Mealtime & Playtime, Pastoral Care, C-Sections & Allergies – PediaCast 347

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  • We have lots of guests in the PediaCast Studio this week! Dr Amy Sternstein and Dr Liz Zmuda stop by to talk about Parenting at Mealtime and Playtime. The Reverend Susan Kyser discusses the Pastoral Care program at Nationwide Children’s and Dr David Stukus helps us answer a listener question pertaining to c-sections and allergies. We hope you can join us too!

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  • Parenting at Mealtime & Playtime
  • Pastoral Care
  • C-Sections & Allergies

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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 347 for July 6th, 2016. We're calling this one "Mealtime and Playtime, Pastoral Care, C-sections and Allergies". I want to welcome everyone to the show.

We have a packed line-up for you this week with four guests, three interviews and an answer to a listener question, which means the bottom-line is I've better kept the intro short and sweet as much as I can this time around. Although, I do want to mention, and this won't come as a surprise certainly to my long-time listeners and many of you who haven't been around quite as long. If you've been around since I think it was March or so, you probably have little hint of this. Our family, and in particular, myself, my wife and my daughter, to a lesser extent my son, he sort of tolerates country music but the rest of us are pretty big fans.

I have talked about it on this show before. In March, my wife and I took an impromptu trip to Nashville to catch the Grand Ole Opry for the first time, so that was fun. As it turns out, Nashville recently came here to Columbus in the form of the Buckeye Country Superfest at Ohio Stadium. So yes, we were among about 80,000 packed into the Horseshoe to see folks like Thomas Rhett., and Lady Antebellum, and Jason Aldean, Dierks Bentley, and Florida Georgia Line, and Luke Bryan.

0:02:09

So lots of fun, great line-up. We'd do it again in a heartbeat. Although, I have to say, initially, it was a little pricey. So we weren't sure that we were going to go and then the good tickets got bought up, and it was getting close to the time. Well, do we do it, do we not do it? And then, a colleague of mine, she had really good set of tickets, really close to the action. Then, she had something else she had to do. That problem for her became opportunity for our family. And so we did go and had a great time.

But, my point, as it relates to an audience looking for a pediatric healthcare podcast, it was loud. Now, I should have known this, it was a two-day affair. The first day, we took earplugs. They're not really earplugs. They're called earpiece, and they let some of the sound in but they dampen the sound so that you can still enjoy the concert. It's just not as loud.

But, I'll tell you, the concert that first day didn't really seem all that loud. I know I was bad. Please do not use me as an example. We took them but we didn't use them. And then, to make matters worse, I thought, you know, we don't even need to take them the second day. We are fine, it really wasn't that loud. And here where things get dicey. The second day was much louder than the first day. Now, I don't know, maybe our ears were more sensitive because of damage that had occurred the day before. I don't know.

They just had had enough, I think. By the time, the second got going. So we were there without ear protection, and it was loud for hours on end. You know the drill, ringing ears. Even for a little while the next day, which is not smart. And there were a lot of little kids there, enjoying the country music, dancing around, cute as can be, but without ear protection. Which I'm not judging because I didn't have ear protection either that second day. The first day I had it but it was in my pocket. So, the message here is don't be like me. And I don't say that jokingly, because the next time that this opportunity comes up, I really do need to use the ear protection.

0:04:25

So if you and your kids are going to concerts this summer, remember to protect your ears and theirs. Take the ear plugs or the dampeners. EarPeace, I think it's P-E-A-C-E, were the ones that we had experience using. Not that we plug one brand or another but that's one I know that you can look up pretty easily or find their competition. But they do seem to work well, but they do have to be in your ears and not in your pocket in order to work. And you actually have to take them with you.

But concerts are fun, so have some family fun together, except for the oversight of the lack of ear protection. But we did have a good time. Always to get outdoors and hear some great music.

All right, so what are we covering this week? First off, I have two physicians from the Ohio Chapter of the American Academy of Pediatrics, and they also happen to be doctors here at Nationwide Children's Hospital. Dr. Amy Sternstein is with the Center for Healthy Weight and Nutrition at Nationwide Children's and Dr. Elizabeth Zmuda is an Urgent Care doctor at Nationwide Children's. They both stopped by to talk about parenting during mealtime and playtime and to clue us in on some great resources that parents and caregivers can use as they engage young children as they eat and play.

So definitely useful information as we consider our nation's obesity epidemic and think about ways we can encourage children to eat well and stay active.

And then, the Reverend Susan Kyser joins us to talk about pastoral care in pediatric health care organizations. She serves as Director of Pastoral Care at Nationwide Children's Hospital. So, she's going to fill us in on the ways in which pastors and ministers from all sorts of faith traditions, how they are meeting the emotional and spiritual need of patients, families and healthcare staff. So that will be an informative and enlightening conversation.

0:06:17

And then, after that, we have a listener question pertaining to C sections and allergies. Now, she's not asking if you can be allergic to C-sections. But rather, can being born by C-section increase the risk of allergies in the baby down the road? So, we'll consider that relationship and to help me do that, Dr. David Stukus, a pediatric allergist here at Nationwide Children's, he'll be stopping by the studio to help answer those questions related to C-sections and allergies.

So lots coming your way this week. Don't forget, if you have a question for me, if you have a topic suggestion or if you want to point me in the direction of a news article or journal article, whatever the source, feel free to get in touch. It's easy to do, just head over to PediaCast.org and click on the Contact link. I do read each and every one of those that come through and we'll try to get your comments or your suggestion incorporated into the program.

We also have a voice line for you, if you'd like to leave a message that way, and we'll get your voice on the show, 347-404-KIDS, 347-404-K-I-D-S.

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

Let's take a quick break and I will be back with folks from the Ohio Chapter of the American Academy of Pediatrics to talk about parenting during mealtime and play time, and then pastoral care after that, and then we'll cover the C-sections and allergy. Should be an interesting show. So all coming up right after this.

0:08:08

[Music]

Dr. Mike Patrick: All right, we are back. Two pediatricians from Nationwide Children's joins me in the studio today. Dr. Amy Sternstein and Dr. Elizabeth Zmuda. They're here to talk about a new program from the Ohio Chapter of the American Academy of Pediatrics called Parenting at Mealtime and Playtime.

Dr. Amy Sternstein has joined us before. She's a physician for Center for Healthy Weight and Nutrition and Nationwide Children's. She was here for Episode 297 when we talked about the Ounce of Prevention Program. It's good to see you again.

Dr. Amy Sternstein: Thank you. Good to see you as well.

Dr. Mike Patrick: Thank you for stopping by.

And Dr. Elizabeth Zmuda is a first-time PediaCast guest, but she knows the program well because we happen to work together in the Nationwide Children's Close to Home Urgent Care Centers, and I talk about the show from time to time. So, a warm welcome to Dr. Elizabeth Zmuda. Thank you also for joining us.

