Bottles vs. Sippy Cups – PediaCast 026

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  • Bottles vs. sippy cups — in a 4 month old?
  • How to help your 18 month-old sleep through the night.
  • School and illness: When should you keep your child home?
  • ANOTHER baby poop question.
  • Listener feedback.


Pediacast 026

Announcer: This PediaCast.



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 broadcast for parents. This is Dr. Mike, coming to you from Bird House Studio. And I like to welcome everyone to this weeks program, it is episode number 26. This weeks topics, we're going to be talking about four month old who won't take their bottle.& Sleep problems in an 18 month old. When to keep your kids home from school because of illness.& And we'll have a brief word about infant stools and then some listener feedback. I'll wrap things up with that at the end of the program.


Don't forget, if you have a question or comment for us here at pediacast, you can go to our website.& At, and then click on the contact link. You can also email me at or call our phone in line at 347-404-KIDS. And by the way, that is definitely in the an underutilized technique for getting a hold of us here, pediacast. I do have a little bit of a backlog in terms of getting these questions answered.& Gee i don't know why, this flu season after all.& And the office has just been crazy. Let me tell you. But anyway, if you call in with the question on the Skype line, 347-404-KIDS, I guarantee that will get you a bumped up and priority. 'Cause I would like to have some audio comment. I think that would be a nice addition to the program.


We do have a lot to cover this week, and again, I said I'm getting behind on the questions.& So, I'm going to get right down to business here.& You may find, I'm hoping, I'm keeping my fingers crossed, that I'm going to be able to get two shows out this week. The second one will be a little bit shorter. And we may, if that goes well, you know I may start to try to do two or three shows a week on a much shorter level.& You know, maybe twenty minutes each, instead of these longer, close to an hour episodes. So, we'll see how it goes, and sort what are your responses to the various formats and links.

So, before we get on to our first question let me 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 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

All right, so we'll be back with our very first question right after this.


All right. Welcome back to the program with our first question this week. Comes from Smitha from New York.& And she says "Hello, Dr. Mike. I like your podcast very much.& And thank you for taking initiative and dealing with all the common problems. Actually, my husband introduce me to your podcast.& We have a four month old daughter who is solely breast fed. I pump milk and give it to her in a bottle. She used to accept bottles since she was two weeks old. But after crossing the four month border, it's like she's forgotten to take the bottle all of a sudden".


"I tried reading a lot of websites but could not find the right answer. Should I introduce sippy cups?& I know it's not a big concern but we're going out more often and it's difficult for me to nurse everywhere. Thanks, Smitha."

Well first let me say don't apologize about it not being a big concern, because it is a big concern for you. So, none of these questions are silly. You know, we're all friends here.& And just because I've answered something several times, and I haven't in this case, I'm just saying. Just because, you know, at least in the office, I answered things over and over and over again.& I know, to parents none of these is minor stuff. So ask away.& It's not a problem.& And we're already talked about how you can write in, or phone in with you very own questions.

So, let's talk about four month olds. So first, I would say that most four month olds are going to be too young for sippy cup. And the main reason for that is it's going to be hard for them to form a seal on the spout. You know,& sort of rectangular shape.& It's more of a hard plastic and, you know, if they don't get a good seal on it when they're sucking, they're going to be swallowing a lot of air. And then that's going cause some upset stomach with gas and you're going to have take more time to burp them.& To get the air back out or they're gonna be more likely to throw up if the air suddenly comes up on a tone.


So, because of this, Ii think it's going to be a difficult to go with the sippy cup at four months of age.& Also, just in general,& getting suction without getting a good seal, that's going to be a problem too. So, not only are they gonna be swallowing a lot of air, they're going to be working harder in getting last of the milk. And then there may be some issues with flow regulation.& Also, you know, with the soft nipple, babies with a bottle, babies are able to sort of regulate how much they're getting in their mouth by squeezing on the nipple and then relaxing their mouth.& That's going to be a lot harder to do with the plastic lid of a sippy cup.


And so, if they get too much at once, they can gag or choke on it a little bit. Now, having said that, you know, if you try sippy cup on a four month old they do really well with it, does it really matter? I mean, as long as they're getting the breast milk and they're not having a problem with the cup, then I think you're fine. My point is just that you probably are going to have some difficulty with the sippy cup. Just as much difficulty without it as you are with the bottle, if not more difficulty.

But again you know, there's no hard and fast rules in parenthood. I mean, if you have a four month old and they're doing great with the sippy cup.& They are making a good seal.& They're not swallowing a lot of air, they're getting enough of the formula. The air milk, the breast milk, either one.& And i mean, things seem to be going OK,& then you know, hey go with it.& But, I'm just saying probably things won't go OK with that.

