Sleeping Positions, Vitamin Supplements, and Potty Training – PediaCast 004
- Sleeping Position
- Vitamin Supplements
- Speech Development
- Potty Training
- Playground Safety
- Head Lice
Announcer 1:& This is PediaCast, Episode 4, for August 9th, 2006.
Announcer 2: Hello, moms, dads, grandmoms and grandpas, aunts, uncles and anyone else who looks after kids. Welcome to this week's episode of PediaCast, a pediatric podcast for parents. And now, direct from Birdhouse Studio, here is your host, Dr. Mike Patrick Jr!
Dr. Mike Patrick: Hi, everyone. This is Dr. Mike Patrick Jr and I'd like to welcome you to this week's edition of PediaCast, a pediatric podcast for parents.
This week, we're going to alter the format a bit and divide the program into four segments based on age. In our Infant Section, we'll discuss sleeping positions and vitamin supplements. Then, we'll move on to Toddler Topics and discuss language development and potty training. In our School Age Segment, we'll look at playground safety and head lice. And then, we'll wrap things up with the teenage topic as we open the Listener Mailbag and answer some questions about scoliosis.
That's all coming up on this week's edition of PediaCast, it's Episode 4 and we'll get it all started right after this.
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Dr. Mike Patrick: All right, welcome back to the program. We're going to get right into our very first Infant Segment and we have two topics for you this week.
The first one is on sleeping position. This is something that's kind of changed over the years. It used to be that babies were put to bed on their bellies back when I was a baby. That was the thing to do. And, of course now, we've had the big back-to-sleep campaign, which means we want to put babies on their back, that that would be the safest position.
Now, how they come up with that? It's pretty simple, really.& They did what's called a demographic study and this was done back in the late 1980s. And what they found is that if you look at the group of kids who died from SIDS or Sudden Infant Death Syndrome, also known as crib death, if you took a large group of those kids and simply ask their parents, "When they died, what sleeping position were they in?" And what you find is that the most of these babies were sleeping on their tummies or on their bellies. And the next number, in terms of amount, were sleeping on their sides and the least numbers were sleeping on their backs.
So, the deduction came that back sleeping would be safer than side sleeping which would be safer than belly sleeping. So they had the big back-to-sleep campaign during the early 1990s. And the rate of SIDS or Sudden Infant Death Syndrome really just plummeted in the United States. So, it really did make a big difference.
Now, there has been a little bit more leniency or laxity, I think, in this and a lot more parents are putting their babies to sleep on their sides these days. And sometimes, I've even seen some neonatologists recommending that. Also some labor and delivery nurses or the infant nursery nurses recommending it.
The official stance of the American Academy of Pediatrics is still that back sleeping is safer than side sleeping. And even though you think, "Well, golly, if babies were sleeping on their back and they spit up, are they gonna be more likely to choke on it?" And for babies who do not have significant reflux problems or significant spitting up, it's really not true. There is no increased incidents of spitting up and choking on vomit if kids are sleeping on their back compared to on their side.
Now, again, we're talking about healthy infants here. Infants with severe reflux disease where they spit up a lot, and that's under the care of your doctor, different sleeping position may be warranted for them.
& You also want to make sure that when you put your baby to bed on their back, that it's in a crib that meets all the current safety standards with regard to spacing between the slats and the size of the mattress. So that it fits into the frame snugly so that there's no spaces that little infant hands can get down into. You also want to make sure it's made of flame retardant material — all of those things.
You want to keep them off of waterbeds, sofas, any real soft spongy kind of mattresses. Because even if you put them to bed on their back, there's going to be, every now and then, where a baby would kick really hard and get up on to their side, and then maybe& even get over on to their belly at a young age. Probably not something they're doing every night, but it could happen once in awhile. So you want to be prepared and just make sure that there's no real soft surfaces that your infant could suffocate on if they were somehow to get turned over on to their belly in the middle of the night.
Also, you don't want to use any objects in the bed that they could suffocate in. So no pillows, no clothes or comforters or any of those kind of things should be in the crib with a sleeping infant. Any of those items could block your child's airway. Even if they're lying on their back, if they were to wiggle and the object would fall on top of their heads. I've seen strange things happen. So you have to make sure there's really nothing on the bed except the flat sheet on top of the mattress and your infants dressed in warm clothes lying on their back. That's the safest way to do it.
Now, a lot of parents are using these devices that are designed to maintain a particular sleeping position, especially ones that keep them on their side, kind of in a snug hold. And these are not recommended. The American Academy of Pediatrics says that these are not recommended. And the reason is, that they can have their own safety issues. For instance, if a baby were to kind of wiggle down into these devices, they could actually suffocate on the device itself. Or they could get turned over on to their belly and then not be able to turn back on to their side and on to their back because of the device. And none of those devices have ever been shown to reduce the risk of SIDS.
So again, safest position is going to be on the back, just put your baby to bed on their back. We are talking, by the way, young infants here – zero to six months of age. So you want them to be on their back and warm clothes, flat sheet, no pillows,& no coats, no comforters, nothing like that.
Again, something else to keep in mind, this is for healthy babies we're talking about. Your infant may have a medical condition that requires a different sleeping position for maximum safety. So definitely talk to your doctor and follow their advice because this is generically meant for healthy babies.
Also, this information is for sleeping babies. Now, that's important because supervised tummy time while babies are awake is an important part of developmental activities. So tummy time is fine as long as it's supervised and they're awake.
Now, with the back-to-sleep campaign and more and more babies sleeping on their backs, we are finding more infants with flat spots in the back of their heads. And that can happen from sleeping on their back every night in one position. You can start to get a little bit of a flat area on the back of the skull. Now, tummy time during the day will help to decrease this a little bit. But in some kids, you can get quite a severe flat spot in the back of the head or a flat area, even with tummy time.
Now, it should be noted that this is not associated with any developmental brain problems if the flatness is caused from sleeping on their backs. So in other words, if they're flat on the back of the skull and the reason they're flat in the back of the skull is because they're sleeping on their back. And in those kids, there has never been any case of developmental brain problem because of that flatness.
On the other hand, you could have some developmental brain problems that could cause a misshapen head. But those misshapen heads are caused because of the developmental problems, whether it be in the brain or the skull and not from sleeping on the back. So if your baby does have flat spots or misshapen head, you definitely want your doctor to take a look. But if your doctor feels that the reason for the misshapenness is because of back sleeping, then it's really not a problem that you have to worry about. &
We do know that those flat spots from sleep positioning, as babies get older in later infancy and toddlerhood — they start to move around more in their sleep, have different sleeping positions — and then, usually, the skull reshapes itself.& And by the time these kids are going to preschool or kindergarten, they're nice and round again and not anything to worry about.