Dr. Elizabeth Zmuda: Thanks for having me.

Dr. Mike Patrick: So, Dr. Sternstein, let's start with you. Tell us a little bit about the Parenting at Mealtime and Playtime program. What's it all about?

Dr. Amy Sternstein: Well, I think we just have to realize that, unfortunately, obesity in children are still a serious health problem. So, the Parenting at Mealtime and Playtime is really attempts to address that issue.

So particularly concerning is that obesity can start very early in life. In fact, a large percentage of children between the ages of two and six are already identified as either being overweight or obese. So, even more concerning is that this excessive weight gain, even in the preschool years tend to persist. And eventually, it can affect the quality and longevity of their adult life, particularly end up with a medical condition.

0:10:18

Dr. Mike Patrick: Right.

Dr. Amy Sternstein: So this threat really highlights the need for early intervention which is what our preventive efforts are all about.

Dr. Mike Patrick: So, the goal here is really healthy eating, more activity as we address childhood obesity — that epidemic that exist in our country — and just encouraging parents to interact with their kids in a developmentally appropriate way during mealtime and play time, to kind of support what the current recommendations are and help them develop best practices for engaging with their kids during those time periods.

Dr. Amy Sternstein: Exactly. We really are emphasizing active parenting because the PMP resources really will help parents build a solid foundation of good nutrition, good encouragement and daily activity, as well as appropriate sleeping habits. And we start at infancy.

Dr. Mike Patrick: And even though this is developed by the Ohio Chapter of the American Academy of Pediatrics, this is really a resource — and we'll explain to folks how they can find it — but it's a resource that's available to anyone with Internet access, right?

Dr. Amy Sternstein: Yeah, that's correct. The Ohio Chapter of the American Academy of Pediatrics has really focused on just early childhood health promotion efforts. And so, it's not exclusive to the families within Ohio, but the idea is really that even teachers or childcare providers or people who are engaging in preschool-aged children can really benefit, as well as parents, from this particular program.

Dr. Mike Patrick: Now, you had stopped by, as I'd mentioned at the intro, and talked about a program from here at Nationwide Children's and the Center for Healthy Weight and Nutrition back in Episode 297 called an Ounce of Prevention. How does this differ from that particular program?

0:12:02

Dr. Amy Sternstein: Good question. The Ounce of Prevention was initially designed to be exclusively used in a primary care health setting, and it was very prescriptive in that we were seeing some weight issues in young children. But oftentimes, when you talk to the primary care provider, they weren't exactly sure when it was best to start solid food, when it was best to maybe wean off the bottle. So we really started focusing on some more prescriptive information that was age-appropriate, as well as portion sizes per age because as you know we are now super-size society.

Dr. Mike Patrick: Right.

Dr. Amy Sternstein: So it gave information for primary care providers along the immunization schedule, but it was very specific to physical activity and nutrition. So what we've done differently now with the Parenting at Mealtime and Playtime is really we've given more of the "how to do it" as opposed to just "do this."

Dr. Mike Patrick: Got you. And really aimed at the parents themselves.

Dr. Amy Sternstein: That's exactly what it is.

Dr. Mike Patrick: Now, there's also a program through the Ohio Chapter of the American Academy of Pediatrics that we've talked about on this program before called Good4Growth. What's that in a nutshell?

Dr. Amy Sternstein: Yeah, that's a good question because the content of some of these programs are certainly overlapping, but we keep learning from our previous experiences and we keep improving our programs. The Good4Growth is a little more specifically focused on the nurturing aspects of parenting, the importance of caring environment, building the psychosocial and emotional support. Because that will really foster not only health, but it will foster child who's ready for school, for instance.

Dr. Mike Patrick: And these are all really great resources for parents and providers, or providers for their own education and to share with their patients and families and certainly for moms and dads. I'll put links to all of these things — so the Parenting at Mealtime and Playtime, Ounce of Prevention, and Good4Growth — in the Show Notes for this episode, 347, over at PediaCast.org, so folks can find all the things that we're talking about really pretty easily.

Now, we kind of touched on why this program was developed. We know that there's an obesity issue. We know that parents need more education in terms of mealtime and playtime and ways to interact with their kids. Is there any other reasons to do this particular program right now?

0:14:24

Dr. Amy Sternstein: Well, I unfortunately see there's little more passivity in parenting. I think families are very busy. They have either two working parents or maybe a single parent household. It's a hopeful engagement for parents to understand that they are the role model, and they're hopefully establishing good habits very early in life because those habits will be sustained over time.

Dr. Mike Patrick: You have to be intentional about doing this stuff and like you say, when you're really busy, it can easily get pushed to the wayside and then parents aren't thinking about it, aren't engaging in those ways. Even though in the back of their mind, they need to and might even want to, but they don't just have the easy tools to do it quickly and effectively. So, hopefully, this fills the gap in for that.

Dr. Amy Sternstein: The other distraction might be electronics.

Dr. Mike Patrick: Yeah, yeah, absolutely. Which we use to get this information out.

[Laughter]

Dr. Amy Sternstein: Exactly. But the kids are entertained with a lot of electronics starting very early. And so, they may not have as much of the parent to parent or adult-to-child interaction.

Dr. Mike Patrick: Absolutely. Dr. Zmuda, when you're starting out, trying to come up with a program like this, who do you get to come up with the content? So, who were the experts that were involved in figuring this out, what parents need to know?

Dr. Elizabeth Zmuda: Well, in the early development, the team included pediatricians that were talking about nutrition and play and the developmental skills in children. And, we also had a really strong partnership with the Ohio Department of Health and we have some dietitians through ODH that helped us developed the content as well.

Dr. Mike Patrick: And parents, you have a focus group or something that looks into like what it is that parents want to know about when you consider these things?

0:16:11

Dr. Elizabeth Zmuda: I think a lot of it comes from our own experiences with parents and being parents. And then, we also learned as we go through the collaborative, when pediatricians talk to us about what their parents need, what their questions are, then we can look back at our materials and help fine tune things to make them better for parents.

Dr. Mike Patrick: Yeah, that certainly makes sense.

Dr. Amy Sternstein: We did do a short version of some focus groups with parents, looking at the PMP Parenting at Mealtime handouts. And we did get feedback from parents directly.

Dr. Mike Patrick: Yeah, that's good. It's always good to know, especially when it's all providers and experts involved, sometimes the language doesn't get translated into a way that a parent can understand. So, it definitely makes sense to do that.

How do programs like this get funded?

Dr. Elizabeth Zmuda: Well, like I said, we do — through the Ohio Chapter of the American Academy of Pediatrics — have always had a strong partnership with the Ohio Department of Health, and this particular program is funded through ODH.

Dr. Mike Patrick: Then I saw in the website too, the Centers for Disease Control and Prevention, there was a educational grant or something that also help to pay for it.