Now, why won't things go OK with the sippy cup? Well again, for all those reasons I just mentioned. But from your baby's point of view, it's not going to go well because I think your baby wants to nurse.& I mean, I think that's the bottom line here.


She's not taken the bottle very well and why.& I don't think that a sippy cup is going to help from her point of view because what she wants is to nurse. I think that's why she won't take the bottle. So, she's learning, the tender age of four months. And trust me it all goes downhill from here.& That she's learning, that if she fuzzes and complains long enough, or loud enough that she gets what she wants, which is to nurse.

You know, so I bet what's happening is, you tried the bottle, you try, you get frustrated and then you finally give in and you let her nurse.& And you know, then she's gotten what she wants which is going to make her continue to exhibit that behavior to get what she wants the next time. So, what do you do about this? Well, here's what i tell people in my office who are in this kind of situation. If they fuzz and they don't want the bottle, put it away. You know, distract them if you can. Don't nurse them. Wait about 30 minutes and try again. If they fuzz and they won't take it, put it away and try again in another 30 minutes. But don't give in. Because if you give in, and you nurse, it's going to be much harder next time because she's learning that you will eventually give in.&  


Now,& I have to say I've been a practicing pediatrician for over ten years now. And I've never seen a baby refuse a bottle to the point where they get themselves dehydrated. I mean, most likely they will give in and drink the bottle. Now, will it be a difficult two or three hours? Maybe even little longer? You know, yeah, it will.& It will be a very difficult.& Because as she gets hungrier and more irate, she's just going to get herself more and more upset.& But the bottom line is that if she's smart enough to know, you know, that she wants to nurse. And has figured out how to make you provide what she wants, then she's also smart enough to figure out that sometimes your going to nurse. Sometimes you're going to get rid bottle.& And you're the one in charge of saying which one she gets and when.


So, I mean this is basic parenting. And it really does start as young as four months of age. You know, again it will be a difficult time. The incident will repeat itself a few times over several days.& But she'll catch on. And as long as you don't give in, she'll learn to accept which one you give her. And my bad is that if you do it this way and you don't give in and you just put it off a little while longer until she gets herself really hungry, and then takes the bottle. I'll bet that within two or three days this won't really even be an issue at all anymore. So, thanks Smitha from New York for the question and we'll move right along after this.




Our second question comes from Robin in New Jersey. Robin says "Hello, Dr. Mike.& I recently came across your podcast. And I am loving all the great info. I listen to you before bed and sometimes when I can't sleep in the middle of the night. Let me explain why I can't sleep".

"I am the mother of an 18 month old girl who is very wakeful to say the least. With no problem putting her down to sleep. But she wakes up over and over again at night. I end up bringing her into bed with me because I am so tired. She still wakes in my bed as well. I don't believe in the cry it out method. I guess I don't believe in crying before bed, period!"

"I'm still nursing her, and yes I do nurse her to sleep.& I'm aware that this might be part of the problem. So my question is this, is there a gentle way to lengthen the stretch of time the baby is down without resorting to crying? And am I crazy to believe she will soon sleep through the night on her own?


"I have not slept for more than a two hour stretch in 18 months. At this rate she would be an only child, if you know what I'm saying. Thanks for your time. I know it's precious and I'll be listening. Sleepless in New Jersey".

All right, Sleepless. Let's get to the meat here. You may not believe in the cry it out method Robin, but your daughter does. In fact she is using the cry it out method to get her way. Now, my answer to this is going to be sort of similar to the last question. Because really, the problem is similar. You got to look what is it that your daughter wants, OK?.& She wants you.& Yes she want s to snuggle with you in a warm bed.& She wants you to pay attention to her in the middle of the night. And she's learned how to get what she wants. You know, by crying until you cave in and you pick her up and take her into your own bed. And I honestly, I don't see this stopping any time soon.


And why? because she's got a good gig going here, you know? I mean, most babies and toddlers wake up in the middle of the night. And the difference really is between the babies and toddlers who want and get attention and the babies and toddlers who look around, you know, everything seems to be going OK.& And, OK, I'll go back to sleep now. And you don't even really know that they have woken up during the night.

So, I don't think Robin that you're going to be able to lengthen the amount of time your daughter sleeps in a stretch.& But what you can do is help her go from being one of this kids that wakes up and demand your attention to one who wakes up and then settles herself back to sleep on her own. So how do you do this? Well,& I only honestly know of one method that really works. And this is, the reason for that I can say this is because I have counseled so many parents. And I've had parents resist it and I've had parents who have tried it. And then I get feedback on what works and what doesn't work. And these sort of thing almost always works.


