Lunch & Recess, Mobile Health Apps, Homeoprophylaxis – PediaCast 376

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Show Notes

Description

• More pediatric news and answers to YOUR questions this week. Topics include kids seeing everything, best practices for lunch and recess, mobile health apps, homeoprophylaxis as an alternative to immunizations, Hirschsprung disease and safe baby sleep that is family friendly. We hope you can join us!

Topics

• Kids See Everything
• Lunch & Recess
• Mobile Health Apps
• Homeoprophylaxis
• Hirschsprung & Autism
• Family Friendly Safe Baby Sleep

Links

• Homeopathic Remedies – PediaCast 040, PediaCast 041
• Teething Tablets – PediaCast 123, Pediacast 152, PediaCast 363
• Homeopathic Treatment for Infections (No!) – Pediacast 148
• Homeopathic Cold Remedies – PediaCast 239
• Essential Oils – Pediacast 298
• The Vaccine War – PediaCast 329
• Childhood Vaccines part 1 – PediaCast 351
• Childhood Vaccines part 2 – PediaCast 352
• Evidence-Based Medicine – PediaCast CME 008
• Hirschsprung Disease – Pediacast 287

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. 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 376 for May 10th, 2017. We're calling this one "Lunch and Recess, Mobile Health Apps, and Homeoprophylaxis". I want to welcome everyone to the program.

I know, that's a big word, homeoprophylaxis. We'll break it down and talk about this. It's actually a listener who wrote in a question regarding homeoprophylaxis. Now, the listener was a doctor. That's explains why it is a bigger term. But we'll still cover it and talk about what it is.

We have a combination of pediatric news and listener questions for you this week. And you know, one thing I love about doing this program is really the listener questions. It's my favorite part of the show.

We're 376 episodes into the life of this podcast and listener questions have always been a part of it. In fact, we answer our first listener question in Episode number 2. I kid you not, we put one episode out there in iTunes and already someone wrote in with a question.

And, of course, we don't give medical advice here. We don't say this is what your child has and this is what you should do. But when parents ask a question about a particular topic, we can talk about that topic. I don't know if that's what your kid has or not. But we can talk about it.

And for particular symptoms, we can talk about what the standard care looks like, sort of what we were taught in medical school and in residency. What we've learn on the job, what works, what doesn't work.

0:02:14

But it doesn't mean that it'll work for your kids because I don't know what your kid really has. So, something to keep in mind as we answer questions. But the point is, I love doing it. And we've been doing it since Episode 2. And here we are at 376.

And, by the way, you can't answer listener question in Episode 1, right? Because you didn't have an audience before then. But my point is just that right from the beginning, this audience has been asking questions. And here we are, 376 episodes later and you're still asking lots of great questions.

Now, some of them have been asked before. Because it's easier I think sometimes just to ask rather than look through the archive to see if we've covered it before. And that's okay because things change, when new information has added. Our first episode was 10 years ago, and things evolve in medicine.

And so, even if we've already covered something before, we don't mind you asking again. Sometimes, we'll say, "Hey, the content in this particular episode in the past is still good. It's still up to date, check it out." And we'll provide the link, so you can find it easy.

And we're happy to do that as well. Because when you're concerned or curious about a specific topic, there's often passion in urgency and you just write in before you even look it up any place else. Because we're talking about your kids.

And I love that. I just love it. So as long as there is a PediaCast and an audience-full of parents, there will always be questions. And ultimately, that's what we're here for.

And so, the listener question part of the show, love doing it. So keep those questions coming. If you do have a comment or a question for me — something related to an illness or an injury, treatment, prevention, maybe something you heard in the news or at the daycare — any child health or parenting or family-centered topic, ask away. I love hearing from you.

And after I run through the line-up here, I'll remind you how easy it is to get in touch with me.

0:04:09

All right, so what are we talking about today? I gave you a little bit of a preview in the title of today's show. So, lunch and recess, mobile health apps and homeoprophylaxis.

We're actually going to start with the news story about kids seeing everything. Children often have difficulty concentrating or focusing, you know this. Even if they don't have ADHD or attention deficit hyperactivity disorder, the younger kids, they just have a short attention span by definition.

We talked about a two-year-old having an attention span of about two minutes and a three-year-old, about 3 minutes. It's probably not exactly those things. But the point is, it's short. And it's difficult for little kids to concentrate and focus on something.

And as they start school, as they continue they have some difficulty concentrating and focusing in today's educational climate, that is often seen as their liability. But, the flipside of that is these kids who have difficulty concentrating, they tend to take it all in. They see details that adults can miss.

So, the child brain and the adult brain are wired differently. And when we think about that and consider it as parents, and educators, and policymakers, we can have a greater appreciation and understanding and impact on the kids we connect with. So, instead of getting frustrated, we understand, "Hey, they're going to have trouble concentrating but they going to take it all in." And so, how can we use that knowledge as we interact with kids and educate them and parent them?

So, important points and we'll flush out more of the details on that during our News Parents Can Use segment here in just a few minutes.

Then, we're going to talk about lunch and recess. Which should come first, lunch or recess? And how long should lunch and recess last, if we want to maximize good nutrition and physical activity? So some researchers ask that question in a attempt to inform school policy. So, we'll shed some light on their findings.

0:06:10

And then, mobile health apps in pediatric patients — are they helpful? Or do they get in the way? How do you find good ones? And what is the role of your friendly pediatrician in deciding which ones to use and which ones to skip? So, we'll have more on that coming up.

