Car Seats, Thumb Sucking, and Picky Eaters – PediaCast 022

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  • Car Seats
  • Thumb Sucking
  • Chickenpox Shot
  • Picky Eaters



Announcer: This is PediaCast.

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Announcer: Hello moms, dads, grand moms, grandpas, aunts and 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 Bird House Studios here's your host, Dr. Mike Patrick Jr.


Dr. Mike Patrick: Hello everyone and welcome to PediaCast, the pediatric podcast for parents. This is Dr. Mike coming to you from Bird House Studio and I'd like to welcome everybody to the program this week. Back from vacation and feeling really refreshed and I just want to say thank you to all my loyal listeners for allowing a little bit of a laxity in terms of getting the podcast out. When you're on vacation even when you do podcast a little bit ahead of time and have them all ready to post, it's still really difficult you know to take time out of your vacation schedule to actually make the show notes and get those uploaded and add the show to the feeds.


So it took a little bit longer than I had hoped and actually I had planned to release one a week while I was gone and ended up being about every 10 days that I was able to get around to. We were gone about 2 and a half weeks when you throw in over thanksgiving weekend as well.


So it was a nice, long vacation I don't have another one for quite some time so you won't have to worry about any more delays. I still certainly I'm hoping to get one out a week until we hit our one year anniversary. So I'd like to welcome everyone to the program this week. We're going to be discussing more of your questions and this week were going to feature car seats, thumb sucking, the chicken pox vaccine and the boosters that are now recommended, and were also going to discuss picky eaters as well.


Now remember if you have a question that you would like us to address on the program, all you have to do is to go our website which is and you can click on the contact link and get to us that way. You can also email me at or you can call our Skype line at 347404KIDS, that's 347404 K I D S.


Now I would like to remind you that the information presented in PediaCast is for educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals. If you have a concern about your child's health, make sure you call your doctor and arrange for a face to face interview and hands on physical examination. Also your use of this audio program is subject to the PediaCast terms of use agreement which you can find at


Okay let's go ahead and right on into our first question. Actually I have a couple of questions I'm going to read together here and then we'll talk about the answer together. The first one says, hi Dr. Mike, I have another question that is on the periphery of the medical field. Although this parenthetically is really is not on the periphery on the medical field cause it is right up my alley.


It says, can you talk about car seats? Things I had to learn along the way were, number one, when to know your kids need to move in to the next stage. My daughter is very tall I needed to move out of the click in click out type of seat that came with the stroller long before she reached it's weight maximum. Number two, kids should stay in the backwards facing position for as long as possible. It's much safer even if their legs don't fit its okay better to have cramped legs than a neck injury.


Wait until the last possible limits of your car seat to turn your kid forward. Three, shoulder strap settings where it goes to the seat itself should be below the shoulder for rear facing kids and above the shoulder for front facing kids. Also keep number four; keep kids in a 5 point restraint system as long as possible. Seat belts and booster seats are great but there is an inherent redundancy built in to an anchor harness restraint system and then it is signed, Megan, so that all came from Megan. Those were her ideas and there are some good ones for sure.


And then from Carrie in Flint Michigan, she says hi Dr. Mike, I love the podcast, I listen to it in, during my morning and afternoon commute. I find the information to be very useful and interesting as I'm a mother of a 1 year old boy. Keep up the great work and I'll be listening. Well thanks Carrie.


I also have a question for you. My son was a preemie. I was only 30 weeks pregnant when they did an emergency C-section due to severe pre-eclampsia. We've had to deal with quite of few things that are different from any other child in my family since no one has ever had a preemie so there was really no one to turn to for help besides his doctor. And when I'm in there, half the time I forget the list of what I supposed to ask him about which is what PediaCast is all about.


Anyways, my son is about 1 year and 2 weeks old now. He weighed or he weighs 18 pounds which I know is low. But he's happy, healthy and it's great. My problem is that he's long and skinny so his kind of outgrowing his car seat lengthwise but not with the wise. His feet are starting to hang over the bottom and his head pops out a bit on top of the rear facing seat that we're currently using. I know they say to keep babies in the rear facing seat until they are 25 pounds but he'll be 3 feet tall at this rate. Do you think it would be safe to put him in a toddler car seat or do you think we should wait until he's at least 25 pounds as they recommend. We were just curious as whether you have any advice or insight for us. Thanks for any help you can give. Love the show.


So thanks both to Megan and Carrie for your comments about car seats and what I'm going to do is to sort of give you my office spiel about car seats. Like kind of sat down and thought about it from the time that they are newborns until the time that they're school age and exactly what kind of recommendations we have for car seats. So let me go through those with you right now.


First of all, in general rules for infants, rear facing middle of the back seat is going to be the safest place for kids to be from the time that they're born until them 12 months old. So from the time they're born, until they're 12 months old, regardless of how much they weigh, the safest place is rear facing middle of the back seat.