I also, I always say that I've been kinda blessed as a parent whose kids have had wide assortment of issues and problems.& And my two kids are very, very different from one another.& So, its kind of nice because I am able to, not only talk to parents about the things that, you know, that I learned in school.& The advice that I'm used to giving and getting feedback on that advice. But really also with dealing with a lot of these things with my own kids.& Because my daughter was definitely a night time "hey-I-want-attention" kind of girl. She's still a "hey-I-want-attention" kind of girl. But that's another issue for a different day.

OK. So, first I want to say, if you have a baby who is waken up a lot in the middle of the night. First, you know, I would start with a visit to your doctor.& And the reason for that is you really do want to rule out anything that could be causing them pain in the middle of the night. You see,& a lot of kids who don't sleep well, you go to the doctor and they have an ear infection lets say.


Now, there may be a kid who has not have a runny nose. They might not have a fever. But I mean you fell pretty bad if you're letting them cry it out and you know they have ear infection. So, I think it is a good idea to at least start by going to the doctor and saying is there any physical reason why my baby would be crying so much in the middle of the night.

Now, again, you have to kind of look also at the context of what's going on when your baby cries in the middle of the night.& I mean, could they be too hot?, are they too cold?.& You know, do they need warmer clothes?, do they need cooler clothes?.& Are they hungry?.& You know, if it's a baby who wakes up and cries and you give them a bottle or you nurse them. And they eat quickly and they're back to sleep.& And it's within 30 minutes. And that's happening once a night., Yeah, that may not be a problem even at18 months. I mean, if they having a growth spurt, they may have a need to eat once, or maybe even twice in the middle of the night.& And as long as that's for a short period of time and it's only a couple of times and everybody, you know,& at night, everybody's asleep again within 30 minutes. Then i don't see that as really being a problem.


But, if that's not the case, OK. If there's nothing that causing them pain.& They're not hungry, you know. Maybe they nurse or take a bottle for five minutes.& But then they're puts him around. And, you know,& wanting you to pay them attention.& And you've made sure that they're comfortable.& They're not too warm, they're not too cold. I mean really, you feel convinced they just want you, OK.& Then its time to start this method.

Now, the first thing I would say is that this method that I'm going to describe is not my own original method. I first was introduced to it in a book.& And this is a book that I have found when my own daughter who's now 12. When she was an infant younger than 18 months.& We had this kind of issues and I came across this book. It's called "Solve Your Child's Sleep Problems" by Dr. Richard Ferber. He is a sleep specialist at Boston Children's.


And, Dr. Ferber's book, it's a good one. It has lots of great advice in it, things I have seen work over and over again.& And it talks about sleep problems not only in infants but in older children as well.

So, this is the basic bottom line of it. And with a little bit of adaptation by me from what I've learned over the years with what works and what doesn't work. At first I would say to try to have a routine in the evening.& So, that your baby knows when bed time is coming.& You know, maybe, you know, a certain time that they eat a certain food. You know, do they get a bath or not get a bath. Is there little bit of reading time. I mean, whatever the bedtime rituals is going to be, I would try to come up with something and stick with it.& So that there's no surprise. You know, B comes after A, C comes after B, D comes after C, right? So, as long as your baby can predict, hey this is when bedtimes happens. And its not a surprise. That's going to make things easier.


The next thing I would say is,& always put your baby, now then again this is, I'm saying always with the assumption that there's a problem.& So, if you have this issue you always want to put your baby to bed awake. Now, of course, you know,& if you put her to bed to sleep and you don't have a problem then fine.& But I’m just saying if wake up in the middle of the night is an issue and they're going to bed asleep, you're just asking for trouble. And the reason is think about it from the baby's point of view. The last thing they remember is that they are in your arms.& They're warm.& Maybe they were nursing or taking a bottle, you know.& I mean life is good.& And suddenly the next thing they know they're in a room with a night light.& Maybe they're a little bit chilly.& Nobody's around.& It's quite.& Its like, hey, where did everybody go? You know, so they're gonna be a lot more likely to make themselves known so that you come in and continue what you we're doing before.

So, if they go to bed awake at least then when they wake up in the middle of the night,& hey, they're just where they were when they fell asleep, you know. There's no surprise there.& So, I think you're gonna have a lot less of a problem.