Then, we'll turn our attention to your questions this week. As I mentioned, one of those is on homeoprophylaxis which embraces the tenets of homeopathy or homeopathic medicine. Natural medicine as some call it, which I don't necessarily like that term and I'll explain why when we get to that segment.

But alternative medicine, homeoprophylaxis is a homeopathic alternative to immunizations. And we'll talk about. Are they good? Are they bad? What's the problem? What's the concern? We'll talk through homeoprophylaxis, let you know what it is and when I think about it.

And then, a reminder of Hirschsprung disease and its possible relationship with autism. We had listener ask about that, actually from the United Kingdom. And then, we have a listener a little closer to home here from Columbus, Ohio who had a comment and a question about safe infant sleep.

So, we'll talk about the ABCs of safe baby sleep — Alone, on their Back, in the Crib. But really the question is, what do you when babies aren't on board with that plan? You know, they don't want to be alone, on their back, in the crib. And they're going to cry and let you know about it.

How can you make life liveable with the baby who cries all the time and doesn't want to sleep? And you may not want them crying and so, you're up half a night soothing them. And then, you become sleep-deprived. So how do you deal with that while still adhering to the ideals of safe sleep? So, we'll talk through that in a thoughtful way at the end of the program.

Before we get started with our pediatric news, I did promise I would share how easy it is to get in touch with me and share a comment or ask a question. So, what you do is this, you just fire up your favorite web browser and head to PediaCast.org, PediaCast.org. And at the top of the webpage, there are some tabs. One of the tabs says, Contact Dr. Mike. Click that tab. A form appears in your window. Just fill out that form, send it in.

0:08:24

I do read each and every one of those that come in. And we'll try to get your comment or your question on the program just like the ones we're going to talk about today.

Also, I want to remind you, the information presented in every episode of PediaCast is for general educational purposes only. As I mentioned, 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, let's take a quick break and I will be back with news parents can use and answers to your questions. It's up coming up right after this.

[Music]

Dr. Mike Patrick: Although adults can beat children in most cognitive tasks, a new research shows that a child's limitations can sometimes be his or her strength. In two studies, researchers found that adults were very good at remembering information they were told to focus on and ignoring the rest. In contrast, four- to five-year-olds tended to pay attention to all the information presented to them, even when they were told to focus on one particular item. That helped children to notice things that adults didn't catch because of the grownups' selective attention.

0:10:08

Dr. Vladimir Sloutsky, professor of psychology at the Ohio State University and co-author of the study which was recently published in the journal, Psychological Science, he says, "We often think of children as deficient in many skills when compared to adults. But sometimes, what seems like a deficiency can actually be an advantage. That's what we found in our study. Children are extremely curious and they tend to explore everything, which means their attention is spread out, even when they're asked to focus. And that can sometimes be helpful."

The results of his investigation have important implications for understanding how education environments affect a child's learning.

The first study involved 35 adults and 34 children who were 4 or 5 years of age. The participants were shown a computer screen with two shapes, with one shape overlaying the other. One of the shapes was red, the other green. And participants were told to pay attention to a shape of a particular color — say, the red shape.

The shapes then disappeared briefly, and another screen with shapes appeared. Finally, participants had to report whether the shapes in the new screen were the same as in the previous screen.

In some cases, the shapes were exactly the same. In other cases, the target shape — so the one participants were told to pay attention to — was different. But there were also instances where the non-target shape changed, even though it was not the one the participants were told to notice.

Adults performed slightly better than children at noticing when the target shape changed, noticing it 94% of the time compared to 86% of the time for the children.

But Dr. Sloutsky says, "The children were much better than adults at noticing when the non-target shape changed." Children noticed that change 77% of the time, compared to 63% of the time for adults.

He adds, "We found that children were paying attention to the shapes they were not required to watch. Adults, on the other hand, tended to focus only on what they were told to watch."

0:12:07

A second experiment involved the same participants. In this case, they were shown drawings of artificial creatures with several different features. They might have an "X" on their body, or an "O". They might have a lightning bolt on the end of their tail or a fluffy ball.

Participants were asked to find one feature, such as the "X" on the body among the "Os." They weren't told anything about the other features. Thus, their attention was attracted to "Xs" and "Os," but not to the other things. Both children and adults found the "X" well, with adults being somewhat more accurate than children.

But when those other features appeared on creatures in later screens, there was a big difference in what participants remembered. For features they were asked to attend to — so the Xs and Os — adults and children were identical in remembering these. But children were substantially more accurate than adults, so 72% versus 59% at remembering features they were not asked to attend to, such as the creatures' tails.

Dr. Sloutsky says, "The point is that children don't focus their attention as well as adults, even if you ask them to. But, they end up noticing and remembering more."

He adds, "Adults would do well at noticing and remembering the ignored information in the studies if they were told to pay attention to everything. But their ability to focus attention on particular details had a cost. They missed what they were not focusing on.

The ability of adults to focus their attention — and a child's tendency to distribute their attention more widely — has both positives and negatives.

Investigators say, "The ability to focus attention is what allows adults to sit in two-hour meetings and maintain long conversations, while ignoring distractions. Young children on the other hand distribute their attention, which allows them to learn more in new and unfamiliar settings by taking in a lot of information."

The fact that children don't always do well at focusing attention also shows the importance of designing the right learning environment in classrooms.

