Sippy Cups, Cavities, and Motion Sickness – PediaCast 028

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  • Sippy Cups and Cavities
  • Autism Prevalence
  • In-Toeing of the feet
  • Motion Sickness
  • Hemochromatosis
  • Speech Therapy
  • Consequences of Teenage Sex
  • Exposure to Online Pornography


Announcer 1: This is PediaCast.


Announcer 2: You're listening to the Tripod Network. What's on?


Announcer 1: Hello moms, dads, grandmoms, grandpas, aunts, uncles, and anyone else who looks after kids. Welcome to this week's episode of PediaCast, a pediatric podcast for parents. And now, direct from Birdhouse Studios, here's your host, Dr. Mike Patrick Patrick, Jr.!

Dr. Mike Patrick: Hello, everyone and welcome to PediaCast, a pediatric podcast for parents. This is Dr. Mike coming to you from Birdhouse Studio and I'd like to welcome everyone to the program. You found the best digital source of news parents can use, answers to your questions about child health issues, and the latest round up of current research topics in the world of pediatric medicine.


If you're new and listening at the website, be sure to subscribe to our feed by adding us to iTunes or any other podcatcher. That way, you won't miss a single episode. And of course, a warm welcome back to my loyal listeners. You know, you folks are the ones who keep PediaCast alive and kicking. I'm serious about that. If you like to breathe more life into the program, be sure to tell your friends, relatives, co-workers, and neighbors about the show. Reviews in iTunes work wonders as do diggs of each episode in the podcast section of, that's digg with two "Gs". And remember, you can digg each episode separately. So, make sure you visit digg every week and give PediaCast a thumbs up for me. We have a full show lined up for you today. Here's a rundown of the topics. In the news parents can use segment, we'll report on sippy cups and autism prevalence. No, not a relationship between those, they're two separate stories. OK.



Then we will answer listener's questions regarding in-toeing of the feet or pigeon toes, motion sickness, and hemochromatosis. And then we have listener comment regarding speech therapy. Then we'll wrap up the show with our research round up. Now, a word of warning, this week's topics are a bit sensitive. So, if you're listening with kids or at the office, you might want to save that segment for later or make sure you listen with your headphones on. What are the sensitive topics? Well, I'm glad you asked. This week's research round up, we'll take a look at sex and pornography. All right. Don't forget, if you'd like to join the conversation and wanted to contribute something to our listener's segment, it's an easy thing to do. Simply swing by the website at and click on the contact link. If you'd rather send an email, you can do that by writing to And if you want to leave a voice message, simply attach an audio file to your email or call the Skype line at (347) 404-KIDS, that's (347) 404-K-I-D-S.


OK. Before we get started with the program this week, I do have a little bit of exciting news. If you haven't stopped by at the website and clicked on the blog link lately, I encourage you to do so. My wife, Karen, has taken over the blog and I'm very grateful for that because as repeat listeners will tell you, the office has just been crazy with flu and strep throat. And I just – I have not had a lot of time to devote to the blog. And so, Karen has kind of taken that project under the wing and she's had some very good posts and a few comments to the posts, but I'm sure she'll like a lot more traffic. And the things that she has to say – you know, I think that they definitely deserve to be out there. The topics that she's done so far – and I'll just read the titles in a nutshell, sort a teaser for you. The first one is Air Tran One: Unruly Child Zero, Little Bobby Learns to Lie, My Day in a Nutshell, Let's Be Honest Here, and Why We Homeschool Part One.


Yes, we homeschool. So, if you like to stop by the blog, we'd really appreciate it and you can find out a little bit more about my family. There are a few embarrassing things in there. She tells the story about me being stranded on the side of the road for about an hour and a half earlier in the week when my – well, actually, it was late last week when my car decided to break down. It was just a lovely thing really, it's about five degrees or so. And normally I'd tell you about it in the program, but since she writes about it in the blog – it was the My Day In A Nutshell post. I'll let you –


– read about it for yourself. The other thing that's been keeping me busy here lately is Mouse Matters. Now, Mouse Matters is a weekly column that I do on the DIS, which is And I'm proud to say that I was really surprised at this. The guy who runs the DIS called me last night on the phone because they're trying to get some sponsors for the column and he had some leads and we were talking about that sort of thing.


But he told me that last month, in January, we had 20,000 page hits with the readers of the column. And so, I'm just really happy about that. And I'm glad – if any of you out there who are regular PediaCast listener, also swing by and read the column Mouse Matters. Thanks for your support. If you know anyone who's a Disney fanatic, you'll definitely want to tell them about Mouse Matters. Right now, we are in the midst of a series of weekly columns about the Magic Kingdom at Walt Disney World. And looking at it from an imagineering standpoint, there's a book called the Imagineering Field Guide to the Magic Kingdom. And it gives away some of the secrets of how they do things and some of the little things that you might not notice. And so, we're kind of going through that book and exploring the Magic Kingdom from the viewpoint of the Imagineers, which if you're not a Disney buff, the Imagineers are the guys who are in charge with making the magic come true.


So, you might want to check out Mouse Matters. If you haven't seen it, it's over at And of course, I'll put a link to that in the Show Notes and you can also get to Karen's blog at the Show Notes site too, that's OK. Well, enough about me and my family. Before we get started with the rest of the program though, 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 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 So, with those ground rules in mind, we'll return with news parents can use right after this.



Our first news item in the news parents can use segment comes from the American Academy of Pediatric Dentistry. Use only water in sippy cups or increase cavity risk. Most parent are well aware of the importance of taking their children's teeth. So, it comes as a shock when they learn their toddlers have cavities during a check up. Tooth decay among young children is on the rise. And many experts believe that sippy cups containing sugary beverages are responsible. Because sippy cups prevent spills, they're ofter used by children for long periods of time over months and years rather than as a transitional drinking device, a purpose for which they were intended. "Sippy cups were created to help children transition from a bottle to drinking from a regular cup, but they are too often used for convenience", says American Academy of Pediatric Dentistry President, Dr. Philip H. Hunke.