Now, if you take a baby who's used to going to bed asleep and you put them to bed awake, what are they gonna do? They're gonna cry. They're gonna cry because they want you.& So you know, I would look at it as they're the one who are starting this whole crying business.& And the parent is the one who is responding to their crying. In a way that the baby wants you to respond.& So, of course what you have to do is stop responding in a way the baby want you to respond.& So what do you do? & Well they start crying.& Maybe they even stand up in their crib, maybe they throw things on the floor. & You just, you let them do that. & You make sure they're safe.& You know, you want to make sure that the crib mattress is low enough that they're not gonna be able to get out of the crib or fall out of the crib.& You want to make sure there's nothing in the crib that they could step up on to that would elevate them enough that they could get over the edge.& And then you just let them be angry.& You know, you let them cry.& You let them do their thing.& And you wait about 10 minutes. And then I would poke my head in the door.& Its all business, you know.& So, they don’t think you've abandoned them.& And you say, you know, look,& it's bed time.& I love you.& Good night.


You walk out.& They start crying again.& They start screaming doing their thing.& This time I would wait 15 minutes and then I would poke my head in the door, just to let them, hey we're here, goodnight.& It's business.& You don't pick them up.& And you basically do this and you let it go for 5 minutes each time.& So, you start out with 10 minutes then you go to 15 minutes, then you go to 20, then 25, then 30, then 35, then 40. I'm serious. & You really do get to the point where you're going this long. & And there are babies who would cry and cry for a solid hour.& And you just have to keep chugging and plugging along with this. You really, really do and not give in.& Because if you get to the point where its in hour of them crying,& and you cannot take it anymore.& And you pick them up, they just learned.& If i cry long enough, & If I cry loud enough, I get what I want.& And, you know, they found something that works to get them the desired outcome.


So, you can't let that happen.& So what if they get so upset they throw up?& If they're, you know,& picking on them but they're not choking on it, honestly i would let it go.& Because you don’t want them to learn, hey if I throw up,& I get what I want.& 'Cause I have seen that happened in several cases, and it's not pretty.& Especially if they get to be kindergarten age and they're making themselves throw up.& Because they learned, hey, mom would take me out of school.

So, you really, I think your best opt is just completely ignoring pretty much anything that they do and sticking with this.& Now, the second night in self starting in 10 minutes. I'd start at 15 minutes.& The third night I would start at 20 minutes.,& You know make it go longer and longer.& And if you stick with that, and you don't give in, honestly I don't think I've ever in 10 years of practice,& I don't think I've ever had a parent come back to me and say that didn’t work.& I mean it almost always,& I can't even think of a time in my mind where it doesn't work, usually in very short order.


The other thing I would do, is with then, its basically the same plan if they wake up in the middle of the night.& I mean you want to make sure they're not hungry. Make sure they're not, you know, too warm, too cold. But once you've just determined that all their needs have been met you let them cry it out.& And you cry, you let them cry, you know, the 10 minutes.& And then go 15, then go 20. The second night start it maybe 15 then go to 20.& And lengthen it a little bit each time.& And again what you'll find, is that after three or four nights of these, they learn, she's not coming.& This is not going to work.& And, you know, then they usually will settle themselves down.& Often times, what you'll find is a kid that you are able to get them to settle down using a plan like this, and then they have an ear infection.& And you go in and pick them up, and hold them.& And give them some Motrin and, you know,& and that's fine.& You know,& when they're sick and they have a need by all means meet that need.

But then, probably things are going to be bad again for few days after they're well again.& 'Cause they get used to you coming to the room and picking them up.& And that's fine.& And you have to have a little mini retrieve the plan.& To get them to start soothing themselves again.& That's expected.& You know there's nothing wrong with that.


Now, I really do look, at it this way Robin, I mean you aren't the one resorting to crying it out, right? I mean your daughter is the one resorting to it. And why not?& You know, it's working. So again, you have to make her plan not work.& And you're the one that's going to have to put a stop to it.& She's not going to do it on her own more than likely.& And there's no easy way, you know.& But as long as you let it continue to work, she's going to keep doing it. Now, you could argue that the parent should anticipate their baby's needs and respond before it gets to this crying out stage.& But where does that end?& I mean at what point do you begin to tell your kids no? I mean is it when they're a teenager?& You know, of course not.& It's going to start now.& It will be hard.& It breaks your heart.& But this is how kids begin to learn about rules and expectations.