0:14:05

Dr. Sloutsky says, "Children can't handle a lot of distractions. They are always taking in information, even if it is not what you're trying to teach them. We need to make sure we are aware of that and design our classrooms, textbooks and educational materials to help students succeed."

He adds, "Perhaps a boring classroom or a simple black and white worksheet means less distraction and more successful learning."

So, interesting information about the difference in a way that a child's and an adult's brain is a wired to work. In addition to the implication for the classroom and for education, I think the other important piece of the study is the insight that it provides parents on the differences between the adult brain and the child brain.

I mean, there are many differences but this is an important one. Because, you know, often as parents, we expect our kids to process the environment as we process it. And we get frustrated when they can't pay attention or follow directions or remember to do what they're told.

But if our brains as adults had the same difficulty in focusing on one thing and instead we took everything in, all the details, would we be able to pay attention or follow directions or remember to do what we were asked to do?

So, let's give our kids a break with the understanding that their brains process the world a little differently than our brains. Important insight and one that is based in science.

A new study finds that the duration and timing of lunch and recess is related to food choices and physical activity of school children. These findings could help schools make policies that promote healthier school lunches and increased physical activity during recess.

This according to research presented by investigators at the University of Illinois at the annual meeting of the American Society for Nutrition recently held in Chicago.

Dr. Naiman Khan, assistant professor and leader of the research team says, "Most studies are focused solely on nutritional intake or physical activity during recess. This is the first study to objectively measure food intake at lunch in conjunction with physical activity and consider the influence of duration and timing."

0:16:19

Investigators recorded the lunch intake and physical activity of 151 fourth and fifth grade students from two low-income schools. Each school scheduled lunch either just before or immediately after recess.

So, what did they find? Well, when recess was held before lunch, so recess came first, less food was wasted. But when recess occurred after lunch, the children ate more vegetables.

Now, here's another interesting observation. When children had a longer time for a combined lunch and recess period, they were more physically active if lunch was before the recess. So, lunch and then play. But, when the lunch-recess period was shorter, they were more active when recess occurred before the lunch.

Investigators say, "Their findings suggest that recess and lunch behaviors are interrelated. However, the specific food choices and activity levels children engage in may be subject to the timing and duration of lunch and recess." The relationships between food intake at lunch and physical activity were independent of factors previously shown to contribute to recess activity such as a child's weight, status, and gender.

The current guidelines from the Centers for Disease Control and Prevention recommend scheduling recess before lunch to reduce overall food waste, a recommendation that was strengthened by the results of this study. However, these recommendations may have unintended consequences for the types of food consumed. After all, more vegetables were consumed if lunch came before recess and the current recommendations could result in reduced physical activity if the combined recess-lunch period is a long one.

0:18:04

Dr. Khan says, "We plan to communicate our findings to school teachers, administrators and policymakers to facilitate the implementation of evidence-based policies that support children's ability to meet their daily physical activity and nutritional recommendations,"

Now the researchers have extensive data on children's physical activity patterns and lunch choices, the investigators seek federal funding to create feasible and sustainable school interventions based on their findings. They would also like to study whether policies regarding lunch and recess affect the risk for obesity, success in academics, and other markers of cognitive development in children.

So, more to come on this one, as researchers consider how lunch and recess relate to one another and what specific recommendations will help kids eat better and be more active.

So more to come just rest in the knowledge someone is looking into it and we'll share the recommendations here on PediaCast when they become available.

Consumers and health providers have their pick of thousands of health apps and programs delivered via mobile devices, but there has been little information available on how effective they are at improving the users' health.

Now, research from the University of Florida and the University of Kansas as published in the journal JAMA Pediatrics suggests mobile health apps can make a difference in promoting healthy behaviors. In a meta-analysis of studies involving mobile health interventions in pediatric patients, researchers found that mobile interventions can improve health outcomes.

Dr. David Fedele, study author and assistant professor of Clinical and Health Psychology at the University of Florida says, "Given the ubiquity of mobile phones and the willingness of youth to use their mobile devices for health-related activities, mobile interventions appear to be a viable way of changing health behavior."

Mobile health interventions are attractive to consumers and clinicians for a number of reasons. Dr. Fedele says, "Today's mobile apps have the ability to capture many different types of health data. While early mobile health programs mostly relied on text messaging to deliver reminders or education to patients, many of these have evolved though to take advantage of new technology that allows apps to capture information on a number of health behaviors, such as a person's daily steps, sleep quality and even engagement in mindful meditation."

0:20:26

He adds, "Using mobile health interventions can leverage all of this information to deliver something that is potentially more tailored to the individual, specific to their needs and maybe even a better representation of a person's daily life. And, depending on the program or intervention, providers can continue to deliver content outside of the clinical encounter."

From the current study, Dr. Fedele and his colleagues searched thousands of scientific papers and found 37 studies that evaluated the effectiveness of mobile health technology to promote healthy behaviors in children. The studies targeted health concerns such as immunizations, diabetes, asthma, obesity and physical activity, among many others. And the studies used mobile health apps in a variety of ways, including providing personalized reminders and information, or to record disease symptoms and offer interactive feedback.

The researchers conducted a meta-analysis of the mobile health studies and found that the interventions were effective at improving health behaviors and health outcomes in pediatric patients. However, the mobile apps with the most success included parents or guardians in the intervention.