A few years ago there seemed to be a bit of a fad with regard to this expensive custom helmets where you could put the helmet on the baby during the daytime and it would help to reshape their head and make sure that the kid's head was rounding out nicely. These are certainly not recommended. They tend to be expensive. Insurance doesn't cover them. Usually, there's like two or three doctors in a given state who does them. And really, they have been shown to help kids in terms of reshaping their skulls.
It's one of those things that were OK, sure, you put these helmets on and maybe instead of having a round head by the time that they're two or three years old, by the time they're 15 to 18 months old, it's a little bit more round. And yeah, it may be nice for baby pictures but it's not something that's medically necessary.
OK, moving on in the Infant Segment, we're going to talk a little bit about vitamin supplements. Now, vitamins are chemicals and they are needed in trace amounts in the body. And basically, they're involved in helping certain chemical processes occur within the body. The body has a limited ability to make these chemicals on its own so they have to come from diet. And failure to get proper amounts of these vitamins lead to vitamin deficiency diseases.
So, in other words, if you are deficient in Vitamin B1, you're going to be at more risk of developing a disease known as beriberi. If you're deficient in Vitamin B12, you're going to be more at risk for developing pernicious anemia. And Vitamin C deficiencies are associated with scurvy. Vitamin D deficiencies are associated with Ricketts.
Now, the point of this discussion is not to define what all these vitamin deficiency diseases are. And the reason for that is because they're extremely rare in the United States. And the reason they're extremely rare is because most infants are getting the vitamins that they need. Infant formulas have all the vitamins that are necessary in them, so separate vitamin supplements are not necessary if your baby is a formula-fed baby. &
Now, breast milk is also full of vitamins. However, moms should definitely take a vitamin supplement to prevent her own vitamin depletion. Because the vitamins in her body are definitely going to get into the breast milk, but they may deplete her body's supply of that vitamin. So it is important that breastfeeding women take a vitamin supplement the entire time that they're breastfeeding. And probably, their prenatal vitamin is going to be just fine for that. Thiamine, calcium and iron, easy to get from the obstetrician. You probably already have plenty of it around the home with some refills left on it. So just continuing to take the prenatal vitamin during breastfeeding is fine to do and that's going to help all the vitamins get in to the breast milk that the baby's going to need.
Now, there is one exception to that and that is Vitamin D. The reason for that is because the skin actually is able to make the amount of vitamin D that you need as long as it's exposed to sunlight. Now, how much sunlight is needed to make an adequate amount of Vitamin D?& Well, that depends on how much pigment is in the skin. So the less pigment that you have, the less sunlight that you need to make an adequate supply of Vitamin D.
So, for Caucasian infants, they need the least amount. It will be about 15 minutes of sunlight exposure a week is enough to make the Vitamin D that babies need. And now, as skin pigment increases, so in Asian and African-Americans, the amount of sunlight that's needed to make an adequate amount of Vitamin D is going to increase. These babies may need more than 15 minutes a week in order to make enough Vitamin D.
Well, the problem with that, is of course, if you live in an area with sunlight that's minimal during a large part of the year, and here in Central Ohio where we are, it seems like during the winter time, we can go days on end without seeing a lot of sunlight. So babies' skin are not really going to be exposed to it that much. And of course, if you live in an area where you got a lot of sun — so, if you're down at Florida, the southeast United States, those kind of areas — you're going to have the risk of sunburn if you let your baby out in the sun too long.
So, breastfeeding babies, some doctors may recommend a vitamin supplement to them. So you don't have to worry about the sunlight issue and your baby is sure to get adequate amounts of Vitamin D. So talk to your doctor about that.
There's not really a consensus on that. It's one of those things, if you got a 100 pediatricians in a room and ask them if breastfed babies needed vitamin supplements, you're going to get a variety of answers. And the experts even aren't going to be able to agree a 100% on what the right thing to do with that is. So find a doctor you trust and go with their opinion on that.
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Dr. Mike Patrick: In this week's Toddler Section, we're going to talk about speech development and potty training. These are topics that are near and dear to all parents' hearts who have toddlers at home. This is something that comes up practically just about every day during well child checkups. Both of these subjects are things that we talk about as pediatricians in the office quite often.
Speech development is a little bit of a touchy subject. And I say that because it's really difficult for parents not to compare kids with one another. And we compare our own toddlers with toddlers who are maybe in preschool with them, who are in church nurseries, play groups, all kinds of places where they come into contact with other kids – a family reunion, neighbors. And then, even within the same household, parents will compare one kid to another. And there's such a huge variation of when speech development happens.
Now, sort of the textbook normal for speech development is going to be, at 12 months, baby should have a handful of words, just doing one-word sentences. And the definition of a word at 12 months is simply a sound that the baby makes and as a parent, you know what that sound means. So it doesn't have to actually be an English word but you want some vocalization, a handful of different vocalizations each one meaning something specific that you as the parent are able to understand exactly what that means.
And for me, that's normal speech development in a 12-month-old. Now, certainly, you're going to have some 12-month-old that are saying 'mama' and 'dada' and being appropriate with it. But more often than not, 'dada' just means an adult person who's in the room. I can't tell you how many times I've had a 12-month-old go "dada-dada", when they look at me. And, of course, the mom is like, "Oh, no! No! That's not dad!" But it's just basically any adult male or even any adult, they're just using the word 'dada' because they don't understand that means father. They just understand that as meaning a person.
I'm not saying for your particular child. When your child says 'dada', I'm sure they mean dad. And when they say 'mama', I'm sure they mean mom.
Dr. Mike Patrick: Like I said, it's a touchy subject.
OK, and then, in terms of normal two-year-olds usually are putting together now two-word sentences. And now, we're getting into more words of whatever language is spoken in the house. And it's also important at this point that parents understand most, definitely half, maybe three-quarters of what a two-year-old is saying. So, they're getting a little bit better at saying specific words and then starting to put a couple of words together into very some simple two-word sentences.
And then, by the time you get to three-year-old, well, guess what?& Now, you're putting together three-word sentences. And now, it's not just the parents that can understand half the three-quarters of what they're saying but now, strangers can even understand sort of half the three-quarters of what they're saying.
Now, again, what I'm giving you is sort of the textbook definition of what normal speech development in children is supposed to be. Now, in a day-to-day clinical practice, what I actually see, there are some definite patterns that you have to take note of.