I mean babies who always get their way in everything they want, will turn into children who always get their way.& And they'll turn into teenagers who always get their way.& And then, in adulthood, when they don't get their way they don't know how to handle it and bad things happen.& So, in the end, I mean, it's about making the tough decision because you're a parent.& It's about making the tough decision even when you don't want to make it.& But, Robin, you know, you don't want to let your daughter cry it out because of the way her crying makes you feel.& And as a parent, you know, you have to let go of how things make you feel.& And do the things that will help your daughter learn to respect rules and expectations.& And how to even to teach her how to handle disappointment.& And yes there’s a lesson, whether they're in the form of how milk is delivered in a bottle or a cup or from the breast or in the form of night time routines,& I mean these are lessons that has to be taught to children by us as parents even when our children are infants.& And we can't let our actions as parents be dictated by every whim and want of our children.


I mean as parents, our job is to know what's best for our children.& And, you know, a mother who is sleep deprived, and all they getting two hours of sleep in a stretch is not at her best during the day.& And so you could argue that this is something that needs fix.& So that I can be a better mom during the day time. And by fixing this situation Robin, and getting the night time issues under control, you and your daughter will both get more sleep.& And your day time interactions will improve as well. Now, will you be sacrificing a few nights? Then it will, Honestly, it will only take a few nights.& But the long term benefits of these few terrible nights will be numerous.& And you know,& I go to the same thing as a doctor. & You know I was thinking about this.& I see a kid, you know,& I make a diagnosis that they have a virus.& I feel strongly about that diagnosis. Their ears look good, their throat looks good, their lungs are clear.& They've got a fever.& You know, they've been sick a couple of days.& They've a runny nose. I feel very strongly it's a virus and I tell the parents that's what I think.


Well, it's not the advice the parent wants.& They came to get an antibiotic.& And if they complain and complain and say but the last time it turned into strep.& And we were back three times before we got the antibiotic. You know, there are a lot of doctors out there who's going to give in and just give that antibiotic just to get the parent out of the office. But, you know, and then moms learn how to get their way, right?& If I complain and stomped my feet and round about it enough, then the doctors going to give me the antibiotic.& And the problem is the doctor gives them the antibiotic and the kids get better.

Now, they would've gotten better anyway.& 'Cause the viruses do go away.& And, you know,& by the time that you've gotten in to see the doctor, the first doctor said no.& You went and saw a second doctor,& or you went to see the same one a second time.& Finally, they break down.& They give you the antibiotic, well, what's it then?& About 10 to 14 days. How long does it take for a virus to go away?& About 10 to 14 days.

But the behavior of mom, you know, returning and demanding the antibiotic is strengthened because their kids get better.& And so the next time our kid has a virus and she says, you know, "this is what happened last time.& And I came back and then I got the antibiotic". You know she's learning, the mom is learning, this is how you get an antibiotic from the doctor.


But what was really best for the child.& I mean they would have fought the virus off and taken about 10 to 14 days to do that.& And all we've done is cut off the good bacteria and made a room for resistant bacteria strains to come in and grow. So,& I don't give in to parents demanding an antibiotic.& It's tough.& You know,& I want parents to like me.& I want parents to respect the advice that I give them when i tell them it's just a virus.& And then they go to another doctor.& Get their antibiotic and the kid gets better.& You know,& know my name is mud.& And so it goes. So, again I'm not picking on you Robin.& We all go through this in slightly different versions in our lives.& But you still have to do what's best for the person at the receiving end.& And you know what, as a doctor,& it's the kid I’m looking out for not the mom's feelings.& And so in this case,& I'm really, I'm looking after your child,& because your baby, Robin, needs to learn to soothe their self at night.

It's an issue if you can't tell that I feel strongly about.& And its one that comes up really often in the office.& And usually patients on my practice get a much shorter answer than the one that I was just able to describe. But, thanks for your question Robin.& If you have any more, feel free to write back in.& I really appreciate it. Again, not picking on you personally.& Just something that I feel strongly about.  

So,& let's go ahead and move on.& And we'll get back to the next question right after this.




All right. Welcome back to the program. Our third question this week comes from Whitney, who is the host of the LD Podcast. And she's in the Pennsylvania. The LD Podcast by the way is a wonderful podcast.& If you have children with learning disorders at home or you're worried you child might have a learning disability. Or even if you just have some behavioral issues at home. Some school issues. You might want to give her podcast a try. It's really a good one. And you can find it at

So Whitney from the LD Podcast says "Hi, Dr. Mike. I heard the latest episode this morning. And I have an older kid question. James is 11. He has rarely gotten sick since we had his tonsils out a few years ago. But this year, he has come down with the pretty nasty cold.& It started out with intermittent fevers between 102 and 103.8".