When kids sips for extended periods on sugared beverages, they're exposed to a higher risk of decay. Sippy cups should only contain water unless it's meal time. In fact, a report from the Centers for Disease Control and Prevention or CDC comparing the dental health of Americans in 1988 to 1994 and 1999 to 2002 found that wall cavities decreased among older children. Cavities in two to five-year olds actually increased 15.2%. Hunke believes the misuse of sippy cups is just the symptom of a larger issue. The fact that many parents wait too long before taking their children to the dentist for the first time. The AAPD or American Academy of Pediatric Dentistry recommends that a child's first dental visit occur shortly after the first tooth erupts and no later than the child's first birthday.


But according to the 2005 National Survey of Children's Health, only 10% of one-year olds and 23.8% of two-year olds had been taken for a preventative dental care visit in the past year. At that first visit, the pediatric dentist provides information about proper sippy cup use as part of the presentation of a complete program of preventative home care. The dentist also checks the child's teeth to make sure they're developing properly. "Studies show that children with poor oral health perform worse in school and have less success later in life", says Hunke. Establishing the right oral care habits early helps kids headed on the path to a lifetime of good oral health. All right. Let's talk about this report for a few minutes. This was a press release put out from the American Academy of Pediatric Dentistry. First, let me say, you know, "Bravo to the American Academy of Pediatric Dentistry for raising the issue about sugary beverages in sippy cups because not only does this practice lead to cavity formation, but it certainly also contributes to the obesity that we're currently seeing in this country."


But, you know, with all due respect to the dental academy, there are some major, major issues I have with this report. First, you know, it says that studies show that children with poor oral health perform worse in school and have less success later in life. OK. So, are they telling us that it's the poor oral health that's doing that? So, if you don't brush your teeth in the morning, you're not going to do as well on your test and you're not going to get paying job? Well, that may be true. But look, the only reason I bring this up is because part of PediaCast is designed to help parents take a critical look at research to make good decisions about their, you know, child's health. And, you know, if you look at the real issue here, it boils down to socioeconomic factors.


In families where oral hygiene is less of an issue, probably general overall hygiene is also less of an issue – and these are going to be kids coming from poor families who – this is the way they're brought up. Mom and dad were brought up not brushing their teeth, not taking good care of their personal hygiene, and these are the kids who are going to do more poorly in school and have less of a chance of – later in life, having a good job and that's unfortunate, but it's the reality. And so, certainly, we do want to encourage good oral hygiene, but it's not like, you know, oral hygiene is the key to life, you know –


– like they are insinuating with this report. So, again, it's just a way to sort of skew the data a little bit to make you look at it in a certain direction and then they just ran off in a different direction themselves. So, you just have to look at it in context of what's going on here.


Now, they talk about kids seeing a dentist after the first tooth erupts and then no later than one year of age. Well, that's fine in the suburbs, you know. I mean, if you've got a lot of pediatric dental practices around you where there's a children's hospital with a big dental clinic, OK, great. But, you know, for most of America, this is pretty unrealistic stuff because if all of the one-year olds were suddenly making dental appointments, the dentists in most communities would be overwhelmed. Most of the dentists where we live recommend that kids start coming in when they get to be two or three years old. And most of them are going to say three years old, unless there's a big issue before that time. So, while I think ideally it would be nice for babies to see dentists every six months, it's not a reality for most of America because they're simply – it's not – there's not a big enough cushion in the dental profession to allow this to happen.


And the dentist would just be overwhelmed if all the twelve-month olds were suddenly going to the dentist. And they also talked about increased cavities in two to five-year olds. An increase of 15.2% compared from the early 90s compared to now, that there's that much more dental cavities. Well, again – and again, I – these are all important stuff. I'm not getting on the American Academy of Pediatric Dentistry. I'm just trying to show you how you have to look at research articles or articles from anyone to see how it can be skewed to make an argument for someone. Now, it is also true that there's a whole lot more two to five-year olds seeing the dentist so that – they don't give you the numbers, but there are more two to five-year olds seeing the dentist now than there were back in the early 90s. So, yes, the amount of cavities in two to five-year olds has increased 15.2%, but how many kids had cavities, who are two to five years old, who didn't see the dentist and they weren't diagnosed with cavities?


They still had them, it's just that diagnosed cavities have increased by 15.2%. So, you know, there's increased dental visits. Then they talk about that – you know, the fact that there were 10% of one-year olds and 24% of two-year olds are all that have been to see a dentist. Well, again, whose fault is this? I mean, it's almost like we should be blaming parents because only 10% of them have taken their one-year old in and only 24% have taken their two-year olds in. But I see a lot of one to two-year olds who talk to their dentist and their dentist says, "Don't come in until they're three". So, who's fault is that? You know, I think the American Dental Association or the American Pediatric Dental Association needs to get the word out to the general practicing dentists that age 12 months or earlier is the time to get their kids in and not blame it on the parents. Now, I also think it's interesting that they talk about sippy cups being created as a transitional device and now, they're being used for convenience.


You know, I don't get this. Who invented sippy cups? I mean, like Tupperware? You know, maybe – what is – the safety flow or the – oh, who are the bottles, you know, with a thick nipples? Evenflo.


I'm sorry. Well, they're not going to want to sponsor PediaCast are they? Well, you know, whoever designed sippy cups did not design them as a transitional device. They designed them to make money. And why did they design them because parents wanted them because they weren't messy. You know, there's nothing about a sippy cup that helps kids learn how to use a regular cup. I mean, you can turn these things upside down, you still suck on them like a bottle, just instead of a soft, round nipple, it's a hard rectangular piece of plastic with a spring in there that you still have to get suction. You can still turn it upside down. It is not a transitional device to go from a bottle to a cup. It's simply a bottle that makes parents feel better about it. But –


– it's really still there for convenience and, you know, there's something to be said for convenience.