Dr. Christopher Cushing, another author of the study and assistant professor of Clinical Child Psychology at the University of Kansas says, "From this study, we're able to tell providers that a range of mobile health strategies are worth trying. However, at this stage, we need to do more work before we can make specific recommendations about what providers should use in their practice. Generally, it seems we can encourage mobile health approaches in clinical practice with a healthy dose of good clinical judgment."

0:22:04

As the field of mobile health grows, more research is needed to examine the effectiveness of this interventions for specific diseases, specific health topics or particular outcomes, as well as the behavior change theories that should drive the development of new interventions. Future research should also evaluate which mobile health features are most valuable to patients.

Dr. Fedele says, "I think we're just scratching the surface of what mobile health interventions can really do."

So, the take home here is mobile health apps — explore what's out there, use what works, but do so in partnership with your pediatric provider. You child's doctor may be able to point you in the right direction for finding an app that has the functionality you're looking for. They may have experience with the particular one because they've had other patients and families use it. And that can save you from an extensive search or starting down the path of using one that's not so helpful for one reason or another.

Now, likewise, parents may be able to discover an app that you really like and seems helpful. And let your provider know about it, so he or she can explore the functionality and give you advice on whether it's a keeper or not. If it is a keeper, then your provider can add it to their mobile medical toolkit and share it with other patients and families in their practice.

Certainly, there's a lot of cool and useful apps out there and many, many more to come.

[Music]

Dr. Mike Patrick: Our first question this week comes from Ryan in St. Paul, Minnesota. Ryan says, "A family doctor here loving your podcast, I share them with my patients all the time. I couldn't find any data on homeoprophylaxis on your podcast, although I have no doubt you've probably covered it. I think vaccines are awesome but wanted to be educated on alternatives, so I provide better education to my patients. Can you refer me to a numbered podcast or weigh in with any available reasonable data. Thanks, Ryan."

0:24:27

Well, thanks for writing in, Ryan. I really appreciate it. And by the way, I think the vaccines are awesome, too. But I do understand you wanting to be educated on alternatives, so you can talk to your patients about them. And we have talked about homeopathic medicine, alternative medicine, natural medicine as some call it, herbal remedies, essential oils.

We've talked about these things many times on PediaCast because these are questions that come up in the exam room. And moms and dads have sent me questions here on the podcast many times related to them. So, we have addressed these before. And I will share some of the relative show numbers with you. So, those of out there who want to take a listen to a particular topic can do so. And I'll put a link in the Show Notes.

Before I mentioned those, though, I want to give you the general framework of my thinking on natural homeopathic medicine, because the same themes tend to emerge each time I talked about them. The first foundation is that everyone's goal here is the same — we want to protect our children from illness and injuries. And when they're sick, or they're injured, we want them to feel better. We care about our kids, right? That's why we talk about these things. So, that's the first foundation.

The second is that chemicals are chemicals. Whether they're found the nature as is, or they're created in laboratory, they either have an effect on the body or they don't. They either achieve the desired effect or they don't. And just because the chemical is found in nature, which I guess what we would call natural, that doesn't necessarily mean that it's effective or that it's safe.

And safety, by the way, is the other piece of the puzzle. We know we want a chemical that works but we want one that is also safe, as we think about disease prevention and treatment for our kids.

0:26:6

And this is where science comes in, to evaluate effectiveness and safety of the chemical in question, whether it's natural or made in a laboratory. Because at the end of the day, a chemical is a chemical. It's made out of atoms that are arranged together to form molecules and those molecules form together to make some sort of substance. And it's all the same, whether it's in nature or in laboratory, it's the same. It's a chemical.

And as we think about these chemicals then and evaluate their effectiveness on the body and their safety, then those results get reviewed by other scientist. So that's what we would call peer review. And if those studies pass muster, they get published for other scientists and clinicians to see. And as time moves forward, we build a body of evidence in the scientific literature.

And sometimes, we take two steps forward and one step back, and two steps forward and one step back, as we learn new things and we do better studies that might show something a little bit different. And so, we have to interpret the whole body of literature and that's why you want someone who has seen these things, can evaluate them for what they are, the studies, and say, "This is a good study. This is not as good of a study." And really take the whole picture into account along with our experience of what works and what doesn't, reported side effects and complications.

And we take all of these knowledge, both scientific and experience. And we consider the risks and benefits of any particular chemical or intervention again, natural or made in the lab. We make decisions as this relates to disease prevention and treatment in adults and children, as we look at risks and benefits and that body of knowledge and experience.

0:28:15

Now, having said all of that, as we think about vaccines in particular, the body of evidence and experience would say that for most kids, the benefit of vaccines far outweighs their risk. Now, there are exceptions, which is why you want a licensed provider helping you make decisions. For instance, kids who have a significance compromise of the immune systems may not want to have a live viral vaccine and there are reasons for that. And so, you want to be making this decisions in partnership with your provider.

And there have been cases where a particular vaccine has been shown to have more risk than benefit and we stop using it. Or we alter it to make it safer, yet still effective. So, we recommend vaccines based on evidence and experience.

So, what about homeoprophylaxis? Well, first, what is it? Well, homeoprophylaxis is where you take a pathogen — so something that would be harmful to the body — and you highly dilute it. And I mean, really really highly dilute it, so that it is just a very small amount of concentration. There's a really low concentration of whatever it is that you are immunizing against.

And then, you give that by mouth. And the thought is it's an effort of train the immune system to kill the pathogen when it comes around in full force in the community. Now, the problem with this is we do not have a good body of evidence showing that it works or that it's safe. I mean, it sounds good. It feels safe. But does it really work and is it really safe?

