Peanut Allergies, Vitamins, and Nap Time – PediaCast 030
- Peanut Allergies
- Step 2 Infant Formula
- Generic Medication
- Nap Time
- Choosing a Pediatrician
- Cold Medicine Feedback
- Cradle Cap
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. It's episode 30, the Question Marathon. This is Dr. Mike coming to you from Birdhouse Studio and I'd like to welcome everyone to the program. We're going to veer from our usual format to squeeze in a few more of your questions this week.
Well, I've gotten lots and lots of really good questions and they're starting to pile up, and I wanted to get to it as many of them as I could. So, we're going to forgo the News and Research segments this week, but don't worry, they be back soon. This is not a permanent change. We're just going to do a question marathon kind of show here and go through a lot questions that you guys have. So, the topics that we have coming to you here in episode 30, we're going to talk about peanut allergies, vitamins, step 2 infant formula, generic medication, nap time, choosing a pediatrician, cold medicine feedback, and then we'll have a discussion about cradle caps. So, that's all coming up in this episode. Don't forget if you have a subject that you would like us to talk about, it's really easy to get a hold of us. All you have to do is go to www.pediacast.org and click on the contact link. You can also email me at firstname.lastname@example.org. And if you prefer to do an audio comment and would like that included in the show, if you could record the audio file and then attach it to an email or you can call us directly on the Skype line which is (347)404-KIDS, that's (347)404-K-I-D-S, that's one option.
Another option is to – if you have Skype, we are username PediaCast. So, you can find us that way through Skype as well. All right, before we get started, I want to complain to you guys because I don't have a lot of people, you know, that I can complain to. My family is not very – very –
– receptive to my complaint sometime. You know, I have had – this is just a little personal thing. But I – really, I've never had a cavity in my entire life, believe it or not. I don't know why. You know, my wife has lot – had lots of cavities and my daughter has had her share of cavities. But for some reason, just the way my teeth are put together, and I – it's not that I have an incredibly wonderful dental hygiene compared to other people, but I've just been lucky that I've never had any cavities.
So, I went to the dentist last week and I've not been having any pain or problems at all, but apparently, one of my molars – I have this internal absorption thing that's going on where, I guess, the inside of the tooth starts to dissolve. It has something to do with the nerve in the tooth. It starts to eat away at the inside part. I don't understand exactly how this happens because I didn't go to dental school. But apparently, this – it's fairly common although I had never heard of it before. But the dentist, you know, showed me the x-rays and, you know, sure enough, over the last couple of years, there's a little hole – there's a little dark spot in the middle of the tooth. So, he tells me I have to have a root canal. Now, keep in mind, I've never had a cavity, I'm 39 years old, never had any dental problems at all, and now they're telling me I need a root canal and I don't even have pain in my –
– in my teeth. Well, my daughter was there during my cleaning. She's 12 and she's had her fair share of fillings and dental problems and braces and head gear and all that business.
So, you can imagine she was sitting in her chair, as the dentist is telling me this, with a hugest grin on her face like, "Ha, you have to have a root canal", which she's had one actually in the past. And, you know, my wife was – she's had root canals before too and so she's – was not very sympathetic either. And actually, when you never had a cavity, it's hard to find someone who is sympathetic. So, I thought I'd share that –
– with you guys. So, I have to have this root canal tomorrow. So, I really thought I'd better get this show done tonight while I can still talk and –
– I'll give you an update next week and let you know how it went. All right, enough about me. 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.
And we'll do it right after this break.
Welcome back to the program. We have our very first segment in the Question Marathon. And this, I'm calling the Christie segment because we have a two questions from Christie in Florida and I'm going to go ahead and get to both of those right now. Here's the first one. "Dear Dr. Mike, I have ten-month old baby girl with a mild to moderate case of eczema. I have finally found a great lotion, CeraVe, and cleanser, also CeraVe, combined with an occasional application of Hydrocortisone Cream for the really bad spots.
I am still nursing her and it seems like when I eat nuts, that her eczema gets worse. Is this just a coincidence or could she be allergic to nuts? I'd like to know before I actually introduce them into her diet after she turns, at least, a year old. Thanks for the great podcast, love your show. Christie in Gainesville, Florida." All right. Christie, well, that is a wonderful question. You know, peanut allergies are common and they can be severe. It's one of those allergies where it can show itself up with just a little bit of eczema, but it's easy for that kind of allergy to progress to wheezing and the hives and, you know, full-pledged bad allergic reaction that can, in some cases, even be life threatening. So, it is – it's something not to really fool with if you are concerned that there might be a peanut allergy in the family. So, I think that this is something I would definitely talk to your doctor about.