I mean, parents are busy these days. I mean there are manic mommies, right, just like the show? And they don't need to have kids, you know, making big messes around the house if a sippy cup is going to help control the mess. Now, the problem is not the cup. The problem is not even exactly what's in the cup at any specific time. The problem here is parents allowing kids to run around all day long with the cup that has a sugary beverage in it and then going to bed with the cup and having it in their mouth. So, if you have a kid who has a sippy cup in their mouth all the time during the day and night and they're getting a sugary substance on their teeth, yeah, it's going to cause tooth decay. There's no question about that. And so, really, I think – I've come up with Dr. Mike's Smart Sippy Cup Rules and there they are: Only use sippy cups during meals and snack time. Now, they talk about only put water in there. But do kids need to run around the house with a sippy cup of water even?


I mean, we don't run around – well, some people do, I guess. But I mean, you don't really want to be running around with a cup – a drink in your hand all the time. I mean, I think just give them their sippy cup during their meals or during their snack times, make sure their getting mostly milk and a little bit of a juice. And – OK. So, at night time, do they have to have a bottle of water or sippy cup of water? OK. So, it makes them be quiet, but shouldn't they be learning to quiet themselves on their own anyway. So, I just – you know, I wouldn't give them a sippy cup. Cups are for drinking. That's during meal times and snack times or if they're thirsty, they can stand in the kitchen and take a drink and they they give their sippy cup back. So, really, it's just a matter of not looking at sippy cups as being the evil thing here. The evil thing is the sugary beverages on kid's teeth all day long. You know, when food goes away, the cup should go away. You know, don't let your kids run around the house with food or with a sippy cup. OK.


Also, again, you got to use common sense with this stuff and for someone to say, you know, that sippy cups are terrible and parents are only using them for convenience, well, that's fine. Parents need the to use them for convenience. OK. I know I'm going off a little tangent here, but it's just, you know, the American Academy of Pediatric Dentistry, they really do want kids to have less cavities and that's fantastic. Again, bravo to them. But, you know, they're just like anyone else. They're using the data to skew things their way a little bit. All right. Our second news item, a new data on autism spectrum disorders from multiple communities in the United States. This comes from the U.S. Department of Health and Human Services and the Centers for Disease Control. The CDC or Centers for Disease Control recently reported findings from the first and largest summary of prevalence data from the multiple – from multiple U.S. communities participating in an autism spectrum disorder surveillance project. The result showed an average of 6.7 children out of a 1,000 had an ASD or Autism Spectrum Disorder in the 6 communities that were assessed in 2000 and an average of 6.6 children out of 1,000 had an ASD in the 14 communities included in the 2002 study.


All children in the studies were eight years old because previous research had shown that most children with an ASD have been identified by this age for services. For decades, the best estimate for the prevalence of autism was 4 to 5 per 10,000 children. But more recent studies from multiple countries using current diagnostic criteria, conducted with different methods have indicated that there is a range of ASD prevalence between 1 in 500 children and 1 in 166 children. The CDC studies provide information on the occurrence of ASDs in 14 communities in the United States. Our estimates are becoming better and more consistent, though we can't yet tell if there is a true in ASDs or if the changes are the result of our better studies, said CDC Director, Dr. Julie Gerberding.


We do know, however, that these disorders are affecting too many children. Overall, the 2000 study found ASD rates range from 1 in 222 children to 1 in 101 eight-year old children in the six communities study. The 2002 study found ASD rates ranging from 1 in 303 to 1 in 94 among eight-year old children. The average finding of 6.6 and 6.7 per 1,000 eight-year olds translates to approximately 1 in 150 in these communities. This is consistent with the upper end of prevalence established estimates from previously published studies with some of the communities having an estimate higher than those previously reported in U.S. studies. Blah, blah, blah, blah, blah, blah, blah –


It goes on and on and on. And the bottom line here is that there's more kids being diagnosed with autism spectrum disorder today than there were, you know, 10 and 15 years ago.


OK. Is that really news to anyone? I mean it seems like, you know, every kid who has a learning problem of any kind is getting lumped into this category of autism spectrum disorder. Now, that is not to diminish the problems faced by these kids. And it's not to diminish, you know, the parents and the teachers who are dealing with this problem. But when we start classifying, you know, every little learning disability into the realm of autism spectrum disorder; at that point, autism spectrum disorder really becomes less of a good term because too many kids are being funneled in there. And really – and I don't say this in a mean way, but it's the truth. That, you know, 10, 15 years ago we would say kids were MRDD, mentally retarded or developmentally disabled.


You know, ASD, the autism spectrum disorder is simply the new MRDD. And the kids who were classified as MRDD and now classified as ASD, it's just a change in name. And instead of, you know – instead of focusing on what we're calling it – OK. Sure, autism spectrum disorder does sound better, I think, than mentally retarded or, you know, developmentally disabled, but it is what it is. And we really have to start focusing more on helping these kids, identifying them regardless of what you call it, and giving them the help that they need in the school system. So, you know, this kind of study from the Centers for Disease Control with our tax money is – it's a good one to show that this is a problem, we're diagnosing it more, I – you know, they say they don't think that there's actually more of it. And, you know, who knows what the truth about that is, but we are certainly diagnosing more it and that's – it is important that we're recognizing these kids regardless of what we end up calling it in the end.


You know, the Centers for Disease Control, even though you think of them more when you talk about infectious diseases, but they've really taken the bull by the horns with autism and they are to be commended for that. They have a campaign going on right now called, Learn the Signs. Act Early. And you can find information about that at and then for more information on CDC's work on autism, please visit And I will put links to both of those sites in the Show Notes. So, you know, the important with this is there – I – autism is being diagnosed more, but as we start to put more and more kids into the autism spectrum disorder – as we start to add more and more to what is considered autism spectrum disorder, we start to lose the significance of that name.


