Food Allergies, Lactose Intolerance, and Student Athletes – PediaCast 009

Listen Now (right-click to download)


  • Food Allergies
  • History Of The Incubator
  • Croup
  • Constipation
  • Stubbornness
  • Lactose Intolerance
  • Hockey Safety
  • Student Athletes
  • Teens Passing Out
  • Obesity



This is Pediacast, episode 9 for the week of September 18th, 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

Hello everyone! And welcome to this week's episode of Pediacast, the Pediatric Podcast for parents. This &
is Dr. Mike Patrick coming to you from Birdhouse studio, and we have another show packed with &
information moms and dads can use. First up this week in our Infants Segment is a report on cereal &
allergies. We'll also look at the history of the incubator, an important medical device for premature infants &
throughout the world.


And in our Toddler portion we'll talk about poop, and also a recent study looking at the relationship between &
constipation and stubbornness. Our child segment this week focuses on hockey safety and lactose &
intolerance. And then in the Teenage portion of Pediacast, we'll discuss high school athletes. What do you &
do if they get light headed or pass out during physical activity and does their participation in sports ward off &
obesity? That's all coming up on this week's edition of Pediacast, it's episode number 9. So let's get &

Now we before we jump into the Infant section, I'd like to give a shoutout to Whitney Hoffman, of the LD &
Podcast. The LD Podcast is a show by a parent of children with learning differences for other parents who &
find themselves in the same situation. Last week, she interviewed yours truly, and we had an interesting &
discussion of learning disorders from a pediatric-medical perspective. So if you have a child with &
academic issues or you know someone in that situation, or you are simply interested learning more about &
the problem, be sure to check out the LD Podcast. You'll find it in the iTunes Music Store and at &


And for those of you with a short attention span, like me, [Laughs] might not remember the website by the &
time this episode is over. Simply head on over to our show notes and we'll have a link up for you.

I'd also like to share an email I received from Brenda, regarding last week's program. She says, "My &
daughter has lazy eye. I inquired about eye exercises multiple times to her optometrist. He said glasses &
were just as effective. She was 6 when she was first seen by him. After two years of no improvement, I &
discussed the issue with our pediatrician. He suggested an ophthalmologist that he referred patients to. &
This ophthalmologist works with children although I don't believe he is pediatric specific. After my &
daughter's first appointment at 8 and half, he began patching her eye. He was somewhat cautious of &
improvement because by this age, improvement and patching is not as great. She's still patching and &
making great improvement. So suggesting parents seek ophthalmologists over optometrists is the best &
advice you can give."


Thanks for your email, Brenda. And you do make a good point I hadn't mentioned last week. There certainly &
are ophthalmologists out there who have a specific interest in working with children but who also see adult &
patients as well. So I guess the bottom line is if your pediatrician trusts this doctor, and you trust your &
pediatrician, then go for it.

If you'd like to leave some feedback or have a topic you would like us to address simply drop us a line by &
email at or go to our website at and click on &
the contact link. By the way, Pediascribe is our daily blog so if you just can't get enough of me during the &
weekly podcast — [Laughs] just kidding — head on over to Pediascribe where you'll find something new &
every weekday, at least that's the plan. And of course everyone's encouraged to participate on our blog. &
Think of it as a parenting support group. You also notice a new feature at the website, and that's PediAlert. &
Now PediAlert is simply a mailing list for bloggers and listeners. Don't worry, we won't spam you out or give &
your email address to any other source.


We'll send you a weekly notice of the topics on the current episode plus a recap of the past week of blog &
entries and we'll also include some e-breaking news that comes out of the American Academy of &
Pediatrics and the Center for Disease Control regarding outbreaks and epidemics, new immunizations &
and vaccine shortages, that sort of thing.

Signing up is easy. Simply go to and click on the PediAlert link. Okay let's move on &
into our Infant section and as we do that we're going to remind you that 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. 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 will not necessarily pertain to your child or family's specific situation. And as &
usual now that we have made the lawyers happy, let's move on with the program.



This week in our Infant segment we're going to talk a little bit about food allergies and little infants and this &
was a study that was done at the National Jewish Medical and Research Center in Denver, Colorado. A &
little bit of background on it: Food allergies affect 6% of all children who are less than 3 years of age. And &
some earlier studies had suggested that if you delay the introduction of solids into the infant diet, that& that &
could decrease the development of eczema and asthma, both of which have an allergic component &
associated with them. So some experts have recommended exclusive breastfeeding until 6 months of age &
for this very reason, with the thought that if you introduce cereals before that time, there might be an &
increased likelihood of developing eczema which is the dry, itchy skin and asthma which would be &


Now current guidelines from the American Academy of Pediatrics, Committee on Nutrition still supports &
introducing solids between 4 and 6 months of age. What these researches wanted to do is to see if they &
can reproduce an association with early cereal exposure to eczema an asthma symptoms in little babies. &
So they enrolled 1,612 children at birth and then they followed them until they were about 4 to 5 years old. &
And the way they did this is they sent out questionnaires that recorded dietary exposures at 3 months, 6 &
months, 9 months, 15 months and 24 months of age. And then when they did these questionnaires, they &
also ask about allergy symptoms such as the eczema and the wheezing. And if those were reported then &
blood tests were done to look for wheat allergy if they had those symptoms. Now so what they find out. &
Well, 1% of the kids studied were shown to have a wheat allergy. So they reported problems with eczema &
or dry skin or with wheezing and then they got the blood tests and showed, "Yup, you have a wheat allergy."


Now the interesting thing with this is that a significant number of the kids who did develop wheat allergy had &
not been exposed to any cereals prior to 6 months of age. And children exposed to cereals prior to 6 &
months had fewer cases of wheat allergy, suggesting that earlier exposure may actually be protective.

Now on the surface this seems counterintuitive because we've been told some time that if certain foods are &
given too soon, that you might develop allergies to them. But perhaps it's just as bad if you wait too long. &
And let's take a look at why this might be. First you have to understand a little bit about the immune system. &
Your body recognizes something that's foreign and then it makes an antibody against it. And the immune &
systems makes a memory of that invader so that next time there is an exposure to that thing, then the &
antibody can be made in mass quantity and that way the invader is defeated, the next time it comes &
around. That's basically how immunizations work.


So you trick your body into thinking that you have tetanus, let's say, from the tetanus shot and so your body &
makes an antibody against it, so that the next time tetanus comes around, when it might be the real tetanus &
bug, then the antibodies can rev up and be made and attack and help you out.

Now the next thing you have to understand that if your body has a strong immune response, then lots of &
chemicals get released and these chemicals, for example histamines, cause many of the allergic &
symptoms that we deal with. So not only when you are exposed to these things do you make the antibodies &
but you also have some chemicals that are released that help in the process but they also cause some side &
effects which in some kids can be the dry, itchy, eczema type skin rash and wheezing for other kids which &
kind of shows up as asthma then.

So the original thought was that some foods you know are basically recognized as foreign and if they're &
introduced into the body too soon, and then your body makes antibodies and the reaction including the &
wheeze and the eczema occur if you are re-exposed to those food things.


But there's also this thing called sensitization that we forget about when we just look at it with that kind of &
simplicity. And this is the idea really behind allergy shots. And that says that if you introduce a foreign &
substance in small amounts repeatedly, then your body starts to accept it as okay and does not recognize it &
as foreign anymore and then doesn't attack it anymore. Then you have no reaction.

