Baby Shoes, Vision Exams, and Eating Disorders – PediaCast 008

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  • Baby Shoes
  • Birth Order
  • Growth Charts
  • Vision Exams
  • Eating Disorders
  • Homeschool




The following is the production of

Pediacast, a pediatric podcast for parents.

Episode 8 for the week of September 11th, 2006.


Hello Moms, Dads, Grand Moms, Grand Pas, Aunts, Uncles and anyone else who looks after kids.

Welcome to this week's episode of Pediacast, the Pediatric Podcast for Parents. And now, direct from Birdhouse studios here's your host, Dr. Mike Patrick Jr.

Hello everyone, and welcome to this week's edition of Pediacast, a pediatric podcast for parents. This is Dr. Mike Patrick, Jr., coming to you from Birdhouse studio and as usual we have a program packed with information for moms and dads. This week is episode 8 and our topics up for discussion this week include baby shoes, birth order — our first born smarter than subsequent children in the same family (there's some dinner conversation for you), growth charts for infants and toddlers — are changes coming?


And we'll also discuss vision exams by eye doctors. Who should get them and when? And then in our teenage segment we'll spend some time looking at eating disorders such as anorexia nervosa and bulimia. All of these, plus an interview with a 12-year-old homeschool student and Podsafe music to round things out. Our featured artist this week is Tim Jennens, so you want to keep your headphones plugged in because his music will be coming up a little bit later on in the program.

Now don't forget here at Pediacast we'd love to hear from you so if you have a question or a topic you would like us to address on the program, you can reach us through the contact page on our website. Simply go to and click on the contact link. You can also email us at, or use our voicemail system to leave comments and questions by calling 347-404-KIDS.


Now before we get started, I would like to take a quick time out to thank the folks over at Upon Further Review for featuring Pediacast on episode 13 in their program. That's great guys. Do the Pediacast review on show 13. You know, don't you think Podcast should be like hotels, you know just skip from show 12 to show 14 and not even mention the missing program? I'll have to think about that as my own number 13 approaches.

Anyway thanks go out to Greg and Clea for providing their listeners with a fair evaluation of our program. They gave Pediacast an 8 out of 10 rating, and provided both encouragement and constructive criticism to help us improve which is always appreciated. If you haven't heard of their podshow, I suggest you check it out. They're kind of like the consumer reports of the podcasting world. You can find Upon Further Review in the iTunes Music Store and at their website which is


By the way, they don't just review podcast, they really review just about everything and anything you can think of. It's a great show, really. We'll put the link over to their site in the show notes. So again, Greg and Clea, thanks for checking us out.

Alright I think we're ready to move in to the first topic up for discussion on the program which would be in the infants segment. And as we get that started, I just wanted to remind you that the information presented in Pediacast should be taken as substitution for the advice of your child's doctor. No radio program or podcast can offer patient-specific information (got to get my lips moving today). We don't try to do that and you shouldn't ask us too. The final word on diagnosis and treatment must come from a doctor who can obtain a face to face interview and hands on physical examination of your child. What we can and will do is discuss generic child health, parent, and family issues which do not necessarily pertain to your child or family-specific situation.


Okay now that we made all lawyers happy, let's move along with the program. The first segment will be the infants segment and the first topic up for discussion is baby shoes.

Now, the purpose of infant's shoes is simply to protect the feet. They do not help infants walk any sooner and shoes may actually delay walking to some degree. Bare feet enable infants to use their toes for balance and give them a better sense of foot placement during the learning-to-walk process. So, if your infant is walking on a surface that may hurt or injure the feet then shoes are required. And examples of that would be if they are walking on cold outside surfaces or hot pavement gravel — you know and other kind of rough terrain like that. So let's say that they're going to walk on something that's kind of tough and you want to protect their feet, what do you use? I think a good first shoes is going to be an infant moccasin. It's going to protect the bottom surface while still allowing a good degree of foot movement and flexibility.


So that's where I would start is with an infant moccasin. You've probably seen those around, but then I would advance pretty quickly to an infant tennis shoe or a soft-sided low cut boot. These are generally comfortable and they're going to provide better traction than the smooth soled moccasins. And traction may help infants with walking but you have to keep in mind, for some other infants, it may actually hinder them as the tractions sort of catches, causing the child to stumble, especially in the early weeks of walking where when your first switch over to a shoe that has traction on it. What I would definitely avoid are the classic infant shoes. You know those hard sided high-cut boots that we usually imagine when we're talking about infant shoes. But you know they are uncomfortable. They have poor ventilation and while their stiffness may seem like a good idea to provide support for early walkers, really their lack of flexibility hinders more than it helps.

Now let's talk about size and fit of baby's shoes. The key here is that infants have really wide feet.