Now the time to turn around the forward facing is going to be 12 months of age and 20-25 pounds and then you can turn them forward. So there are a couple of reasons to wait until they're 12 months and 20-25 pounds. And the main one of those reasons is that they are really, at that age, when they are less than a year old, regardless of how much they weigh they really are not going to have very good neck control.


So the most likely way that you're going to be on a car accident is moving forward. And if you think about what the back of the seat is doing, it is well; let me put it this way, when the car suddenly stops in the case of an accident your body continues to move forward and it's the seat belt mechanism that catches you up.


Well if a baby is forward facing, their head is still moving even though the car had stopped and so the head is going to go down so that the chin meets the chest if the baby is forward facing and the neck can cause neck injury. Now if they're rear facing the back of their head is up against the back of the seat so that the car, and the seat, and the baby's head are all going to be stopping at the same rate.


So now if you are traveling backwards really, really fast and have a collision, rear facing is not going to be good at all. But how many of us are driving 50 miles an hour and reverse if you're doing that you probably shouldn't have a baby in the back seat.

So the reason that you should be rear facing until they're a year old and 20-25 pounds or so, the main reason is going to be to protect their neck in a forward moving accident, where the car suddenly stops and the baby's head is still moving. So I hope that make sense, there really is a reason why they should be rear facing.


Now, I also want to mention that what if they are getting too long for the carrier style seat but they still aren't a year old and they still are not really to 20-25 pound range. Well if they're getting too long, you should switch to a larger car seat that will accommodate them but that still can be used rear facing. Because you really don't want their head up over the top of the carrier style seat because then the benefit that you get of having head support behind them is not there anymore. So they might as well not even be a rear facing if the back of the car seat is not going up past their head and giving them some protection.


So if they are growing too long, you know it's okay if their legs are a little cramp as long as they fit well otherwise. But if their head is moving up above the top of the car seat then it really is time to get the bigger car seat. And the larger car seats most of them do have instructions for how to install them so that they're rear facing. So that is something that is important to look into.


Now, having said this, probably the most important thing that I can say regarding car seats and it seems like goes without saying but a lot of people don't think about it. You have to look at the instruction manual I mean this is one time when you want to make darn shirr that you have installed the safety seat according to all the guidelines and that your child is the right age, the right link, the right weight, everything fits into the recommendations for the particular car seat that you're using.


If you've lost the instructions and you're interested, usually you can go to the manufacturer's website and look at where your model number and be able to download like in a PDF type situation what the exact instructions are for that particular car seat. Now what about this tethers? Tethers are sort of an anchor system for car seats that in addition to using the belt system, there's also a hook or a way to tether the car seat in. Newer model cars have this newer model car seats have it.


It basically just provides a second layer of protection against ejection from the automobile. Because there have been some situations where seat belts even use properly can fail and so if you have a back-up system to hold that seat in the car, it's going to be safer for your child.


So again back at the back seat, middle of the back seat, rear facing until they are a year old or 20-25 pounds and that's primarily to protect their neck and then it's okay to turn them forward when they're 12 months and (not or) and 20-25 pounds. And you want to make sure that they fit in lengthwise as well as anything else so you want to make sure that their heads' not up above top of the car seat.


Okay so then now you've got an older child but between the age of 1 and 2 years old who's now an allergic to car seat and they're forward facing, what do you do now? What's the next step? Well I'd leave them there just as long as you possibly can. And again the middle of the car seat it's going to be the safest place but what about booster seats? Well, some would say that once your kids are 4 years old and 40 pounds to try to make the 1 year and 20 pound system, you know just try to come with an easy way to remember it.


Some will say 4 years and 40 pounds but it is safe to go to a booster seat but really, that's over simplifying it because as kids grow sort of the shape of their bodies is also going to come into play here. Now there's 2 types of booster seats you know, one is basically a more spacious infancy that has a harness type restraint and this is the safest and when used with a tether, if that's possible in your car, that's going to provide the best protection in terms of booster seats.


And there's also the more open style which just utilizes the car shoulder harness and the lap belt. And here is where fit is going to be the key because you want the child that is sitting on this open style booster you want the lap belt to come across their hip bones. Now you don't want it so low that it's overlying the bladder and you don't want it too high so that it's overlying the flashy abdomen.


You really just kind of feel for the hip bones and you want to make sure that that lap belt is coming right across the hip bones and not over the bladder, so not too low and not between the hip bones and the belly button that would be too high you want it right over where the bones. And then the shoulder harness should fit in such a way that it crosses the shoulder that it does not cross the upper part of the arm and you don't want it to cross the neck and it really needs to go right over the shoulder.


And never put the shoulder restraint behind your child that can cause a lot of difficulty in a forward car accident. They can still be ejected, they can cause abdominal organ injuries, you definitely you don't want to be in a situation where you child just has the lap belt on and just putting the shoulders straight behind them.