So that's how the allergy shots work. If you're getting allergy shots against certain plant material that you are &
allergic too — these allergy shots are actually injecting a very small amount over the course of several &
weeks into your body to hopefully sensitize you, or make your body used to that thing. Now we think, same &
thing could be happening with cereals. So cereals that are introduced earlier and continued daily may &
result in less allergic reactions down the road, because of the sensitization idea. So which is it? You know, &
is it better to give it too early, or try to sensitize your body, and not develop an allergy, or if you give it too &
soon, is your body going to recognize it is foreign and then you will end up having a problem?

So you know, which way do you go? Who do you listen to? Well you know it's probably different for each &
person. I mean there's probably some people that earlier exposure to cereals is going to cause the &
sensitization and then they won't develop a cereal allergy that they might otherwise have had. And then &
there's going to be other kids other babies who if you give them the cereal too soon, they are going to have &
a problem and if you have waited then they wouldn't have developed their eczema or their asthma. So I &
think more research really is required to understand this better, so we can hopefully someday be able to &
better sort of predict which kids are going to do better with introduction of cereal earlier and which ones &
later. So you know for those of you whose kids have never had any eczema, dry skin or wheezing problems &
in the past, you know you're probably thinking what's the big deal.


But you know if you have a baby with these problems, it really can be quite distressing and requires lots of &
trips to the doctors, especially if there is serious wheezing involved. And then of course there is the &
expensive medications, and for the eczema a lot of times we resort to prescription-strength steroid creams &
and those can have side effects too. So for a lot of people this is a big deal and I think right now you know &
the best advice is to stick with the American Academy of Pediatrics Committee on Nutrition and probably &
starting cereals some time between 4 and 6 months of age is going to be your best bet.

Best advice of course is to listen to your doctor. They definitely have experience. They see lots of kids and &
when they seem to do best with cereals and for my patients you know I generally recommend that they start &
the cereals at about 4 to 6 months of age.

Okay we're going to actually move on to a little bit of a different topic here for the second part of the infant &
segment of our program this week. And rather than talk about a medical issue, I ran across this in the &
magazine, Contemporary Pediatrics.


It was the August 2006 issue and it's an article written by Dr. Andrew Schuman who is the assistant &
professor of Pediatrics at Dartmouth Medical School and it was an article that basically described the &
origins of the incubator that we use for premature babies. And it was really interesting and I wanted to &
share some of the information that was contained in this article with you, and then in the show notes there'll &
be a link so that you can actually go to the article itself because it does have some really cool photographs, &
so if you are a history buff, this will be right up your alley. If you're not really into history, or have had a &
premature baby at home and really don't care about incubators, then yeah, just hit the fast forward button &
until you hear the bad music in between our segments and go on over to the Toddler segment. But for those &
of you who are sticking around. Basically in the mid-1800s, European doctors realized that premature &
infants would not survive unless they were kept warm.

And the first device to keep babies warm was developed in Russia, actually. And it was simply a double &
walled tub and they would lay the baby down in the tub and then the space between the walls was basically &
constantly replenished with warm water. That was water that was warm from an outside source. They just &
basically dumped it between these two layers and then every couple of hours, they'd drain it out and then &
replace it with some different warm water. Well in the late 1800s I think it started to change a little bit. &
Obstetricians actually took care of babies after birth at this point, not pediatricians. And there was a French &
obstetrician — and you know I'm not really good with foreign names, so you have to cut me a little slack here &
— but his name is Dr. Étienne Stéphane Tarnier.& And he visited the Perez Zoo in 1878 and as he toured the &
chicken hatching facility, he was struck with an idea. He thought you know if an enclosed warm space helps &
little chicks hatch and survive then perhaps it would help human babies, too.

& We're not just talking about a little tub with two layers and warm water in between the layers, I mean we're &
really talking the contraption that completely surrounds the infant on the sides and on the top — you know &
what I'm talking about with an incubator. So this Dr. Tarnier went to Odile Martin who was the designer of &
these warm hatcheries for chickens and he commissioned to help him design and build basically a &
hatchery for baby. And the result was the Tarnier-Martin couveuse and it was first used — and please, &
I'm probably pronouncing these French words a little wrong, too, but again forgive me. And so this first &
infant incubator actually was all enclosed and based on a chicken hatchery. It was first used in 1880, at the &
Paris Maternity Hospital. Now what was this thing like? Well again, if you go the link in the show notes, &
there's actually a picture at the actual article.


It was basically an infant bed with four walls, and a top even to it, and it was sitting on top of a &
chamber of warm water that was supplied by a connected external boiler. So there's actually a boiler &
separate from the incubator itself and the steam from that would heat water which was then piped into this &
chamber underneath the baby. So it's basically hot water under the baby. Now during the first three years of &
its use, Dr. Tarnier showed a 50% reduction in mortality among premature babies who weighed less than &
2000 grams, which is about 4 1/2 pounds at birth. Of course now we talk about saving babies who are right &
around 500 grams, so you can see, we've really made lots of progress since these days but those are for &
different reasons. So these were babies that were about 4 1/2 pounds and it showed that you could save &
50% more of them by using this incubator.


Now over the next 10 years, Dr. Tarnier improvements on the original design. He replaced the boiler and &
water-filled chamber with circulating warm air and this heat source then was a collection of hot water bottles &
& and those had to be changed every two hours. But now instead of the heat source being under the baby &
that made a circulating air system that actually was piped into the incubator, and what he did, it was just hot &
water bottles that again, were changed ever two hours.

Now first incubator in the United States was developed by Thomas Morgan Rotch and he was the first &
professor of Pediatrics at Harvard Medical School. And during the 1890s, Dr. Rotch teamed up with John &
Putnam, Boston inventor, and he developed the first infant brooder, that's what they called it. And this &
device not only provided a warm environment, but it also had an air-filter system to trap microorganisms &
and keep dust out. Now the Rotch-Putnam brooder it was huge and heavy and expensive and again there &
is a picture of this one, too, if you follow the link in the show notes.

But its walls were made of two copper layers with warm water flowing between the layers and it even &
sported an integrated scale and connections for oxygen hookup as well. Now about the same time that the &
Rotch-Putnam incubator came into being in America, the French were busy working on their own second-
generation type contraption, and this was actually the first incubator then with a thermostat. It was originally &
used for hatching eggs and raising chicks. But another French obstetrician by the name of Alexander Lyon &
who made some alterations to it which made the unit suitable for a premature infant. Now Lyon's incubator &
was a bit more sophisticated. They had an oil lamp that boiled the chamber of water and then the steam &
moved warm water through a series of coils that surrounded the inner chamber. And the thermostat &
actually controlled the heating source and it was reliable enough that nurses were freed from the chore of &
changing water every two or three hours, as the first-generation device has required, or the hot water &
bottles also had to be changed every couple of hours.

So this was something that gave the nurses the chance to do something different with their time, and the &
thermostat kept the temperature inside the incubator at a very constant level. So this was a much more &
sophisticated kind of device. Now the interesting, Lyon, and in order to fund the development of his incubators, he actually charged visitors a fee to view thriving infants in a room full of his incubators and this human hatchery was so popular in financially successful that Lyon built human hatcheries in four more French cities and the money is collected from curious visitors who actually paid for the production of these incubators. So, [laughs] it's kind of interesting. I can't imagine that happening today. The modern incubator that we use now was developed in the United States. American Pediatrician Julius Hess is credited with developing the modern incubator that we use and he had studied these first- and second-generation incubators from Europe and then the ones from the Boston area as well.