Dr. Amy Sternstein: The Ohio Department of Health has also been involved and they're involved in the Center for Disease Control, the CDC, nationally. So, we get recommendations that come out of the national organizations. And then, the states look at those national recommendations, and then we design our programs based on what is recommended.

Dr. Mike Patrick: So to some degree this is our tax dollars at work, in terms of really being a benefit to the communities and to families. Certainly, another reason, even if you don't live in Ohio, they take advantage of this educational material that's evidence-based.

So Dr. Sternstein, how can parents then, where the rubber meets the road, benefit from this particular program?

Dr. Amy Sternstein: Well, the Parenting at Mealtime and Playtime has really looked at the developmental milestones. So, every parent is so excited when they see their child achieve a milestone that they hadn't done previously. So we've looked at the feeding and nutrition as the transition from formula or breastfeeding to solid foods, and then solid foods to finger foods, and finger foods to utensils. And we've talked about the development that takes place during that period of time.

0:18:28

As well as motor skills, obviously, parents are very excited the first time they see their child sit up, then they start crawling, then they start walking. So we want the parents to engage particularly in developmental milestones. If they're running, and they're playing and kicking a ball, or throwing a ball and catching a ball, they're really developing motor skills or developing balance, muscle tone and flexibility and strength. So it's really exciting to see that.

Dr. Mike Patrick: Yes, so that the parents can actually see. It's one thing to read it in a book, but then just sort of have that information in the back of your mind as you're playing and as you're sort of seeing the developmental milestones happen, it certainly reinforces what kids should be doing. And it maybe encourages parents to interact with them to help develop those skills.

Dr. Elizabeth Zmuda: Right, and we want to make parents focus on the fact that mealtime is playtime. And so, all of these developmental skills that they're watching their child learn, they can use those and take advantage of those during mealtime to learn more about their child and know what they're ready for.

Dr. Mike Patrick: And so, the site itself is pretty cool in terms of lots of photos and interactive videos. And really, even though it's a website, it really does engage the participant with great educational content.

Then, we also have a benefit for providers here as well. Tell us a little bit about that.

Dr. Elizabeth Zmuda: Well, the Parenting at Mealtime and Playtime Collaborative was originally focused on healthcare providers, so pediatricians and family practice physicians who are seeing kids in their office, and really trying to educate them as far as risk assessment, how to counsel families and really how to bring families focused towards this. So it really is a quality improvement program for pediatricians as well.

0:20:14

Dr. Mike Patrick: So, your target audience for the program is certainly for parents, but then also for providers and pediatrician offices in a sense to give them the tools that they need to provide this kind of education to their families that come through. Because I know, and I'm sure both of you know too, that it's very busy being a pediatrician, and anything that you have to help you streamline education for each individual family is certainly helpful.

Dr. Elizabeth Zmuda: Right, and the PMP website and app is really focused on being an additional resource that pediatricians can start the conversation and then they can direct families to look more and get more information at that site.

Dr. Mike Patrick: Now, at this point in time, the mobile app is a website. So it's mobile website, and folks can find it — and, of course, we'll put a link in the Show Notes for this episode, 347, over at PediaCast.org — but folks go to PMP which is Parenting at Mealtime and Playtime, PMP.Ohio.AAP.org. You need to provide your email address, your child's birthday, gender, your mobile number and your ZIP code. Then, you'll receive a login and a password to get into the site and view all of the resources.

The reason they need your child's birthday and gender is that some text messaging goes out that is really specific for your child. Is that correct?

Dr. Elizabeth Zmuda: Right. There will be a message that says, "Hey, your child is four months old today. Remember, this little tip about being four months old. Tummy time is really important." And also, a reminder for them to schedule those well checks that we know are so important.

Dr. Mike Patrick: Yeah, great. So it's really customized and tailored to their particular child. So that's the reason that you need that kind of information to be able to provide the age appropriate developmental messaging. So that's great.

0:22:09

Now, I would imagine that the website itself and the mobile app, anybody, as we mentioned, with Internet access can access this information, but the Learning Collaborative, that's something just for Ohio pediatricians at this point?

Dr. Amy Sternstein: Yeah, the funding for the Learning Collaborative has come from the Ohio Department of Health. And so, we have retained that program within the state. Although, it's very widely spread throughout the state which is excellent to anyone who's interested. Because the providers, we want them to incorporate this into their normal routine well-child care, so that it will be sustained over time. So that's the whole idea of a quality improvement project, as you see how can your practice provide maybe a little extra care and then actually embed that into your day to day activities.

Dr. Mike Patrick: And then, do you look at outcomes before and after to see if there's been a benefit to the program?

Dr. Amy Sternstein: Yeah, so we have different ways to look at outcome. One outcome really is specifically looking at the particular provider's change. So if the provider for instance wasn't checking blood pressures routinely and documenting it, or wasn't checking BMIs routinely, we look at what the baseline was for that particular provider or practice. And then, we look over a month's time, and we're looking at improvement.

So we're saying, "That's one of the risk factors. So you need to check the BMIs. And if you continue to check more and more BMIs, then you're improving your quality of care." So they do do their own what they call chart reviews and they're looking at their own performance. That's one outcome measure.

The other outcome measure we were looking at is specific behavior change among the families. So if the provider says, "I really want you to be careful about how much juice your child's consuming," then we ask the parent directly, "Is that something you would be interested changing? Do you understand the importance of that? How would likely would you do change that?" And then, when the child comes back for the next visit, that same provider will say, "Did that child actually make a behavior change?" So that's one exciting outcome measures, really looking at behavior change as well.

0:24:09

Dr. Mike Patrick: And since this is a quality improvement initiative, pediatricians that are out there know what I'm talking about when we say that you have to have so much credit to maintain your board certification and part of that credit revolves around quality and practice. Do they get official credit for participating in the collaborative?

Dr. Amy Sternstein: Yeah, absolutely. Although, apparently our MSE credit may be changing some. Yes. So in order to maintain a board certification in pediatrics, the primary care providers need to qualify and they need different types of credit. So we are offering both Part 2 credit and Part 4 credit. Part 2 is really the learning education piece, and Part 4 is actually a quality improvement project within their practice.

Dr. Mike Patrick: That Part 4, that's a little elusive in terms of finding opportunities. So this would be a great thing for offices to get involved with.

So, if there's a pediatrician or office manager out there listening right now who's not involved in the collaborative, is it open-ended or is there just a set number of practices or providers that you can take into it?

Dr. Amy Sternstein: We welcome anyone who's interested. We do have funding for specific number of practices, but we've also had several waves of our learning collaborative and so we are definitely open. If anyone's interested, please contact us and we will follow through.

Dr. Mike Patrick: And that's just through the Ohio Chapter of the American Academy of Pediatrics. And we'll put all the links on the Show Notes for this episode.