So these are the two-types, one is just sort of a modified car seat, it's still has the harness system that comes down over him. That's going to be the safest and then the next one is to get the little bigger the more open style one that basically just loose them up so that the cars internal shoulder harness and lap belt fit a little bit better but again, they key is the lap belt has to go across the hip bones and the shoulder harness has to cross the shoulder and not the upper part of the arm or the neck so that's really important that everything fits properly.


Also this is important too, your child has to be able to maintain that position so if you've got a real squirmy kid or a kid who falls asleep all the time in the car and you know every land and every which way in the car seat the open style of booster seats probably not going to be the best option for them, I mean you really want a kid who's going to take it seriously and sat upright and make sure everything stays in place or the way it's supposed to.


What about the built in boosters? Again I have, when my kids were small, I did not deal with those at all, none of our cars had the built in car restraint systems. But again, like what these others, you do want to make sure that you follow all of the manufacturer's instructions including appropriate sizes so that you make sure that whatever child is using the built in booster that they are the right weight, the right link, and all that business.


I also want to say something about air bags. Air bags you know they can kill kids and the reason is because the air bag is meant to cushion an adult who is flying into the dashboard. But it can come out with such a force and it's just at the right level where the top part of the air bag catches a kid's head. It can actually cause a decapitation injury that has been known to happen. And that's the reason that car seats, I'm sorry the air bags are now made to turn off on the passenger's side. So if you have your child sitting up in front with you, you definitely want to make sure that the air bag's off or that you have some sort of an automatic system in the car on the passenger side that can tell a kid who is sitting there and so that the car turns off the air bag.


And every time you get in the car, if your child's going to sit on the passenger seat you want to make sure that that system work right and that there is an indicator like saying that the passenger side air bag is off. Because for kids air bags are dangerous because again they don't come out at the right level and they can cause a decapitation injury, certainly a severe neck injury can occur.


Now having said that, the best place for kids, even as they get to be older and even as they get to be young teenagers, the best place is in the back seat. So you are taking more of a risk with your child's life if you were on a severe car accident and they're sitting up front even with the air bag turned off. So the safest place is always going to be in the back seat.


Alright now how long do you use all these things? Well you use the car seats and the boosters following all manufacturers' instructions as I've said over and over, you get the manual on the internet, if you threw it out, and basically you want to use that device until the child has outgrown the recommendation for the device in question.


Kids will definitely want out sooner especially because of friends but don't pave. It doesn't matter that little Bobby's best friend, he's been out in his car seat you know since last year, don't worry about little Bobby's friends. The safest place is in the car seats as long as you can. So I would you know, don't pave into the pressure of letting him out early.


Now what about school buses? Well you know there's no clear cut answer with regards to school buses. Lap belts alone may increase the risk of head injury hitting the seat in front of the child or it could cause a nominal injury if they're not properly adjusted across the bones of the hips, as of the pelvis or hips as we've mentioned.


The shoulder restraint in a bus would require a new seat design and of course that's going to cause a lot of money if you had to repair the entire seat or, I'm sorry replace all of the seats in the bus fleet in the entire country. So the cause of doing that is actually high compared to the risk because only approximately 10 kids a year die in a school bus accidents now of course if your kid is one of who dies you know, that's horrible tragedy.


But when you look at a public health standpoint, you know 10 kids, if you look at all the kids who ride in school buses and how many hours all across the country kids are in school buses, it's pretty safe forms of transportation the way that it is. And so the thought that has been that the cause of putting in brand new seats that have a shoulder harness and a lap belt would be more costly than the benefit that you get from it.


So again I'm just talking from a public health standpoint and I'm sure that with the schools have the financial difficulties that they do these days, often from mismanagement, but okay we're not going to go there. So anyway, you know they don't want to spend in their money on a new school bus seats apparently.


Now you are going to get different opinions on the risk benefit ratios of this. The folks who are against putting the new seats in are going to be the national educators association that NEA and you can find their policy statement online, I'm going to have a link on that in the show notes. They're against the school bus belt safety belts.


Also the Canada, the Canadian safety console is also against it. And again these things when the schools are against and the government agency is against it, you do have to wonder you know as your secondary gain with the cost of what it would take to replace all of these seats and seat belts you know. The teacher unions don't want to do it because then the schools are going to be spending money on bus seats rather than teachers' salaries and they make a point.


Now who's for putting safety belts in school buses? Well the National Coalition for school bus safety and I have a link to their website as well. There are also pro seat belts in buses. Also the American Academy of pediatrics does endorse the National Coalition for school bus safety and they also do suggest that school buses should have safety belts.


Another resource that I want to give you in the show notes is just the American Academy of Pediatrics Car Safety Seats, a guide for families 2006. It's a website that goes through how to fit a car seat. Basically a lot of the information that I just went through is in that hand-out and it's something that you can print right from your computer. It's a car seat guide, that's up to date, it's a pretty good one and again there'll be a link in the show notes for that.


Okay let's go ahead and move on, that is enough about car seats and so hopefully I covered everybody's questions on that. The next question comes from Scott in Austin Texas and Scott says at what age should we start to worry about trying to stop finger and thumb sucking? Well first let me say that infants do have a need to suck beyond just eating. I mean they really have a need to put things in their mouth and suck on them and they're less likely to suck on their fingers and thumb to begin with if you introduce a pacifier or a binky, as I like to call them.