And in 1922, he developed a double-walled bed, containing water but the water was heated by electricity and a thermostat regulated the amount of heating. Hess later modified his design to also include connections for oxygen delivery. Now the Hess beds used less water. They were lighter and more easily mobile and these were actually the first units that were used in the very first neonatal transport ambulances if a premature baby was born out of the house or out in the country or a really small hospital, they'll be transferred to the big city to the neonatal unit in one of these contraptions.

So again for more information about incubators just visit the show notes and click on that link and there are some photographs there for you as well. So that's our History 101 in the Infant segment of Pediacast.



And we're going to move on right along to
& the Toddler segment of this week's Pediacast and the first item up for discussion is croup. Now what is croup? Well, croup is, you know it's not really a specific disease. Croup is more of what we call a syndrome. It's just a word used to describe the condition when you have airway swelling at the level of the vocal cords. And because of the location of the swelling, you're going to hear a hoarseness in the voice and barky cough and noisy breathing. But there's several different things that can actually cause a croup-like syndrome. Now it's most commonly seen between the ages of 6 months and 3 years of age. It can occur any time of the year but it's most common in the fall and winter months.


Now the most common cause of croup is going to be a virus, and the most common of those virus is going to be the parainfluenza virus. So basically it starts as a cold, with kind of a runny nose, and a little bit of cough but very quickly it leads to barky cough and a hoarseness. And if you ever had a kid at home with croup, you know exactly what I'm talking about. Now this barky coughing can progress into what we call stridor. Now stridor is a condition when they breathe in, you hear a real high pitch noise, kind of like a kind of noise. And again if you have had a child at home with pretty severe croup, you know what I'm talking about. And the stridor gets worse when your child is real active or they're crying, or they're upset, and that's just because they're breathing heavier during those times, so they're moving more air across the swollen vocal cord area and you're going to hear it a little bit more. Now this stridor noise we're talking about is different than wheezing. Wheezing is when more when you breathe out, and that's actually a little smoother, higher pitch noise whereas a stridor is when you breathe in, and it's originating in the throat rather than down in the lungs.


So it's going to be a little bit louder and a little bit coarser noise. And if you've heard kids with both wheezing and stridor you see that definitely there's a difference there that you can tell pretty rightly if you know what both of them sound like.

So basically if your child's making funny noises that you've not heard before, that should be a warning sign, even if you don't know the name of it.

And then also with the viral croup, we also see fever a lot of times associated with it. Now another form of croup is called spasmodic croup. Now, this is a more severe form of croup and it comes on very suddenly and the stridor is even worse than with regular croup and it can occur even at rest. So they can be sitting there just as calm and quite as can be and you can really hear them making this higher pitch noise when they breathe in with every breath. Now, this spasmodic croup may be caused by a virus or it can also have allergic causes to it as well. And there can even be some wheezing associated with it if it's an allergic cause along with that spasmodic croup.


Now with both types of croup, you know the stridor I'm talking about, this noise when they breathe in, it's a pretty big deal, because if stridor is present, then that means the airway is compromised. And if left alone, it could progress to a degree of obstruction that then limits your child's ability to breathe and sometimes they can even stop breathing all together. So you don't want to play around when you hear airway noises that you've not heard before. You want to seek help right away.

So what do we do? Because croup is caused by a virus — or you know in some cases an allergic reaction, but most commonly a virus — antibiotics are not going to help. And even if it's caused from allergic reaction to something, antibiotics aren't going to help with that either. Note, however, that a child might have a bacterial infection along with your croup, you know, like an ear infection or something. So that may require an antibiotic. And I only mentioned it because if you go to your doctors and they say, "Yeah your kid has croup and an ear infection, we're going to give you an antibiotic," just realize the antibiotic is only going to treat the ear infection part of it or whatever other bacterial infection they may be treating, whether it be sinus infection, pneumonia, ear infection.


But the antibiotic is not going to help at all with the croup symptoms because those symptoms are caused by swelling which in turn is caused by a virus and the antibiotics aren't going to do anything for you. So how do you treat croup. Well, the primary goal is basically to ease your child's discomfort and to protect the airway to keep them breathing easier, so that it doesn't get so swollen that they stop breathing and basically get them through until their immune system fights the virus off, which usually takes about a week although the worst part of it usually is just a few days. Now croup does have stridor and barky cough which tend to be worse at night. You know why exactly is that? Well you know at night time, especially at the time of the year that it's happening in the fall and the winter, you know it's getting colder outside at night and so your furnace is kicking on and that makes the air inside the house much drier when your heater is kicking on frequently.

So usually at night time you're going to have drier air in the house, and then that can make the swelling worse in the airway. Also you know if your child breathes with their mouth open, that may help dry things out a little bit as well around the vocal cords. That's why sometimes you wake up in the morning with a sore throat, your voice sounds real scratchy when you first wake up in the morning, because the mucus membranes down there are drying out. So because it has a drying effect, that tends to make it worse at night time. So if drying makes it worse, you know it stands to reason that moisture is going to help make it better. And that is true. Moisture tends to ease the swelling around the vocal cord. So one thing that we tell parents to do if their child is real barky at night or they have a little bit of stridor that's just there when their upset but then when they calm down it goes away, one thing that you can do is turn on the hot shower and close the bathroom door and let the bathroom get real steamy, and take the child in the bathroom. I always to mention to parents, don't take them in the hot shower. Just [laughs] stand with them in the bathroom and let them breathe in that steamy air. And a lot of times that will help.


And now you know why. Now something else that you can do is a humidifier in the bedroom may help ease things as well. There are some safety issues with both types of humidifiers that are out there these days — actually three types. One type of humidifier is the old-fashioned kind that gets very hot and I don't think you can really buy those new anymore but if someone has them you know around the house you just have to be really careful especially at this age because it's toddlers. If they get up in the night and knock it over, they could scald themselves. So these are probably not the best ones to have around. Then there are two kinds that you can buy today. One is a warm one but you have to add like some salt to it to get it to start going. So you're lowering the boiling point, but those still can get pretty hot and could still cause some burns. And the third one which is probably the safest one to use are going to be cool-mist humidifiers. And these are the ones that basically just have a really rapidly spinning device on the inside and that helps pick up some water moisture and then it blows it out.


The issue with those is that bacteria and fungus can grow in them so every couple of days you want to make sure you rinse it out with dilute bleach water and then rinse out really good and that will help to prevent any growth on the inside of it. Now another way that you can get some moisture into their airway is if you take the freezer and open up the freezer door and you know that moisture comes rolling out of the freezer when you open it up. Well that cool moisture will actually help calm down the airway too, so that's another way that you could try to introduce some moisture to help them out. This is interesting. A lot of times kids will sound really creepy at home and just sound terrible and the parents take them out to the doctor's office or the hospital emergency room or urgent care center, and by the time you get to the doctor's office or the hospital over the urgent care, the cool night air which has more moisture in it than inside of the house has really helped things out.


So by the time you actually see the doctor, the doctor is looking at you like "You are worried about this?" [Laughs] Well we do understand that things were worse when you were home, but when you went outside that moist air helped to calm the croup symptoms down a little bit. So that leaves you to another idea. You know rather than going to the hospital, if they're not in distress or you’re not really worried about their breathing, you know you could just take them outside for a quick walk even if it's winter time and that cool night air oftentimes will help calm things down a little bit for them because of the increased moisture.

Now if these actions don't improve noisy breathing, you definitely want to call your doctor and if your child's working extremely hard to breathe, so they really have a loud whistling stridor which each breath or they're breathing so hard they can't talk to you or they're sucking in between the ribs or in& the neck area with each breath. Or you have nasal flaring at the openings to the nose, so if their nose holes seem to be getting bigger and then smaller and then bigger and then smaller with each breath, that's definitely something you worry about or if they're just struggling to breathe.