The first is that, in general, girls develop speech a little bit faster than boys do. And just even in my own kids, my daughter when she was 18 months old, she could recite nursery rhymes back to you. My son, when he was just turning three, he's grunting and pointing at stuff still. So there's definitely a difference between girls and boys. Incidentally, my son is nine now and my daughter's 12 and of course, his speech is just fine. But you do definitely see a variation between boys and girls. And not just in my own kids, I see that in the office quite often.
The first thing is that first children tend to develop speech faster than subsequent children. And the reason for that is because first-born children are there with the adults, the adults are talking. And if the children want their feelings known, they have to learn how to speak a little bit faster. Whereas, subsequent children, well, one, the parents are getting better. They're probably better at anticipating needs. But, also, the older kids now, oftentimes, will start to talk for the younger kids. So if the younger kid wants his sippy cup refilled, the older sibling may say, "Hey mom, little Buster needs more milk in his sippy cup." And so, he doesn't have to learn to say milk quite as fast.
So, a lot of times younger kids, and it does seem that the more older kids that are in the house, the longer it takes. So you're going to have children who are first-born developing their language a little bit faster and girls developing their language a little bit faster. And then, when you start comparing them to one another, it seems like the second and third and fourth-born boys, they're the ones that develop their language usually last.
Now, again, these are just generalizations and you have to take each kid separately and look at the exact context. And I say that because if you do have a kid that you're concerned about, and it's a boy and there's other older kids in the house, are there some things that you can do to give yourself some reassurance that they still have their language development on track? And it is true that there are some things that you can look. So things that make you feel pretty good about older two-year-old or even early three-year-old who may not be talking quite like mom and dad want them to talk.
One is, do they have good receptive language? And what that means is, do they understand what you're saying? So mom says, "Hey, go pick up the ball" or "Go close the door" or "Put your toys away." For a two or three-year-old, if they want to do what mom says and they actually do it, they understand the language that's spoken in the house, they may not be repeating or coming up with it on their own, but they understand it, that's a good sign that language development is on track and it's going in the direction that you want it to go.
The other thing is, if they're not talking a lot, or they grunting and pointing a lot, but they have good receptive language and they have good social interactivity and all of their other developmental milestones are OK, that makes you feel a lot better about it as well. If you have a two or three-year-old, however, who does not seem to interact with other kids or even with mom and dad, or they're behind in other developmental areas and they don't have good receptive language, now, you got a two or three-year-old that you're worried about.
So what kind of things can cause speech delay that you're worried about? Certainly, hearing problems. So, if you have deafness, that can definitely cause some language delay. Also, autism, mental retardation, various developmental diseases are all going to be a possibility when you have kid whose speech is delayed.
Now, so, where is the role of speech therapy come in all this. Well, if you ask a speech therapist and if there are any of you out there, I certainly don't mean to offend any of you. Speech therapy definitely has its place. I think it's most helpful for kids who have articulation problems who are in the four, five and six year old range. Kids who are not quite talking yet who are two or three, well, certainly they're not going to hurt from speech therapy.
A lot of these kids are shy. They don't interact well with strangers anyway. And so, it does becomes a little bit of a more play therapy than speech therapy when you're talking about two and three-year-old kids.
But certainly, it's not going to hurt by having a kid who's having some language delays see a speech therapist. They could only help, but it probably won't help that much until they're more in a four and five year age range with that. At least, that's been my experience.
Also, it becomes a little bit of a cost issue getting insurance companies to pay for speech therapy in a two or three-year-old. It becomes a little bit difficult. You can certainly make the case for them paying for it in a four and five and older child a lot more.
And it also comes down to parent comfort level. I mean, if you have a two or three-year-old who's not talking really well and you're really concerned about it — even if they have receptive language that's good and social interactivity and all of their other developmental milestones are going OK — if it's going to give you some comfort to have hearing screens and speech therapy and all that business and you're willing to pay for it, then it's something that may be right for your family.
OK. Our second topic in our Toddler Section this week is potty training. We talked about another issue with a large degree of variability. Once again, as with speech development, girls tend to develop faster and are able to potty train a little bit quicker than boys in general. And really, potty training can range anywhere from 18 months to four years of age, so there's a big range of when it can happen. Now, most kids, it's going to be somewhere between two, 2 1/2 and 3 to 3 1/2. But certainly, you're going to have& few that do it early and a few who do it later. That's still all within the range of what you would consider normal.
Obviously, urine or pee potty training is going to come before stool, poop. Also, the child, and this is really important, they have to be physically ready to do it. So there comes a time when even if they really want to use a potty and they want to be able to tell you, there is a physical barrier. So you have to actually be able to hold your bladder and actually be able to hold your stool in order to be potty trained. And a lot of these kids are not physically ready until they're two or three years of age.
& Now, are you going to have the really rare occasional 18-month-old who points at the potty and mom sits him on it and they pee, and yeah, they soil now and then, but mom says they're potty-trained. I'm not going to argue with that. But most kids are going to be two or three years old really before it happens.
Now, in addition to being physically ready to potty train, they also have to be emotionally ready and interested. And the 'and interested' part is really important, because a lot of times what happens is, in the beginning, things seem to go really well. You got this two-year-old and they're wanting to go into the potty and "Well, this is great!" Everything's working well for about two weeks and then, all of a sudden, all is lost. Backslides occur, they're wetting their pants again. They're forgetting to tell you. And really what happens is they just lost interest in it. Some of these kids are just not emotionally ready and it becomes a battle of wills. And at that point, it's probably better just to say, "Yeah, let's forget about the potty training, wait a month and just start all over again."
Some helpful hints that I've come up with along the way in terms of when's your child is physically ready to potty train, and emotionally ready to potty train. What are some things that you can do? Well, you really want to have, I think, both an immediate reward to them doing the act, I guess you'd say. And also sort of a long-term reward, something that they can be working toward that make it seem like a game.
OK, so what kind of things am I talking about? Well, and these are just examples, you can certainly tailor it for your own kids. One thing that's nice is to have some kind of treat that they like to eat, whether it be a type of non-chokable candy or the M&M's. If your child's really good at chewing those up and swallowing them. Really, just any kind of treat that they're going to like, could be even small bite-sized cookies, little handful Fruit Loops, just something that's really going to catch their attention and put that in a jar and every time that they go, then they wash their hands, and then they get a little treat. So there's definitely a reward right after they do it.
Now, the other thing that you can do, and this especially works well for some of the older kids who were taking a little longer to potty-train, and that's to come up with a sticker chart kind of system. So every time that they go in the potty, whether it be their little potty chair or the big potty, they get to put a sticker on their sticker chart. And I'd start with a low number, so you could say, "Now, when you get three stickers, then we're going to go to Chuck E. Cheese's or we're going to the toy store or we're going to go to the park." It doesn't have to be something that cost money, but just something that's going to get them really excited that they can look forward to. And then, you can say, "OK, you did so well with three stickers. Now, we're going to go four stickers." And then after that, "OK, you just got to get five stickers this time," and stretch it out that way.