And it's a lot easier then and later on a childhood to get rid of a pacifier or a binky than to stop him from sucking on their fingers and their thumbs. So I see very few if any toddlers who become thumb suckers after binkies are taken away. If you take them away you know on down the road or let him have him a couple of years.


So it's most of the kids who wouldn't take binkies or pacifiers to begin with that end up sucking on their fingers with thumb or the ones who have the pacifier or a binky taken away you know within the first years so then they might pick-up some sucking tendencies.


So let's say that you didn't use a binky, or your child wouldn't take it, or you got rid of it a little soon and they started sucking on their thumb, how do you get rid of that? Well first, the child has to be able to understand what you're doing. You know they have to be able to understand that you don't want them sucking on their fingers or the thumb that this is the behavior that you want them to stop.


You have to be able to understand what is it that you're getting at and for most kids that's not going to be until they're 2 or 3 years old and for many kids, it's really going to be more like 3 years old before they are really able to understand what you're trying to do. Now how do you deal with it?


Well I would break it up into dealing with it first during the day and then dealing with the night time issues. So during the day I would say that it's okay to let them suck on their thumb or their fingers when they go to bed. But when they're up and about in the house, it's something that you don't want them to do.


Now, I think the best way to do this is a strategy that we've talked about before when we talked about potty training and that was the sticker chart. And sticker charts work for most kids because basically it's a game, I mean you're just; you're coming up with a need system that it's fun for him. So what I would do is make up a chart with the days of the week and buy some really cool stickers. And then you wanted to start with something that your child is actually able to accomplish so that they can see the positive result that comes from the sticker charts.


So they can be successful when they do it. So what I would do is I would start with saying, at the end, you may even start with okay, we're just going to take the morning, we're going to have this place on the sticker chart every morning and every afternoon, and if your child gets through the whole morning, and every time that you asked them to take their finger or their thumb out of their mouth and they did it and now it may be gone in 10 minutes later but then you reminded them and that came out, and they are very cooperative then I would let them put a sticker on the sticker chart for that morning or for that afternoon.


Now as you work up to it you can say, alright now, I'm going to remind you, but if as long as you don't do it again for a while then you got to put the sticker on their sheet. Keep them making it a little bit harder and a little bit harder until you get to the point where you can say if you went to the whole morning and I didn't see the fingers or your thumb in your mouth at all, then you got to put a sticker on the sticker chart.


Now once you've broke it up in the mornings and afternoon then you can do the whole day as they start to have success and say okay, now you've done great, now to get your sticker, now you got to go the whole day and both morning and afternoon and I can't you know, if I see that you had your thumb or your fingers in your mouth, then you're not going to get your sticker.


Don't worry if you know you're not successful with that you can make a 3-strike to right kind of policy. Okay I saw you in there once, I saw you have sucking on your thumb a second time, oops he's sucking on the 3rd time you're not going to get your sticker today so there's a lot of flexibility in this kind of system.


Now the sticker itself is the immediate reward but you also want them to working towards something, so you can say that once you get 10 stickers on your sticker chart, we're going to go to a Chuck E. Cheese or we're going to go to the park, or we're going to go get a 5-dollar toy at a toy store. You know something that they can look forward to that they like to do that gives him some incentive to when to get these stickers and there's a first place. So that's what I would do in terms of taking care of it during the day.


At night time, I'd let them suck their thumbs or their fingers because some would say, well it gives the wrong message if you're saying you're not doing it you shouldn't do it at night time either. But you also have to be realistic and a lot of kids, you know it is a security measure and it's going to be a lot more difficult to be successful with it which also mainly what you want is success.


And you're going to have a lot of harder time with it if you try to get rid of that behavior both during the day and at night. So once you haven't taken care of it during the day then you can just start working on the night time stuff. And I find one way that you can do that is to have him put socks on their hands, you have to have a kid that's cooperative, who understands, and who is all for wanting to get rid of this behavior.


And you know they're motivated otherwise you know if you have tried this to a 2-year old then you got to take the socks off and thumbs go into their mouth then you can't spend the entire evening up in their room pleasing this. So I think you know more along the lines of getting through 3 or even a 4-year old you can say, look if you keep the socks on your hands through the night as a reminder that your thumb doesn't go in your mouth and you know in the morning we check on you before you go into bed, the socks are still on your hand, and if you wake up in the morning and the socks are still on your hand then you get a sticker on another sticker chart, that kind of thing.


They do have the reminder liquid that you sort of paint on the fingers or thumb nasty taste. I've heard from many parents that kids don't seem to mind the taste. It's much as parents pay testers do. So I don't find that that works very often, the little reminder liquid that tastes bad that you paint in your thumb and your fingers.


