics and educational strategies.

There'll also be an opportunity for conference goers to participate in live chat rooms with local and national 22q experts and some of the chats will be broadcast live on the internet so families around the world can join in. You can expect separate sessions designed for school age and Pre-K children and speakers include experts in Allergy, Behavioral-Developmental Pediatrics, Cardiology, Education, Endocrinology, Genetics, Psychiatry, Reconstructive and Plastic Surgery, and Speech and Language Therapy.

Light refreshments and lunch will be included. And the date is September 22nd 2012. It's happening right here on the campus of Nationwide Children's Hospital. If you like more information about the conference and to register be sure to find the link in the Show Notes at pediacast.org.

49:06

All right. I want to take a moment to thank all of you for taking part in the program and for making PediaCast a part of your day. We really appreciate your support. I do want to remind you iTunes reviews are helpful and when you read an iTunes review that you feel is particularly helpful, just make sure you click the "I agree with this or this review is helpful" button, that helps. This is important because iTunes reviews are really the way that parents try out this program.

And ultimately, we want lots of moms and dads in the audience. Not because that I have some agenda to be the best and biggest podcast out there. I really, truly just want to get evidence-based information into the hands of moms and dads. And the more parents that we can reach the more families we can positively impact and the more kids we can positively impact. So part of that is through iTunes reviews.

So if you are listening to this program and the reason you decided to take a chance and take a listen was because of the reviews, I would just ask that you take a few moments of your time to write a review and put it there in iTunes. It's really important.

We also appreciate any mentions of the show or links in your blogs, on Facebook, in your tweets, on Google+ and Pinterest. Really whatever social media site that you interact with, if you could just give us a shout out here at PediaCast, just help get the awareness out there. We would really, really appreciate it.

The other way that I talk about quite frequently is when you go to your doctor's office for a sick office visit or well check-up, sports physical, whatever it is. When you see your doctor, just mention, hey, I want you to know there is an evidence-based pediatric podcast aimed at parents and doctors from the folks at Nationwide Children's Hospital and I just want you to know about it. It's available at pediacast.org and also let them know we do have posters that folks can download and hang up in exam rooms, on bulletin boards, day care centers the Y, your church, nurseries, wherever it's appropriate to hang up information, we do have posters available that you can download. They are under the Resources tab at pediacast.org.

51:30

I also want to remind you that if there's a topic that you'd like us to talk about, if you have a question for the program or you have an idea for a topic or you want to send a news story our way or a research study our way, it's easy to do that, just head over to pediacast.org and click on the Contact link. It's easy to get a hold of me and I do read everything that's submitted through the Contact link, comes directly to me.

Also, you can also email pediacast@gmail.com that's another way to get in touch. If you do go that route, make sure you let us know your name and where you're from. And we also have voice line, this is a Skype line at 347-404-KIDS. 347-404-K-I-D-S or if you the numbers 347-404-5437. You'll get a voice message and you just leave a message and just let us know what your question or your comment is and we'll get your voice on the show. That's another option if you'd like to ask a question that way.

So we really just appreciate you helping to getting the word out there. We don't have an advertising budget at all here at PediaCast. So we really just rely on moms and dads to help spread the word and if you're brand new to this program, we don't spend usually this much time talking about this. But you know, every few months I like to really kind of point out how the listeners out there can help to expand our audience and expand our reach so that more parents have great information in their back pocket.

53:01

All right. We're going to go ahead and wrap this program up. So next week, I did look it up, we do have our medical and surgical management of obesity show coming up. We're going to have our medical director of our Center for Healthy Weight here in the studio. So we're going to really ask the hard questions – What causes obesity? Who's to blame? What can we do? How is it managed? What consequences does obesity present down the road and what can you do about it?

From medical standpoint and then also from a surgery standpoint, should teenagers have bariatric surgery? Gastric bypass, is that an option for teens? When is it an option? What kinds of risks are involve? How do you decide if that's right for you and your family?

So, it's all coming up next week. I hope you'll be back to join us. And until then, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long everybody.

[Music]

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