And so, we do have to be careful about that, in my opinion. OK. So, that wraps up today's news parents can use. We'll be back with out listener's segment right after this.


Welcome back to the program. First, in our listener segment, is Barbara from Vancouver. She says, "Thanks for your very informative and entertaining shows that keep me engaged when I'm up during the night with my two-month old. My question is about my ten-year old son. His feet roll inwards. He saw a pediatrician about it three years ago at the recommendation of his teacher. This doctor said it was not a problem and that his bones were still soft and he would likely outgrow this.


However, his feet are still like this and I am concerned. I have the same problem and I have to use orthotics to keep my feet from rolling in. Is there anything that can be done to help him so he does not suffer the same fate. Many thanks." And a similar question came from Adrienne in Indianapolis. She says, "Hi! I have an active 5 1/2-year old daughter. I'm writing because my husband and I are concerned about her ankles. She has really flat feet and her ankles seem to roll inward towards each other. Is there something we should get examined? Thanks, Adrienne." So, thanks to both of you for writing in to PediaCast. This is a common complaint. And mostly, it's a common complaint because of grandparents. You know, there was a time when we were really concerned about whether kid's feet went in, they went out, you were – you're flat-footed, you know, and kids wearing braces and special shoes all the time and you really don't see that much anymore. The bottom line with that is there is a condition called tibial torsion.


And that a lot of kids who have in-toeing or their feet going in a little bit or rolling in a little bit, they actually have this thing called tibial torsion. What it is – you know, there's two bones in the lower part of the leg between the knee and the ankle. There's the tibia, which is the bigger bone and then the fibula, which is the smaller, thinner bone on the outside. Now, the tibia in some kids, the shaft of it, has a little bit of an internal rotation toward the inside so that the shaft itself – if you were to sort of trace a single line on it down the front, instead of going straight down, the shaft itself – just sort of think of a cork screw, you know – it just has a little bit of an internal twist to it and that's what makes the feet go inward. Now, what we know is that for these kids, as the bone lengthens, it has a tendency to twist back toward the midline.


And the way they found this out is back – oh, probably 20, 25 years ago or so – you know, they put kids in these special shoes and braces in an effort to try to get their feet to go back out and their feet went back out, you know. So, you think, "hey, the braces worked". But if you look at another group of kids who didn't have the braces, you know what? Their feet went back out too. So, it wasn't the braces, it was basically growth and there's – a lot of kids of who – it's just the normal growth pattern for the feet or for the legs as they get longer to sort of rotate back out toward the midline. Now, are there some problems that kids can have that aren't tibial torsion that do need to be addressed and yes, there are, of course. And so, you do want your doctor to examine your child's feet to make sure that the – or their legs, to make sure they're the same length, to make sure that there's no joint problems in the ankles, in the knees, and especially with the hip, that's very important. And so, you definitely want to bring it to your doctor's attention.


If they – If your child does not seem to be in any pain or discomfort and there's no obvious looking deformities other than the feet sort of rolling in or flat fleet, you know, I think it can wait until your next regular well check up. But if your child is having functional problem, seems to be in pain, or you're worried that something just doesn't look right, by all means, make a special appointment outside of the well check up visit to go in and see your pediatrician and have them take a look at it for you. If nothing, you know, they may say, "Yeah, it's no big deal", but then at least you'll feel a little bit better about it. And of course, sitting here in Birdhouse Studio and not being able to see, you know, what your child's feet and legs look like, it's sort of difficult, you know, to give advice on a specific person. So, I would just say, if you're worried, you know, have your doctor take a look. But most of these kids really don't need anything done. Now, the other thing to keep in mind is, it's not about how your feet look, it's about how they function and are you having any discomfort or problem. So, if your kids feet, you know, are – if they're flat-footed or if their feet roll in, they roll out, you know, any of these things, but from a functional standpoint, you know, they're running, jumping, hopping, skipping, going up and down stairs, and, you know, getting along just fine then it's not a problem.


Now you – also keep in mind that, you know, when kids get to be older toddlers, they start tripping and falling a lot more because early walkers, their brains are, you know, right there where their feet are and they are paying attention to every single step, but once they get pretty good at walking, their brain starts to go out, you know, a few feet in front of where their feet actually are. They're thinking more about where they're going than where they are at the present time and so they get tripped up a lot and they become a lot more clumsy. And that's not necessarily from in-toeing, out-toeing, flat feet, any of these things, it's just a problem with them thinking about where they're going instead of what they're doing at the present time and they get clumsy because of that. So – I – you know, it's usually not the feet causing the problem when kids get to be clumsy when they're two and three years old.


And also, I would say – and especially to – I have to look back up here and remember. It was – oh, let's see. I'm so sorry. It was Barbara from Vancouver who – she has to use orthotics to keep her feet from rolling in. My question to you, Barbara, would be, if your feet rolled in, does it cause a problem? So, if when your feet roll in, they hurt, you have issues, you know, then I – you know, the orthotics are a great idea and just when your child start to have problems with pain, discomfort, you know, that's when you think about getting them in some orthotics as well just to help them with comfort. On the other hand, if you're just using the orthotics because your feet rolled in and – but you walk fine and they – you know, it doesn't hurt, then, you know – at what point do you start looking at whether feet going in or out as sort of a normal variant? You know, some people's ear lobes are attached; some aren't attached.