Also just lots of positive reinforcements you know goes into this as well. I will say again, it's a lot easier to get rid of a binky and a pacifier that it is to stop a thumb and finger sucking. But in terms of Scott's question on what age should you start to worry about it, you know I'd say it's probably 3 or 4 is a good time to start thinking about stopping.


Now that is a lot longer you know than a lot of other people may have thought. You may have thought oh we don't want him to do that once they're 2, or early 3 but again you have to be realistic of what you can accomplish and you have to remember that 2-year old still do have quite an oral fixation. You know things are always going in their mouth.


Now in terms of the binky, when you get rid of that? Well again I think it's helpful to go in steps you know daytime first, a binky stays in the bed or pacifier stays in the bed in the morning, you may even have to hide it during the day time and then out it comes at night so they can use it in bed, and then you can't worry about getting rid of it at night time little bit later.


And again at age 3 again is probably the good time to think about getting rid of the binkies and the pacifiers, again because at that point they have lot less on an oral fixation and less of a need to suck. Now one thing that we did with my son who's really into his binkies I mean he had one that he called a binky rub nose. He didn't suck on this binky, this binky was just a rub on his nose, trust me it comes from a long line of minimal issues.


No, just teasing. But this was a binky that the rubber was pretty warm and he would just rub it on his nose and it was like a security measure so you know that aren't going maybe a little bit longer. But the regular binky, he was 3 years old and what we did is we let him collect all of his binkies and we told him than when he, we gave him a date and says, this is the day that you're not allowed to have your binkies anymore or because you're going to be too big.


And we've sort of have a countdown like okay only 5 more days left and you get rid of your binky and your pacifier then the next day you got, okay we only have 4 days, 3 days, 2 days, you give him you know a warning that it's common so they can understand. And then what we did is we went to a toy store and let him pick out a reasonably priced toy.


And then when we paid with it we left all his binkies with the cashier lady which was probably just as traumatic for her, if not more so, then it was for my son because he was prepared for. He knew this was happening. We had already discussed that he was going to exchange the binkies for a toy so he kind of had in mind what he was going to get anyway.


And so he was, you know he is a big boy, we went to the store, we picked out what he wanted and then we left the binkies with the cashier and we gave all of it to him, when we got home there was no binky in the house so we did have a rough a few nights you know within a week it was all done and forgotten about.


So you just have to be persistent with it if you stash one away and hide it, I can guarantee you're going to resort to give him a back to him. So oftentimes it doesn't work you just got to get rid of them.


Alright, and I also just want to remind you that you know in the question, I'm not picking on you Scott, you just said at what age you start to worry about trying to stop finger and thumb sucking, well you know really there's a lot of myths out there about thumb sucking and pacifiers. And really I don't think there's much need to worry about it at all.


Now what are some of these issues, let's talk about them really quickly. Is there an increased association with ear infections with kids who use pacifiers, binkies, and suck on their thumb? You know it does not to me make much sense from a science point of view. In fact, from a science point of view, you would think the opposite is true, because if they're sucking on a binky or a pacifier, or sucking on their thumb, it's going to help their Eustachian tube open, kind of like when you go up and down on an airplane you chew a gum and that is to keep the Eustachian tube open to help equalize the pressure on both sides of the eardrum.


Well if Eustachian tube dysfunction or collapse is related to ear infections, you could argue that sucking on to something and keeping the Eustachian tube open would decrease the incidents of ear infections. But the bottom line is I've seen no large studies that confirm or prove against any of these myths. So I don't really think there's much of an association between ear infections and binkies, and pacifiers, it's never really been shown to be the case in any large clinical trial that I know of. If you know of one that does, by all means email me and let me know.


Also then there dental issues you know kids who suck on their thumbs or fingers or on a binky or pacifier, are they going to be more likely to have bucked teeth or to have a palette issues. I don't buy this one either I mean if your child ever have a palette expander where you know you have to crank with the key that meddle the expander palette or a meddle braces then you see what they do to tighten those things up. I mean you think that they crank on these things and you have to use just a little key to crank on meddle to expand the palette.


You know, I'm sorry, sucking on flesh or rubber is just not going to make a difference in my opinion on the shape of the inside of kids' mouths. And I know plenty of pediatric dental professionals who agree with that and again I know if no large statistically significant clinical studies that back up the idea that sucking on a little piece of rubber is going to change the shape of your mouth.


Now thumb sucking can lead to dryness, eczema cracking of the skin infections. And if these are happening, make sure you see your doctor cause you may need to try different strategy and sometimes you have to treat with antibiotics too if they have a skin infection from their thumb sucking.


So you know so there's really no long term worry with thumb sucking and binkies. You know I think age 3 to age 4 you know is a good time to eliminate these things and again I understand that this is later than some others might recommend. Kids lesson 3, again they still have a strong oral fixation and this combined with their limited inside into what you're trying to do, you know makes it more difficult to get rid of thumb sucking and pacifiers and the 2 and under crowd.


And since there are really no proven long term worries associated with thumb sucking and pacifiers, I think it's okay to wait a while before you crack those things.