So you want to look for shoes made by a manufacturer who specializes in baby's shoes. Even though these shoes will cost you more, they'll like likely fit better, because the manufacturer knows to experience that young walkers have wide feet. It's a case of, really, you get what you pay for. Bargain brands are often too narrow which can result in pain, sores, and blisters. Now when you read a lot of child and infant advice out there, you know, they'll tell you, "Oh, no you don't have to get the expensive shoes. Just stick with the cheap stuff." But I really find that the kids who I see with feet sores and rashes and things of that nature, they usually are in cheaper shoes. So again, you get what you pay for. The feet should fit snuggly in the shoe but not really be crammed inside and then again not so loose that the shoe slips around. Ideally the big toe should be about a half an inch from the front tip of the shoe and the heel should rest against the back of the shoe pretty nicely. Now the width of the infant shoe should be slightly wider than your infant's foot. Now keep in mind early walkers grow quickly so you want to re-check the fit often.


Shoe size may need to change anywhere from 2 to 4 times during the first year of walking, really depending on how fast your child grows. If you do go with the more expensive but better fitting brands, your child will probably outgrow the shoes before he wears them out. That's fine, just save them for the next child, or you could donate them to a family in need. Now in terms of recommendations, what brands do I suggest.
There are a couple I want to tell you about, but before I do, I want to be clear that neither of these brands sponsor Pediacast, but there are any representatives out there, call me. We'll see what we can do.
Stride Rite is the first one. Now, our family has had lots of personal experience with Stride Rite shoes. We used them for both kids when they were early walkers and we found them to be well-fitting. They were comfortable and durable. And really Stride Rite has a long experience in making infant and toddler's shoes. Each style usually comes in a variety of widths which make good fit easier to obtain. And the sales people are usually knowledgeable and proficient in taking accurate foot measurements.


Yeah, yeah, I mean you come up with the dead salesman now and then, but most of the sales people that we ran into were experienced and were of great help. Just a couple of them that weren't so good. But you know, having two kids who went through all the infant and toddler years, that's saying something. Also, Stride Rite has a pretty liberal return policy if there's any problems with the fit or with the craftsmanship. And you can find Stride Rite at They spell it s-t-r-i-d-e r-i-t-e. So and if you head over to the show notes after the program, we'll have a link up to their site.

Now the other brand I want to tell you about is called Preschoolians. This is a brand that's only available only online and this makes it a bit harder to fit. But they do have explicit directions for measuring your child's feet and they have a reasonable return policy if you get shoes that you're not happy with or the fit's not quite right. Now the cool thing about the Preschoolians is that the clear rubber sole at the toe of the shoes.


So at the toe of the shoe has a clear rubber sole. So you can see exactly where your child's toes are located compared to the tip of the shoe. That's pretty cool. They also have the option of custom designing the shoe style and color scheme. It costs more to customize them but it's an interesting option that I haven't seen out there before. Now I have to say I don't have any personal experience with Preschoolians so I am basing my analysis only on what I have seen in their website. If anyone out there has tried them, shoot me an email or voice message telling us what you think and we'll share the information with our listeners.
Now the Preschoolians, you can find at I'm going to spell that for you. It's P-R-E-S-C-H-O-O-L just like "preschool" and then add I-A-N-S. So it's, and as usually we'll put a link over to their site in this week's show notes.


Okay moving on to our next infant topic. This one is birth order and intelligence. Now there have been some studies in the past which found a possible link between birth order and intelligence. This study has suggested that first-born children did better on intelligence tests than subsequent children in the same family. So to see if these results were reproducible, researchers at the Ohio State University, my alma mater, embarked on a new study. Their investigation followed nearly 3,000 families over a 12-year period and they conducted intelligence tests between the ages of 7 and 8 and then again between the ages of 13 and 14 and then they compared that the data to birth order to see if first born scored higher than subsequent kids in the same family. Now they also compared families to one another to see if any environmental factors were associated with overall higher scores for the family as a whole.
Okay so what kind of results did they get? Well, subsequent-born kids you can all breathe a sigh of relief out there if you're a second, third or fourth-born child.


No significant differences were found in this study at any age when comparing kids from the same family. However significant differences were seen when comparing families with each other. Basically they found that the older that the mother was when she had her first born resulted in overall higher scores for the family. Now this doesn't mean that smart people have kids later but it may be an indication. Actually I think smart people probably had their kids earlier. Let's see if with a little bit more time out of the house, you know what I'm saying.

Anyway, what this may be is an indication that older parents spend more time stimulating their kids during key phases of development. Now another variable was family size. Families with fewer children had higher intelligence test scores than larger families and again this may suggest that fewer numbers of children in the house result in parents spending more time with each child which might make a big difference. Now this study did not look into the reasons these relationships held.


I'm only making a guess when I say the increase stimulation with the older the parent and the less kids in the house, but you know, I think it would be interesting to know why older parents with fewer kids appeared to have the smartest children. I bet the reason is increased time and stimulation put into each child, but I could be wrong. It would make for an interesting expansion on the study. That's for sure. But you know we also have to keep this in mind, we are talking about kids taking intelligence tests and these tests are not always a true indicator of a child's potential. Test taking skills are influenced by skills such as learning differences and attention problems too. So there may be a socio-economic, cultural, language barriers that affect intelligence testing, and dampen intelligence potential. So I think the bottom line: yes it's important to expose every child, whether first, second or third born, really to as much stimulation as early as possible and this includes reading and music and playtime and games. You really can't spoil your kids this way. So, put down the newspaper, close your novel turn off the TV, log off the internet, get down on the floor and play with your kids. Why? Because it is important.