You know, some people's feet grow in a little bit, some grow out a little bit, some are perfectly straight. You know, you could be an Olympic athlete and run hurdles and, you know, high jumping have in-toeing, you know. It's not necessarily a functional problem. Yeah, I think the biggest problem with the feet in position come from grandparents because they remember the days, you know, when kids had special shoes and braces to fix these things. And so, they just, you know, they keep begging you about it and finally you have to tell your doctor –


Grandma is bugging me. Please do something about this feet, you know, and they don't really care. And so, you just, you know – as a pediatrician you have to say, "Look, things change and right now, we're not really worried about that." OK. Let's go ahead and move on. I –


– in the listener segment. Here's a quick question from my daughter. She emailed me from the back seat of our car. Now, I have to explain, if you – again, you need to go to the blog and read My Day In A Nutshell from Karen because it was a crazy day.


And I had the kids, there was, you know, terrible winter storm, snow on the ground, it was freezing cold. I was driving the car and my kids are in my back seat. And my daughter was bored and she forgot her Game Boy. Oh, the world was coming to an end. And my son had his Game Boy and he's playing it, wouldn't let her play it, there's an argument. So, I grabbed my Blackberry and handed it back to my daughter and said, "You know, there's a game called brick on it, just play that. All right? And quit arguing with your brother and look at me and play with my Blackberry". Well, she found my Gmail program and she emailed me. So, this is what she said, "Dear Dr. Mike, if I'm car sick, what should I do?


Your biggest fan, Kathy". Oh, my goodness' sakes. OK. So, I thought, you know, this is actually a good question because we can extend the question to motion sickness in general and talk about car rides, bus trips, airplane rides, cruises – you know, what causes motion sickness? Well, it's caused by a disagreement in visual and sensory data.


So, the sensory data comes from fluid movement in the semicircular canals of the inner ear. So, the semicircular canal – the fluid is moving in there and it's telling the brain that you are moving, but visual evidence of movement is missing. So, if you're in a car – you know, your semicircular canals are picking up the motion of the car and this is fine if you're the one driving because you're constantly watching the road and you're basically seeing what you are feeling. But if you're a passenger and you're reading or you're playing an electronic game – you know, your eyes aren't seeing the motion. Your eyes are seeing just the stillness of the paper or the video screen and this can lead to – leads to the feeling of that motion sickness and that same mechanism takes place too on boats and in airplanes – you know, basically you're sensing the motion, but you can't see the motion. So, prevention becomes pretty easy then. You want to try your best to see the motion. So, if you're in a car, you know, you want to watch out the front windshield and stare off at the horizon.


You want to avoid looking out the side window or looking down. It's a little bit more difficult in a boat or in an airplane, but still you can look out at the horizon, sort of see yourself going up and down so you're seeing what you're feeling as best as you can. Also, sometimes it helps just close your eyes so you just get rid of the visual miscue altogether. Although for other people, that can actually make things worse and that seems to be different from person to person. And then taking a nap, a lot of times, that will help too, if you can, depending on what kind of situation you're in. Antihistamines tend to be a good treatment for – and also a preventative for motion sickness. It seems that whatever brain signals cause the symptoms of motion sickness, the antihistamines help to decrease those signals and get rid of the nausea and dizziness and that sort of feeling when you get motion sick. Benadryl or diphenhydramine, is the generic name for it, that's good for treatment of motion sickness.


It's not quite as good at preventing it. You know, it's sure acting and it can cause severe drowsiness. The longer acting less drowsy type antihistamines such as what's in Dramamine or what's in Bonine, the metoclopramide, those are – these kind of medicines are better at preventing motion sickness than it actually treating it. Ginger root – there's also been some studies to say that true ginger root is effective. I'm not sure if there's actual ginger root in ginger ale. You know, my nurse at work swears by it – ginger ale when she goes on cruises. And so, you know, maybe there's some truth to it. I'm not sure if there's ginger root in that or not. OK. Also, I do have – there's a nice summary of motion sickness at a website from the medical college of Wisconsin and I will provide a link to that in the Show Notes. Lots of links this week in the Show Notes. All right. Let's take a short break and I'll be back with more from our listeners right after this.


Welcome back to the listener segment of PediaCast. Item number three comes from Garet in Maryland. He says, "Great show. I'm about to be a first time dad so I've been reading up and listening up on everything I can find that's baby related. I know you don't get into specifics, but if you could possibly touch on hemochromatosis with regards to passing it on to a child, I'd appreciate it. It runs in my family. Great show and wonderful resource. Thanks."


Well, hemochromatosis is an inherited disorder. It basically affects how the body absorbs and stores iron. And in this disorder, it – you get too much. So, you get too much absorption, too much storage of iron, and the extra iron build up in the organs damages them. And the primary organs that are involved with this are the liver and the heart. Now, identification and treatment is important to prevent organ damage and failure. The most common type of hemochromatosis is called hereditary hemochromatosis and it's caused by a defect in a gene called the HFA gene. I'm sorry. It's HFE. HFE gene. And this is hereditary hemochromatosis. It's present at birth and symptoms rarely appear, actually, before adulthood. So, the main way that kids are going to get diagnosed with this is by testing because of a family history.


So, if there is hemochromatosis in your family, it's important to let the young adults who are going to be having babies know about this so that they can let their pediatricians know. It's not something that you want to sweep under the carpet. There's also juvenile and neonatal hemochromatosis. And these are severe forms that are much more rare, less common than the hereditary kind. The cause of juvenile and neonatal hemochromatosis is unknown, but it leads to significant iron overload at much younger ages, which then lead to severe liver and heart disease. And often times, these have a high mortality rate associated with them. So, you know, they're very bad diseases and that's why there's – one of the reasons why there's a low iron formulas out there, they're not to help with constipation, they're made to – for kids who need to be on low iron diets because they iron storage diseases. But again, juvenile and neonatal forms of hemochromatosis are, you know – they're rare kind.