Also if they are drooling or they have extreme difficulty swallowing, or they look blue around the mouth or under the fingernails, obviously any of these things
& — don't bother calling your doctor, call 911 because the next thing that can happen is your baby stops breathing and then what are you going to do? Hopefully you know infant or toddler CPR which you can get through the American Red Cross, but you definitely want to be prepared and call 911 and get some help if they're having that much trouble breathing.

Now what about medications. Well we said antibiotics don't work, but when you do have stridor with croup, a lot of times we do use steroid medicines because steroids are really good at reducing swelling in the airway. You only want to use these if you really have to because one of the side effects of steroids is they decrease your immune system's ability to function and since this is a virus and we're relying on our immune system to take care of it for us, you really want your immune system in top shape taking care of this.


But at the same time, you have to have an airway in order for your immune system to work, so sometimes we do have to use the steroids to keep kids out of trouble. Now the steroid medicines are available in a shot form, you can also give them by mouth, or if the kid's in the hospital because the croup is so bad, then they can also be given through an IV. Now for the spasmodic croup, where there may be a n allergic component to it or it's a very severe type swelling, aerosol treatments with albuterol or epinephrine may also help. And the key with this one is you do have to really closely observe your child for a while after you give these kinds of aerosols, because once the medicine has worn off, there is a risk for what we call rebound, which is when the swelling comes back even worse than it was before. So if we have a kid in our office that we have to give epinephrine aerosol to, a lot of times, we'll ask the parents to please wait around for an hour or two so we can make sure that the kid's going to continue to sound good after the aerosol and things are going to get a lot worse once they leave our office.


Now what about over-the-counter cough and cold medicines. Well they can provide some relief, but you know you don't want to get your child too sleepy because that may decrease the stimulation to breathe and since this is a breathing issue you have to be aware of that. So you don't want to use a big dose of antihistamine type of medicine because that can decrease their breathing a little bit. Also remember with these colds and viruses, whether it's croup or even a regular cold virus, the mucus that kids have is there for a reason, You know it's to trap the virus and their cough keeps that mucus out of the airway, so it helps it to prevent pneumonia. So you know to some degree, you want that mucus and that cough to be there. On the other hand you know, you do want your kids to be comfortable and able to get some sleep so there's got to be some sort of a middle ground here. And you just want to ask your doctor for their advice on what you should do with your child in terms of cough and cold medicines when they have croup. Now a final word about this thing called epiglottitis is important.


The epiglottis is a flap that's in the back of the throat and it basically covers the trachea, the opening to the trachea when you swallow. So it prevents choking. Well epiglottitis is an infection of that flap, and it's usually caused by a bacteria so it does require antibiotics. It's a very very dangerous disease because that swelling can come on quickly and it can get severe rapidly and then completely obstruct the airway and lead to death. Now the symptoms of early epiglottitis are similar to croup as you're going to have the barky cough and a little bit of stridor but they progress really quickly to those other warning symptoms I was telling you about in terms of turning blue around the lips or drooling or blue underneath the fingernails or really working hard to breathe, sucking in between the ribs or neck or nasal flaring. These children are often sitting upright and keeping still to maintain their airway and again they're often drooling and working really hard to breathe. So these kids definitely call 911. They usually need a breathing tube down their throat until the swelling goes away.


And that tube is actually best inserted not even by the ER doctor, usually they won't even do it. They'll call a pediatric ear, nose and throat specialist. And they'll usually insert the tube in the operating room because the airway is such at high risk. The good news with all of these is we hardly ever see epiglottitis anymore and the reason for that is the bacteria that usually caused it was one called Haemophilus influenzae Type B, and the Hib vaccine that we give at 2, 4, 6 months and then again some time between 1 and 2 years of age. That Hib vaccine protects against Haemophilus influenzae Type B. That same bacteria also cause many cases of meningitis in toddlers and led to many deaths before that vaccine came out. And then that now meningitis caused by H. Flu as it's known for short is very rare, thanks to that Hib vaccine.


Okay moving on along in the Toddler segment, our next item up to discuss is actually a study that looks at stubbornness and how it relates to constipation at the University of Virginia at Charlottesville and the hypothesis was that toddlers who had constipation would be viewed as stubborn kids by their parents to hearing potty training, so that if you could treat their constipation, these kids will become less stubborn and potty training would proceed easier. So the study looked at 101 families with children who are between the ages of 2 and 6. They were basically coming into their primary care doctor with the main complaint of constipation. Now three different questionnaires that measure stubbornness [laughs] were given to these parents. And then the children were treated for their constipation for two months and then they were reassessed. Now there were also parents of a control group. So these were kids who did not have constipation and they were also given the questionnaires just to see how the groups compared with one another. Well what they found was that constipated kids were viewed as significantly more stubborn than the control group in terms of general stubbornness and stubbornness related to their toilet training both.

And then after two months of constipation treatment, the stubborn kids had significant improvement in their stubbornness rating when reassessed by their parents. [Laughs] So basically parents who think their kids were very stubborn and they were constipated, and then you treated their constipation and from the parents' point of view, everything went easier.

Now, constipation's one of the more common problems that we encounter in pediatrics. You know, we see ear infections a lot, we see colds, we treat allergies and asthma, but I tell you, constipation is right up there with the other problems. And for many kids, you know, the cause of their constipation is really a combination of genetics and diets. You know some bowels are just more prone to constipation and you know kids aren't eating a lot of fiber. They probably can eat more fruit although you know it just depends on the child and they're usually not drinking enough water either.


So if your child is particularly stubborn about toilet training, then you might want to think about the fact they could be constipated and talk to you doctor about diet changes or stool softener. And if your child's like the one in the study, then their stubbornness may improve and toilet training may progress more smoothly. Now keep mind this is important: kids who have one soft bowel movement every day, they can still be constipated. You know constipation is basically having a surplus of stool in the intestines which then causes abdominal cramping. And kids, you know, they have to sit on a toilet long enough, because normally when we poop, you go once, you have a big amount out, and you have to sit there in order to let the rectum fill a second and sometimes even a third time to get more of it out. So if you have a kid who just basically gets the first turd out, you know what I'm saying, and then they're up and off to their races again, if they didn't get number 2 and number 3 out, that's going to back up.


And so if everyday they could have gotten three turds out, excuse my French, but they only get one out, then you've got two that have backed up every day. Well do that for a month and how many do you have backed up? And here you have a kid who's having a normal bowel movement everyday, from the parents' perspective. So, even if your child's having bowel movement everyday. But they are stubborn with their potty training, you know, you may want to talk to your doctor about increasing the fiber in their diet, increasing water, increase in fruits, and then even stool softener can come into play as well. You know, the best stool softeners are the ones prescribed by your doctor because they may want to do a physical exam, and make sure there's not some other reason that they're having their potty training issues.



This week in our School Age Child segment of the program, we're going to first talk about lactose intolerance. Now lactose intolerance& results from the inability to break down lactose which is a sugar that's often found in dairy products and the enzyme lactase is missing in the gut, and so you have a hard time breaking down the lactose because you don't have lactase. Now significant lactose ingestion in these folks who are missing this enzyme results in abdominal discomfort. It can also make you feel nauseous. You can have increased flatulence or passing gas, bloating feeling and sometimes some diarrhea can be associated with it as well. This is a pretty common problem. It's more often seen in childhood and teenage years than it is during infancy and toddler years, and it's usually really not seen after kids are about 2 or 3. And then in Hispanics and Asians and African-Americans, you start to see it in early childhood after 2 or 3 years of age and in Caucasian children, usually you don't see it until after they are about 4 or 5 years old.