Now, in this situation, here's what I think I would do, but again, you know, the experience of your doctor and your comfort level will certainly going to be what dictates what actually happens for you. But I know if I have a patient who is in this kind of situation, there is a blood test that you can do called a RAST Test, which stands for radioallergosorbent. So, Radioallergosorbent Test – and you can – what it basically does is it's looking for antibodies in the blood that would attack peanuts. So, they're the peanut protein. So, it's something that either you can, sort of, get numbered to see if there is an allergy there or not. Now, it's important if you're worried about peanut allergies that you also look at almonds, pecans, coconuts, and sesame seeds because they're all in the tree nut family. So, usually when you order the RAST Test, you can get a tree nut panel that looks at all of those different kind of nuts.
Now, you have to also keep in mind that just because you're testing for these antibodies in the blood does not mean that if it's negative that there's definitely not a problem because you may just not – there may just not be enough of those antibodies in the blood at the time that you take the test and this is especially true in young babies who may have some intermittent episodes where they're making some of the antibody and then other times when they're not making as much of it. As they get older and develop a real, you know, peanut allergy then almost always, they're going to have enough of the antibodies in their blood to make that test positive. So, I think if the – if that RAST Test, which is a blood test, is negative and the only problem is eczema, so there was no hives and there was no wheezing, it was just really dry skin. You know, I would say to my patient that it's probably OK to introduce, you know, some peanuts, you know, after they're – I don't know. I might even wait until 15 to 18 months to try some peanut products.
But, you know, at the first sign of problem, you know, you have some Benadryl on hand and, you know, make sure that you call if there's – if anything happens. But again, with a negative RAST Test and only dry skin is being the only issue, then you're probably OK there. Now, if they did have hives or wheezing and not just dry skin and the RAST blood test was negative, I would not try any kind of peanut product. In fact, what I would probably do at that point is send the baby to an allergist to get some skin testing done to look for peanut allergy. Now, again, with the skin test, I think we've talked about this in prior episodes. Also in infants, in particular, a negative skin test may give you a false sense of security. I mean, they may just not – don't have enough antibodies in their system yet to make that skin test positive. But I think that's unlikely in the baby who also has – have hives and wheezing.
I mean, they're probably going to show up positive on their skin test. It's the kids who may have just mild allergy symptoms to peanuts and they haven't really developed a full blown allergy to it yet. Those may be the ones who will have a negative blood test and a negative skin test. So, this can give you a little bit of false sense of security. So, it's something you still have to really keep an eye on. Now, if you do have a child who has a peanut allergy, the RAST Test also helps as time goes by to recheck to see, sort of, the level of allergy that's there. So, if you have a RAST Test that was really high and as the child gets older, that number is coming down, you know, then in consultation with the allergist you may be safe at some future time to have some reintroduction to nuts. However, that's more likely to be the case with, like, milk allergies and sometimes with egg allergies, although not as often. Peanut allergies tend to be more lifetime.
But still that number is useful to judge or to compare, I should say, to future years when you can recheck that RAST Test and just, sort of, see where you stand. You know, are you getting more antibodies in the blood against certain things or less, you know, compared to how it used to be? So, that if you – you know, you can tell whether the allergy is getting worse or starting to get better. So, in any case, that's how those blood test work. With peanut allergies, it's particularly important that you do have an EpiPen at home. Benadryl is a good thing to give if your kids have an allergic reaction to something, but if it's really bad and they're having trouble breathing, an EpiPen is something that you definitely want to have around so ask your doctor about that. And there are EpiPens for infants as well that you can use so, you know, regardless of the age, at home, if there's a peanut allergy, you really ought to have an EpiPen on hand. And for more information about peanut allergies, I found a great website, which really goes into a lot detail about them from the Mayo Clinic and I'll put a link to that in the Show Notes, which you can find over at pediacast.org.
OK. Let's move on to Christie's second question. She said, "Dear Dr. Mike, I have a healthy four-year old son. I was wondering if it is necessary to give him vitamins. He eats a wide variety of foods and I work very hard to give him balanced diet. I love your show. I look forward to each new episode of PediaCast because it's always packed with great information. Thanks, Christie from Gainesville, Georgia." All right. Christie, again, thanks for that question. You know, vitamins are substances that the body needs in small quantities to perform specific chemical reactions. And the body must obtain these substances from an outside source because either the body can't make them or the body can make a little bit, but not all that's required of these substances. So, if you don't have enough of a certain vitamin, basically, the chemical reaction that needs that vitamin is going to fail. And generally, that's going to result in specific vitamin deficiency diseases.