Dr. Amy Sternstein: Yes.

Dr. Mike Patrick: All right, well, thank you both of you for joining me today. So, let's just little practical nuggets at mealtime and playtime, kind of the sort of thing that parents would find in this app. What do you have for us? What should parents be doing?

Dr. Elizabeth Zmuda: First, focus on variety. Variety is part of the learning process for a child. So we know that it's normal for them to have certain foods that they select and they prefer over time. But really to make it fun and encourage that variety, so the child is exposed to more and more things. Their preferences will change over time.

Dr. Mike Patrick: There are a lot of picky eaters. In fact, this is not violating privacy because I was not acting as someone's pediatrician, but as a friend, someone just asked me yesterday, "You know, my kiddo is a picky eater. What do we do about that?" And I imagine that you hear that question a lot as well.

Dr. Elizabeth Zmuda: Right. And that's where the variety comes in. Take what they like, and you can keep that same familiar food there, but introduce something new and just keep trying and really focused on how fun it is and more of the experience of trying new things than adding any pressure to force the child to do that.

0:26:40

Dr. Mike Patrick: And your pediatrician will be kind of watching after the kid's growth, to make sure that they're looking okay on their growth chart what would be expected for that child and for that family in the whole context of their health, to let you know if there's really an issue nutritionally.

Dr. Elizabeth Zmuda: Absolutely.

Dr. Amy Sternstein: I think the other key piece is that the dietitians that have really researched this have comfortably told us that the food preferences are really not set in stone prior to school age. So, they may have a few preferences, but that's really your opportunity to really keep exposing kids to a variety of foods. Once they get into school, they seem to have a little bit more preference, and it's a little more difficult to change that but you really have this opportunity within the preschool ages to really do that major introduction and that's one of the things we're emphasizing.

Dr. Mike Patrick: So, great material, great educational resource at mealtime also. At playtime, we talked a little bit about knowing what developmental milestones that you're after and really engaging kids in play that help encourage them to meet those milestones — and so, really great program all around.

Dr. Amy Sternstein: Thank you.

Dr. Mike Patrick: Again, thanks for stopping by.

Dr. Amy Sternstein: Thank you.

Dr. Elizabeth Zmuda: Thanks for having us.

[Music]

0:28:23

Dr. Mike Patrick: All right, we are back. Our next guest is the director of Pastoral Care at Nationwide Children's Hospital, the Reverend Susan Kyser. It's an honor and pleasure having her join us in the studio here today. Thanks for being here.

Rev. Susan Kyser: Thank you.

Dr. Mike Patrick: Really appreciate you stopping by. So what exactly is pastoral care, and why is it important in a health care setting?

Rev. Susan Kyser: Pastoral care is a ministry in the fullest sense in that it is a journey with patient's families and staff embracing the spiritual and emotional part of our being. So chaplains are well educated and disciplined in the art of journeying with others. This ministry is not a ministry to take people to a certain faith, a certain place but to hear deeply and journey with them where they are.

Dr. Mike Patrick: Yeah, that absolutely makes sense. And the healthcare environment in particular can be really stressful and high stakes for family. So, it must be pretty challenging supporting where they are the moment because where they are can be very difficult.

Rev. Susan Kyser: It surely can be very difficult from acute crisis or acute illness, even to someone dying, all the way to something which we might deem not very traumatic such as a tonsillectomy, needing stitches, a broken bone. But if you think of it, that no one comes to a hospital because they can cope with what they have without being in a hospital presence.

So they may be under some stress and yet still have excellent coping, excellent ways of being, and we are here to support them in all levels of that.

0:30:11

Dr. Mike Patrick: That's a great point. A lot of the things that, as staff in the hospital, we just sort of take for granted that you see so many tonsillectomies every single day and the kids do great. But for the family, that's their very first maybe, probably, tonsillectomy and there's a lot of fear and anxiety that go along with that.

Rev. Susan Kyser: Absolutely. And to appreciate that, each person comes to the hospital from their own point of being and their own needs. Sometimes, in the emergency department, we may don an attitude, "Oh, the child's crying, so they're going to be all right," as opposed to being silent or intubated. And yet, at the same time, that child crying and whatever's going on with that family can be quite serious.

Dr. Mike Patrick: Yeah, that's a good point, too. So, like you say, when you see a crying baby, they're vigorous, they're moving here, they look great. From the medical standpoint, "Oh, this kid's crying, that's a good thing." But I could see why that would stress the parents out, "Hey, I don't want my child to be uncomfortable or upset." So, yeah, great points.

Now I would imagine too that you are available 24 hours a day, 7 days a week, right?

Rev. Susan Kyser: Absolutely. Our chaplains are part of the Trauma Team, which means that any trauma that comes into the hospital, they respond as other staff, too. They stay in the hospital 24 hours a day. And so, anything that happens in the hospital, when there's a need, they respond to that. They are the chaplain of the entire hospital, whether it's on the hospital units or in the emergency department.

Dr. Mike Patrick: And then, you must have to work pretty closely with local pastors of various faiths just around the community who come in and see folks that they take care of in their home religion, religious place. How do local pastors and ministers fit in to the bigger picture?

0:32:11

Rev. Susan Kyser: Well, we have a responsibility and a calling to support the local clergy. We are not here to take away their job or their responsibility and their ministry. However, there are many families that are out of Franklin County and are distant from us. So, we would, and we do, we step in and we administer to the families knowing that some have home congregations and pastors and communities that support them very well, often from a distance.

We also know that there are many both in our staff and our communities now that are not connected with a religious community. So, many people name themselves as spiritual but not religious. And if we understand that, all people will tell us what is of ultimate concern if we listen carefully, whether we use God talk or anything like that. So, our role is to listen them, and that those that do have religious communities, to support the clergy and really bless the work that they do with their families.

Dr. Mike Patrick: Yeah, absolutely. In terms of specific patients and families within the hospital, you mentioned that you're involved with the Trauma Team, so that you would know when a trauma comes in, that you're going there to be there for the family. But for all the other families in the hospital, you can't check in on everybody, can you?

Rev. Susan Kyser: We sure wish that we could.

[Laughter]

Rev. Susan Kyser: Our chaplains are assigned to different hospital units and their role in that unit is to introduce themselves to as many of the patients and families as they can. That means that some families they might introduce themselves and say, "Oh, no, thanks, chap" and really do not wish to have a conversation with their chaplain. And others are very grateful for our entry, and we would have a longer conversation.

0:34:04

So we seek to have a presence on every one of the hospital units, knowing the staff as we can, that they would call us if there is a need. But more than that, that we go and we are one of the disciplines that goes without a referral, that we go room to room, not in an evangelistic way but a way to meet them and offer support as part of the healthcare team.

Dr. Mike Patrick: Just let them know that you're there, what you do, and if they need you, you're there.