But by the adulthood, actually about 70% of the world's population is deficient in this lactase enzyme so they're lactose-intolerant. Almost all Asian and American-Indian adults are deficient in that enzyme and a majority of Hispanics and Blacks are also deficient in the lactase enzyme and so that they are lactose-intolerant.

Now lactose intolerance also gets overdiagnosed though, so if you have any of those any of these symptoms, lactose intolerance is actually an unlikely cause and these symptoms are blood in the stool, or if you become anemic because of chronic blood in the stool, or you have quite a bit of weight loss and this may indicate milk allergy, or celiac disease, or gut infections with bacteria among other things. So if you're having blood in the stool or you're losing weight or you find out that you are anemic and all these things are going on, don't blame it on lactose intolerance.


Make sure you see your doctor, so that you get the right diagnosis and the proper treatment. Now there's also this idea of temporary lactose intolerance and what this is is there are other gut diseases such as gastroenteritis, like from a virus or a stomach flu sometimes we call it, and they have a diarrhea associated with it. And the diarrhea can actually wash out that enzyme lactase that breaks down the lactose out of the intestine and that will make you temporarily lactose intolerant. Now once the diarrhea is gone, your body starts to make the lactase again, as long as you didn't have underlying lactose intolerance to begin with, but if you normally could tolerate dairy products, and then you have diarrhea, you're not going to be able to tolerate the dairy products again right away, because that diarrhea flushed that enzyme lactase out of your system and it can take a week or two before you can tolerate drinking milk again. Now sometimes, this happens in kids. You know they'll have a diarrhea illness that's caused by a virus, and just as soon as they're getting better, their parents are putting them back on milk again, and then diarrhea is coming back.


And it seems like it's just passing from kid to kid in the family or it's a terribly long-lasting diarrhea — sort of a vicious cycle because the diarrhea, first it's caused by the virus, but then it's caused by the lactose intolerance and then that lactose intolerance won't go away because you keep having the diarrhea. So sometimes you just have to get them off all the dairy products that has lactose in it for a week or two in order to get their intestines making that lactase enzyme again, and then it's safe to give them their dairy products again after that. And then the diarrhea won't come back after they make an enzyme again.

Now of course there are a lot of other things that can cause chronic diarrhea in kids as well so again, you make sure you see your doctor. You don't want to just blame it on — first, you had a virus, and now it's a lactose issue — especially if there's blood in the stool, or your child's getting dehydrated or they're having vomiting along with it. So make sure you talk to your doctor about those things.


Now how do you diagnose lactose intolerance. Well, the common way to diagnose is really just to eliminate lactose from the diet for two weeks. And you'd not only have to eliminate obvious dairy products but many foods such as cakes and breads too. Just look at the ingredients. If it says nonfat milk products on the ingredient label, then it is going to have some lactose in it. So you basically want to really pay attention to labels and make sure you're getting all dairy products, all, even the non-fat milk products out of the diet completely.& And if the symptoms resolve after doing this for two weeks, then you re-introduce dairy and if the symptoms come back, then lactose intolerance probably is the answer. Now there is a confirmatory test you can do, it's called a hydrogen breath test. And basically, how this works is that, you fast overnight — so you don't have anything to eat or drink overnight, and then in the morning at the hospital, you ingest a standard amount of lactose and then the amount of hydrogen that you breathe out over the next 2- to 3-hour period is measured.


And if you have a pretty rapid and strong increase in the hydrogen levels that you're breathing out after about 60 minutes after this lactose ingestion, then that's consistent with lactose intolerance. Now why? [Laughs]

Why would you breathe out more hydrogen if you're lactose intolerant and you've had lactose. Well the reason is that, if you constantly have undigested lactose in the gut, you're going to get an overgrowth of particular types of bacteria that like lactose and like to break it down. Now if you're not lactose intolerant and you are breaking down your own lactose, you're probably not going to have very many of these particular bacteria in the intestine because they don't have anything to eat. You know they're not going to want to be there. But if you're lactose intolerant, you have plenty of lactose around and these particular bacteria really like to break it down. Now they break it down which you know, that would be a symbiotic relationship, right? When you want these bacteria in there to break down the lactose.


So the problem is they do break it down but not enough to keep you from having the symptoms. So you are providing basically the nutrition for these bacteria and it just so happens that these particular bacteria when they break down lactose, hydrogen is a byproduct of that and that hydrogen gets absorbed in the intestine, goes to the bloodstream, goes to the lungs and you breathe it out. So, if you have these bacteria in your body, and you take a big diet with lactose in it, and measure the hydrogen, it's going to definitely increase when you breathe out, whereas someone who's not lactose intolerant are not going to have those particular bacteria in their intestine.

Okay well, let's say you are lactose intolerant, especially if you have a child who is, we all know that dairy is important. If you look at episode 7 of our program, we do talk about milk and the fact that it's a good source of calcium, vitamin D, and lots of other vitamins and minerals, so what do you do if you are lactose intolerant and you can't drink milk?


You know because it is important to get it in. Well there is good news. For one, many people who have this lactase deficiency don't really have total absence of it. They just have less of it, that would be ideal. Each person sort of learns what they can tolerate, given the amount of lactase that they have in their intestines. So they might be able to eat a couple of yogurt or a slice of cheese or a small glass of milk and then only have the symptoms if they really overdo the dairy. So for one if you know your limitations, smaller but more frequent servings of dairy, it really maybe all the treatment that you need and you're able to work in the dairy products that way. Now yogurt often is well-tolerated because the bacteria that are in active yogurt — now we're not talking about frozen yogurt, here just the fresh regular yogurt that has good bacteria in it, so to speak. Those bacteria do help break down the lactose, so some people will tolerate yogurt pretty well, when they won't tolerate other dairy products. And then you can also consider the calcium fortified juices. You know there's orange out there now that has just as much calcium in it as a glass of milk does.


Although you do want to make sure that you have a good source of vitamin D as well because that's going to help the calcium get absorbed a little bit better, and again in episode 7, we talked about that with a lot more detail. Also cereals and dark veggies such as broccoli, spinach, and the colored greens — yeah right, you're going get your kids those, right? But if you can, then those also have lots of calcium in them as well.

Of course the spinach thing, and I didn't really prepare for this. Maybe we'll touch on it in our next episode of Pediacast. But you know the whole E. coli business, okay so, maybe don't go with the spinach right now. I wrote that before we had this whole spinach problem with E. coli. So hold off on the spinach for a little while, if your kids would eat anyway in the first place.

Okay, another important thing with the treatment of this is lactose-free milk is available. It's kind of expensive. This is basically milk with the lactase enzyme added to it, so the lactose that's in the milk is basically pre-digested by the enzyme that they have added. Now this kind of milk tastes a little bit sweeter than regular milk. It does take some getting used to. And it's often more expensive than regular milk as well.


And then they also have chewable tablets that have lactase in them, it's called Lactaid. And that's also available. So basically if you're going to have a meal that has some dairy in it, you could chew up one or two of these Lactaid tablets and then that's going to provide the enzyme lactase which will then digest lactose and help keep those symptoms away.