Okay we're going to move on into the toddler's section of the program and we're going to start with growth charts. Are changes coming? Growth charts currently used in the doctor's office come from the CDC which is the Center for Disease Control and they're based on population data during the 1970s and the 1980s. What they basically did to come up with these growth chart is they recorded the baby weights and lengths of 82 million infants and they also recorded these measurements on 5,000 kids between 2 months and 24 months of age and 10,000 kids between 2 and 6 years of age.


The only exclusions were very low birth weight premature infants and there was a nice mix of breast fed versus formula fed babies and the sample really came from a cross-section of the US population and included a broad collection of socio-economic groups and racial backgrounds. So they took this big mix of kids. They did a bunch fancy statistical analysis on their weights and heights and they came up with the charts that we use to plot kids' growth. If you take in an infant or a child to the doctor's office, you know what I'm talking about here, it's the chart always say kid is 25th percentile or 50th percentile or 75th percentile or greater than the 95th percentile, which we are seeing more and more of. So why do we need new curves. Well the World Health Organization didn't like comparing the world's kids to American children from the 70s and 80s, surprise surprise. So they recently did their own statistical analysis with the data from 6 countries. Now they did use the United States but they only used one community and that was Davis, California, that was supposed to represent all the American children.


And then they also looked at data from Brazil, Norway, India, Oman and Ghana and the World Health Organization picked children a bit differently than the CDC did when they did their growth charts. They only included infants in high socio-economic groups in an attempt to limit bias caused by poor nutrition.

They also picked more kids whose mother is well-educated and worked outside the home and all the mothers were non-smokers and all babies were singletons, that means no twins or triplets. And all of them were full term. The infants also had to breastfeed exclusively for at least 4 months but most of them breastfed a full 12 months. And they also controlled when solid food was introduced to all of these babies which was at about 5 months of age. Is anybody seeing a problem here? You know the World Health Organization basically created a large sample of perfect babies to compare with the world, you know what I'm saying?


So what are the differences in these charts, the CDC ones that we use now in this new World Health Organization chart. Well these group of perfectly selected children are smaller than the American kids from the 70s and 80s. So if we use these charts in America now, fewer kids would be below the 5th percentile and more of our kids would be above the 95th percentile. So why change, you know, why change from what we use now to the World Health Organization ones? I mean this is really the big question. Why should we compare our kids to those in Oman and Ghana. I mean why not repeat the statistical analysis on a large sample of our own population and just have our own growth charts for America?

Well the problem with that is that the chart would move in the other direction. With the current rates of childhood obesity in America, more kids our overweight compared to the 70s and 80s which would elevate the 50th percentile and put fewer kids over the 95th percentile. I know this all sounds confusing.


Let me put it this way. If we read through the charts based on today's population in the US, then what we know call overweight will suddenly be called "normal" since so many kids are obese, right? Well of course, we can have that. On the other hand, if we go with the World Health Organization charts, even more kids appear overweight because now we are comparing them smaller kids. That may not be a bad thing for the Department of Health and Human Services because if they can lobby for more money to combat the problem which they conveniently made to look worse than it really is. But in reality you know it's only worse because they are comparing our kids in Oman and Ghana. So what's the bottom line? Well I think it's crazy to change our growth charts either way. Look, absolute percentile isn't even what's important. What's important is comparing a child's height to their weight, looking at a child's overall growth trend and comparing that trend to their family's pattern while putting it into context with the child's overall health. We need to spend less time and energy drawing little pretty circles on graph paper and spend more time figuring out how to help American children eat less and exercise more.


Okay enough on that. Vision checks. This is an important topic. And it stems from some listener mail that I got. What I'd like to do is just talk a little bit about vision screenings for each age group. We're going to start — I know this is the toddlers segment but I think I've mentioned before that some of these topics are going to sort of span from one age group to another. So in babies — let's talk about vision screens there. Currently many states require newborn hearing screens in an effort to pick up hearing impairments early on. But vision checks in babies are not done routinely. Why is that? Well, vision is a subjective thing and babies aren't telling you what they can and can't see. Now there are devices that utilize laser technology to see if kids in infancy are far sighted or near sighted. But you aren't going to put glasses on a newborn infant, you know, so why bother? What infants do need is a good eye exam by a pediatrician. The eye exam for infants is relatively simple and straightforward.


You want to make sure their pupils are equal and react to light. You want to make sure the eyes are symmetrical. They move in all directions and they move together for the most part, and I say for the most part because young infants may appear to have intermittent and brief episodes where the eye goes in a little bit or out a little bit. And this usually improves within a few weeks. If it's severe or persists past a few weeks of age, you want to be sure to let your doctor know about that. The other important part of a newborn eye exam is checking for red reflex. Now this is like the red eye you see in photographs. And what causes red eye? Well, light from the camera flash enters the pupil, it travels through the eye, it's the back of the retina, the back of the eye which is known as the retina. The retina contains lots of tiny red blood vessels, so the red light waves bounce off of the retina and come back out the pupil. So the lens of the camera picks up the red reflection and all the other light waves are absorbed by the retina, only the red ones are the ones that bounce off, that's why we see the color red. You remember from your physics classes. [Laughs] Right? Enough of that.