Rev. Susan Kyser: Absolutely. Absolutely.

Dr. Mike Patrick: In addition that one-one-one sort of support, there are also general activities that you do throughout the hospital for patients and families. What are some of those things?

Rev. Susan Kyser: Well, predictably, we have worship services. And we have a beautiful chapel in one of our main lobbies that is an inter-faith chapel. So we have Catholic mass regularly. We have inter-faith service regularly. We also have Muslim prayers on Friday. We have services during major holidays such as Holy Week. We have Good Friday services, Easter services.

We also have funerals, as asked for. And I say that with some hesitation simply because we are not a funeral home, but we, at times, will have memorials here in the chapel.

Dr. Mike Patrick: If families ask for it.

Rev. Susan Kyser: Absolutely. And then, we oftentimes have prayers in the chapel and other times as we do that.

Dr. Mike Patrick: You talk about the chapel. Is that open all the time for folks to stop by?

Rev. Susan Kyser: Yes, it is. And if you'll notice in our chapel, we think it's quite a unique space in that we have symbols from the five major world religions as a way of saying, obviously, that is not all inclusive, but a way of saying that all are welcome. Whether you have a religious community or you do not have a religious community, you're welcome to come and rest in this place of peace.

0:36:09

Dr. Mike Patrick: How are you able to support such a wide diversity of faiths and beliefs? You wanted to be inclusive but each of the pastors on the staff have their own personal beliefs and their own background. How are you well enough versed in particular faiths to be able to support diversity if that makes sense?

Rev. Susan Kyser: If you think of it, that all life is spiritual if not religious, we have the capacity to minister to people who are different than our faith tradition. That as a Christian, I don't need to have someone be Christian to minister and journey with them and hear them at their depth. Having said that, if someone wishes someone in their tradition to come and be present, whether it's Muslim, Jewish, Hindu, Buddhist, something else other than Christian, then we would invite those clergy to come. And we have persons that we can call and invite to do that.

Dr. Mike Patrick: And I would imagine that you have some educational opportunities for your own staff to learn about different faiths, so they can have empathy for the patients that they are supporting and journeying with.

Rev. Susan Kyser: Absolutely. I wish we had more opportunities for that education but an important part of the training is that we train in different religious groups in doing that. And actually, we do some education with our nursing staff and our hospital staff around different traditions.

One unique aspects often with our Muslim families, there are contingencies especially around the time of death, and we certainly want to be more than respectful. We want to be hospitable and caring and compassionate at those times.

Dr. Mike Patrick: Speaking of healthcare workers, we've talked a lot about the ways that you support patients and families. Being a healthcare worker can also be very stressful. What kind of services do you provide for the staff?

0:38:07

Rev. Susan Kyser: We have really been able to integrate with a program at the hospital presently called YOU Matter. And YOU Matter offers lots of different supports to our staff.

Having said that, I think one of the unique qualities of pastors is that they can journey with people one on one. It is not that we don't want our staff to have grief or stress but trusting that any human condition, with conversation and with community, we can make sense of our grief.

And so, a major part of the work we do as pastors and clergy is that we journey with staff individually simply saying, "How are you?" Simply hearing the grief or the stress. And as you know, with the healthcare worker, that our stresses aren't always work related. We come with families and all that that brings to our soul. So the conversations aren't always just about patient or family, but certainly, that's an important part of that.

Dr. Mike Patrick: Yeah, that's such an important job. How does one become a hospital chaplain?

Rev. Susan Kyser: Well, some think it's just "Oh, I care a lot, so I'm going to be a chaplain." However, it's quite an arduous journey. To be a board certified chaplain, you first have to have a Masters of Divinity in whatever your faith tradition is. Then, you need to be ordained in your faith tradition. You then need to be endorsed by your faith tradition.

And, after that, you need to have a minimum of four units of what we call clinical pastoral education. Now, one unit of clinical pastoral education is 400 hours of supervised training, which is quite intense. So, basically, it's 1600 of this clinical training. And that is an action-reflection model of training, where people not only look at themselves. They look at theology. They do a lot of processing of "Why did you say this?" "Why didn't you say this?" "Whose needs are being met?" And you integrate all of that with your theology and your faith tradition.

0:40:20

Then, you become board certified in the Association of Professional Chaplains, or the National Association of Jewish Chaplains, or the National Associations of Catholic Chaplains. And there is a Muslim community as well that is endorsing chaplains as well. So it's a professional designation and quite an arduous process.

Dr. Mike Patrick: And, we're really part of that training here at Nationwide Children's Hospital too, correct?

Rev. Susan Kyser: Absolutely.

Dr. Mike Patrick: We participate in the education of folks who are earning CPEs.

Rev. Susan Kyser: Yes, we have a very vigorous training program through Clinical Pastoral Education. And we have had interns and residents for over 30 years being part of that program. Our CPE interns offer a significant part of our ministry here, and that they are part of being assigned to hospital units during our on-call chaplaincy. And with their stringent supervision and reflection, they offer powerful ministry.

Dr. Mike Patrick: Absolutely. Speaking of powerful ministry, there is a program that you guys kind of spearhead called the Seasons for Healing bereavement program. Tell us a little bit about that.

Rev. Susan Kyser: Correct. Actually, we are the facilitators of the bereavement program at Children's Hospital and have been for many, many years. And our program is both education and supportive. The educational piece, we do education with staff around grief, loss, spirituality of children, so forth.

The supportive piece is around staff, as well as our patients and families. We offer them a bereavement packet at the time of death. We do memory making with them with the support of our child life specialist. We offer them reading and support them that way.

0:42:09

But a bigger part of that is that we offer one-on-one for our patients, or at this point, it would be our families. We have a bereavement group that meets once a month. We have a group that meets before the holidays just called Surviving the Holidays. During that, we have a memorial service that is once a year that we invite families of the last two years who have had a child die. So we have a very important part in that, at supporting staff and our families when a child dies.

Dr. Mike Patrick: There's so much stress on the family for such a long period of time after the loss of a child and higher divorce rates and other mental health issues. So I think it's such an important program for folks to be a part of. And you have separate groups for siblings, support group for them as well.

Rev. Susan Kyser: Well, we have at times had a six-week support groups for our siblings that they would meet separately at the same time the parents are meeting. And those are integrated times that then they come in and are given invitation and education of how to talk with one another.

Even in the strongest families going through something as so painful as the death of a child, whether an infant or older, that it puts stress on how we communicate with our whole family. So, some of that is giving them techniques to do, to have conversation, but also permission giving of "It's okay to talk," "It's okay to cry together," which can be quite frightening.

Dr. Mike Patrick: Yeah, absolutely. And the grandparents as well, you have a program for them, too.

Rev. Susan Kyser: Right. And that is not an on-going program for grandparents but as whether you're grandparents or not, you can imagine that you love not only your child, and your heart breaks for your child, but certainly, your grandchild as well.