& Now, if you have a kid who's absolutely refusing to do it, what you could do in the beginning is say, "I tell you what, if you just sit on the potty and try, you don't even have to go on it. But you just sit there and try, then you're going to get to put your sticker on the chart. And once you get four, five stickers, we're going to go to a special park or do something fun that's real special." And then, you can start doing advancing it and say, "OK, now, you don't just have to sit there. You actually have to do it and then you get the sticker." Or it might even be, "You tell me that you have to go, and then you get the sticker."
Again, there's no right or wrong or definite way to do this. It's just a matter of doing what feels good for your family and what your child's going to respond to.
OK, now, what are some normal things that you can expect in doing this? Well, number one, you're going to see a lot of kids who go in their diaper and then they come up to you and say, "Oops, I went." And you're frustrated because you want them to tell you before they go so you can put them on the potty. But you do see a lot of these kids who forget or they don't want to go in the potty and they go in their diaper and then they want to change right afterward.
Don't leave these kids in their wet and dirty diaper. Sometimes, you hear the occasional relative saying "Oh, just leave him on it for a little while, let him be uncomfortable. That will teach him." You really don't want to do that. If they come to you and tell you that they want change, I would praise him, tell him, "That's great that you went and you knew that you went. We'll get you a clean diaper." And then, you can encourage him, "Now, you don't get to put your sticker I know this time. If you can tell me before you go, then you're going to get to put your sticker on."
So that's something that we do see quite a bit. And it's actually a good sign. A lot of these kids, it's only a month or two after, they're doing that sort of thing that the potty training process is starting to be completed.
Another thing you'll see is kids wanting to wear underwear and then asking to have a diaper put on especially when they have to go poop. And the reason for that, a lot of kids are just afraid of the toilet. When they're going to pee, especially boys, they're standing up to pee, they're going into their little potty chair. But a lot of times with going poop, you& want them to use the bigger potty so that's a little bit of less of a mess. And it can be frightening for them. Or it may be, too, just… Nah, I hate to say laziness, but you know, it may be easier for them just to put the diaper on and poop that way and mom cleans it up afterward.
So, you do see this a lot. I'm not sure exactly why for every kid, you see it. But it does seem to be a bit of a pattern. And a lot of these kids again who were in their underwear and then asking to use the diaper to poop, I wouldn't make a big battle of the wills about that, either. Just kind of go with it. And a lot of times, within a month or two, the potty training process is complete.
So, those are some things that we do see quite often. Now, some pitfalls, again, you want to definitely avoid arguments and sort of war of the wills because everyone just gets frustrated. And unless there's a physical condition which is really unusual, your kid is going to be potty-trained. You don't see kindergarteners going to school with diapers on. And so, really, don't get too stressed out about this. A lot of times, it's the parent's stress that makes it an unpleasant situation. And sometimes you do really just have to take a step back and say, "All right, we're just going to go back to diapers and pull-ups and we'll wait a month and then, we'll introduce something new."
Also, and this is kind of interesting, you want to do take some risks. A lot of parents say, "Well, I'm not going to do underwear until they're dry and they're not spoiling." But a lot of kids, especially when you get into the three-year-olds, if you're given that chance and say, "You know, let's go ahead and get you an underwear,"& you'll be amazed that the number of kids that do just fine with that. They understand when they have the pull-ups on that it's OK to poop and pee on them.
And even bedtime wetting — my own son, I remember, he was in pull-ups and every morning, he'd be wet. And I was like, "What are we going to do, how are we going to get him out of pull-ups?" I mean, like, he was late too. How are we going to do this? And our pediatrician at that time, because I was a young doctor then, our pediatrician at the time said, "Just put him on underwear." And we did that, and you know what, the very first night we put him in underwear, dry. Dry in the morning.
So, a lot of these kids, you take a little bit of a risk and they end surprising you. If you're worried, of course, you want to make an appointment with your doctor, There are diseases than can cause failure in potty training. And if they are potty-trained both for urine and stool and they have been for quite some time, and all of the sudden, they're regressing and not able to do it, then that's something that you probably do want to talk to your doctor about.
Some common example of things that can cause a failure in potty training or regression once they seem to have been potty-trained — constipation's probably the leading one. Constipation can cause failure in stool and urine continence or the ability to hold it. If you're constipated, and this is interesting, we'll have a constipation talk at some point on one of these PediaCast, because that's one of the things that we just see day in and day out in pediatrics.
But constipation, the definition of it is just having an intestine that's full of stool. You can have a normal soft bowel movement every day and still be constipated. And if you have a lot of stool in the intestine and that's pushing on the bladder, the bladder's kind of trigger happy and it can squeeze and make kids have some urgency and just have to go to the bathroom pee wise real quick. So a lot of times, if they get their constipation taken care of, then the urine problems go away.
If it's isolated bedwetting, usually, constipation is not going to do that. It's more of the kids who are having some accidents during the& daytime.
And then, there are& some other more serious diseases but they're much less common. I guess, that's the good news. And there are things like tethered spinal cord, neuromuscular diseases and diabetes and those are all things that also can cause some problems with stool and urine continence or ability to hold it.
So, things to talk to your doctor about if you're worried and getting to be a late three or four years old and still not potty-trained, or if they were potty-trained at one point and were doing really well with it for a long time and then they're starting to regress and having some problems. And again, those aren't things that you look up and take into your own hands. If there's a problem, go see your pediatrician.
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And now, we're going to move on to our School Age Section on PediaCast and this one, you know, a little bit of an off-medical topic. It's more of a safety discussion. But I think it's an important one during the summer. And that's on playground safety.
& Now, each year, 250,000 American kids who are 15 and under are treated in emergency departments for playground injuries. And somewhere between 10 and 20 of them would die from their injuries. Most of these injuries occur at school and on public playgrounds but about 25% of them occur on a home equipment.
Now, what kind of injuries are we talking about? Well, they can range from mild cuts and scrapes and bruises to sprain joints, broken bones, dental trauma and head injuries. And head injuries are going to be the most serious of all of those in terms of the possibility of causing death.
Seventy five percent of all playground injuries are caused by falls and it's usually from climbing equipment such as monkey bars and slides that they fall from. And then, other kinds of injuries are going to come from equipment impacts. So in other words,& swings and teeter totters and that sort of thing. Splinters can come from old wood, cuts and scrapes can come from loose parts, exposed nails and screws, that sort of thing. Also there's the possibility of pinch point in playground equipment and also sharp edges.