"Congestion. But the fever was the worst part. He would seem to be better in the morning and partially because of his near the end of the marking period in school. If his temperature was around 99, and he felt OK. Otherwise, I give him Motrin and Mucinex and send him to school.& Expecting that they would call me if it got any worse. He seem to do fine. But the next morning his temp would spike again to 101 or 102. He would stay home and he had a week like this". What it sounds like the flu. I've seen a lot of the that here recently. "The pediatrician looked at him said it was going around and then he was negative for strep. So just treat it symptomatically. While the temps are all gone now but he has simply an awful cough still. One that when he is exposed to the cold outside causes him to hack until he sometime vomits. I've been driving him to and from school to avoid any long exposure to the cold until the cough gets better. So here are the questions. Number one. What are the good school exclusion rules? Temple for 99 or a hundred.


Now, Whitney, I'm going to answer these questions sort of as they come. The first one, when is a good school exclusion rule. You know, the trouble is, school once you're there, but yet they don't want you there if you're contagious. But these viruses, you know, with them you're contagious. You know for several days even if you don't have a fever. But, you know, if you ask someone at, with the, school, is it reasonable for kid to be out of school for three or four days for just a cold virus. They're going to say no. You know, so, I mean if everyone with a virus stay at home. The absentee rate would just soar in the winter time, right? So, I think they have to accept that some kids are going to be contagious with viruses at school. I think you just have to accept that. And then I would say that if they have a fever of 101 degrees or higher. That is definitely a stay home criteria. And the school are going to boot you out anyway. But what do you do with these kids between 100 and 101? Well, I mean technically as we've said before, 100.5 is the medical definition of an elevated temperature that you would consider a fever.


So, 100.5 to 101, I would see how they're feeling. You know, I mean if they feel pretty good and they're 100.8 and they got a stuffy nose but they don't have a sore throat, they don't have an ear ache. You know, they just have a mild cough. Personally, I'd still send them to school. Once you get to 101, I'd say you'd definitely have to stay home. 99 to 100.4 is technically still a normal temperature. And if they have no other symptoms or problems, you know, I'd definitely send them to school.

Now, other reasons to stay home regardless of the temperature itself. You know, if they're wheezing, they have severe cough, they're vomiting or severe diarrhea. You know, in these cases, you need to see your doctor anyway. And when they examined your child to let you know what's going on. They could give you advice on when to go back to school.


All right, the second question. Should you keep a kid home one extra day just to make sure or return them to school as soon as possible?& I would say return them to school as soon as possible. I would only keep them home as long as they have the fever. Or if they continue to feel bad. You know, there have been wheezing. They didn't sleep very good and they're just exhausted. You know, the next morning, if they have severe cough, they're vomiting, severe diarrhea. But, you know, if they got a good night sleep and they're fever is gone and they're feeling pretty good. Then, I'd get them back to school that day, not wait an extra day.

What about our next question that Whitney asked. What about coughing. If there is no temperature is morning coughing and coughing induced by cold enough to keep a kid home or should they be send to school. Well, I cannot say if the cough is mild. I'd go ahead and send them to school. If they have a severe cough or it's a persistent cough that's lasting many days, then I’d take them to see your doctor. Because there could be a virus, it could be allergies. There are some kids who have asthma that's a cough varying asthma. So they just cough a lot. And if you treat them as an asthmatic with Albuterol and some oral steroids, that sort of thing, makes things better. So, coughing persistently can be a sign of asthma in some kids. So they really should be seen by the doctor.


And then she asked, question number four, how long should I let this cough persist before taking him back to the pediatrician? We're treating it with over the counter stuff.& He seems to be OK. But this is a cough that keeps him up and me sleeping down the hall sometimes in the night. When do I have to worry about bronchitis et cetera? Now, once you see the doctor Whitney, I would say you're going to have to give the cough a week or two to clear up if it's a virus.& Now, if the cough changes, it becomes more severe, it suddenly becomes productive of, you know, thick green mucus. Where it haven't been productive before or if it sounds croupy or barky. You know, if there is any change in the cough. Or it's lasting more that a couple of weeks, then I would see your doctor again.


Also, if there is a new fever or you know, new vomiting. Or there is something new or it's changed in some way, then I would go back sooner than a couple of weeks and see your doctor. Because you don't want to miss if it's progress to a pneumonia or to a bronchitis. Which bronchitis is kind of a, it's more of an adult medicine term. You know, in most kids, a bronchitis kind of pattern is going to be caused by a virus and not bacteria. So, generally they don't need an antibiotic for bronchitis. Even in kids. But it will take a couple of weeks for the cough to go away. And let's look at why that is. Because this is an important thing to understand. When you have an upper respiratory virus, the virus infects the cells that have these little cilia in them that lined the airway. And the job of these cilia, they're like little tails coming out of the cells. And they sweep things up out of the trachea. Which is the top part of the breathing tube. So, these cilia are there to keep stuff out of the lungs. Okay, anything that starts to go down the trachea is going to get swept back up by these cilia.