Dr. Mike Patrick: And the regular meetings and more information on the Seasons for Healing bereavement program, we'll put a link on the Show Notes for this episode, 347, over at PediaCast.org. So, folks can find information about that program and get involved if it's something that they're interested in.

Rev. Susan Kyser: That's great.

Dr. Mike Patrick: So what are the most challenging aspects of being a hospital chaplain? Many, right?

0:44:16

Rev. Susan Kyser: There are many. I think to continue to integrate into the hospital team, there are many demands as well know in healthcare these days, and many of those make us less human. And how do we want to be accountable to outcomes and behavior-based kind of ministry, be faithful to the chart in that and behavior-based methods in entering into relationships, and at the same time continue our humanity and continue to grow and allow our staff to have invitation to be human? It is always our kindness and our compassion that is life-giving whether we are a physician, a nurse, respiratory therapist, chaplain whatever and so much of healthcare that we are indeed truly accountable to can take us away from that. So I think it's a challenge, whether we're a chaplain or other healthcare giver to continue to remember it is our kindness and our humanity that can be life-saving.

Dr. Mike Patrick: And with there being so much emphasis placed also on patient satisfaction, in surveys that go along with that, we have to remember that embracing that humanity and really forming relationships and interacting with our patients and families is directly tied in to patient satisfaction — which, research has shown the more satisfied the patients and families are, the better the outcomes in terms of compliance in quality of life and all those sorts of things. So, yeah, definitely challenging and such an important thing.

What are the most rewarding parts of the job?

Rev. Susan Kyser: You know, one might say it's always rewarding when someone gets better and goes home. And thanks be to God that most of our children do get better and go home. At the same time, there are often very rewarding encounters with families in deep crisis, even death, that we are so privileged — and I say privileged — to be invited in and to have encounters with families in times of great crisis and great need.

0:46:26

So, it is not joyful as in going to the park or the amusement park, but it is great and deep meaning and having that privilege of journeying with others.

Dr. Mike Patrick: Yeah, absolutely. Well, we really appreciate you taking time out of your day to stop by the studio and talk to us.

Again, we'll put links for the Seasons for Healing bereavement program in the Show Notes and also a link to Pastoral Care in general at Nationwide Children's Hospital. So, if you're interested in learning more about the programs that they do, you can check out the Show Notes at PediaCast.org for this episode, number 347.

So, the Reverend Susan Kyser, Director of Pastoral Care at Nationwide Children's Hospital. Thanks for joining us today.

Rev. Susan Kyser: Thanks for having me.

[Music]

Dr. Mike Patrick: All right, we are back. And this time around, Dr. David Stukus joins us in the studio. Dr. Stukus is a pediatric allergist at Nationwide Children's and an associate professor of Clinical Pediatrics at the Ohio State University College of Medicine.

He's no stranger to the studio. He's been here before to talk about allergies and asthma. Today, he's going to help us answer a listener question related to C-sections and allergies.

So, let's give a warm welcome back to Dr. David Stukus. Thanks for stopping by today.

Dr. David Stukus: Well, thank you for inviting me. I'm really happy to be here.

Dr. Mike Patrick: Really appreciate it. So I have a listener question. I've mentioned to folks that we're going to try — especially some of these more complex and complicated questions — just to get some specialist into the studio to help me answer those. And I thought this would be a great one to start with.

0:48:25

It comes from Kendra in Akron, Pennsylvania. And Kendra says, "Hi, Dr. Mike. Thank you for your podcast. I just started listening in the past three months, and I'm enjoying all the information you share. I have a six-month-old son. He was born via C-section. I have heard that when babies are born vaginally, they benefit from contact with the flora of the mother's birth canal, something which C-section babies are not able to experience.

"Can you tell me if there is any research that suggests that C-section babies struggle more with allergies or sensitivities. We are observing that he is sensitive to what I eat, as I am breastfeeding, and his skin is also very sensitive to perfumes, cosmetics and skin care products. There are some history of food allergies in my family, so I realize this could very well be what's going on with my son. But I'm also curious if it could have anything to do with his C-section birth.

"I find his constant skin rashes rather perplexing. We have observed that he gets rashes when we use certain soaps or lotions on him, or even when someone wearing lipstick or lip gloss kisses him. My mother tickled his belly with her one day and his belly became covered in very fine lines with welts that crisscross the belly just as her hair had.
"He has had recurrent rashes on his cheeks for about two month. Mupirocin cream keeps it in check, but as soon as I stop the cream, the rash gets worse and begins to ooze. I look forward to your insight and hearing what research there is in this area. Thanks, Kendra."

So you see why I invited a pediatric allergist into the studio.

Dr. David Stukus: Yeah, there are 25 different question and/or topics in that one little vignette.

0:50:03

Dr. Mike Patrick: Yes, it's a good place to start. So, let's try to break it down. From an allergy perspective, I think a good place to start it with is what benefit is afforded a baby from contact with micro-organisms in mother's birth canal?

Dr. David Stukus: This is a really hot topic and a very timely question from the listener and I appreciate it.

So, what we're getting at here is really the microbiome or microbiota. We all, as humans, live with trillions of bacteria on us and inside us, and there's been great research over the last few years that had shown that bacteria that lived with us may dictate some of our health outcomes, the development of certain disorders including allergies, asthma, eczema, things along those lines.

And, interesting, I've read about some op-ed pieces about how they may even determine our cravings, our food cravings, which is kind of neat. Thinking that the bacteria our intestine prefers certain type of salty or sweet and that's what makes us eat it. So who's driving who here?

Dr. Mike Patrick: So the bacteria in my gut are craving pizza and…

Dr. David Stukus: Quite possibly. Mine like chocolates, so…

[Laughter]

Dr. David Stukus: So, in regards to this question, people had been looking at the microbiome, and we still don't fully grasp what's going on here, or more importantly, ways that we can sort of manipulate it to either prevent the development of some disease or treat them.

But there is some new data, limited data regarding Caesarian sections and risk for allergy. There's been a couple of studies most over the last year, mostly epidemiologic studies that have looked at, okay, children born vaginally versus Caesarian section and then who goes on to develop allergy, who doesn't? And they've shown that those kids born by Caesarian section do have an increased risk of developing allergic conditions, namely food allergy, not necessarily eczema, but there are other factors involved as well.

So, if you have a parent who has a history of allergy and you're born by C-section, then that may increase your risk even more. And the thought would go, yes, you are exposed to billions of bacteria to the birth canal which get inside you and on you and that can, you know, this early life exposures may then interact with your genetic footprint which may turn on and turn off certain genes. And if you lack that very early life exposure to the birth canal by having a C-section, then that may alter the development of these allergic diseases.