Okay let's move on to item number 3, and this one we have actually 2 listeners who ask this question regarding the chicken pox shots. Let me get to the questions and then to my feelings on this. The first one comes from Christy in Grand Rapids Michigan and Christy says, I recently listened to your podcast on vaccines, and with a 4-month old I'm right in the middle of the worst or best of them. Can you give your opinion on the varicella vaccine? Do you anticipate the need for re-vaccination or problems with shingles later in life?


And then Susan in Washington says I am planning on having the in-laws visit during the holidays and I've just recently be informed that one of them has shingles. My child is still an infant and not immunized for chicken pox. Is it a good idea to have exposure even though it is not highly contagious?


Okay, let's start with, and thanks by the way Susan and Christy for your questions, I appreciate you writing in. Let's talk first about the impact of the vera vax. You know when I trained, this would have been in the early 90's, when I trained as a resident, we saw lots of chicken pox disease. And there was always a kid or two with it in the hospital and occasionally in the intensive care unit, so things that can put kids in the hospital because of chicken pox, would be dehydration from vomiting, from not eating or drinking very well so they can become dehydrated.


There is an increase incidence of flesh eating strep bacteria that they can get on the outside of the skin seems that there is a higher increase incidence of that when they take Ibuprofen. So ibuprofen, motrin, advil, those kind of things are not recommended when the child has chicken pox.


Also they can get pneumonia, pneumonitis which is the inflammation of the coverings of the lungs that can be particularly bad and can result in kids needing to be on a mechanical ventilator in an intensive care unit when they're at chicken pox. Also encephalitis which is an inflammation of the brain, Reye's syndrome is a syndrome that was associated with aspirin ingestion during the chicken pox episode and that can lead to liver inflammation and liver failure and also inflammation of the brain.


So Reye's syndrome could be deadly and it's really bad that's why you don't want to give aspirin when your kid has chicken pox. So you don't want to use aspirin, you don't want to use ibuprofen, just got to stick with Tylenol. So chicken pox is not always a benign disease I mean you can't definitely have some problems associated with chicken pox that can be significant. And in fact when the vaccine first came out you know many resisted it and say chicken pox is not that big of a deal.


And because of this for a few years chicken pox was the most common cause of death from a vaccine preventable disease in United States of America well over time you know the vera vax vaccine caught on and today nearly all kids get a first dose of it when they get 12-15 months of age.


Now the impact of the vaccine really has been impressive. I mean there are far, far, far fewer cases of severe disease in fact I get. Parents are forgetting what chicken pox even looks like you know I have people coming saying hey it's just chicken pox and you look at him and say no. But the problem is that people don't see chicken pox severe cases of chicken pox anymore and so over time it's a society we've sort of forgotten what they look like.


Now it is true that kids can still get chicken pox when they had the vaccine but usually for most children, it's going to be a far, far milder form of a disease with a fewer complications associated with it. The vaccine have this a really small failure rate where it can actually, as time goes on, lead to re-infection with more severe chicken pox and because of this we have seen, because of this waning immunity that we've seen over the years, it is important for the need for a booster shot because of this waning immunity in the risk of chicken pox.


So it's now recommended that kids get 2 doses of the vaccine, one at age 12-15 months and then another before they enter kindergarten. And the current recommendation is also all kids who are school age you know above kindergarten up through 18 that they should get a second dose of chicken pox if they only had the one and they did not have a case of clinically significant chicken pox.


So if you've had chicken pox to disease full pledged, you know 4 or 500 of these big lesions then you really don't have to worry about the shots so much. But if you're a school age kid, if you have a school age kid or a teenager who only got the 1 shot of chicken pox at 1-12 months, it's now recommended that all of those kids get a chicken pox booster. And in our office we're catching them as they coming in for the well child's check and then also before they go to kindergarten well that's the time that we'll be giving them the routine second booster with that.


So you want to ask our doctor for details on the office policy where you see your physician but again at our office again as kids go to kindergarten, kindergarten shots will be given them and those of the chicken pox of vaccine. And again it was always said you know hey we keep a close eye on this. It could be that the immunity will get less as time goes by you know that's always been an idea that was there. And sure enough, now we've decided that yeah, once you get the few years out the immunity does start to wane and it's important that we give everybody boosters. Because if an adult woman of child bearing age would get chicken pox while they're pregnant especially early on during pregnancy can lead to lots of problems and miscarriage, possible miscarriage of the fetus.


So it is important that everyone stay protected against chicken pox. I also want to say this, I think it's funny that when the chicken pox shot first came out everyone's like what's the big deal, it's chicken pox? Everybody gets chicken pox you know there is a real; a real resistance on the part of both doctors and parents to get this thing. And now that everybody gets it, we started to see some outbreaks of ‘chicken pox and it's like oh my goodness there's chicken pox out there. Get everybody immunized! Get them in here! Well you know parents are knocking down our door because one of our communities didn't have an outbreak of chicken pox in one of our school.