When doctors examine the babies' eyes we don't use the camera flash of course. But what we do use is a light source and a lens, just like a camera. We shine a light in each eye and we look for the red reflex. Now why do we do this. Well, if you see a nice bright red reflex, then you know the space between the pupil and the retina is clear. If there is a cataract or a tumor in the eye then the normal red reflex does not appear. So that's why it is important to have that checked out. And anything inside the eye such as cataract or a tumor has to be addressed in the infant period because if the brain isn't getting good picture — we talked about this, I believe it was in episode 2, when we talked about lazy eye. If the brain is not getting a good picture over time, it starts to just shut that eye down, and once you lose vision in an eye because the brain is ignoring the eye, it's lost permanently. So that's why it's really important to pick up cataracts and tumors inside the eye during the infant period.


Now for toddlers, the best eye exam really is close observation by the child's parents. You want to bring in any problems or concerns to your doctor's attention. Now what kind of things should arouse concern. Well, if your child's routinely getting really close to books, games, toys, television, routinely unable to see faraway objects that seem to be seen by the rest of the family and then also routine clumsiness that just seems extreme to you. Why should you only be concern if these problems are extreme, you know toddlers often do strange things we don't always understand. And those of your with toddlers at home know exactly what I'm talking about. So I mean they may sometimes get real close to books and games and toys and TV if they're really interested and they may be stubborn enough to deny seeing faraway objects and clumsiness at this age is common because their brains are often several steps ahead of their feet. But still if these things occur routinely or seem extreme, then you want to let your doctor know. The other thing to watch for in toddlers is one eye gazing slightly inward or outward compared to the other eye.


And this may be strabismus, which can lead to amblyopia or lazy eye, and again this can progress to permanent blindness in the lazy eye if you fail to intervene. And again, for a detailed description of strabismus and lazy eye, I do believe it was episode 2 of the program where we discussed in a lot of detail.

Okay, what about before kindergarten. Well, kids with no previously defined vision problems or suspicion of problem really should get their first official vision test just prior to kindergarten. Now who should do this test? Well, for one the school will do it, during the pre-kindergarten screening and then your pediatrician will also do one at the pre-kindergarten well child check. If your child passes both of those exams and you've not had any previous concerns with vision, then I think you can comfortably assume that vision is fine. Now, granted, these screenings are simple eye chart exams and they'll identify problems with acuity such as nearsightedness and farsightedness. They don't specifically pick up astigmatism or color blindness or glaucoma but keep this in mind: the vast, vast majority of vision problems in young kids is going to be nearsightedness, and then sometimes some farsightedness too.


Astigmatism almost always accompanies nearsightedness or farsightedness. It's not usually there by itself with a 20/20 vision. So if we pick up an acuity problem in the screening, we're going to refer those kids to a pediatric ophthalmologist, and astigmatism will get picked up on that secondary exam. Now what about color blindness. Well, color blindness tends to run in families. There is a simple test for it that consists of looking at pictures and some schools and doctors include that their screening. But if your doctor or school doesn't test for color blindness and you have no family history of color blindness, and your child's doing well, learning and differentiating colors especially red and green, then really likely there's no problem. But you know if you are really worried about it, you can do a Google search for color blindness and pull up the little pictures and test your child yourself at home.


Do you remember, it's a circle with little tiny circles inside of different colors. They've got numbers in green circles surrounded by red circles and you just see the child can pick out the numbers and see them.
Now with regard to glaucoma, congenital glaucoma is usually picked up in infancy because of an abnormal exam and possible cataract formation that's often associated with it. Open angle glaucoma is very rare in kids and when it does happen, there's usually a strong family history of it. So often times you pick it up that way. So and that's the next point too. If you have a strong family history of any eye problem then your child probably should see a pediatric ophthalmologist you know around the pre-kindergarten age and earlier if the family history is an early childhood eye disease such as amblyopia or lazy eye.

Now how about an optometrist. Well I wouldn't at this age. Now what's the difference between an optometrist and an ophthalmologist? Well, optometrists have an OD behind their name. They are trained to prescribe glasses and contacts, they screen for serious eye disease and they manage relatively simple eye conditions.


If they find a serious problem, they're going to refer to an ophthalmologist. To become an optometrist, most people leave college after two or three years and then enter a four-year school of optometry. Pediatric ophthalmologist on the other hand are medical doctors so they're going to have and MD or a DO behind their name. They finished four years of college followed by four years of medical school, followed by a year of internship then three years of residency and one or two years of fellowship in pediatric ophthalmology. Okay maybe I'm also a little biased you know, since I'm a medical doctor, but this is the only eye professional where I would refer a young child. You can usually find one associated with the nearby children's hospital. Now he or she may not have an office in your neighborhood but I think you'll find that it's well worth the drive. Now there has been some controversy lately in this arena. The American Academy of Pediatrics and the American Academy of Ophthalmologists basically recommend what I have outlined here.