So, they have an important role. But when you have a viral infection, those cells with the cilia, become infected. And the cilia don't work correctly anymore. So, now your body has to rely on cough to keep stuff out of the lungs. And you're going to have that cough until your body can remake these cells with the cilia. And that's going to take a couple of weeks. It takes a couple of weeks to make new cells with cilia that work that aren't infected by the virus. Now, during that two week period, you're not contagious.& The cough is important because it's protecting the airway. And honestly, you don't want to get rid of that cough completely. I mean, that cough has a job. You know, it's protecting the lungs and keeping stuff out from the lungs. It's keeping you from getting pneumonia basically.& So, you know, your kids are going to cough when they have a virus and that cough is going to last for a lot longer than there contagious with the virus.


So, I would definitely send them to school even with the cough.& I wouldn't make it your goal to get rid of a cough completely. Because that cough has a job, a function. But, I would say if it lasts for more than a week or two, and you go back and see you're doctor. Just to make him listen. And if there is a change in the nature of the cough or, you know, they're making, producing a mucus. So they have a fever with it. Then, you want to go back a little bit sooner. OK. And then Whitney, we accept her message by saying sorry to sound like an amateur parent. Again, these apologies. Don't apologize folks. It's OK, ask away. She say's "Sorry to sound like an amateur parent. But it's these soft signs where no one thinks significant enough to keep a kid at home all day, particularly with tests and the like in school. But I don't want to get everyone else sick either or make my son any worse. So help".


You know, it's a tough decision with all of these. Because, the school gets upset, you know, when you keep your child home too much. I mean, but then again, they don't want him there sick either. And that is one thing that always bothered me about schools. Is their, the award for perfect attendance. I mean, people can't help being sick, right? I mean illness happens. And I think perfect attendance is just an unrealistic expectation.& I mean I see so many kid's who's disappointed because they get strep throat in May. You know, and they ruin the year of perfect attendance. Just, seems like a silly award to me. But, okay, I digress here. So, let me summarize. I'd stay home if they have a fever of 101 or more. If their fever is between 100.5 and 101, then I will look at the whole picture, you know. If they're otherwise feeling pretty good, I'd probably go ahead and send them. If they're 99 all the way up to 100.4, technically, that's a normal temperature. And that, you know, if they don't have a lot of other symptoms with that, I'd still send them.


If their temperature is less than 100.5. So, technically they don't have a fever. But, they have a severe cough, severe vomiting, severe diarrhea. Any of those things, then, you know, you want to keep them out of school. And take them to see your doctor. If the cough is viral. And your doctor says that after looking at him, expect that cough to last a couple of weeks. But if it changes or there are new symptoms, let your doctor know. And then back to school as soon as the fever is down and your child is feeling better. So, again Whitney, thanks so much for your question. Again, that is is Whitney from the LD Podcast at And we'll put a link in the show notes over to her program. And we'll be back with our final question right after this.




All right. Our fourth question of this episode comes from Fizel in the United Kingdom.


And Fizel says "Dear, Sir. My baby is six days old today. He is normal. He pass stools perfectly in the first five days. He was using formula milk and breast feeding. Since yesterday, he's having more than 80% of breast feeding but didn't pass any stool on the 6th day. And now the 7th day has started.& Also, we started giving him Fer-In-Sol drops for Iron on the fourth day. I want to know if something is wrong. Is he not passing stool because of drops or due to breast feeding? And what shall we do now? Thanks".

All right, well thanks for your question Fizel. I appreciate it. I'm going to kinda take the cheap way out on this one. If you look back at episode 16, which is still in the feed and all of the episodes are available at the website at But episode 16 was devoted completely and totally to infant poop. And in episode 16 we did talked about this.


The bottom line, sort of in a nut shell. Is the consistency is probably more important than frequency when it comes to baby stools. So, if you have an infant who has nice soft and mustard like bowel movements. And they're going every three or four days, that's fine. You know, if they go through three or four days without bowel movement and it's hard and formed.& Then you want to do something to help them out a little bit. And if it's soft but they're going the whole week in the between bowel movements, then you probably want to help them out a little bit too. And there is lots of ways you can do that. It's unlikely that the Fer-In-Sol is causing your baby not to have poop. You know, they talked about Iron causing constipation. But really it is not been shown to cause that significant of a constipation issues. And the benefit that you get from the iron drops probably outweighs any problems that that maybe causing with the stool. But you want to talk to your doctor about it.