So, for instance, if you have a lack of vitamin c that interferes with chemical pathways that are needed in collagen production, and collagen is part of a connective tissue, so mucus membrane, skin, that sort of thing. And so, if you don't have enough vitamin c, you end up getting scurvy, which is a disease where you get open sores on the skin or you get blisters inside of the mouth and the gums can become really inflamed and that you can even lose teeth. And this is a disease that sailors and pirates back, you know, when it took weeks and weeks to cross the ocean because you're just using wind power. They would get scurvy because they would run out of fresh fruits and over a several weeks time, they would not get any vitamin c and so that would result in scurvy. Now, similarly, if you have a deficiency in vitamin b1, you get a disease called beriberi and if you have a deficiency in vitamin d, then you can get rickets.
Now, these are all very rare disorders in United States and that really is due to our relative good nutrition compared to many countries in the world. And also the foods that we eat tend to be pretty fortified with vitamins and minerals probably to the point where it's in a bit of excess. So, vitamin supplements are probably not needed unless your child is extremely picky. So, kids who eat a balanced diet over the course of a week or so will be just fine. If you're in the United States, more than likely. But again, if you have a kid who's really picky and that, you know, they never touch fruits and vegetables or they never eat any meats or they're never doing dairy, you know, those kids probably could use a vitamin supplement with vitamins and minerals just to make sure that they're getting enough of what they need. Now, again, I'm making a generalization here, but for your children who are, you know, normal eaters and they eat well and they get a good balanced diet or getting all the food groups over the course of a week, I say that because you certainly have two-year-olds who are very skimpy eaters. We've talked about this before in the past too.
And, you know, it's something where you're going to have your good days and your bad day. But as long as there are more good days than bad days, you know, vitamin supplementation is probably not necessary. Now, the vitamin people, you know, are going to tell you it is necessary because they have a product to sell. But the truth of the matter is that there are millions of children who do not get any vitamin supplements and do not have beriberi, do not have scurvy, they don't have rickets, and those kind of things. Now, there was a report a few years ago about the rise of rickets in the United States. And there has been bump up with that. And some of that has to, you know – there was this idea going around that the use of sunscreen could be decreasing the amount of vitamin d that your skin makes. Well – and vitamin d is important in calcium absorption, which then the Vitamin D deficiency can lead to rickets.
So, that kids who are using a lot of sunscreen may be at more risk for that. Of course, there – if you don't use a sunscreen, you're more at risk for skin cancer. So, you can't win –
– which ever way you go. So, do you put on the sunscreen and take a multivitamin? Maybe. But then again, you know, you don't have a kid in every neighborhood with rickets when we say that there is an increase in it, you know. We're still talking about a very, very small number compared to the population at large. Also, I do want to mention that fluoride – over-the-counter vitamins do not have fluoride in them, and we did talk about fluoride last week. And, you know, it's one of those things where if you're community has fluoride supplementation in the water or you're using bottled water that has fluoride in it, then you really – your children don't need fluoride in vitamin form. But if you don't have fluoride in those things, don't think that using an over-the-counter vitamin is going to get fluoride in the form because it's not. You have to go to your doctor and get a prescription for vitamins that contain fluoride.
It's not because the vitamins are more dangerous with the fluoride in. It's just that so many places put fluoride in the water and so many parents buy vitamins that you don't want kids getting too much fluoride by getting it from both places. OK. Christie, thanks for both of your questions and we'll move on to our next segment of listener issues right after this break.
OK. Welcome back to the program. Here's our next question. "Hi, Dr. Mike. I love your podcast so much so that I printed out several of your fliers and got my pediatrician to listen and put it up at her office. And one is also up at my daughter's daycare, which is at the hospital where I work. So, hopefully, you'll start getting some new listeners soon." Well, thank you. "I do have two questions.
First, what do you think of the stage 2 formulas, the ones for ages 9 months through 24 months? Are they really better than a whole milk or is it just a way for the formula companies to make more money? Second, are generic medication as good as a name brand in over-the-counter and prescription form? Are there any differences because generics are so much cheaper? Thank you for all the time you spend on this podcast and for leaving out the politics. Keep it up. Melissa from Fort Worth in Texas. OK. Melissa, well, thank you for your questions. And thank you very much for going to the poster page and downloading some of our promotional materials. That is really appreciated. Let's talk a little bit about stage 2 formula. You know, when you do a podcast, you know, I guess the goal is to try to get a sponsor so that you can continue to do this and spend, you know, all the time and effort it takes to put this thing together. So, you know –
With taking the risk of stomping on my future sponsorship opportunities, I'm going to be truthful with you. I think that the stage 2 formula is really or largely a marketing gimmick. And I know – OK. It's going to get me in trouble with some people, but I want to be honest with the listeners. You know, the formula people – and rightly so, it takes a lot of money to produce these formulas. I mean, they do the research that should – that you need to do to show that it's safe. There's a liability involved that if you, you know, make any kind of mistakes, you can bet there's going to be a huge class action law suit immediately if there's any problems with the way that it's made. And so, you know, there's a lot of checks and balances that go into formula – the formula making process and it's an expensive endeavor. So, if you're a formula company and you can capture the 12 to 24-month old market, I mean, you can basically double the amount of sales that you're doing.