The American Optometric Association on the other hand recommends eye exams by an eye doctor at six months of age, 3 years of age, and 5 years of age. Apparently they don't trust the eye exams performed by primary care doctors. That's okay. I don't trust the recommendation. So I guess we're even.
Now what about older children and teenagers. Well, for school age kids and teens, yearly eye exams and vision screenings are reasonable component of the yearly well child examination. And then if you notice a concern, or if there's a significant family history, it comes to your attention or if the screening has failed, then refer to a pediatric ophthalmologist as warranted. Also I would pay particular attention to screening both vision and hearing for kids with learning problems and ADHD. You certainly want to make sure the vision or hearing problem is not contributing to the academic issues. Now, a final word on this whole referral business is in order. If you want to child to see a pediatric ophthalmologist, maybe because of the concern you have, or because of a family history, or because of failed screening or simply because you want them to see an ophthalmologist because it's going to give you peace of mind.     


And then if your primary care doctor won't give you a referral or at least point you in the right direction, what you can do is just call your nearest children's hospital and find out who the pediatric ophthalmologist there and make an appointment, and this even goes for teenagers.

A referral, you have to remember, is not an admission ticket. A referral is simply a mechanism that some insurance companies use in determining to approve or deny a claim. Many insurers no longer require referrals. But let's say your insurance company requires a referral and you don't have to pay out of pocket for one visit. Because if the eye doctor finds a problem, I guarantee you you'll get that referral for your next visit. So what, you're looking at a hundred bucks or so. How much do you pay in a year for oil changes or cigarettes or cable TV or internet access. I mean if you are that concerned about your child's vision, pay to have it examined. Don't give up on your conviction just because your insurance company won't pay for one measly visit.



Dr. Mike Patrick: Okay this week our school age segment consists of an interview with Katie: She's a 12-year-old home schooled 7th grader and let's get right to the interview.
We have a special guest this week on Pediacast. I would like to introduce everyone to Katie: Katie is a 12-year-old, 7th grader who home schools rather than going to a public school. So welcome to the program,

Katie: Hi.

Dr. Mike Patrick: How are you today?

Katie: I'm good.

Dr. Mike Patrick: I appreciate you coming on to Pediacast to talk to our listeners. So you go to school at home. You don't get on the bus or walk to a different building. You actually do your classes in your house, is that right?


Katie: Yeah the furthest we had to travel was down the stairs and through the hall.


Dr. Mike Patrick: So do you like learning at home or do you wish that you were going to school?

Katie: Well, it varies. Most of the time I'm glad, though, that I home schooled.

Dr. Mike Patrick: Who teaches you? Your mom and dad at home?

Katie: Yeah. Both of them. They share subjects.

Dr. Mike Patrick: I see. And you have a brother at home I understand.

Katie: Yeah, I think he's in 4th grade; he's 9.

Dr. Mike Patrick: You think he's in 4th grade?

Katie: Yeah I'm pretty sure. I don't really keep up with him very much.

Dr. Mike Patrick: Well and it is a little bit harder to remember what grade you're in, isn't it?

Katie: Yeah, I always almost say, "Oh I'm in 6th–ah–7th grade."

Dr. Mike Patrick: Yeah, it's a little harder to keep track. So what's your favorite subject in homeschooling.

Katie: I like Science and Composition.

Dr. Mike Patrick: Why do you like those the best?

Katie: Because, in Science, you can do experiments and learn about how stuff works and all that. And
Composition, it's fun to make up stories and write on the computer.

Dr. Mike Patrick: So you do Science lab at home, too?

Katie: Yeah, every once in a while there is an experiment but sometimes there are some that we don't do because they don't seem like they're going to work or they really don't need to do it to explain anything anymore.
 Dr. Mike Patrick: So you feel that you understand it and sometimes it's just a little busy work.

Katie: Yeah. If it's something cool like putting Drano in Jell-O then yeah, without eating it, of course.


Dr. Mike Patrick: Putting Drano in Jell-O… I have to make a comment. Please don't try that at home at least without homeschooling supervision. No but seriously, it doesn't sound like it's such a good thing to put Drano in Jell-O. Where do you come up with the material that you use. Like, who's telling you to put Drano in Jell-O?

Katie: We use this program called K-12 and they provide all of the experiments and online lessons and materials that you need for it — well mostly materials.

Dr. Mike Patrick: Oh I see. So you actually do your school work on the computer for the most part?

Katie: No, it's about half and half. There are online lessons that explain stuff but then you do, like, reading and stuff like offline most of the time. But when you're done reading, like for literature, when you're done reading you go back and do check your reading and it asks questions about what you've just read and you answer on like a little fill-in-the-bubble on the computer.

Dr. Mike Patrick: That sounds neat. So you kind of blend the traditional stuff with technology as well.

Katie: Yeah.

Dr. Mike Patrick: Now let's say you're doing these laboratory experiments, where do your parents
get the equipment that they would need to do lab experiments? Like is there a lab store nearby or something and you take a supply list and go pick things up. How do they get all the materials?


Katie: No, for a lot of the materials they send it to us when they send all of our books. They'll send us like graduated cylinders and thermometers and stuff like that but a lot of it is there'll be this thing that pops up and say, advanced preparation, and then also like, you need to have this for a few lessons later.