And I'd tell you parents are coming in left and right worried oh my kids got chicken pox, what do I do? I mean 10 years ago you know was why we are giving them shots, it's just chicken pox. Okay anyway so the current recommendations are that you get two of them now instead of just once. If your child's only had the one chicken pox shot and they did not have the natural disease you know do a significant degree and they are over the age of 5. Call your doctor and ask about getting that second chicken pox shot form.


Now what about shingles? We've talked about this in some earlier episodes of PediaCast and shingles remember is a reactivation of chicken pox virus inside your own bodies. So when you get chicken pox or when you get the shot, which is a live virus shot, some of that virus stays living in your body the rest of your life.


And what shingles is, is a reactivation of that specific virus. It wakes up so to speak travels down a nerve ending and causing interruption that you see, that it's just the skin that is supplied by the nerve that the virus was living in when it woke up so to speak. So can you get chicken pox from shingles? Well technically if this virus is in the source on the skin and that virus gets aerosolized in the air, and your child breathes that virus in, it is possible that they could get chicken pox from the shingles.


Now that's unlikely, it's unlikely because the shingles that the chicken pox virus in the shingles is not being let out of the respiratory system in the person who has the shingles. So you know, as long as they keep it covered. It's pretty unlikely you know in practice of good hand washing technique and you know intimate type of contact. It's really unlikely that a child is going to get chicken pox from shingles.


It's possible. It's possible, but it's unlikely so I would say, let me just put it this way, if it was my baby and I was going over to a relative's house that I knew had shingles, you know if that relative was being properly treated for shingles and the rash was kept completely covered, and that person was not allowed to hold my child, and I was really careful about you know what things they were touching. Personally for me, for my baby, I would feel comfortable with that.


Ask your doctor. Get your doctor's opinion you know you got my opinion Susan, get your doctor's opinion and go from there. But I think you know, if you look at the mechanism by which shingles and chicken pox are related, you'll see that it is going to be difficult for the virus in the shingles to get breathe in by the baby which in really has to happen in order for the baby to get chicken pox. But the potential is there but it would be unusual.


Okay let's see, we've got one more question to cover, we're running a little bit late on time and unfortunately this is a fairly quick topic. And actually I have 2 emails on questions on this topic as well and this is the subject of picky eaters. The first question comes from Yasmine Clark in Tewksbury, Massachusetts and Yasmine says, Dr. Mike my 8-month old daughter has just had her first cold. Before her cold she used to love all kinds of fruits but since she had her cold she doesn't want to even touch any fruit.


Is it normal and how can I get him to eat them again, thanks, Yasmine. And then the second one is from Evelyn from the Netherlands, and Evelyn says, dear Dr. Mike first I'd really like to say that I really like your podcast. It is very informative and answers questions that are of interests to many parents as well as professionals. I'd like to submit a topic I'm interested to hear about toddlers and pre-schoolers who refused to eat certain kinds of foods. What can we do about this? And there is a risk involved with a lack of nutritional intake and can we prevent this common problem? Thanks, Evelyn.


Well, thanks Yasmine and Evelyn for your questions. So let's talk about picky eaters. You know nothing frustrates grandparents more than a picky eater because I find usually, when I have a picky eater, the parents themselves don't really care so much. I mean maybe they do a little bit but they see the kid day in and day out and they know these picky eaters are running around, they're playing, they're acting normal, they don't often see it as a problem themselves until a relative who you know means well says hey why doesn't Johnny eat green beans? Hey he never eats corn? Hey he you know.


And so they start to inject doubt and fear into a parent's mind. And the bottom line is this, you cannot force feed your kids and you cannot make them like certain foods. Kids are pretty smart. They're going to eat when they're hungry and they're going not want to eat when their body doesn't need to eat. For the vast majority of kids this is the truth.


So what I would suggest is that if you have a kid who's really a picky eater first I would make sure that they do some kind of a vitamin supplementation if they're not eating fruits and vegetables so that you are getting all the vitamins and minerals that they need inside their bodies and you feel pretty comfortable about that. I would also make sure that they're getting enough iron and calcium, and the multivitamins is going to help with that getting some meats, and some cheeses, and dairies are also going to help with that as well.


If they won't drink milk, there are other ways that kids can get Vitamin D, and iron, and calcium. And these are all things that we sort of discuss in previous episodes. If you look up in the search index on the website for milk, and for different foods, and food issues, we have talked about a little bit of what you can do, sort of in a roundabout what way when we discuss this food issues in the past to what some alternatives are that you can use.


And you can talk to your pediatrician too or your doctor about the specific type of food that your child won't eat and how you can make that up. But for most kids it's going to be the fruits or the vegetables. Vegetables much more often than fruit and the most important thing is it that they are, you know that you do have a vitamin supplements so that they're getting the vitamins and minerals that they need including the calcium and iron.