0:52:18

Dr. Mike Patrick: But we don't really understand the exact process by which that happens. It's just sort of an observation at this point, and the microbiomes seems like the most likely what would cause the observations that we're seeing.

Dr. David Stukus: That's exactly right. This is the tip of the iceberg. It's just been recognized over the last few years that this may be a factor. And we still have a very incomplete understanding of how this interaction occurs.

Dr. Mike Patrick: So our listener asked specifically about research, but the research really is more, yes, there's a relationship but not really getting into the box and figuring out exactly what's happening.

Dr. David Stukus: Right. Like everything else, any other discoveries that we have in medicine, the first step is, is there a relationship there? There appears to be a relationship there, so now it's diving in deeper in trying to figure out how that relationship takes place.

Dr. Mike Patrick: Now, considering that information, would that enter at all into sort of a risk-benefit analysis on deciding whether to do a C-section?

Dr. David Stukus: You know that's a great question. At this point, I would say absolutely not. I think that there are so many other much more important factors at play including the health of the baby and the health of the mother. So that decision should always be with those ideas at the forefront, as to what's the best for the baby or for mom.

Dr. Mike Patrick: There are really bigger risk than this with C-sections that kind of play in to the risk-benefit scenario.

Dr. David Stukus: Yeah, there's a lot of different ingredients that go into recipe to determine which children become allergic, have food allergies, eczema, asthma, things like that. And some of the ingredients have a much stronger impression than others. Family history, we know, genetics drives a lot of this.

It can also be early life exposure that are still fully understood, such as children born into a house with pets may actually have less likely developmental pet allergy, whereas those are exposed to pets later may be more likely to be allergic.

0:54:07

And, with food allergies, we now know through some landmark studies that early introduction of food such as peanut to children that are at risk of developing peanut allergy can be very effective in reducing the development of peanut allergy later in life. There is a lot of factors that go into play aside from C-sections.

Dr. Mike Patrick: And certainly, having a vaginal delivery does not mean that your child won't have immunity issues or problems.

Dr. David Stukus: That's great to point out, actually.

Dr. Mike Patrick: And our listener, in particular, Kendra, if she had her baby vaginally, she might still be dealing with all these same issues.

Dr. David Stukus: Yes. The one thing, there's a lot of misunderstanding and myths out there about can mom do anything while she's pregnant that will prevent the development of food allergies or eczema or things like that and the baby? And, unfortunately, no.

But that's actually a good thing because I like to tell mothers — because they carry a lot of guilt, unfortunately — it's not your fault, there's nothing you could have done in regards to what you ate, what you didn't eat, probiotic supplementation, Vitamin D, C-section versus vaginal delivery. We all do the best that we can with the information we have available. And, right now, there does not appear any solid evidence that shows that you can do anything while you're pregnant that will prevent that.

Dr. Mike Patrick: Now, in terms of the rashes that Kendra was describing, is that typical? Again, we don't make diagnoses here. We don't give advice to specific patients because you really have to have a doctor see your child and examine them. But the sort of thing that she was describing, are those typical for food allergies?

Dr. David Stukus: No, they're not. Those are typical for chronic skin conditions. And there's two that come to mind with the description here. The first, the most common one is eczema or atopic dermatitis. And eczema is a chronic skin rash that presents usually in the first six months of life and has a waxing or waning course. Some kids are worse than others. It's due to defective skin barrier which leads to a lot of water loss from the skin.

So you lose all the moisture, the skin gets very dry and itchy. It's very inflamed. Barriers work both ways, so it also allows a lot of irritants and even allergens to enter into the skin and cause more irritation and inflammation. A lot of people mistake the presence of eczema as being caused by food allergy. There are some children absolutely that have very severe eczema that fail conventional therapy and multiple medications that they have to remove food from their diet. But by and large, their eczemas is not caused by that, it's just a contributing factor.

0:56:26

But a lot of people get sent to me as the allergist say, "Oh, I want you to tell me what's driving my patient's eczema, what's causing it." And I know the exact cause of it. You have a mom who is predisposed to have allergies, who got together with the dad, who's predisposed to have allergies, and they have a baby who's predisposed to have eczema and allergies. So it's a barrier problem.

The other thing she described which is kind of neat is something called dermographism and this little image right on the skin. There are great pictures on the Internet of people writing poetry on the skin and things like that.
And what this is, this one very much looks like an allergy but it's not. It's just the same allergy cells in the skin that are involved in allergic reaction. They release histamine which causes a big raised itchy bump and some redness. But the provoking factor in this case is just stroking or scratching of the skin. And you can just anywhere that you scratch on the skin leave this line in place of basically causing a hive.

Now, that looks like an allergy. Allergic reaction often occur with hives, but not all hives do the allergy. So in this case, she's describing anything that touches the skin — her mom's hair, things like that — that's dermographism really to its essence.

Dr. Mike Patrick: And is that something that kids outgrow or they have that for a long period of time?

Dr. David Stukus: Yes, so for eczema, the vast majority of kids improve by the second or third birthday. There are some really severe cases, but most kids get better often by one. They'll have periods where if they're exposed to something very irritating, which we'll get to in a second, if they have an illness, they may flare up.

And dermographism isn't going to wax or wane for years, actually. Some people live with it throughout most of childhood. It may present during adulthood. Oftentimes, other family members have it as well, but that one will drive a lot of people insane, looking for a cause.

0:58:02

Dr. Mike Patrick: It seems that if you have a skin condition that waxes and wanes naturally, then it would be easy to start making associations that aren't necessarily causative. So, you may say "Well, when I eat this, it seems to get worse," but maybe it would have gotten worse even you hadn't eaten that particular food.

Dr. David Stukus: That's exactly right.

Dr. Mike Patrick: Especially with the mom that's breastfeeding.

Dr. David Stukus: Yeah, absolutely. So you have a baby who's eating six to eight to ten times a day, and they have a chronic skin rash that's going to sort of wax and wane throughout the day and throughout the week. And then, the one thing we all want to type out is what's the cause? And it's very easy to attribute to the last thing that you ate or that your baby ate, but oftentimes that's not the case at all.

Dr. Mike Patrick: Now, what about chemical. So those are allergic things that, in one way or another, we've talked about so far. And one, you're predisposed to the allergy of the breakdown of the skin. What about just sensitivity? So kids whose parents use a certain soap or laundry detergent and they get a rash, what's happening in that case?

Dr. David Stukus: With eczema, especially, or anybody with chronic skin rashes or may have just sensitive skin, anything that has a fragrance to it can be potentially irritating, even if it's natural or potentially helpful. So the first recommendation we offer is go fragrance-free. And that includes soaps, shampoos, detergents, even skip the powdered detergent because that may not get out the dryer cycle. No dryer seeds, no fabric softeners. Try to avoid essential oils. Perfumes, colognes, anything that really has a fragrance to it, because this can all be very irritating to the skin.