Okay moving on along in our School Age side section of Pediacast this week, we're going to talk a little bit about hockey injuries. Now the particular thing that we are talking about with regard to hockey is body checks. For those of you who don't know what a body check is, that's when one hockey player sort of slams up against another hockey player against the boards, and oftentimes this results in injuries such as concussions and fractures.

Well prior to 2002, Canada's National Hockey Regulatory Association banned the body checking in 10- and 11-year-olds but they continued to allow it in 12- and 13-year-olds.


Well that policy changed in 2002, when 11-year-olds were moved to the same division as the 12- and 13-year-olds. So first, the 11-year-olds were with the 10-year-olds and they weren't allowed to body check and then in 2002, they moved the 11-year-olds to the 12- and 13-year-old division, and then they were allowed to body check. Well the impact of this change was evaluated by the Children's Hockey Injury Prevention Initiative in Edmonton, Alberta and investigators there identified all 10-, 11-, and 12-year -olds who are seen in seven different emergency departments for hockey-related injuries. And they looked at data from 2 years before the change until 2 years after the change. And what they found is that hockey injury rates in 11-year-olds significantly increased after the policy changed but they did not change significantly for 10- or 12- year-olds.


So the 10- year-olds who were never body checking and continue to not body check had no difference in their injuries and the 12- year-olds who were allowed and were continued to allow to do it also did not have any change in the number of injuries but the 11- year-olds who used to not body check and then they started to body check had a significant increase in the number of injuries. So the authors basically make the assumption then that these increased injuries must be due to body checking. Because this was a study looking back at data, they weren't there in any emergency department asking these kids how did you get hurt. So they're making an assumption. Now you could also say, were these 11- year-olds playing with 12- and 13- year-olds? They weren't quite clear about that. Because if you have a group of 11- year-olds who are used to playing 10- year-olds, and now they're playing 12- and 13- year-olds, we all know that a lot of boys have growth spurts right around this time.


So if they are playing with much bigger, heavier players when they join the 12- and 13-year-old league, you know how much of it is not body checks, that's the issue, but it's just playing with this bigger kids. And that's one criticism that I would have with this study, that you don't know for sure that it's the body checks that caused the increase in the injuries because you have this other variable of playing with bigger kids that's out there. But still, you know, it makes you think about the possibility that the body checks had something to do with it.

And one of the places that I get material for Pediacast, there's a weekly publication that comes out called Pediatric Notes that's put together by Dr. Richard Goldbloom and it's basically a summary of the different research studies that have come out so you don't have to actually go the abstract itself and read through all the statistical analysis. It's just a nice summary of what the study does and then there's a reference material that you can go back and look at the original study if you are interested in doing that.


And so with these particular study, I am going to put a link to the show notes. So if you'd like to see what one of these scientific studies looks like in its raw form, go to the show notes and click on the link for Hockey Safety Study, and you can look one of those over.

I can guarantee you probably won't read every word through it, because they're pretty boring to read the actual research article itself but it is a nice example of what a scientific article in a science publication actually looks like. But the reason I mention Dr. Richard Goldbloom is because he did have a quote that he put in to the Pediatric Notes when he follows up this particular study. And I really want to read his quote, and I think it's a good one. He says, "Speaking as a long lapsed hockey player, I've watched the game of hockey especially in the recent decades from a game of skill to a game of heel."

Now I couldn't agree more with Dr. Goldbloom. You know it's one thing for adult men to slam each other into the boards, that's paid entertainment by thousands of fans in the NHL, but subjecting our children to injuries in this fashion really is uncalled for.


So if you are a parent with hockey-playing kids, I would take an active role in limiting the body checks from your child's league.


This week in our Teenage segment, we're going to discuss student athletes a little bit. And the first topic is syncope, which is lightheadedness and then passing out. And this temporary loss of consciousness from syncope is due to inadequate cerebral perfusion and up to 15% of children have had at least one episode of syncope. It gets a lot of attention in the media because children having sudden death on the sports field gets your attention and increased attention means increased ratings, increased ad revenue, you know how that goes. Many more kids of course die from asthma, diabetes and cancer but you don't hear about those because it's not as newsworthy I guess.


But anyway, most cases of athletic syncope where they pass out actually do not result in death, but it's for a reason that is more benign. The incidence of sudden death with athletic syncope is actually only one in anywhere between 100,000 and 300,000 kids. So, for every 100,000 to 300,000 kids who actually pass out while they are playing sports, only one of those is actually going to have sudden death associated with it. So it's a pretty rare thing for the death but the syncope itself is fairly common.

Now what are the causes of syncope? Well the most common cause is what we call vagal episodes.


And this is not life-threatening. You've probably experienced it to some degree at some point in your life. If you go from a sitting to a standing position really fast, sometimes you can get a little bit of dizziness, blurry vision or seeing spots in your vision and this also can occur after a vigorous activity, not just when you stand up suddenly, but it can also happen basically during vigorous sporting activity especially right after you're done with the vigorous activity and then you're standing. You get a little dizziness, some nausea, and maybe a bit of headache, blurry vision, and seeing the spots, feeling really warm, having a little belly ache with it, and then you can even pass out. Now if you pass out from this sort of thing, the loss of consciousness rarely lasts more than a minute or two, and there a little or no symptoms at all after you regain consciousness. Now what causes this? Well, one of the commonly accepted theories is that if you have a sudden change in posture, or you have some kind of stimulus that your body does not like, like having real vigorous exercise over a prolonged period, your body doesn't like that.


And it activates this reflex that results in your heart slowing down and your blood pressure dropping and then perfusion to the brain, that just means blood flow to the brain decreases which is what causes those symptoms of dizziness and headache and blurred vision, and then finally loss of consciousness if you have too much for too long in terms of decreased brain circulation of blood. Now when you do have the loss of consciousness, then usually, whatever stimulus it was that the body didn't like, it goes away. So in one sense your body is sort of being smart in terms of if you're doing something that it does not like, that may be taxing your body too much. You figure, well if you passed out then you're not doing that anymore.


In terms of changing positions too fast, I can't explain that one quite as easily. Also, you should note that& if people do pass out and it's one of this vagal episodes, if you help them out too quick, sometimes the event will happen again and that's because they went from lying on the ground to being in an upright position, so it can happen again. So you really should get up pretty slowly with it. But the key here is once they do wake up you know after a minute or two, usually they will feel pretty good, that those symptoms of dizziness and nausea and headache, blurry vision, seeing spots — all that stuff usually goes away and they are feeling pretty normal.

Now another cause of syncope is going to be cardiac, or heart-induced syncope. And there's basically three general categories for this type of syncope. Rarely is there any kind of warning for the impending loss of consciousness. So with the vagal episode, you may feel a little dizzy, but with the cardiac kind, there's no dizziness feeling such as basically, bam! it happens.


Now the three different kinds of cardiac syncope. One is what we've just called an arrhythmia. So you have a heart rhythm that is not conducive to being conscious. Now one that's the more common ones of these is going to be super fast rhythm that we call supraventricular tachycardia and these kinds are, basically you get — because the heart is beating so fast, you don't get a lot of good blood flow out of the heart, so in order to really have a good efficient heart, you're going to have to have enough time for the heart to fill so that when it beats or pumps, it's able to eject a lot of blood out of the heart. But if it's beating too fast, you don't have long enough time where the heart can really fill with blood and so you're going to get less cardiac output or less blood coming out of the heart, or less flow coming out of the heart because it's just beating too fast and then that can lead to these syncopal episodes.