So these are all things to look at. But really the impacts with swings and teeter totter and falls up a monkey bar and slides, these are going to be the things that worry you the most.
OK, how can you prevent this kind of injuries? Well, probably, the biggest thing that you can do, since the one that's going to cause the most serious injuries is going to be the falls, is to use an impact absorbing surface beneath the equipment. Now, why is this important? Well, a one-foot fall, one foot, a 12-inches fall on your noggin' on the asphalt or concrete can actually cause a fatal head injury. And it can cause a broken blood vessel in the brain. It's definitely rare but it's something that can happen. One-foot fall, bare head, concrete or asphalt and you can have a very bad outcome.
You know, I can't get over that statistic because it is true and it has happened. But gosh, when I was a kid, and maybe when you were a kid, playgrounds were on top of concrete. I mean, I remember this enormous slide that was in my elementary school playground that I'm sure was twice as tall as any safety standard today. Made out of metal in the baking sun and literally it was concrete on the bottom of it. Now, I never knew any kids that fell from it, but I'm telling you if any of them had, that would have been bad news. So we've definitely come a long way with playgrounds safety.
Now, you may say, "OK, so we don't want to do concrete or asphalt. What about just dirt or grass?" Well, a four-foot fall on compact earth or grass can also result in serious injury or even death. So, what are some safer things that you can do? Well, safer surfaces are going to be those that help absorb the impact and reduce the chance of serious injury or death. And they have to keep in mind that these things are not going to eliminate that risk completely.
OK, so what are some examples. Well, sand is a good example. And you have to have sand about ten inches deep to provide an adequate safe surface. We've seen wood chips used a lot. Wood chips have to be 12 inches deep in order to be considered as safe impact-absorbing surface.
More and more we're seeing these rubber chips, like mulch tires, that sort of thing. And those are great. It depends on the exact type of chip, the size of the chip, the exact density of rubber that it's made out of.
So in terms of figuring out how deep with those that you're going to need to make it, you just want to be sure to follow the manufacturer's directions on those kind of items. Now, whether it's sand or wood chips or these new rubber chips, you're going to want to rake the surface at least weekly to keep the surface soft. You don't want to get hard clumps in certain areas and by raking it, it will just help keep the whole absorbing impact area soft.
Also you want to make sure you have enough extra to refill as needed, because certainly, some of the sand or wood chips or rubber chips are going to spread around and carried inside the house, around the rest of the yard. So you're going to want to make sure that you have some extra so that you can keep the recommended depth all the time.
OK, and then, if you do have the safe absorbing surface underneath, any platforms that are above the surface should not go any higher than eight feet above the ground. That's considered the maximum safety level for platforms, whether it be slides, monkey bars. Really, nothing on the playground should be higher than eight feet. And any platforms that are eight feet should have guardrails on them that are at least 38 inches high. You don't want no guardrail because it obviously could fall off the platform and you don't want too short of a guardrail because you don't want kids to be able to lean over them and topple that way. So you do want guardrails up on top of the platforms.
Also, if there's any vertical or horizontal openings — so any slats in the guard rails or any horizontal monkey bar type openings — all of those should be less than 3 1/2 wide or more than nine inches wide. And why is that? Well, it's to avoid head entrapment. So if you have an area that's between 3 1/2 inches and nine inches, it's more likely that children could get their head through that opening and not be able to pull it back out. Also, to keep a safe playground, you're going to want to check the equipment for sharp edges, pinch points, splintering woods, any loose parts and any exposed nails or screws.
Now, you know, not a lot of people are going to have major playground equipment in their backyard where we're talking about and putting in a foot of those rubber chips. So why are we talking about this? Well, most of these playground injuries do occur at schools and parks. And certainly, you can be a proactive parent. Check out the playground at your local park, check out the playground at your school. Make sure that it meets the safety recommendations. And if it doesn't, talk to your city commissioners or you can talk to the school board members. Make yourself heard and if your school or park is not up to snuff in terms of following the safety regulations — recommendations, I should say — then, you want to put them out to them and make sure that they are.
Other points with playground safety, you want to make sure that you follow all manufacturer's instructions when installing. Make sure that you have proper anchoring because that will help prevent tipping of any equipment. And again, that should all be in the manuals of how to install.
Playground equipment should be at least six feet from any barriers such as walls, fences, trees, that sort of thing. Swings should be at distance from other objects that is twice the height of the swing. Swing seat should be made of rubber, plastic, or canvass and kids who are under the age of five should use chair swings rather than just free ones.
Also, if you have any S-hooks on swing chains, those should be all closed to form a figure eight. You don't want any open S-hooks, because things could come undone a little bit too easily that way. Slide should be positioned in the shade or away from the afternoon sun. And, of course, keep in mind that metal slides can get very hot and result in burns and plastic slides are much less likely to burn kids. Slides should have platforms at the top with handrails . And the sides of the slide on the way beyond should be at least four inches high. You want to make sure that the bottom of the slide is kept clear of debris and of rocks, sticks or toys.
Make sure that the kids follow safety rules, that they know they have to keep clear of swings while they're in use. Keep the bottom of the slide clear. Only one person at a time on the slide and the swings. Make sure they understand all that.
And also, when they're playing on playgrounds, you really don't want any drawstrings — like hoodies, jackets, they have drawstrings on them — because those can get caught in equipment. Especially if the drawstring's around the neck, it can result in strangle injuries. And there had been kids that have died on playgrounds because their drawstrings and their hoods have got caught on playground equipment.& So really the safest thing to do is just not having any clothing with drawstrings on them at all if they're playing on the playground.
All right, moving on to our second topic in our School Age Segment. And this is a back-to-school and it's head lice. Head lice is something that in the Fall we see quite often as kids go back to school and they start passing it from one to another. Head lice, really is just like any other infectious disease. You know, you catch it from other kids. It is not a sign of being dirty or keeping a dirty house. It happens and it happens in poor families. It happens in middle class families. It happens in families whose dad is a CEO of a major company. So it really can happen to anybody.
Live lice are the little grey bugs that live on the scalp and in the hair and they cause itch and rash on the scalp. The adults are tiny, they're only one-sixteenth of an inch long. They're grey and they're kind of hard to find because they move around quite a bit. They can be difficult to see. You have to almost have a trained eye. But if you see something that's one- sixteenth of an inch and grey moving around your kids hair, and there's little white things which we call nits, then it's probably head lice.