And so, that is going to help to drive further research in the further safeguards that are in – that, you know – the cost of formula production. So, you know, is this a bad thing that they're trying to capture more of an audience, so to speak, in order to make more money? Not necessarily. I mean, you know, this is America. We're a capitalist society. I understand that. I get that. But, you know, to say that it's better than whole milk for, you know, most kids is probably an exaggeration. I mean, most kids are going to do just fine on vitamin d, whole milk, once they're 12-months old. They're going to get enough calories. They're going to get enough vitamin d, enough calcium, everything is going to go great. So, whole milk, really, is fine for most of those kids. Now, if we're talking about soy milk, we do have a bit of a different situation because kids with a milk allergy or who are lactose intolerant and they're using a soy product, the step 2 soy products are really better than soy milk in terms of the amount of calcium, the amount of vitamin fortification, the amount of calories.
So, I do think that for kids who are on soy products that the step 2 soy formulas probably are better for your children than just plain soy milk is. I think they're going to, you know – they're going to get more calories and more calcium, more vitamins and minerals in that step 2 soy product. But for kids who are on whole – or on regular cow's milk based formula like Similac and Enfamil, those – you really, I think, probably fine switching the whole milk once kids are 12 months old. Now, again, if you have a kid who really likes the formula and likes the taste of the formula and you switch them to milk and they're very resistant to it, you know, then stick with – you know, go to the stage 2 formula and they may very well do better with that. You know, it's sort of an option several years ago before there were these step 2 formulas – was to put little bit of strawberry quick or vanilla quick, that sort of thing, in the milk to sweeten it a little bit because I think the formulas, you know –
the taste is certainly different than whole milk and when you add the sweetening, the kids would take to the whole milk a little bit better. But then you're increasing the amount of sugar that these kids are getting and the amount of sugar that's setting on their teeth. And that's probably, you know, not in the long run, a good thing. So, for those kids who are really resistant to the taste of milk, there is another reason to keep doing the stage 2 formula. So, again, if your kids are real picky eater and solid food wise, they're not getting that much, there's – you know, those stage 2 formulas are a little more fortified than a whole milk is. But, you know, if you have a kid who's a great eater, they're getting a balanced diet, they're getting plenty of calories, they're growth chart looks good, you know – is it going to make a difference in their life? Probably not. Now, in terms of the generics, keep in mind, the generics –
the drug is the same in the name brand versus the generic. So, the specific drug that's in there and the amount that's in there, you know, are going to be similar. However, the delivery system of the drug maybe a little bit different. So, the tablet and the brand name one might dissolve a little bit better, you know, if it's a capsule – the little beads, you know, the way that things are distributed once it's inside the intestine. It may work a little bit better in the brand name versus the generic and it's going to be different for each drug. Now, what we call – how much of the drug actually gets to where it's supposed to work is called bioavailability. So, the bioavailability of a brand name drug may be better than the bioavailability of the generic equivalent in some cases. Now, in this situation, I would say, ask your doctor and just see what they say because they're prescribing these medicines day in and day out and your doctor is going to have a really a good idea of which particular drugs the generic is going to be fine for and which ones where –
– when you do the generic, it just doesn't seem to be as good as the brand name one. Because your doctor can always write "Dispense as written", if there's a particular reason that he wants you to get exactly the brand name one and not the generic one. Now, I can think, just to give you examples, two instances where I think the brand name is better than the generic. The first one – and this one doesn't really come up much anymore. It's sort of an outdated example to be honest with you. But there are many of these kind of situations. But, when I – when we were prescribing a lot of Ritalin for kids with ADHD before Concerta and Adderall and Metadate and Focalin and Daytrana patches – before all these things were out – when pretty much the main thing that people were using was Ritalin, you know, there was genetic – genetic, I'm sorry.
It was generic methylphenidate, that's the drug name.