So, I think, Garet's – if it's running in family, he's talking about hereditary hemochromatosis. So, it's one of the most common genetic disorders in the United States. It's most common in Caucasians of Northern European descent. Five people in a thousand carry two copies of the defective gene and so they have the disease. And then one person in every eight to ten in the United States are actually carriers of the defective gene and that means that they have one copy. Now, if mom and dad – if you remember about the high school where you talked about genetics, do you remember making those little squares, you know, where you have a gene that has two possibilities, like, a capital letter and a little letter? If it's autosomal dominant and it having two little letters? If it – and you have that – two of them, if they're – if it's autosomal recessive? Do you remember that, making those little squares? Well, You got to think back to that.


With this particular disorder, if mom and dad are both carriers, each child will have a 25% chance of being unaffected, a 50% chance of being a carrier, and a 25% chance of having the disease. So, this is what – this would be an autosomal recessive disorder. So, you have to have both genes in order to have the disease. So, this is one of those things where, you know – if one person in every eight to ten are carriers and you marry someone who is a carrier and you're a carrier, you know, whether you know it or not, your children have a 25% chance of having the disease, each child. So, it doesn't mean that, you know, if you have two without then you're more likely to have one. It's each child has a 25% chance of having hemochromatosis, the disease, has a 15% chance of being a carrier and a 25% chance of being completely unaffected and not being a carrier at all. Signs and symptoms, usually, this is, again, not seen until mid-adulthood.


A joint pain or arthritis is the most common initial complaint along with fatigue and lack of energy, those are also common, enlarged liver leading to cirrhosis, abdominal pain, and ultimately, liver failure can happen. Iron also gets stored in the pancreas and can lead to damage of the pancreas which then can lead to diabetes. Iron stored up in the heart can cause a heart enlargement, irregular heart rhythms, and congestive heart failure. Also the iron can get lay down with the skin pigments and that can cause a bronzing of the skin. It can also cause some thyroid problems and some adrenal gland problems as well. So, how does a good diagnosis, especially in kids, where, again, suspicion arises with the family history. There are some blood test that look at iron storage, things like transferrin, TIBC, ferritin, these kind of things. You can also look at liver enzyme levels. There is genetic test looking for the HFE defect in that gene that can be done.


And then if you really think that that's what it is, a liver biopsy to look for iron accumulation and evidence of liver damage is another way to go about diagnosing this. Now, what's the treatment? Well, again, this is going to be mostly an adult thing, but basically, you want the body to use this extra iron and the main way that the body uses iron is to make replacement red blood cells. So, basically what you do for the treatment of this disorder is phlebotomy. So, it's good old fashion blood letting. You know, like they did for lots and lots of diseases back in the 1700s. But in this case, blood letting and, you know, not from leeches but –


– but with just a needle. You give a pint of blood once or twice a week for several months. So, basically, you bleed a person to the point that they need to make more red blood cells and then they'll use that iron that they're storing to make new red blood cells and that will help the iron levels come down to normal.


So, again, it usually takes giving, like, a pint of blood once or twice a week over the course of several months to get the iron levels down to where they should be. And then usually, one pint every two to four months is usually enough to keep the level normal. So, basically these people just have to keep giving blood in order to get their iron levels down where they should be and avoid organ damage. Now, again, identification and treatment of this is important prior to organ damage happening. So, again, if there's a family history, then you should definitely want to let your doctor know so they can be right on it and start monitoring for these things as quickly as possible. And we will – I do have a link in the Show Notes to a great site at the Mayo Clinic that talks about hemochromatosis. So, just go to and look in the Show Notes for this episode and you'll find a link to hemochromatosis among all the other links that we've been talking about. OK.


Before we move on to out research round up, I have a quick comment from Diana. She says, "Hello. I just started listening to your podcast, heard it on PregTASTIC, and thus far have really enjoyed it. I listened to podcast number four today, which in the toddler section, addresses speech and language delays. I was so disappointed to hear you say, "you" in general, of course, don't really find speech language therapy to be helpful until a kid is closer to four or five years old. Some of your points were valid. The cost can be prohibitive and there is the comfort factor of a two-year old receiving therapy. However, you must know that about Early Intervention Services under Part C of IDEA, Ohio must provide free developmental evaluation for children suspected of a developmental delay and services; such as, special education, occupational, physical, and/or speech language therapy as well as social work nutrition, et cetera, for children demonstrating moderate to significant delays.


It is play-based family-centered treatment and research supports the use of this model with children whether they are simply late talkers or they have down syndrome, autism, et cetera. I realized it's possible you maybe, hopefully, quite familiar with this system, but you didn't mention it on your podcast. As this is a service that's available in the majority of states. I'm from Connecticut. It's important your listeners and most importantly your patients have access to this information through you. Speech language therapy does not have to cost a lot nor does it have to be anything but family-centered. Thanks for listening and keep up the great work." All right. That wraps up today's listener segment. We'll return with the research round up right after this.



All right. Welcome back to the program. We're ready to head into the final portion of the show, our research round up. Now, again, this is a warning right now, even though our tag on the show says "clean", we are going to talk about some sort of sensitive topics during the research round up. So, if you're listening in your car right now and you have children in the car, why don't you wait until later to listen to the research round up part or if you're at work, you know, and you're blaring this around the lobby, you may want to wait. OK.


Our first item up for consideration is adolescence reported consequences of having oral sex versus vaginal sex. And this is a study that comes from the Department of Psychiatry at the University of California in San Francisco and it was published in the February 2007 edition of the General Pediatrics, which is the official scientific journal of the American Academy of Pediatrics.


The purpose of this particular study was to examine whether the initial consequences of adolescent sexual activity differ according to the type of sexual activity and the gender. Now, what they did is they used surveys that were administered to 618 teenagers from two public high schools in California in the autumn of their ninth grade year and this was in 2002. And then they repeated the surveys at six-month intervals until the spring of tenth grade, which would have been in 2004. Forty four percent of those who were surveyed, which ended up being 275 teenagers reported engaging in oral and/or vaginal sex. And all of these kids were 14 years old at the beginning of the study period. Fifty six percent of them who reported having either oral or vaginal sex were female and 44% were male.