Dr. Mike Patrick: Is there still an allergic mechanism behind that or is it just more mechanical irritation?

Dr. David Stukus: That's right. It's more mechanical. So it doesn't really involve the immune system as an allergy would, so we can't really do allergy testing against essential oils or soaps and detergents. Although, there is a delayed type called contact hypersensitivity or contact dermatitis. That's very different than with eczema.

So eczema is imagine, you just have defective skin there and you're applying an irritant to it. Whereas, with the contact hypersensitivity like nickel allergy, that's normal skin, and then you're exposed to say nickel and then you get the rash very different.

Dr. Mike Patrick: And in terms of treatment, it's really just figuring out what chemicals are irritating your skin and avoiding those.

1:00:15

Dr. David Stukus: Right, it's avoidance and it's what something like eczema, it's really replacing the moisture that you're losing. So it's moisturize, moisturize, moisturize. I often tell families that, "I want your child to be so greasy that you can't pick them up because they slip through your hands," just to get the message across.

And type of moisturizer is important. So some of them will have lavender or fragrances in them, so that can be irritating things. So you want to go with an ointment that holds on to the water as opposed to lotions that are water based, may not absorbed very well. And then, avoiding anything that can potentially be irritating. And those are the main stays of therapy.

Dr. Mike Patrick: And the greasiness is because water doesn't like to go through the grease and so kind of locks in the moisture into the skin?

Dr. David Stukus: Right. Unfortunately, these are same things that destroy all the linen and clothes, so they're messy but that's good, because that means that they're soaking into the skin and protecting it.

Dr. Mike Patrick: Now, what bathing? Can you bathe too much? It seems the recommendation used to be don't bathe kids as often when they have these kinds of skin problems. And now, it seems it's swinging back more toward it's okay to bathe them. What are your thoughts on that?

Dr. David Stukus: So if you line up a hundred allergists and dermatologists, you'll get a hundred different opinions on this, but you're right, it has swung back a little bit towards it's probably best to bathe daily. You know, limited bathing, five to ten minutes at a time, lukewarm water. More than anything, just kind of clean the skin. You don't have to use soap necessarily or scrub vigorously but just kind of clean the skin of any dirt, bacteria, and irritants.
And then, immediately, after bath time is the best time to apply an ointment because you're going to lock in that moisture to the skin. You don't want to dry them off completely and lock them in.

Dr. Mike Patrick: Kind of pat them dry and grease some down.

Dr. David Stukus: Yeah, exactly. Just make it part of the daily routine.

Dr. Mike Patrick: And then, Kendra had mentioned oozing that gets better with Mupirocin, which is a type of topical antibiotic. I guess, and again, we don't make diagnoses here but based on that information, it is easy when you lose your natural skin barrier to be able to get sort of superficial skin infections like impetigo. Something else to worry about but you'd want to talk to your doctor.

1:02:14

Dr. David Stukus: Absolutely. Yes, staph aureus is the most common bacteria that we all have that lives on our skin. Anytime we break the skin barrier like you mentioned, it can enter and then cause infection. And if there were a board exam, with this question on, then that would scream yes, there is infection there with the weeping and oozing, that gets better with an antibiotic ointment.

Dr. Mike Patrick: Yup, but it's really important to address all these concerns with your child's doctor because again they're going to ask more probing questions about the history, about the family history, examine exactly what the rash looks like because how you describe may be different than… I mean the picture I get in my mind may be different than what Kendra is actually seeing. Right?

Dr. David Stukus: Absolutely, yeah. So, it's all individualized but it takes some time, and you have to have sort of — if that's the diagnosis in fact, the eczema — then realistic expectations regarding the course of it. So there's no cure that we're aware of. The skin will be very sensitive and rashes will come back from time to time, but there are very effective treatments out there. Some of which don't even involve medicine, so just moisturizer and avoidance of irritants, and most kids do great.

Dr. Mike Patrick: Well, we really appreciate you stopping by the studio to talk to us today.

Dr. David Stukus: Yeah, it was my pleasure. Thank you again for having me by.

Dr. Mike Patrick: Absolutely. And thanks for the questions, to Kendra from Pennsylvania.

Remember, if you have a question for me, it's easy to get in touch. Just head over to PediaCast.org and click on the contact link. You can ask your question that way. You can also call our voice line at 347-404-KIDS, that's 347-404-K-I-D-S.

All right, let's take a quick break and I will be back right after this.

[Music]

1:04:24

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

Lots of guests to thank this week — Dr. Amy Sternstein with the Center for Healthy Weight and Nutrition at Nationwide Children's Hospital, Dr. Elizabeth Zmuda, Urgent Care doc at Nationwide Children's, the Reverend Susan Kyser, director of Pastoral Care at Nationwide Children's, and Dr. David Stukus, a pediatric allergist, also from Nationwide Children's.

And, you know, we love having folks from there because that's where we are and it's so easy to have them stop by the studio and visit with us. So really appreciate all of them for taking time out of their very busy schedules to share their knowledge and expertise with all of us.

That is all the time we have today. PediaCast is a production of — you guessed it — Nationwide Children's.

Don't forget, you can find us in all sorts of places. We're in iTunes, in the Kids and Family Section of their podcast directory. We're also in most podcast apps for iOS and Android.

If you can't find us in your favorite podcast app, be sure to let me know and I will do my best to get the show added to their line-up.

We're also on iHeart Radio, where we not only have this program but also PediaBytes, B-Y-T-E-S. These are shorter clips from the show. They can be weaved together with other content providers to make your own custom talk radio station.

And, of course, then, there's the landing site, PediaCast.org. You'll find hundreds of past episodes, Show Notes, transcripts, our terms of use and a handy contact page to ask questions and suggest show topics.

We also have a voice line if you'd rather phone in your question or comment. That number is 347-404-KIDS, 347-404-K-I-D-S, just 5437 if you need the digits.

And, we're on social media including Facebook, Twitter, Google+ and Pinterest with lots of great content you can share with your own online audience.

1:06:17

Of course, we always appreciate you talking us up with your family, your friends, neighbors and co-workers, anyone with kids or those who take care of children, including your child's healthcare provider. In fact, next time you're in the office with your kiddo — maybe for a sick office visit, it could be a well check-up, a sports physical, medicine recheck, really, whatever the occasion — let them know you found an evidence-based pediatric podcast for moms and dads. We've been around for nearly a decade, so tons of content, deep enough to be helpful but in language parents can understand.

And while you have your provider's ear, please tell him we have a podcast for them as well — PediaCast CME, which stands for Continuing Medical Education. It's similar to this program, we do turn up the science a couple of notches and offer free Category 1 CME Credit for listening. Shows and details are available at PediaCastCME.org.

We also have posters if you like to share the show the old-fashioned way — but hey, it works — and those are available under the Resources tab at PediaCast.org.

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

[Music]

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

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