The nits are basically eggs that the lice lay. And they attach firmly to the hair shaft. Now, you don't want to mistake dandruff for lice nits. Dandruff's going to be dry skin that can look like nits, but dandruff is easily removed with just a simple share. You just barely touch it and it comes right off of the hair. Whereas the nits are just firmly attached to the hair shaft. In order to remove them, you really have to use a bit of force to pull them along the hair shaft and then off of the hair to get them off of the head.
So that's one way to know, if there's something little white in the hair and you pull it right out, it's probably fuzz or dandruff from the scalp. But if it's something that's really stuck to the hair shaft that you have to pull it along the shaft to get it out, then it's much more likely to be a nit from head lice.
Now, how does it spread? Really, just like any other infectious disease, scalp to scalp contact is going to be one way that head lice can transfer from one kid to another. Also, by sharing things that you use in relation to the hair –, so hats, combs, hair brushes, any decorative accessories that girls use in their hair. If you share those, then it's going to be more likely that you could transfer head lice from one kid to another.
Now, in order to find it, we talked about that a little bit. Once it's been transferred, to find it — we talked what the lice looks like, but where do you look? Best place is going to be behind the ears and at the back base of the neck where it's kind of a warm area. That's where they like to live the most. So if you get a bright light and just move the hair back and forth behind the ear and at the back base of the neck, that's the most likely place where you're going to be able to see the live adults.
OK, so let's say that you see some live adults and there's some nits and they're hard to get out. So you really do believe that is the case of head lice. Do you have to take your kid to the doctor? Well, if it's the first time they've had it and it's not been a recurring thing, not necessarily. There are over the counter anti-lice shampoos that you can get. Examples of those are going to be RID. That's one of the brand names. Nix is another brand name. And there's several generic ones out there. You know, get the WalMart brands, it's going to be a little cheaper and will work just as well.
The way that you do this is you take about two ounces of the anti-lice shampoo and rub that into the hair, add a little& warm water. Lather it. Scrub it for about ten minutes or so and then, rinse it thoroughly. After that treatment, you're going to want to wait about eight hours after you used the lice shampoo. And that just gives enough time to make sure that all those nits are dead. And then you're going to want to remove them all.
Now, removing the nits, since we've already discussed that they attach pretty firmly to the hair shaft, it's going to be a time-consuming process, there's just no way around it. You can try a fine tooth comb. Really, probably, the easiest way is to just use your fingers and pull them out one at a time. You look at the gorillas at the zoo and they're pulling little insects and such out of the hair of one another. And that's what you got to do. I guess, you got to become a gorilla in your house and just pull them out. It's all you can do.
If you have trouble pulling them out, because they're just so firmly attached, you can use a mixture of half vinegar and half water to help loosen the grip. So the nit has like a natural cement that it's using to stick to the hair shaft and the half vinegar-half water solution will help to loose that up and make it a little bit easier to get out of the scalp, or out of the hair.
You're also going to want to use that shampoo on pretty much all the other family members that are in the house, whether you see the lice or not. The exceptions going to be, if you have a kid that's under two, who has a pretty thin hair and you can see the scalp, and you see absolutely nothing on their head, you probably don't need to use it.
If you have a real young infant in the house, call your doctor and ask them what their recommendation is for infants. If the infant has live lice or nits, probably your doctors would want to take a look at that. And then, also, there are certain anti-lice medicines that are not safe for pregnant women to use. Those are all going to be the prescription ones though. So pregnant women, you would want to talk to your doctor too, if you're worried that you have head lice. But for the most part, you're going to want to treat everybody in the house.
And then, you're going to want to clean the house itself. Now, it's important to realize that live louse cannot live more than about 24 hours off of the human body. So once you've taken care of this and killed all the lice that's in the hair of everybody in the house, in terms of any live lice that might be on clothing, or hair accessories, combs, brushes, that sort of thing, just keep in mind that as long as they're not on the human scalp, they can't live more than about 24 hours.
Now, the nits are a little bit different. They can actually live off of the human body for up to two weeks. So we're going to have to handle some things differently. Because we don't want any of the living nits that might be on a carpet or furniture to be able to hatch and then make a live lice that could then re-infect somebody.
So, how do you take care of the house? First, you're going to want to vacuum all the carpets and furniture. And then, I would take that vacuum bag and just send it out in the trash. Because if there's any nits that are still living in that vacuum bag, again, they could hatch and you can have a live lice over the next two weeks. So you're going to want to just vacuum up all the carpets and furniture and just change the vacuum bag. Or if you have a home house pack, empty it.
OK, and then, clothing, you're going to want to wash in hot water any sheets, pillow cases, any recently worn clothes. Just do all that in hot water and that should be just fine. And then, combs, brushes and hair accessories, you just make a little solution of the anti-lice shampoo, the Nix, the RID or the generic one and place them in there for about an hour or so.
Now any personal items that can't be washed, soaped or vacuumed should be sealed in a plastic bag. So we're talking about hats, coats, stuffed animals, and you basically leave them in the plastic bag for two weeks. And that will ensure that if there were any nits that were still alive, they'll either all dead or they're all hatched. And since we know live lice can't live for more than about 24 hours, any live lice inside that plastic bag should be dead as well.
And then, after about a week, you're going to want to repeat shampooing, especially of anyone who actually had a lot of nits in their hair and had definite live lice. Just a week later, go ahead do another round of the shampoo. Whether you need to do everybody in the house, if no one else saw live lice and there were no nits and they don't have any itching or rash in their scalp, then you probably don't need to do the repeat shampoo for those people, just the person who's primarily infected.
And then, this is a very important point. You want to do your best to avoid re-exposure. So if your kid gets head lice at school because they're sharing a brush or they're playing with a certain person really close at recess, and you get it all taken care of, but the other kid doesn't get it taken care of, then, it's going to be really easy for them to get re-exposed. And a couple of weeks later, they got the head lice back again. So, you know, even though you're kind of embarrassed about it happening, you probably should let the school know, because if one kid at school has head lice, they really need to check everybody. Because you want to get all the kids treated so as to avoid re-exposure and then everybody getting head lice again.
There are certain times though when you don't want to treat it on your own at home and you want to visit your doctor. And if there's any open sores or signs of infection on the scalp or really intense itching that's keeping your child awake, you want to take a trip into the doctor to have him take a look.
Also, you may need your doctor to verify that it really is head lice especially if it seems to be recurring over and over. I can't tell you how many times I've seen folks who wanted some lice medicine called in and we did it, because they already tried the over-the-counter one and that didn't work. So we tried something a little stronger. That didn't work.& And, you know, the second or third time, you got to say, "Why don't you come in, let's take a look." And sure enough, there are going to be times it's just dandruff and there's no live lice and it's not really nits. It just comes out way too easily.