The authors note that the teenagers were from diverse socioeconomic and ethnic backgrounds. So, what were the results? Well – then what they did is, the surveys were tallied only, by the way, for the 44% of respondents who reported that they had engaged in oral and/or vaginal sex. So, the kids who have never had oral or vaginal sex were thrown out and they only used – they only looked at the surveys of the 44% who said that they engaged in these activities. In comparison with adolescence who engage in oral sex and/or vaginal sex, adolescence who engaged only in oral sex were less likely to report experiencing a pregnancy or a sexually transmitted infection. Well, as my daughter would say, "duh!"


They were less likely to feel guilty or to feel like they were being used and they also were less likely to feel like their relationship had become worse and also less likely to feel like they were getting into trouble with their parents as a result of the sex.


Adolescence who engage only in oral sex were also less likely to report experiencing pleasure or feeling good about themselves and having the relationship become better as a result of the sex. Boys were more likely than girls to report feeling good about themselves, experiencing popularity, and experiencing a pregnancy or sexually transmitted disease as a result of the sex. Whereas, girls were more likely than boys to report feeling bad about themselves and feeling like they had been used. So, the author's conclusion in this study where the adolescence experience a range of social and emotional consequences after having sex. Now, why do I put this report in here? It – to me, it's not about what they found out in terms of what the kids were feeling.


It's just the fact that this report should be an eye opener for parents. I mean, we're not talking about 17 and 18-year olds here. These are 14 year-olds and nearly half of them – now, it is in San Francisco, OK, but –


I'm sorry. Listeners in San Francisco, I didn't mean anything by that, really. If, you know – almost half of the 14-year olds reported having oral or vaginal sex. And they also report emotional consequences, of course, from these activities including feeling bad about themselves and feeling used. Now, as parents, are we talking to our 14-year old daughters and sons about sex? You know, I'm not just talking about the birds and the bees stuff here. I'm talking about the day to day urgings – urges and temptations that they're dealing with. I mean, are we addressing these issues? This study shows that these kids in the 14-year old age group are dealing with these issues and if they're not talking to you as mom and dad about them, who are they talking to?


You know, what are they doing? How do they feel about what they're doing? And do you want to enter the conversation as a grandparent? I mean do you want to wait until your son or daughter is involved with a pregnancy before you start to talk about these things and – or how about that, you know – are you going to be the support person of the newly diagnosed kid with HIV because you didn't talk about these things in detail and have your children feel comfortable talking to you about them. In my pediatric practice, and granted, you know, I'm in small town America, really, and – you know, we see teenagers weekly in our practice with gonorrhea and chlamydia. I mean, the stuff is out there. And mom and dads you have to be proactive with your kids. You have to take the first step and talk to your kids about sex because they're talking to somebody about it and really that somebody should be you. You know, half of these 14-year olds are having oral and vaginal sexual relations and then –


– you know, feeling free to talk about it in the survey, I'm just interested in how many of these kids in the survey, the parents have no idea, probably a lot of them and that's a shameful – and it's just as much the parent's fault as it is the kid's fault. So, how do you talk to your kids about sex? Well, there's a great web site for that. It's called and that they have a whole section in there about how to talk to kids about sex. They also have sections on how to talk to them about alcohol and drugs and bullies and that sort of things. So, it's and I'll have a link to the sex portion of the website in the Show Notes. Well, like I said, lots and lots of links in the Show Notes this week.

Announcer 3: Janine Mark is a 12-year old and was fairly normal. She spent a lot of time online. One day, she met a new friend. The new friend had the same problems at home. They like the same bands. They worried about the same subjects in school. They promised to keep each other's secrets.


They wished they went to the same junior high. The new friend had good news. He said he was going to be in Janine's area one Saturday. He thought it would be amazing if they could just hang out, go to the mall. Janine agreed. The new friend didn't want parents messing this up. Janine showed up alone, so did her new friend who wasn't in junior high, wasn't nice, and wasn't a 14-year old boy. Every day children are sexually solicited online. Help delete online predators. Call 1800-THE-LOST or visit to learn how to protect your kids online life. A message from the National Center for Missing and Exploited Children and the Ad Council.

Dr. Mike Patrick: OK. Now, we can move right along. The second item in our research round up is Unwanted and Wanted Exposure to Online Pornography in a National Sample of Youth Internet Users. And this study comes from the Crimes Against Children Research Center at the University of New Hampshire in Durham, New Hampshire.


And it was also published just like the last one in the February 2007 edition of the journal Pediatrics. Now, the goal of this study was to assess the extent of unwanted and wanted exposure to online pornography among young internet users and to identify risk factors associated with this exposure. What these folks did was they used a telephone survey and they talked to 1,500 young internet users who are between the ages of 10 and 17 years of age and these interviews were conducted between March and June in 2005. And what they found was that 42% of your internet users reported exposure to online pornography in the previous year. So, again, nearly half. Of those half, 66% reported only unwanted exposure and this unwanted exposure was related to only one internet activity, and that was using file sharing programs to download images.


A filtering and blocking software reduce the risk of unwanted exposure as did attending the internet safety presentations that were given by law enforcement personnel in various communities. The unwanted exposure rates were higher for teens and the youth who reported being harassed or sexually solicited online or interpersonally victimized online are also youth who scored in the borderline or clinically significant range on the child behavioral checklist subscale for depression. Wanted exposure rates were higher for teens, boys, and youth who used file sharing programs to download images, talk online to unknown persons about sex, used the internet at friend's home are scored in the borderline or clinically significant range on the childhood behavioral checklist subscale for rule breaking.