Now there are some conduction type problems that can cause this and I only mention these so that if you've heard them before, not really to teach you about them, but just to put this sort of into context if your family member have had one of these things. One of them is called Wolff–Parkinson–White syndrome and another one is Prolonged QT Syndrome and these are things that, if you have them or they run in your family, you're going to be a little bit more prone to having these super fast rhythms all of a sudden start. Also some folks who have blunt trauma to the chest may also go into these really super fast rhythms so, if it's a baseball player and they're hit in the chest with a fast ball, that could also cause them to go into one of these arrhythmias and have a problem. The kind of fast-rhythm due to a chest impact is going to be more common in boys, especially between the ages of 13 and 18 years of age.


So really, and mostly baseball is going to be the most common sport in which this would happen. In one reported series, only 16% survive the event and though 28% of the victims were wearing chest protectors. So even with chest protectors, if you get a big thump to the middle of the chest, that could cause you to go into one of these super fast rhythms which could then in turn lead to death. And we're going to, in a little bit, talk a bit about treatment of these things. So this is one instance where having one of these automatic external defibrillators or an AED device could save someone's life if you have them at the sporting event and again we'll talk about that as we get more into what you do if this happens.

Now the second kind of problem that can be cardiac-related or heart-related with athletes passing out is going to be a super slow heart rate. So you don't want a super fast heart rate but you also don't want a super slow rate either. If your heart rate is too slow, then that also is going to decrease cardiac& & & output because blood coming out of the heart happens with each beat and if there aren't enough beats in a minute, not enough blood is going out of the heart per minute, so you may not be able to tolerate exercise very well.


Now I'm not talking about you know 60 or 70 beats per minute. Because a lot of people who are conditioned athletes are going to have heart rates that are that slow, and it's just your heart is conditioned and really healthy, so it's able to get a lot of blood out with each pump which means you don't have to have as many beats or pumps per minute. So we're talking really slow heart rates like in the 30s and 40s. Now this is going to be most common in kids who have had past heart surgery for congenital heart problems. That's really where you're going to see that the most.

And then the third category that relates to cardiac syncope or passing out in on the sports field or arena because of a heart cause, and that's going to be structural heart disease. So any obstructive type lesion which means something that interferes with the blood flowing out of the heart so if you have what's called aortic stenosis, which is just the aorta — that's the big blood vessel that comes out of the heart and goes to the rest of the body.


Stenosis just means narrowing or the valve is real thick so the hole is not very big, then blood's not going to be able to get out of it very easily. Mitral valve stenosis is the same thing. It's basically a thick, small-holed valve that — well the mitral valve, it's between on the left side of the heart, the upper pumping chamber and the bottom pumping chamber, or the ventricle. So that's another defect of the mitral valve, like mitral valve collapse. This is just one of the internal valves in the heart.

Another one is hypertrophic obstructive cardiomyopathy. Now I know I said I wouldn't use these big terms, but if we break it down, hypertrophic just means that the muscle is too thick. Obstructive means that the thick muscle is blocking something and it is usually blocking the outflow tracks in the area of the heart where the blood is leaving the heart.


The heart muscle is too thick. It's blocking that pathway, so the heart is having a hard time getting blood out, and cardiomyopathy just means there's something wrong with the heart muscle and in this case it's too big and obstructing.

Something else, bad placement of coronary vessels, if they are surrounded by heart muscle in a way that when the heart is pumping hard and fast they get squeezed and that cuts off the circulation to the heart itself and then you can have a heart attack. And these are things that kids are born with, or what's called an and this is just a coronary artery which is one of the blood vessels that supplies the heart with blood so that they can get oxygen. This particular artery is placed between the aorta and the pulmonary artery so that just means the aorta where it is just carrying blood to the rest of the body and the pulmonary artery which is carrying blood to the lungs. This particular coronary artery which is supposed to give blood to the heart is squeezed between those two big blood vessels and it basically gets squeezed like it's in a vise and then that could cut off the blood flow to the heart itself, and that could cause you to have a heart attack.


So these are things that aren't very common but then when you have a kid who suddenly goes out on the — you know they're playing basketball, one minute, just fine and the next minute they're basically laying in the floor dead. More often than not, these are the kinds of problems that they had and unfortunately there's no real good way to pick those up before that kind of event happens. Now in addition to — there a couple of other little cardiac ones that we probably hadn't mentioned. One is will be a coronary artery aneurism. These are really rare in kids. If you've ever had Kawasaki's disease, again, some of these things I only mention because if a lot of you out there have probably never heard of this, and Kawasaki's is not the what this particular segment is about. But if you've heard of Kawasaki's or someone in your family has it, you know it can be associated with coronary artery aneurism, so you definitely have to follow up with your doctor and make sure whether it's safe to play sports or not.


And then Marfan's syndrome is another one that can be associated with aortic aneurism of the aorta coming out of the heart and going down through the chest and down into the abdomen. And if they have an aneurism or a ballooning out associated with it, that can lead to rupture which could cause sudden death. So if you have Marfan's syndrome, you definitely want to be following up with your doctor.

Okay moving out of the cardiac or heart realm for this syncope, neurologic is another one. And this is basically loss of consciousness from something like a seizure. And this is going to be different because they're going to be stiff or their extremities stiff or shaking. The loss of consciousness is usually persisting for longer than one or two minutes and incontinence is common so they can pee and poop in their pants. And then they have some postictal symptoms that follow this seizure episode. What that means is if they wake up from the seizure, they are not their normal self.


They're dazed, confused, sleepy and that can last for up to 1 to 2 hours after the seizure. So when it says vagal episode, it's going to be more, they're down a minute or two and then they're feeling okay. Whereas with the seizure, it lasts longer and they are sort of dazed and confused after the actual event.

Heat stroke is something else to take into consideration when an athlete goes down. This occurs when temperatures and humidity are high and the patients going to be severely dehydrated with a pretty elevated body temperature along with it. So what do you do if you are at a sporting event and you witness a teenage athlete actually lose consciousness. What do you do? Well, first you got to remember ABCs: airway, breathing, circulation. The first thing you're going to do is call for help. And then you're going to assess the ABCs. So you start the CPR if you have to, and let's be on this scope of this segment of Pediacast, but certainly if you call your local chapter of the American Red Cross, they can get CPR training for you.


They also can show you how to use one of these AEDs or automatic external defibrillator, so once you have CPR going, if one of those is available at the scene, it's really easy to use. You basically put the pads on the chest, there's two of them, and then you turn the machine on and push the button and it analyzes the heart rate and the voice actually will come out and tell you what you do. If it's a normal heart rhythm, they'll say so, if it's something that needs shock, it'll say, basically push the shock button and then stand back and then it'll do the shock automatically after it's given you time to get out of the way. It's brand is going to work a little bit differently but the instructions are inside the case and they are very very explicit in terms of what you need to do to use the device and then most states do have laws that govern a good Samaritan kind of laws so that if you use one of these or try to save someone's life you are protected to some degree against liability if something goes wrong as long as you are following the directions inside the case, and they really are pretty easy to understand.


But if you're at student or athlete functions on a regular basis, you know it may be a good idea to call your local chapter of the American Red Cross, and get CPR training and actually learn to use one of these AED devices.

Now let's say you have one of these syncope episodes but it only lasted a minute or two and then you're up and feeling pretty good, so no one really got to the point where they were calling for help or doing the ABCs, because maybe by the time they realize that you are on the ground, you are already starting to get up. So you're going to see your doctor. What are they going to do? Well, you're doctor is going to listen real carefully to the heart and lungs, they'll listen for abnormal sounds, usually get an EKG to make sure the electrical rhythm of the heart looks good. Now if you went out because of a rapid heart rate or slow heart rate, probably by the time you go see your doctor, the heart rate's going to be normal so the EKG may or may not be helpful in that situation. But still we typically get one.