There's no evidence to support that it really works. Vaccines, on the other hand, as they're given now, we have huge body of knowledge and experience that show they do work and they are safe for the vast majority of kids.

0:30:06

So, that's how it boils down for me. I don't care where the chemical comes from or how it's given. Sort of silly to divide chemicals into medicine and homeopathic and natural remedies. Chemicals are chemicals. The question is do they work? Are they safe? Or someone just out to make a buck? That's what I want to know.

So, let me give you some specific PediaCast episodes that we've covered on a so called alternative or natural medicine. Again, silly terms, but I use them so you know what I'm talking about. My earliest example, if you really want to go all retro here, which is fine because the argument was the same then as it is now.

PediaCast Episode 40 and 41 was really my first attempt at explaining my feeling on homeopathic remedies. My first attempt was in Episode 40. And then, a fellow pediatrician wrote in and scolded me for not being forceful enough with my argument. And so, I tried again in Episode 41. So, that might be fun to go back and listen to.

And then, in Episode 123, we talked about Hyland's teething tablets and the fact that they have belladonna, which is a natural occurring chemical that can be very dangerous for kids. And it's actually been in the news here again recently as the FDA is saying, "Please, parents, do not use teething tablets. The belladonna can be dangerous and there's not a consistent amount in there."

By the way, the other thing to point out is a lot of these remedies, you say why are they even out there being sold? It's because they're considered food items. I mean there's such lack of evidence that they actually have any affect on a biological system that they're not even classified as drugs. They're classified as food.

And so the instance with the Hyland's teething tablets, the FDA can't necessarily ban it unless they find, absolutely, it's dangerous all the time. But they can make recommendations. And the recommendation is the parents should not use those.

0:32:09

And then in Episode 148, we talked about homeopathic options for treating MRSA, instead of antibiotics. Is there a more natural way to treat Methicillin-resistant Staphylococcus aureus infections? The short answer to that is no.

[Laughter]

Dr. Mike Patrick: There's not an option that is safe and effective. You want an antibiotic for that because you can get septic and it can kill you. So, antibiotics are important as we treat serious infections.

And then, in the Episode 152, teething tablets were again in the news. 239, we talked about homeopathic cold remedies. 298, we talked about essential oils. And by the way, I love essential oils for aroma therapy. I mean, I love the smell of essential oils but they don't treat illness. There is no studies to show that they're effective for doing that. And then Episode 363, we talked about teething tablets again.

So, nothing on homeoprophylaxis per se but the same logic follows. Show me it's safe, show me it works, and it's approved because it's safe and it works, and I'm in. I don't get any kickbacks from big pharma, no drug company writing me checks. It's just that I'm a believer in science. Show me it works, show me it's safe, and I'll buy in.

And for homeoprophylaxis, it just doesn't follow. It has not been shown to be effective. It's not been shown to be safe. You know, it's probably not unsafe, other than the fact you're not immunizing your kid. Which is not safe, because then when real measles comes along, or whatever other disease that we're talking about, your child can get it. So, in that sense, it's not safe.

But in terms of the efficacy, does it work? Homeoprophylaxis has just not live up to that whereas vaccine have been shown to be effective and work and be safe in many, many very large prospective clinical trials.

0:34:07

Speaking of vaccines, let me give you my favorite vaccine episode as well. The Vaccine War, PediaCast 329, with Seth Mnookin who is a New York Times bestselling author and investigative journalist that really dug deep into the story behind the MMR autism fiasco. And so, we talked about that. That's a pretty good episode, one of my favorites.

And Dr. Mike Brady, he's an infectious disease doctor here at Nationwide Children's Hospital, but also very involved with the CDC and AAP and The Red Book and really coming out with vaccine recommendations. And he was my guest for PediaCast 351 and 352, which was a two-part series — Childhood Vaccines Part 1 and Childhood Vaccines Part 2.

Again, Episodes 351 and 352, where we really just take a survey of all the childhood vaccines. We talked about what the vaccine, what it's made out of, what's in it, how it works inside the body and all the different diseases that we protect against, and why we protect against those diseases. So, I would definitely recommend those.

And then, finally, this is one of our CME episodes, our Continuing Medical Education for providers. And it was on evidence-based medicine. PediaCast CME Episode 8, and you can find that at PediaCastCME.org. And that one, I think, is really helpful for providers in terms of finding information that allows you to look at efficacy and look at safety, the data. And as you're thinking about risks and benefits of any particular treatment, really using evidence-based medicine and or evidence-based findings in clinical practice medicine.

So, I would highly recommend that episode over at PediaCastCME.org. And I think, for parents out there who want to know, you've heard that term, evidence-based medicine. What is it? How do doctors use that to make decisions?

0:36:05

Because again, not all studies are strong. Sometimes studies conflict with one another. And so, how do you judge what the strength of the study is? What resources are out there to help you do that? And so we go through some of those during that particular episodes. So, I think some parents might find that interesting as well.

I'll put the links to all of these shows that I mentioned in the Show Notes for this Episode 376, over at PediaCast.org. So they are all together in one collection and you can find them easily.

So, I hope that helps, Ryan. Thanks for listening and sharing the show with your colleagues and patients. And of course, thanks for writing in. Really do appreciate that.