But you're going to have some instances where it is lice and it is recurrent. And Nix and RID and over-the-counter medicines are not helping because the lice have become resistant to it. So in those cases, there are some stronger prescription medicines that can be used. But again, you really have to see your doctor before those are prescribed. Because you want to make sure it's safe for who you're prescribing it for. And you want to make sure it really is lice that you're treating.
And then, a few miscellaneous points on head lice, one of the things that you hear about is putting Vaseline in the hair. Vaseline will drown live lice but it won't kill the nits. And it can be very hard to remove out of the hair and kids are going to have a really greasy look to them for the next several days, and sometimes, even a couple of weeks. It can be very hard to get out of the hair. So I wouldn't recommend that.
Also, you hear grandma saying put mayonnaise in the hair for lice. And it's going to be the same concept as using Vaseline. You're going to drown the live one, not live ones. Now, the other advantage to the mayonnaise is that it does have sort of a vinegar -like component to it. So it's going to loosen up those nits. But it's not going to kill the nits. So all these nits that you're picking out of the hair are live and they're going to hatch. So, you know, the Vaseline and the mayo stuff, nah, don't do it. Plus, you know, food in the hair, I don't think so.
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Dr. Mike Patrick:
OK, we're going to move right along to our last segment this week. It's our Teenage Segment. And our first topic in the Teenage Segment is going to be scoliosis. The reason that we're going to talk about this is because I got an interesting piece of Listener Mail. This comes from Pam in Texas, and I'd like to thank you for writing in, Pam.
Pam says, "I took the kids in for a physical on Wednesday last week. When they did my daughter, the doctor kind of got concerned. He was looking at her back and asked me to take her to the hospital for x-rays. He noticed the curvature in her spine and mentioned scoliosis. The x-rays were done and there definitely was a curvature. Now, I am freaking out a little. She had to carry a really heavy backpack last year and I'm wondering if that has anything to do with it. A friend told me that I could request a note from the doctor& and the school would have to issue her a set of books to keep it home, so she wouldn't have to carry anything heavy. She's grown a lot over the last two years. She's now 5'1" and only weighs 75 pounds. Thanks for the help — Pam, in Texas."
Well, thanks for the Listener Mail piece, Pam. We appreciate it. We're going to talk about what scoliosis is. And then, in the process of doing that, I think we'll get your questions answered pretty quickly.
Scoliosis is a sideways curve of the spine. Now, remember, the spine is made up of series of vertebrate which is kind of like building blocks, one of top of another in a straight line right down the back. And most kids, they don't have a lot of fat between the skin and the spine. So you're able to feel those pretty easily.
Now, the sideways curve of the spine that we see with scoliosis is most commonly seen in the thoracic part of the spine. What's the thoracic part? Well, that's going to be between the waist and the shoulder blades. It develops gradually and you usually first notice it about the time of the onset of puberty. And then, it often gets worse during adolescent growth spurts. So as the spine is growing rapidly in the linear direction, that's when it's going to have a little bit more of a tendency to curve a little bit there, somewhere between the waist and the shoulder blades. Usually, more up towards the shoulder blades.
Scoliosis is seen in both sexes but it is more common in females.
OK, so what causes it?& Well, there's basically two types of scoliosis. There's going to be one called idiopathic and basically that means that we don't know what cause it. And then, there's going to be ones that we do know the cause and they're usually more developmental or congenital problem. So you can have vertebrate that are incompletely formed or a little bit misshapen that can cause a curving as they grow.
Kids that have different leg lengths can end up having some compensation by making their spine curve a little bit one way or the other. So any problems in bone structure or leg length problems can result in scoliosis. Also, certain tumors and neuromuscular diseases. So diseases of the nerves and muscles that can result in scoliosis as well. But these ones that have a cause like that are the least common. So the most common type of scoliosis is going to be idiopathic which means it just happens.
Now, there does tend to be a genetic component to scoliosis.& So if you have a parent or grandparent or aunt and uncle who has scoliosis, you're going to have a little bit of higher risk of developing it yourself. So it does appear that there is a little bit of, at least a bit of a genetic component to it. It's not of those things where it's a strong relationship. I see a lot of kids in my office with mild scoliosis, whose parents never had it and they've never known anyone in the family to have it. Of course, it could be that since it's so mild, the other family members also have mild scoliosis and maybe it was never diagnosed.
But the kids that have really severe scoliosis, almost always, there is a family history of someone else in the family who had it, whether it be mom or grandma or an aunt or an uncle. Now, of course, that's not all the time. But a lot of times, when you see this severe cases of scoliosis, there is an obvious family history.
One theory of what causes it is that in the area where the curve is happening, a set of rib muscles might be pulling a little bit harder where they're attached to the vertebrae in the back. So, this is one of those things though it's sort of speculative and we just don't know for sure. But the thought is, that is these rib muscles on one side are pulling a little bit harder or have a little bit more tone associated with them, then those vertebrae that those particular rib muscles are attached to may twist out of their straight line a little bit and cause a bit of a sideways curvature.
Things that we know that do not cause scoliosis are poor posture, participation in sporting activities, carrying around heavy books bags or backpacks. None of those things have been shown to cause scoliosis. I do want to say though that if you already have scoliosis, especially if it's severe scoliosis that has pain associated with it, then using heavy book bags or backpack or participating in certain sports or maintaining yourself with poor posture could aggravate the pain and make scoliosis worse.
So your question about the book bags and heavy backpacks, those things would not cause idiopathic scoliosis. However, if your child has bad scoliosis that's associated with back pain, then using a book bag or backpack may hurt more, but it probably won't make the scoliosis any worse. But certainly, if there's a lot of books and your carrying them back and forth to school and it's causing a lot of back discomfort, then that's certainly something that hopefully the school would be able to help you out with, like a second set of books like you talked about in the Listener Mail piece there. But you shouldn't be afraid to use backpacks that should not make idiopathic scoliosis worse. It just might actually make it hurt a little bit more.
Some symptoms of scoliosis — early on, really it's painless. And really, no symptoms at all other than seeing a little bit of a curve to the spine during a physical examination. Now, as scoliosis, if it gets worst, then you start to see an uneven appearance to the shoulders or the waist. One side of the back may hump a little bit or one shoulder blade may stick out a little bit further than the other. And you may even notice some leanings, like to the one side, and then eventually when you have severe scoliosis, it's going to end up causing some back pain associated with it.