Depression could also be a risk factor for some youth. Youth who use filtering and blocking software had lower odds of wanted exposure. So, the conclusion – more research concerning the potential impact of internet pornography on youth is warranted given the high rate of exposure. The fact that much exposure is unwanted and the fact that youth with certain vulnerabilities; such as, depression, interpersonal victimization, and delinquent tendencies have more exposure. Now, again, I included the study in the research round up as a wake up to parents. I mean, again, nearly half of the 10 to 17-year olds surveyed reported either wanted or unwanted pornography exposure on the internet. Have your kids have that – had pornography exposure? I mean, are you even sure of the answer? Have you asked them? Have you prepared them for unwanted exposure? I mean, what happens when they download something and, you know, a naked woman pops up. I mean, do you – have you talked to them about it? The fact that this could happen and what they should do if it does happen.


Do you have a filtering system in place? You know, any – do you have some sort of game plan because when researchers just randomly talk to 1,500 10 to 17-year olds, nearly half of them had come across pornography in the internet. And again, how many of their parents knew about it, you know? So, again, it's something that parents – we got to be on top of these things and not just shut it and pretend it doesn't exist, but, you know, to be open and honest with our kids and say, "Look, this stuff is out there, you know. We don't agree with it. This is what you should do, if you accidentally come across it." And then if your kids have delinquent tendencies, they, you know, tend to be more rule breakers, have problems with interpersonal victimization of any kind, depression, delinquent tendencies, keep in mind that these kids are going to have more of a rate of wanted exposure to pornography. And so, you may have to be proactive at preventing that exposure from taking place.


More information in keeping your kids safe online is available at a place called and again, we'll have a link in the Show Notes. I'm also going to link to Alicia's story, which is a testimonial from a girl who was kidnapped by an online predator when she was 13 years old. It's a story of her ordeal. It's very difficult to read, but I think it should be a required reading for parents who have young girls at home. And I'll put a link to the Show Notes – in the Show Notes to Alicia's story as well. OK. That concludes today's research round up and I'll be back with a final word right after this.

Announcer 4: Hi.


LOL. Well, AISI. It was NDD.

Announcer 5: Kids are spending more and more time online. And even if you heard what they're typing, you wouldn't know what they're saying.

Announcer 4: Some PPO, whatever. ISS.

Announcer 5: They chat online in a language full of acronyms. And unless you use it everyday, you won't understand it.


Announcer 4: YIWGP.

Announcer 5: You won't know what they're saying or who they're saying it to. A lot times, neither do they. Everyday, children are sexually solicited online. So, here's an acronym for you: HDOP, Help Delete Online Predators. To protect your kids online life and to get a full list of acronyms kids are using call 1800-THE-LOST or visit A message from the National Center for Missing and Exploited Children and the Ad Council.

Dr. Mike Patrick: All right. Welcome back to the program. I don't know about where you live, but we are in the midst, as I speak, of a pretty severe winter storm. You know, in some ways though – and I feel bad for the people who are stranded out there, you know, who weren't prepared, who may have, you know, slid off the road, that sort of thing.


So, don't get me wrong here. I'm not wishing badness on anyone, but it was such a bad prediction that our office – our medical office actually decided to close tomorrow during the day today. So, I went in to work in the morning. It took me about an hour to get to work. It usually takes about 25 minutes. It took an hour because the roads were so bad. And I went in and saw three patients. Only a three – two, I can understand. One had strep, one had a flu, and one was a nine-month old whelp, but they only live like five minutes from the office so I can understand that one too. And that was it, just those three patients and then we closed for the afternoon, called and canceled the schedule and then – because it was predicted that we were going to have an ice storm, which we are in the midst of it as I speak, and get ice pretty much all night and possibly, you know, half to an inch of ice on every surface out there.


We went ahead and decided to close the office tomorrow. Now, this is like an unheard of thing, you know. I've been at this medical practice for eight years and they've only closed because of weather one other day and I was on vacation in the Bahamas –


– at the time and missed the closure. So, this is – it kind – were going to be kind of interesting to have a snow day basically tomorrow because I haven't had one of those since I was in school. So, it's kind of cool, I just thought I'd mention it.


All right. Of course, as usual, I'd like to thank all of my new and returning listeners out there for making a little time in your day for PediaCast. and thanks go out also to my family for supporting this crazy project. And of course, thanks also to Vlad over at for contributing the artwork for the website and also the artwork that we use on our sound files. You can find free custom wallpaper and easily affordable high-definition prints at his website.


And you can find all of that at vladstudio, that's V-L-A-D I did get an email last week from a listener who wants to decorate her nursery with his art. And I pointed her to because he does have a posters link on the top toolbar of the website, and that will bring up a page of posters. You can click on the one you like and then you'll be transported to, which is an American online store where you can order his prints and – he's a fantastic artist. So, make sure you support Vlad by visiting OK. Don't forget, if you have a question or comment for the listener segment, simply browse over to and click on the contact link. You can also email me by writing to And if you want to send a voice message, you can attach an audio file to your email or call the Skype line at (347)404-KIDS. Reviews in iTunes are really, really, really important for the continued success of the show.


So, if you have not stopped by iTunes and given us a review, please do that this week. Also, diggs of each and every episode in the podcast section of, again, that's digg with two "Gs", please go there every week and digg us so we can move up on the charts and let more parents know about PediaCast. You can also leave reviews in Podcast Pickle and at Podcast Alley. Promotional materials are also available for download on the poster page at Also, the blog is out there. Karen has put a lot of effort into making some posts on there. So, if you like to read what she's thinking about, please go to and click on the blog link. And be sure to tell your friends, family, co-workers, and neighbors about the show so we can empower more parents to understand and make great decisions regarding the health and well-being of their children. So, until next time, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long everybody!


Announcer 2: The Tripod Network, what's on?

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