Our next question comes from Kirstie in the United Kingdom. Kirstie says, "Hi, my little boy's four years old and has Hirschsprung disease. He has the short segment type. At first, he had a colostomy bag, but then we had that reversed. Now he suffers with open wounds on his bum from the poo. But I would like to ask you, is it true that autism is common with Hirschsprung disease? We've noticed certain behaviors with my little boy that are common with autism. Thank you, Kirstie."

Well, thanks from writing in, Kirstie from the United Kingdom. Really do appreciate that. So, three things to address as I think about your comments.

First, Hirschsprung disease — this is congenital condition of the large intestine where nerves are missing. So, it is something that kids are born with. And there are nerves missing in the large intestine, in the segment of the large intestine. So, the bowel can't squeeze. It can't move. It can't move the poop. So, we have a functional bowel obstruction, which can be fatal if it's not recognized and treated.

Now, you probably already listened to our Hirschsprung episode, Kirstie. But in case, you haven't — or anyone else out there who is really interested in Hirschsprung disease — I would highly recommend that you take a listen. It's Episode 287. And I'll put a link in the Show Notes for this episode, 376, over at PediaCast.org.

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And it was an interview with the Dr. Mark Levitt, who is really the best person in the world to talk about Hirschsprung disease. And I'm not exaggerating. I mean, truly, like world renowned expert on the treatment of Hirschsprung. So, we were really honored to have him on the podcast to talk about it. Actually, it's probably our most downloaded episode ever in the history of the podcast, because of his prominence around the world as the world leading expert on Hirschsprung disease.

So, I definitely recommend you check that out, PediaCast Episode 287. And again, I'll put a link in the Show Notes for this episode, 376. If you're interested in learning more about that as a disease.

Second, the sores on the bottom — or your child's bum — from stool or poo touching the skin. Remember that poop has digestive enzymes in it. And not only do those break down food, they can break down the skin as well. And there are other irritative components of stool.

And that breakdown of the skin can end up leading to infection, which might require topical or oral antibiotic. Sometimes, it even need a hospital admission, an IV antibiotic, especially if there's an abscess or blood infection associated with it because it's been there for so long. Sometimes, they need surgical drainage.

So whenever he had source on the bottom, you want to have those look at right away. It's an urgent thing if it's firm and very tender and lots of drainage coming out. If there's any fever, you'd want to have someone to take a look at right away. But you definitely want to get in touch with your regular doctor if you do have source on the bum.

If it's not infected, and it's just a wounds that are irritations, contact wounds from the poop, one trick is to use a thick barrier cream. And here in the United States, and in particular here at our institution, we like to use is the cream. It's like a mineral oil type cream called Aquaphor. And then we mix Maalox, the antacid, into that.

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Remember those digestive enzymes need an acidic environment to work. And so when you add a medicine like the Maalox, which is an acid reducer or an antacid, then it will deactivate those enzymes, so that they don't work and they don't break down the skin.

Zinc oxide preparations and things like Desitin, Balmex — the zinc oxide is anti-inflammatory and can help reduce the inflammation. And then, soothing ointments with vitamins A and D, like A&D ointment.

Everyone has their favorite, which of those creams, but making a barrier is really what you're after. So, as you're putting on the creams, you want to make sure that you're using a really thick layer of the ointment, so that the poo touches the ointment instead of touching the skin. And again, that's going to be the best bet when it's just a contact.

When there's an infection though, you may need an antibiotic, either topically, sometimes even by mouth. And sometimes even more intervention with IV antibiotics are possible. Drainage, if there's an abscess present.

So, at the end of the day, you want to make sure that those source get looked at by a medical provider, so that they can give you the proper thing to do based on the skin lesions that your child has. So get those looked at for sure.

Third, and definitely an interesting great question, the Hirschsprung disease – autism connection. So, I looked at this two ways. Number one, just generally, could there be a connection between these two disorders? And it's an interesting question. Both have genetic origins. Both involve multiple genes. So could there be some overlap? Both involve the nervous system, one in the bowel wall, the other in the brain.

And there has been some recent research looking in to possible connections between Hirschsprung disease and autism. But the jury is still out on if there's a definite connection. We still don't know for sure. It's an interesting question. And research into a possible connection is ongoing.

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But that brings me to the second way to look at this. Instead of thinking about it generally, let's think about it in terms of your child, Kirstie. If you're worried about some of your child's behaviors, it doesn't really matter if they're connected or not. Your child could have Hirschsprung disease and autism, even if the two aren't connected, because autism is common in all kids, whether they have Hirschsprung disease or not.

We also know it's best to identify autism early and get families and kids the intervention and education and support that they need. So definitely bring up your concerns with your child's doctor. They can perform developmental and behavioral screenings. They'll obtain a detailed history and physical and make any necessary referrals based on their overall assessment.

But, again, if you're worried about autism based on specific behaviors, it doesn't really matter that your child has Hirschsprung disease. It doesn't really matter whether there is a connection or not, your child could have autism. And if they do, you want that evaluated and identified and the intervention started as quickly as possible.

So, great questions, Kirstie. I think we'll hear more about possible connections between Hirschsprung and autism as more research is done and we learn more. But for now, for your child, again, it doesn't really matter. If you're concerned, talk to your child's provider. It's always good advice regardless of what you are concerned about. As always, Kirstie, thanks so much for writing in.

My next question comes from Brent in Columbus, Ohio, a little closer to home. Brent says, "We talk about safe sleep and the perfect state of ABCs, so Alone, on your Back, in the Crib. But we rarely help new parents achieve that. So, their child cries when they're alone, on the back, and in the crib. How do parents cope at 3AM with all the crying?