Early to mild the scoliosis, because it is so mild, it often does go unnoticed by teens and parents and there's an awful lot of adults out there who had scoliosis. There's teenagers that probably never know they had it, because it was mild and maybe they didn't see a doctor. It didn't have any kind of back screening at school and so it never really got picked up. And really, they were no worse for the wear because it was very mild scoliosis. It didn't progress and they lucked out, basically.
But you know, some of these folks with early to mild scoliosis, it is going to progress to something more serious. So it's important to identify these kids and follow them along. So at the first sign that it's getting worse, you can do something about it and try to prevent some the pain and disfigurement that may happen later on.
So how do you find it? Well, best way is yearly back screening at your doctor's office. So this is one of the reasons why well checkups are so important in teenagers. And the way that doctor is going to diagnose it is basically by having you stand up, leg straight, bend over and touching your toes. You don't actually have to touch them but basically head down, arms sort of falling downward. You know the position I'm talking about. And then, the doctor's going to look from the back and look from both sides and just make sure the spine looks straight, and there's no humping on one side of the other and that the shoulder doesn't stick out a little bit more on one side compared to the other.
& And now, also, many schools screen by a nurse during gym class or health class and then refer you to your doctor if they feel that there's some scoliosis there.
OK, so let's say that you had the school nurse refer you to your doctor and the doctor took a look, or it was during the well checkup during adolescence and the doctor looked at the back and there was some scoliosis there. If there was physical exam evidence of scoliosis, then you get an x-ray. I'm sorry, not a chest x-ray. You got an x-ray of the back, scoliosis series. And what they're going to do there, the radiologist is going to actually measure the degrees of curvature. So, they basically draw a straight line in one plane at the beginning of the curve. And then at the end of the curve, they draw another straight line to the spine and they just measure the angle between their two lines.
& So, basically, you're going to look at the number of degrees. Now, mild scoliosis, they probably doesn't need anything done with it, it's going to be less than ten degrees. Between 10 and 15 degrees, you probably still don't need to do anything. I'd probably go ahead and refer to a pediatric orthopedic doctor just as a baseline assessment. And once you get up to 15 to 20 degrees, then you got more issue that needs to be dealt with and the best person to deal with that is going to be a pediatric orthopedic surgeon. So, it's basically a bone doctor who takes care of kids, that's usually associated with the children's hospital. That's going to be your best bet in terms of where you want that referral to go.
In terms of your primary care doctor, if the curvature is less than ten degrees, you probably can get away with just doing serial x-rays and following along every six to twelve months. Either with a physical exam or with another x-ray, just to watch for progression of that curve, especially during any rapid adolescent growth spurts that are going to be happening. So during the time of most linear growth, you're going to want to do six to twelve months x-rays to measure the curve and see if it's progressing. And then, once you get to 10 to 15 degrees or so, then I'd go ahead and refer to a pediatric orthopedic doctor.
How are they going to treat it? Well, if it's up there in the 15 degree or so area or more, you start thinking about braces and back braces. They also have some molded plastic shells that you can use. And these are things that basically, physically, try to keep the curvature from progressing. And these devices will not correct any curvature that's already there, but they just help to slow down any further progression of that curve.
Sometimes, these things just don't work and you have to have surgery to prevent disfigurement and severe pain. So those are going to be the most severe cases. I've been in clinical practice for about ten years now, as a pediatrician, and I can probably count on my fingers how many kids I've had that had needed braces and the plastic shells and those sort of things. And probably, I could count on just a couple of fingers how many actually needed surgery for scoliosis. And it doesn't mean I'm missing them. Because we certainly check for scoliosis at all of our well checkup exams.
So it's not something that we see a great deal of, in terms of the severe cases. I see a lot of mild scoliosis out there. We check and it'll be a five degree curve or an eight degree curve and they never really progress. So you see that a lot. So if your doctor tells you that your child has mild scoliosis, I wouldn't get terribly concerned. You certainly want to follow up and follow the advice of your doctors in terms of when to get repeat X-rays and when they feel that it's time to refer to an orthopedic surgeon, you'd definitely want to follow through with that.
Also, if you do have scoliosis, it is important to practice good posture. Avoid over-exertion with certain sports, particularly like wrestling, weight lifting, those kind of things. Also, you want to avoid heavy book bags and backpacks.
And again, we're talking about kids with severe scoliosis who have pain associated with it. Good posture,& avoiding certain sporting activities and heavy book bags and backpacks are going to just help keep the pain away in those severe cases of scoliosis. Swimming, I think, is an OK sport. Running track as long as you're probably not doing discus or pull vault. Things where it's going to be a little bit more stressed on your back and shoulder, then, you might want to avoid those kind of activities.
Outcomes with scoliosis, the curve that's there really never goes away. It's always going to be there. But the good news is, that once you get through the adolescent growth spurts into the adult years, usually progression at that point is pretty unusual. Now, you will have some adults that continue that have some progression and may end up needing bracing and surgery. But for the most part, once you get done with the adolescent growth spurts and the young adult years, progression of any scoliosis, if it's there, is usually going to stop at that point, as linear growth is done.
It's also important to understand that, again, if scoliosis is recognized early and with appropriate orthopedic intervention, progression usually can be slowed and pain minimized. However, there are going to be cases which do continue to progress and which may require one or more surgeries and may end up causing some pain issues associated with it.
Also, again, I mentioned this before but I think it's an important one. You got to look at your family history. If you have some scoliosis and it's mild and your doctor's talking to you about it, and there's no other folks in the family with scoliosis, your scoliosis probably is not going to progress and be much of an issue. Although, it still needs to be followed just to be sure.
On the other hand, if you have fear for relatives who've all had scoliosis surgery and you have mild to moderate scoliosis, well, I'd be a lot more concerned about that, and make sure that you're doing everything that your doctor's asking you to do to try to prevent progression of that.
If you like more information on scoliosis, I did come across a really good website and I'll put it in the Show Notes for you. It's www.iscoliosis.com. And the most interesting part I thought of that website is that if you click on the Frequently Asked Question link, the fact, they did have a whole bunch of questions about scoliosis. And then, they had some experts, some pediatric orthopedic doctors answer all of those questions in their own words. I thought it was really a good site with great information about scoliosis. So, I'd check that out.
Well, that wraps up this week's edition of PediaCast. I'd like to thank everyone for joining us this week. Remember, if you have a question for us, that you'd like& answered during the course of the program, all you have to do is let us know. Just write to email@example.com. Or you can go to our website at www.pediascribe.com/podcast, click on the Contact link and leave us a message that way.
So, once again, thanks for joining us. This is Dr. Mike Patrick Jr from Birdhouse Studio. We'll see you next week. And until then, so long everybody!