Dr. Mike Patrick: So you said that the material that you use come from a place called K-12, is that right?

Katie: Yeah.

Dr. Mike Patrick: And I did a little bit of research before we started the interview and apparently folks can find out more information about K12 if they go to, and we'll put a link to that in the show notes too so people we'll be able to find it pretty easily.

Okay so what about your brother. Does he use that same curriculum, too?

Katie: Yeah, he just does a different grade of it — easier problems.


Dr. Mike Patrick: I see. Okay so he does all the stuff that you did a couple of years ago?

Katie: Yup, basically.

Dr. Mike Patrick: Does he get hand me down materials?

Katie: For some of the things, yeah. A lot of the things, though, will be ordered from K-12 for him.
But like some of the things like my Math book which this year and last year was really nicer than it was last year or two years ago. So he'll use some of that stuff but most of it we get new, because you do write in a lot of the books.

Dr. Mike Patrick: What's your least favorite subject?

Katie: Definitely Math.

Dr. Mike Patrick: Math?

Katie: Yeah.

Dr. Mike Patrick: Yeah. I wasn't a big Math fan either, to be honest with you. But still you hang in there and you get it done, right?

Katie: Yeah, I usually pass all the assessments, so.

Dr. Mike Patrick: But it just doesn't come as easy to you, huh?

Katie: Yeah.

Dr. Mike Patrick: Now, who's your Math teacher?


Katie: My Mom does that.

Dr. Mike Patrick: And does she answer all your questions pretty well? Does she explain things so that you can understand it?

Katie: Yeah, sometimes I have to wait because she's going to go with my brother but… yeah.

Dr. Mike Patrick: I see. So since you're doing these school stuff at home, what parts of public school do you feel like you're missing. Like what do you think is the advantage that the kids have who are going to public school. What kind of advantage do they have over the experience that you're getting?

Katie: They spend all day with their friends and I can't do that because I'm at home most of the time. But I do spend time with my friends.

Dr. Mike Patrick: So you just have to find different times to be with them that's not necessarily during school hours.

Katie: Yeah.

Dr. Mike Patrick: I guess that–

Katie: Well, um–

Dr. Mike Patrick: Yeah, go ahead. I'm sorry.

Katie: I'm on different schedule type thing with vacations at different times and stuff.

Dr. Mike Patrick: Now one of the biggest complaints that you hear out there about homeschooling is the lack of socialization. Do you know what I mean by that?


Katie: Yeah

Dr. Mike Patrick: Like being with other kids the same age and maybe–

Katie: Uhuh.

Dr. Mike Patrick:  Because you don't spend as much time with other kids that you might have problems forming friendships and getting along with others. Is that a problem for you?

Katie: Not really. We do all sorts of activities. We act in plays and do theater and sometimes we'll take swimming lessons, and there's a lot of kids around us who are the same age, so yeah.

Dr. Mike Patrick: So you have experience being around other kids and making friends and that sort of thing comes pretty easy for you?

Katie: Yeah.

Dr. Mike Patrick: I see.

Katie: And I go to camp every year, so I make a lot of friends there.

Dr. Mike Patrick: Right. And do you go to Sunday School?

Katie: Yeah.

Dr. Mike Patrick: So you have friends there too that you see?

Katie: Yeah.

Dr. Mike Patrick: So your friends, are most of them also home schooled or do you have a lot of friends who also go to public school?

Katie: I've got one friend that I think is home schooled but most of them go to public school, which makes it a little bit tricky to get together with them, unless it's in the summer.


Dr. Mike Patrick: Now do you think that you'll continue to homeschool throughout all of your schooling or is this just something that you're going to do until high school and then your parents are going to have you go to a public school at that point?

Katie: No, I'll probably go through high school but I'm going to go to college, normal, obviously. Because I don't even think they have a home school for college.

Dr. Mike Patrick: You can't do college at home, though.


Katie: Yeah.

Dr. Mike Patrick: Do you feel like your homeschool experience is going to prepare you for college?

Katie: Yeah a little bit with the studying on your own, so.

Dr. Mike Patrick: So when you are studying at home, do you take notes and that kind of thing too?

Katie: For some of the subjects I do. For Science, I do, when there's something really important, and same with History, but for Math and stuff like that, I usually don't.


Dr. Mike Patrick: So you're learning how to take notes and try to filter out what's important and what's not important and learning to study for tests. Do you take tests?

Katie: Yeah at the end of every lesson we have assessments and then at the end of each semester we have a big assessment for everything we've learned.

Dr. Mike Patrick: I see. So you are getting some practice at taking tests and taking notes and that sort of thing.

Katie: Yeah.

Dr. Mike Patrick: So it sounds like you'll be fairly prepared for college.

Katie: Yeah, probably.

Dr. Mike Patrick: Now what about music class. Did your mom, does she help you learn to play an instrument or do choir, something like that?

Katie: No. We do piano lessons. I don't know where it is. But we do piano lessons every week so I know how to play the piano.

Dr. Mike Patrick: That's excellent. What about art class and gym class, do you do either of those kinds of things?