Okay now what about those kids doesn't seem to want the same ten foods? You know it's frustrating but you have to remember as long as the kid is healthy, they're growing well, they're meeting the percentiles that make you happy, they're length matches up with their weight, and they're running around and yeah you can see their ribs. But you know you're supposed to see these little kids' ribs.


I mean when I was a kid your grandma tried to count your ribs and would tickle it. And now we got so much child of obesity out there. You see a kids' ribs and you think oh my goodness they're scrawny, they're unhealthy but its okay to see kids' rib. So you look at their grow chart, you make sure that their length and weight match up just fine and that they're healthy, they're running around, they're playful, you look at the family pattern in terms of what kids, you go back to baby pictures of mom and dad, grandma, grandpa you know was mom and dad, were they kind of scrawny when they were little?


I do find most of the time that kids who are picky eaters do tend to be a little bit on the smaller side, but are they small because they eat just small amount of food or are they programmed to be small in the way that their body is achieving their genetic programming is by having less of an appetite.


So you know our grandma says, oh look he's not scrawny because he's not eating. I think for a lot of these kids know is they're not eating because they're supposed to be small. So you know you have to look at it that way as well. Now in terms of not liking certain types of foods I would suggest continue to offer. You know continue to offer the fruits and vegetables.


The things that your child won't eat you know keep offering him, keep offering him, you know have a no thank you helping or they just want to take one bite of everything. My son for the longest time would not eat mashed potatoes. He's 9 years old now and still really mashed potatoes are difficult. We still, you know, he has to eat a bite one bite cause someday he may start to like them or he may resend us and you know, he'll be on psychiatrist couch at one point.


It will all put back to all those little bites of mashed potatoes that we made him try. So keep trying, don't get too crazy about it, you know in terms of driving you out of your mind. Kids are really good in making this into power struggle and sometimes the more you push, and push, and push the less likely that they are to try new things.


That's another thing I would point out, if I had to do it over again with my kids I think I would offer them more of a variety of things from the time that they're really young because they grow up with sort of a kid friendly foods and then when you want them to try salmon, or you want them to try cheese, or you know anything that's just sort of non-traditional kid food, it's like eww, what is that? They don't even want to try it and I think that if from a really young age, you expose them to a big variety of different sorts of foods and spices that they're more likely to like bigger variety of things.


Of course, that's going to be true for all kids and maybe that's just my own wish. Because I think back now over the years how picky my own kids have been and I think back, were there something I could have done to prevent them from being so picky. And then my mind I'm thinking if I had to introduce them to more different kinds of foods when they were younger, maybe they would do better with it.


But I'm not so sure that's the case. They may just reject those foods back then as well. So if you have a picky eater on your hand you're not alone. I hear this all the time in my office practice. And again as long as kids are growing well, they're healthy, you know you do have some sort of supplementation system in place where there'll be a multivitamin or you know getting calcium and vitamin D through orange juice instead of milk, or other dairy products you know and you can talk to your doctor about the specific thing that you're worried about your child's not getting and then kind of tailor your supplementation for that.


In terms of supplementing calories like with Pediasure, that's going to be really rare that kids need that. And I would definitely not do that on your own, I would talk to your doctor about it because a lot of times I'll see parents they'll say he doesn't eat much, he's you know I want to give him Pediasure, grandma says he needs Pediasure.


But you look at the kid and they tend to percentile on their length and their weight. Mom is 5 foot 2, dad is 5 foot 7, you know you're not going to have a 75th percentile kid if mom and dad are both 10 percentile, you're going to have a 10 percentile kid regardless of what grandma and grandpa want, especially grandma, sorry.


But that's usually what it is. So you know again, I think the most important thing for moms and dads is use your judgment, use common sense, and if you're not worried, don't let someone else put fear and worry, if you're not worried don't let someone else put fear and worry to your mind it's you turn be the parent. It's your child and don't let yourself get upset because someone else is saying oh they're not eating enough.


And of course as always, as I always say in PediaCast be sure to talk to your doctor if you have any questions or concerns at all. So again PediaCast just throw out some ideas, let you know what I'm thinking but the book has to stop with your regular doctor. Then if you have a concern make sure that you give them a call.


Alright that would conclude this week. I don't know how I took 50 minutes to answer 4 questions, my goodness! If I took 50 minutes to answer 4 questions at the office my nurse would tackle me. There would be a loud buzzer you know out of the nurses' station to get me out of the room so I'll just thank everyone for giving me the opportunity to do this and answer questions in this kind of forum.


So thanks to all my listeners also thanks to the family, really appreciate you putting up this project. Also I'd like to thank vlad over at for providing the artwork that you see at And just a reminder, you can submit a question or comment, view the show notes, sign up for a news letter and read my blog which has not have very many entries lately, but sorry folks, holidays, vacations, oh get back to it after the first of the year. You can find all of these things at And if you like PediaCast please spread the word by telling your friends, relatives and neighbors about our program. You can download the free promotional materials on the poster page of our website and of course reviews on iTunes, cause there hasn't been any new ones quite some time, that would also be most helpful. So until next time this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids, so on everybody.


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