And again in episode 16, we go into much more detail about what's normal and what's not normal for infant poop.


Also, in the pedia scribed blog, I did a whole article on the baby poop. And what's normal and what's not. And I'll put a link to that in the show notes as well. So, I'm going to take a little bit of the easy way out on this one. But only because we have talked about that in so much detail. So that resource is there for you to check out at the website.

OK. I also have a final bit of feedback that I wanted to read here. This comes from Christie in Georgia. She says "Holy cow! I wanted to stand on my rooftop and tell everyone about PediaCast after I listened to my first episode. I have a wonderful wealth of knowledge right on my I Pad now. I loved the exercise and listen to you on my walks. I was doubled over on the corner the other day because I was laughing so hard. I'm afraid that was probably the laundry episode". I bet. "I'm afraid the neighbors are going to start talking. I'm a physical therapist. And I love my job"


"I have days from time to time when I'd rather be with my kids than at work. It makes up all worth it when someone tells me how much I helped them or I that had made their pain go away. I realized why I do what I do. And it makes me feel great. You should feel great about what you do because it has made such a difference in my life and in the lives of others. Thank you for the information that you provide to help parents like me. They can form decisions about our children's well being. I'm looking forward to future episodes. I hope you enjoyed your vacation. Sincerely, Christie".

Ah, Christie. That is really nice of you. And I appreciate the feedback. I really do. You know, I get enjoyment out of doing PediaCast too. And I'm really glad to do it. You know, really, and I've said this before, so I won't make it too big issue out of it. But, it's nice being able to have a form, you know, where there aren't really too many time constraints. That we can talk about the things that are on parent's mind. And I really do get a lot of enjoyment out of doing this. I wish I could, you know, answer more questions than I do.


& But the problem is, that, in order to answer them completely. Which I want to do. Because if I give you short, quick answers, you know, again you can get from your doctor. I do that all day long in the office. So, to be able to talk about something that length takes time. And so that's the reason that we're not getting too as many questions as I have liked too. But again, I have toyed with the idea of doing some shorter episodes. And more frequently and just devoting them to parent's questions. You'll notice if you listen to probably 10 episodes ago now. I did a lot more research type oriented things. And honestly, I kinda miss that a little bit. But there just been so many questions that I've been getting through email. And I'm so many behind actually. That it's been tough to try to make time to look at some of the research topics. But I would like to get back to that a little bit. Maybe we'll have a research oriented episode or something at some point. Or if we did shorter episodes, but more frequently. We could still put a little news in. Answer a question or two.


You know, do a little research segment. Try to wrap the whole thing up in half an hour or so. So, we'll see. The blog and the newsletter, you know, there not been much progress on those lately. And I do apologize for that. It's just again so busy at the office. And then trying to get your questions answered. That's the priority.& And so, you know, when I have time maybe we'll get to the blog and newsletter again. Although, I think if we start doing more than one episode a week, something's got to give. And it maybe the blog and newsletter that have to go. Although I'm trying to talk my wife into taking the newsletter over. 'Cause she's a pediatric nurse by training. And that I think she'll do a really nice job with it. So, Karen if you're listening, please take over the newsletter.

All right, we should wrap things up. I want to say thank you to you. my listeners for making this happen. 'Cause, if it weren't for you, you know, there is no sense in doing this. I'd like to thank my family for putting up with me and allowing me to buy really cool studio equipment and have a Mac. And put these things together. 'Cause it's a lot of fun. And I really am thankful for the support of my family with all of this.


Thanks to Vlad over at He is from Russia. And he is responsible for the artwork that is at the website. So we really appreciate him. Don't forget you can submit a question or comment. View the show notes, take our listeners surveys, sign up for the not quite yet the defunct newsletter. And read the not so updated blog at

And if you like PediaCast please spread the word by telling your friends, relatives and neighbors about our program. You can download free promotional materials on the poster page of our website. As usual, reviews on I Tunes are all so important for a helping to keep us up in the number raise. And the number raise is important. So we can recruit a larger audience and help more parents and answer more questions. And who knows, maybe I can go part time in my office practice and do this a lot more if we secure a sponsor or two.


So,& reviews in I Tunes are really helpful. Also, Podcast Pickle, Podcast Alley. You know, all of these places, reviews are helpful. Also They have a podcast section. And if you could dig this at in the podcast section, that would be helpful as well. So, my hope is to have another episode out before the end of the week. We'll keep our fingers crossed and see how that goes. And until then, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long everybody.



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