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"Many parents turn to books and the Internet for help. Instead of just telling parents to cope with crying and go through life sleep deprived, what is an acceptable continuum of care? What are your thoughts on putting children on a demand feeding schedule as proposed by the book, Babywise? What about sleep consultants to help coach baby into a sleep schedule based on feeding?"

All right, well, thanks for your question, Brent. Great observation by the way. So, it is true, we talk about safe sleep and we say kids need to be alone, on their back, in their crib. And then we kind of move on without acknowledging the fact that some babies don't like being alone on their back, in the crib, and they cry. And that can cause some sleepless nights for parents. And sometimes more than some can go on for nights on end sometimes. And the parents are sleep-deprived and it can be a problem.

So, I totally understand what you're saying there, Brent. Here is the thing about baby sleep. Each infant and every family is unique. And as I think back on my own kid, my daughter, she was a terrible sleeper. She cried when you put her down, just right from the get-go. And through babyhood and toddlerhood, and even as an older kid — and she's 22 years old now — she had a lot of sleep issues.

And as I think about when she was a little baby, if she fell asleep and you put her down on a crib, you knew she was well asleep and you put her down just as gently as possible, she'd wake up and start crying. We did learn that if we took a water bottle, one of those that you put warm water in, warm water bottle, you know what I'm talking about, the plastic ones. Not the kind you drink from, the kind that you warm it up and can put it on a sore muscle or something.

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So, we would take up one of those kind of warm water bottles, fill it up with warm water, lay it down where was going to lie. It would be a two-adult job of one moving the water bottle and the other getting the baby down gently on the warm sheet. So that it's a little warmer than room temperature, but not hot. Then she would stay asleep.

Of course, we wanted her to stay asleep and not cry. And so, we will go through these elaborate tactics of figuring out what would work best for her and warming the sheets with warm water bottle did the trick.

Now, that's what when she was fairly little. As she got older, then she would wake up and cry. And we try the cry-it-out method, the Ferber method. We've talked about that on this program before. That usually would work. You'd have a few rough nights, and you gradually lengthen the amount of time that they're crying. And the first night, you might let them cry five minutes, then poke your head in the door like, "Hey, I'm here." Then the next time go ten minutes, and then 15 minutes.

And then, the second night, start at ten minutes and then go to 15 minutes. And so you know, a little bit longer the time. Finally, they've cry themselves to sleep. And, usually, after a few nights, that worked. But then, she'd get sick and have a cold or an ear infection. And so, you didn't want them to cry it out because you felt bad for them. And it just took one night of not doing the cry it out and suddenly, you'd have to do it again for several nights in a row. Just basically starting the technique from scratch.

And she got a little older, naps became an issue. So if you were running errands and she's in the car seat, and she falls asleep on the way home, she might be asleep for five minutes, but she would count that as her whole naps. So you'd have to keep her awake in the car until you got home and put her down for a nap. Or else, it was all over with.

And so, we'd sing loudly in the car, try to keep here awake to get her home, so we could put her down sleepy, because even a five-minute nap in the car counted as her entire nap.

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And, of course, then the toddler years brought new challenges. We'd have to come up with elaborate sticker charts to get her to stay in her room, stay in bed, and be there at bedtime and not keep coming down asking for things. So, we had the sticker chart and the reward system. And we've talked about that before on this show as well.

So, you know, we have to come up with some pretty creative ideas to help her with sleeping. My son, on the other hand, lay him down, went to sleep. He was our second one. And so it was like, "Wow, I didn't even know it could be this easy." As a toddler, he just put himself to bed. We'd look around and be like, "Where did Nick go? Oh, yeah. He put himself in bed because he was tired."

So, my point is just that babies and toddlers are different and families are different with regards to styles and tolerances. The ABCs are non-negotiable because they're founded on a very large body of evidence that supports the idea that young infants are safest if they're alone, on their back, and in a crib. Or their own safe sleep space.

And we know that reduces the incidents of infant death associated with sleeping. Now, beyond that, there really are no one-size-fits-all sort of recommendations. You want them to be alone. You don't have any bumpers. You don't have pillows, blankets, stuffed animals, nothing. They're just alone in their sleep area.

You want to lay them down on their back. And once they get to the point that they can turn themselves over and turn themselves back, and they're six months old and doing it easily, still put them down on their back but you don't necessarily have to flip them every time that they roll over. But the first few times that they flip, yeah, maybe you do put them back on their back.

And so, when they're young infants, you want them alone, on their back. And then, we say in a crib, although as long as it's a contained sleep area that's safe, this new sleep boxes that some states are handing out maybe safe. Like a Pack 'n Play maybe safe.

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But you don't want something with slats that aren't the approved small amount of space between them. You don't want something that your kid's arms or head is going to get caught in.

And so, just that the ABCs are very important. Beyond that, though, there are no one-size-fits-all recommendations. Set feeding schedules work for some, feeding on demand works for others. Soothing and sneaking babies in the bed, like I described, work for some and letting babies cry it out especially as they get little older works best and often quickly for others.

For others, it doesn't seem to work well at all. And so, maybe some sort of feedings schedule that does work for your family is going to be better. Letting babies cry it out might create just too much trust for some families. While it's a walk in the park for others, maybe not a walk in the park but not necessarily the worst thing in the world.