Also a chest x-ray to make sure your heart's size is normal. And if all those things are normal and a vagal episode is suspected, based on the history of it, then your doctor may recommend just trying to increase salt in your diet or increase in water intake and decrease in caffeine consumption. The reason for that is that these things are going to increase your blood volume. Salt, you know, normally, low salt diet if you have high blood pressure. Well, if you have a tendency to not get good perfusion or blood flow to the brain during sporting activities, you actually want more blood in the blood vessels and that's going to help this not happen. And one way to get more blood in the blood vessels is to increase the amount of salt in the diet and also water intake along with that. And of course caffeine is a diuretic which means it acts kind of like water pill. So if you are drinking a lot of caffeine, you're going to be peeing a lot and then you're going to be sort of border line dehydrated. So decrease in caffeine consumption and increasing salty snacks and water oftentimes will help these things go away. This is not something to try yourself at home though.


I am just explaining what most doctors would do after a normal assessment. I'm not giving medical advice that "Hey, just eat some pretzels and drink some water, and you will be fine." That's not what I am saying. You should see your doctor. You should have an evaluation. And then in the end if it looks like it's a vagal episode, these are things that can help. There's also medications that are available to help if these vagal episodes are happening over and over again. And usually for that we refer to a pediatric cardiologist to make sure that there's not something going on with the heart. And then they can do fancier tests, like an echo-cardiogram or they'll look at the heart with sound waves. And they can even do a tilt table test where they'll have you laying down flat and you are hooked up to monitors and then they have this table swings up real quick and put you in an upright position, and they see what happens to your blood pressure and your heart rate. And it gives you an idea if you're having one of these vagal episodes. And if you are and you know increasing salty snacks and water and decreasing caffeine is not helping, there are some medications that can help with that.


Now athletes often outgrow the tendency toward having these vagal episodes. Heart conditions are more difficult because it really depends on what the problem is. So some of these kids who are prone to conduction problems whether real fast or real slow rhythms, sometimes they can have their problems fixed, so they stop going into those rhythms and then of course there are surgical procedures to put in internal cardiac defibrillators and pacemakers and that sort of thing, but oftentimes kids with the cardiac problems are going to be restricted from vigorous physical activity really the rest of their lives. If it's a vagal episode, then most of those get better with time, and usually those kids can go on to do normal athletic activities on a long term basis. In terms of the seizures, those are a little less common and that's something that ones you get your seizure disorder under control, then it's going to be pretty safe to most athletic activities. You know, certainly if you're prone to seizures, you don't want to be swimming in a pool by yourself or basically being in any situation where if you had a seizure despite being on a medicine, that could get you in to trouble.


Okay moving on a little bit with student athletes, we're going to talk about obesity. This is a study that was presented at the annual meeting of the Pediatric Academic Society in late April and early May of 2006 out in San Francisco, California. Basically the presentation goes like this. The prevalence of overweight children in the United States has tripled in the last 20 years. Many assumed that kids who participate in kids are going to be leaner than who don't but there is little published data on that topic so researchers basically looked at nearly 7,000 high school students at Fairfax County Public Schools in Virginia during pre-participation sport physicals and they measured the body mass index which is a way of comparing the proportion of a person's height and their weight. And their BMI or body mass index was measured and then compared to age-specific data for the general population. So the idea here was to see if athletes had better BMIs or were less overweight than kids who did not participate in athletics or compared to the general population of kids that same age.


So what they found for boys is that boys participating in football, wrestling, lacrosse, crew baseball, and these sports, the number of students with BMIs above the 95th percentile was comparable or higher than the general population. And football players particularly had higher BMIs than anybody else in the group and much much higher than the general population. So a lot of these football players were obese and a lot of wrestlers, lacrosse, crew baseball, those kinds of things also were obese if you looked at weight versus height comparisons. Now this did not take into account percent body weight. So you know some of these athletes, if they have a lot of muscle mass and not a lot of fat mass, it's really not taken that into account, it's only looking at BMIs, which is based just on weight and height measurements.


Now four of the 14 sports had BMIs significantly lower than the general population for boys and these were cross country, indoor track, golf, and gymnastics. Those were the only four where the BMIs were lower than the general population.

Now for girls, girls’ participation in sports has significant lower BMIs than the general population for all sports except for few, which is rowing. So the girls who participated in sports and all of them did have lower BMIs whereas boys, it was just those four that I mentioned: cross country, indoor track, golf and gymnastics. So, also students participating in three or more sports in a given year had significantly lower BMIs than those who only participated in one sport.


So what does this mean? Well it means that participation in high school sports does not automatically mean that you're going to be leaner and healthier especially if you are a boy who is participating in only one sport per year. Well participation in the high school sport is certainly better than a sedentary lifestyle. Students still have to watch their eating and seek additional means of exercise to maintain a healthy body mass. So it's important even if you are a student athlete, you still have to watch what you eat and make sure you're getting plenty of exercise because remember if you're only participating in a sport one time during the year, you're only talking a few months and in the off season, really you need to be active. And I do think more and more schools are putting exercise rooms and equipment to do weight training and aerobic training and I think that's a great idea. They really, in addition to gym class, ought to have time when kids can exercise at school if they are not able to do so at home.


That really would help with the obesity problem in America and then keeping the soda out of schools and encouraging kids to eat better is going to be important as well. Okay that wraps up this week's edition of Pediacast. Thanks everyone for joining us. Once again, if you have a topic that you would like us to discuss here on the program, you can email us at or you can go to our website which is Click on the contact link and you'll be able to ask us a question or give us some feedback that way. And then we also have our voice line 347-404-KIDS and we encourage you to utilize that.

Also if you have some time and don't mind giving us a review over in the iTunes Music Store, you know a lot of parents I think would enjoy the information that's presented in this program and the more parents that we have listening, the more questions we're going to get and then more will be able that& to address topics that are adventurous to you rather than ones that I think are interesting to you.


And the more people we have listening, the more we're going to be able to generate these ideas and people really read those reviews in iTunes and base their subscription on those so if you like what you are hearing on Pediacast, and would like other parents to know about it, make sure you leave us a little bit of feedback there, if you have time.

Also when you are out and about during the day, you know let your friends know, colleagues at work, if you're in parenting groups or church nurseries, wherever you are, let me people know about Pediacast because, word-of-mouth from the listeners is really the best way to increase our audience. And again, we want to increase that so that we have more discussion out there among ourselves.

Speaking of discussion, you also want to check out the blog at and if you click on the PediAlert link, as I mentioned the first thing in the program, we do have a mailing list that we are starting& that will let you know weekly what topics are in the podcast, what topics were in the blog over the course of the last week and then we'll also have e-breaking news from the American Academy of Pediatrics and the Centers for Disease Control as they have information that comes out and is available.


Also one other thing on the website both for the blog and the podcast, if you look in the side bar, I do have a new topical index, so that if there is something in particular you're looking for like constipation or ADHD, or really, any particular subject, if you find it in the side bar and click, it'll take you to the episode where we discussed that particular issue or the blog entry that discusses that particular issue. So, you may want to check that out also in the side bar.

Alright, I think that just about wraps things up for this week of Pediacast, thanks for listening everyone and don't forget to stay safe, stay smart, and stay involved with your kids. This is Dr. Mike Patrick. saying, so long everybody!


Leave a Reply

Your email address will not be published. Required fields are marked *