Katie: Sometimes we go to this thing called Swim Gyminar at the YMCA. That's got a swim lessons and then there's art classes and usually we do projects and painting stuff and then there's a gym class too.


Dr. Mike Patrick: Well that sounds interesting. What kind of things do they do in the gym class?

Katie: Mostly play games like dodge ball and stuff, but sometimes we'll do hockey or basketball or something.

Dr. Mike Patrick: I was never very good at dodge ball.

Katie: No?

Dr. Mike Patrick: Do you ever play crab soccer?

Katie: No.
 Dr. Mike Patrick: [Laughs] That's one where you had to walk with your hands and legs but with your back facing down and your belly button facing up in the air and you're walking around like a crab with your arms legs.

Katie: That doesn't sound very good.

Dr. Mike Patrick: And it was like soccer, you had to kick this ball back and forth. No I wasn't very good at all [Laughs], to be honest with you. I'm glad they don't do it anymore.

Katie: Yeah. I like dodge bell where they have things that you can hind behind.


Dr. Mike Patrick: Yeah. [Laughs] That would have been the bigger kids. For me.


Katie: Yeah.

Dr. Mike Patrick: How about drama class. Are you involved in any drama kind of stuff?

Katie: Yeah, I just auditioned for a play not too long ago I didn't get in, and my brother got a call back but he didn't get in either. But there's a show that's coming up and auditions are Sunday or something like that and I'm going to audition for that.

Dr. Mike Patrick: Okay. Well now is that through your local school?

Katie: No, that's actually through this place in Columbus called the Children's Theater.

Dr. Mike Patrick: Uhuh.

Katie: And I've also been in a show with the Davis and my brother has done things at the Phoenix and Columbus.

Dr. Mike Patrick: So you guys are really into acting, huh?

Katie: Yeah, I am. My brother doesn't appreciate how easy he gets parts.

Dr. Mike Patrick: Why does he get parts so easily.

Katie: Well there's typically more girls auditioning than boys so it's much harder to get a part than it is for a boy to get a part and usually they have fewer girl parts anyway.


Dr. Mike Patrick: Oh I see. So he doesn't appreciate the parts that he gets and you really want the parts but it's harder because there's a lot more girls who are trying out.

Katie: Yeah, he appreciates them not as much as I would.

Dr. Mike Patrick: [Laughs] I see.

Katie: He doesn't even want to do acting when he gets older.

Dr. Mike Patrick: And you do.

Katie: Yeah, I want to be in movies.

Dr. Mike Patrick: Oh that's great. Well you know, it's sounds like you're pretty busy. So you have all your homeschool stuff that you do and then you have piano lessons and you do this drama stuff and Swim Gyminar–

Katie: And I used to do ballet.

Dr. Mike Patrick: And you used to do ballet too?

Katie: I'm not going to do it this year, though.

Dr. Mike Patrick: Just a little bit too much on your plate.

Katie: Yeah. I have been doing it for five years.

Dr. Mike Patrick:     Oh wow. Five years of ballet and you're going to stop. Why?

Katie: Yeah I want to do more for acting. Last year there was a play that I wanted to audition for, "Little Women." And I couldn't do it because I would have missed like half of my ballet rehearsals for the recital at the end of the year, so I decided not to do it and open up more possibilities for acting.


Dr. Mike Patrick: Well that sounds great. Well it sounds like you got your priorities set and you're happy with the way school is going, and–

Katie: Yeah

Dr. Mike Patrick: And I think you will do well. I really appreciate you coming on our program today and letting our listeners get an idea of someone who home schools and what it's like at home.

Katie: Uhuh.

Dr. Mike Patrick: So thanks for coming and we come back and join us —

Alright, now I have to come clean here. Katie really is a 12-year-old homeschool student, but she's also my daughter. Now I know I conducted this interview as if she were a stranger but you to realize my intentions were good. The point wasn't to fool my listeners out there but to test out my equipment and see if I had the parts I needed to do a Skype interview.


Dr. Mike Patrick: It was also a good learning experience for my daughter, and I thought that might give me some insight, you know, on how she viewed her education. I have to say I am quite pleased and  proud of her responses. But you know instead of burning the interview onto a CD and locking it away on a memory box, yeah, I thought I would share it with you.


And the final segment of our show this week is our Teenage Segment. And we're going to talk about eating disorders this week.

Anorexia nervosa and bulimia are eating disorders that begin with the distorted image of one's body. They are most common in teenage girls, although younger girls, young adult women and sometimes boys and men are also affected. Nobody knows for sure how this distorted body image begins, but it probably results from a combination of brain chemistry alterations, environmental experiences and genetic predispositions.


And the typical scenario, a teenage girl or a young adult woman feels and believes she's fat, when she clearly is not. Oftentimes other mood and mental disorders such as depression, anxiety, bipolar, and obsessive-compulsive disease co-exist with the eating disorder, which is why we believe brain chemistry likely plays an important part.