Some prefer their baby in the nursery. Others want the crib in their bedroom. And I know the American Academy of Pediatrics added that suggestion, that rooming baby's crib in your bedroom in the early days. And there's some wisdom in that. But the important thing really here is finding something that works for your baby and your family.

And whatever that something is, we don't want to compromise safety. Now, parenting books and coaches, friends and relatives who traveled this path before you, there is some great ideas out there. There's some differing ideas, sometimes conflicting ideas. And that's because one size does not fit all.

So, read their words, hear them out. Make adjustments that seem right for you, and your baby, and your family. We don't all have to do this the same way but we should stand firm on the ABCs of safe sleep. So alone, because babies can smother against pillows and blankets and bumpers and stuffed animals. And because parents can and do roll against their babies resulting in the death of babies, that does happen.

You want babies to be on their back because stomach and side sleeping has a much greater incidents of sudden infants death syndrome compared to back sleeping.

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And you want them in a crib or a safe sleep space, so that the babies are protected from their environment including pets and toddlers and other kids. So that they're contained and they don't get rolled on and because studies showing that babies sleeping unattended in car seats and carriers and swings and high chairs, all of that does have a higher incidents of death and injuries, compared to those in cribs and Pack 'n Plays and sleeping boxes that meet all the safety guidelines.

So, you want to be mindful of those ABCs, but beyond that, do what works — whether that is feeding schedules, sleep schedules, feeding on demand, whether that's letting them cry it out, whether it's warming a hot water bottle and warming up their sheet a little bit before you lay them down.

And whatever works for you, do it. And that will probably take a little experimentation but still, be mindful of the ABCs. And if keeping those ABCs does cause some inconvenience, it's better to be inconvenienced than to have a dead baby. But don't sweat the other details. Consider what works for you and your family and go for it.

So, I hope that helps, Brent. Great observation and thanks so much for writing in.

Don't forget, if you have a comment or a question for me. It's really easy to get in touch, just head over to PediaCast.org. You'll find a tab at the top of the screen that says Contact Dr. Mike. Just click on that tab, there'll be a contact form, fill it out, send it in. And I do read each and every one of those that come through. And we'll try to get your comment or your question on the show.

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Dr. Mike Patrick: 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. Really do appreciate that.

Also, special thanks to those who wrote in and contributed to today's program. So, Brent in Columbus, Ohio. We also have Kirstie from the United Kingdom, and Ryan from St. Paul, Minnesota. Really do appreciate all of you taking the time to write down some thoughtful questions and send them my way. It was fun answering those and hopefully the rest of the audience got something out of the answers as well.

Don't forget, if you would like to send in a comment and question for the program, easy easy thing to do. Just head over to PediaCast.org, click on the Contact link and ask away.

Also, I want to remind that you can find PediaCast in all the places where podcasts hang out. So, we may be easier to find than however you listened to us today. We put our links in social media, so maybe you saw a tweet, and you clicked on link. I just want you to know that we're in all sorts of places. We're in iTunes, Google Play, iHeart Radio, Stitcher, TuneIn, most mobile podcasting apps for iOS and Android.

And actually, there's a new podcast app out there for the Parents On Demand Network. And this is just a network of parenting podcast. So, PediaCast is one of them. There's a whole collection of other parent-oriented podcasts. And Parents On Demand has their own app as well. And PediaCast is in that app. And you can find that in the App Store for iOS and for Android. Wherever you find your mobile apps, you'll be able to find it. Just search for Parents On Demand.

And you can also search in any other podcast app for PediaCast, we should be in there. Whatever your favorite podcast app is, if we're not in it, let me know, and we'll do our best to get the show added to their lineup, like we did the Parents On Demand Network.

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We also have our landing site where you can find our entire archive of 376 episodes, Show Notes for each episode, transcripts, our Terms of Use Agreement and, of course, that contact page. You'll find all of that at PediaCast.org.

Of course, we're also on social media including Facebook, Twitter, Google+ and Pinterest. And we always appreciate you connecting with us there, so you can share our content with your own online audience.

And, of course, telling others face to face really works well, too. So, let your family, your friends, your neighbors, co-workers, those folks who take care of your kids, baby sitters, daycare workers, grandparents, anyone who has kids or takes care of kids, let them know about PediaCast.

Including your child's teachers, so the folks at schools, we talk a lot about educational stuff including in this program. We talked about lunch and recess. We recently talked about when is too early for school to start. We talked about attention span of kids in schools. We actually covered a fair amount of educational content. So, letting your child's teacher know about PediaCast may be a good thing.

And, of course, your child's doctor — whoever your child's pediatric provider is, whether that's physician, a nurse practitioner, physician assistant, family practice, pediatrician, internal medicine, pediatric specialist — whoever it is, make sure you let them know about PediaCast. So they can check it out for themselves but also share the show with their other patients and families.

And while you're letting them know about the program, tell them we have a podcast for them as well, PediaCast CME. That stands for Continuing Medical Education. Similar to this program, we do turn the science up a couple of notches and offer free Category 1 Continuing Medical Education credit, which is something that all pediatric providers need.

So, we do provide that absolutely free. Each of those episode is an hour's worth of credit. And shows and details are available at the landing site for that program, which is PediaCastCME.org.

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We have 25 published episodes. We're just getting ready to published number 26 here. I think it will be next week. So, definitely check that out and let your providers know about PediaCast CME.

All right, I want to thank all of you one more time 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.

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