Now signs and symptoms of eating disorders are really also the warning signs for parents. Here's what to watch for. Severe weight loss from strict dieting. With bulimia you also see binge eating which is defined as eating large amounts of food in a short a time, followed by purging, or making yourself throw up, taking laxatives or water pills. The frequent vomiting allows acid to dissolve tooth enamel which can result in a lot dental problems. It also results in electrolyte imbalances which can result in fatal heart rhythms. In both types of eating disorders, we also see weakness and dizziness from malnourishment and dehydration.


Hormone imbalances may cause an increase in body hair, brittle nails and feelings of being constantly cold and unable to stay warm. These hormone changes accompanied by low amounts of body fat often result in termination of menstrual periods too. Now if depression or bipolar disease accompany the eating disorder which is often the case, you may see withdraw from friends and usual activities and decreased interest in the things that they used to enjoy. Appetites seem diminished, yet they constantly think about food. They often count calories and carbs and grams of fat in an obsessive way, but strongly deny any of these behaviors if you confront them. And they tend to exercise in unusual amount of time and fear weight gain and even try to lose more weight when everyone around them can plainly see they're normal or underweight.

Now identifying these kids and getting them help is tough. You know they seldom ask for help. So as a parent you have to intervene. Unfortunately, many mothers suffered or suffer from the same problem or simply don't wish to admit or confront the issue.


So many of these kids continue to suffer because of parental neglect. If you are concerned, you know, call your child's doctor. Treatment — first addressed is physical safety. Now we have to correct dehydration and electrolyte imbalances to prevent fatal heart rhythms. Plus we have to determine if there's a suicide risk especially if depression or bipolar is co-existing with the eating disorder. And then once we address physical issues, we turn to the psychological component. Lifelong counseling and group support are important in restoring and maintaining normal body image and you have to address and treat any co-existing any mental health problems along with the eating disorder. Now once these issues are out in the open, many teenagers and young adults are relieved. You know it's like a weight being lifted that their loved ones finally understand and want to help them without being critical about it. And these teens who end up wanting help really are the easiest ones to treat.


Now let me say a quick word about the ones who are a little bit more difficult. And these tend to be the younger teenagers who are still in a "me against the world" mentality, if you know what I mean. You still have to treat the physical and the psychological as I've outlined but many of these younger patients relapse and fail in their treatment. And for them, sometimes if tough love approaches, you're required to keep them out of harm's way. And now how do you do that?

Well, weekly weight checks with a goal weight and a minimum tolerated weight is a good for a start. If they go below the minimum weight and they are admitted to an inpatient facility and this could be a hospital or a psychiatric clinic but the key here is that if they go below that minimum weight, they're going to get admitted and there's no exceptions and no negotiations. Hey, they'll not be released until they're back up above their minimum weight plus a percentage above that. When they go in, at first they have absolutely no privileges basically except to sit in the doorway of their room and eat meals. And then as they gain weight, they gain privileges back. So put on a pound and they can shower and brush their teeth again. Gain another pound and they can sit inside their room.


Gain another and they can read a book. Gain another and they can watch TV. Now it may sound mean but you have to remember these are young teens who aren't that far removed from sticker chart days and positive reinforcement and suspension of privileges at home and groundings and that sort of thing. Sometimes it's the only way to keep them at a healthy weight and as hard as it is to see for parents to see this happen, you know to that precious baby who they used to rock to sleep. You have to remember maybe their only hope of saving that baby's life once an eating disorder has reached level of seriousness.

Now what's the long-term outlook for a person with an eating disorder. Well you know it's a life journey. It's like any other chronic illness. It's important to stay connected to a counselor that you trust and support groups that help. And you have to stick with reasonable diets and exercise plans, and you have to be accountable to someone who loves you and is willing to step in and intervene, if the progress is slipping. It takes courage and guts and lots of support.


If anyone listening to this podcast has an eating disorder knows someone who has an eating disorder, please don't continue sitting back, doing nothing about it. Seek help. Confront your friends or loved one. Then if you don't know where to turn, and you can't talk to a friend, ask your doctor or teacher or pastor what you should do. Always remember, you're not alone. And you can find help online from the National Eating Disorders Association and they're located at, that's, and of course we'll include a link to their site in the show notes.


Well folks that wraps us this week's edition of Pediacast, thanks for tuning in. Don't forget if there's a topic you would like to hear on the program drop us a line on the contact page which you will find at and you can also email us at Or you can leave us a voicemail at 347-404-KIDS, that's 3-4-7-4-0-4-K-I-D-S.


As always we appreciate your support. If you like Pediacast, be sure to tell your friends and family about the program and if you have time to leave us some feedback in the iTunes Music store or at Podcast Pickle, that would be appreciated because other parents do read those comments and use them to base their selections.

Now if you don't like what you are hearing on Pediacast, you can write us an email, telling us how you think we can improve or simply unsubscribe and pretend we never existed. Yeah that's the ticket. Nah, just kidding. [Laughs] Let me know what you think, really. We're going to leave you this week with a song from our featured artist Tim Jennens. Tim is a pop R&B and jazz keyboardist and vocalist from the Buckeye State, Ohio. He composes, performs, records and produces his own music, which you can find at


This is one he calls, "More Each Day." So until next week! This is Dr. Mike Patrick, Jr. saying stay smart, stay healthy and stay involved with your kids. So long everybody!


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