And I would find that the generic methylphenidate compared to the brand name Ritalin with the same those – I would have a lot more parents tell me that the drug seem to not work as well or seem to wear off faster than those who were getting the generic methylphenidate compared to the brand named Ritalin. So, it's one of those things where probably the bioavailability of the brand named Ritalin was a little bit better than the generic methylphenidate. So, more of the drug was actually getting in the blood stream. So – but I, you know, the only reason I knew that is because I start – you know, you start to see patterns where the people are getting brand name Ritalin – you can ask them, you know, "Hey, bring in the medicine next time you come in so I can see what you're getting." And the people who are getting brand name Ritalin I notice seemed to do better on lower dozes whereas the generic one seem like you have to go a little bit higher. Now, that's not really an issue anymore. I'm just using it as an example because now, you know, I don't use much brand name Ritalin anymore because there are things that seem to work better with single-day dozing in the morning and you get a nice, long effect during the day like Concerta and Adderall, and those things.
Another example where I really prefer the brand name is a medicine called Orapred, which is a liquid steroid and it is the – the generic equivalent would be Prednisolone. And the generic Prednisolone honestly has got to be – or Prelone was a brand name of that generic form. But the Prelone, Prednisolone, Pediapred, is another one – honestly, worse tasting medicine known to man. I mean, this stuff is nasty and it seems like, more often than not, you put a little bit of this in the kids mouth and they're puking it up. I mean, it really just taste horrible. Whereas with Orapred, they had basically wrapped each steroid molecule with this great polymer.
And Orapred really taste great. So, it's a lot more expensive, but, you know, when you have a kid who's wheezing or they have bad croup or they have, you know, a terrible rash and you think steroid is going to help it because it's, you know, a certain type of rash, then this – I think Orapred is a much better alternative to the generic Prednisolone just because it taste so much better and it's going to stay down better. So, they're just a couple of examples where I think the brand name is better than the generic. And your doctor, you know, may have some other ones in mind. So, you know, definitely just ask your doctor, "Hey, is this something that the generic is going to be fine for or do I really need to get the brand name medicine?" You know, certainly the generic is going to work as well given whatever medicine you're talking about. I would go with the generic because you're going to save a lot money doing it that way. OK. Let's move on to our next question. This one comes from Mindy in Springfield, Ohio. She says, "My daughter just turned one-year old and she gets very tired at nap time. I can easily get her to sleep by rocking her; however, when I lay her down in her bed, she starts to cry.
I have tried various methods, letting her cry, trying to soothe her by patting her back and laying her back down, but nothing seems to work. What should I do to get her to sleep at nap time?" OK. Mindy, well, thank you for your question. Really appreciate it. You know, I would – for most kids – I'm going to get myself in trouble here again with some people, but – and I apologize. But I still think for a lot of kids that as long as you create an environment where they're ready to take a nap, for most kids, and then you, kind of, practiced that Ferber method that we had talked about where, you know, you put them down and when they cry, you basically let them cry – cry it out and probably the biggest mistake parents make with that, is you get to the point where you cannot stand them crying any longer and you get to the point they've been crying for an hour and you just – you cannot take it anymore, maybe it's way before an hour for you –
– and you go in and you pick them up and what your babies learn is that if I cry long enough and if I cry loud enough, mom is going to come in and pick me up. And so, you're really not going to get the baby to soothe because they know if they keep doing what they're doing, they're going to get what they want. And, you know, it is manipulation even in young babies. Now, again, I'm not talking about a two-week old. I'm not talking about a one-month old. I'm really – I'm talking starting at about six months of age maybe, you know. I mean, certainly, the little infants, you're not going to spoil them, you know, by being there for them and holding them and hugging them and – yeah, you know – but once they get to be to the age where their brain is really waking up and they are manipulating you, it is going to be harder to stop that kind of behavior later on. Now, what can you do to make it more likely that they will go to sleep for their nap. You know, one would be to really try to wear them out. You know, a lot of play right before nap time.
Now, not crazy play because you –
– they're all worked up, but, you know, let's say an hour before the nap. You know, you really get them going and make sure they're getting lots of stimulation and then, you know, gradually, you know, get to the point where things are quieting down, they're settling down. OK. Now, it's nap time and I think that's going to help out if you really try to wear them out beforehand with lots of stimulation. Now, also, I would really watch out for catnaps. You know, even brief five-minute ones because if they – and I'm saying this from, you know, no one teaches you this in medical school, but just from my experience as a parent, I remember my daughter. If she felt asleep for even three or four minutes on the car ride home, like – let's say, you know, we went out shopping and we're going to go home and it was going to be nap time. If she fell asleep for two or three minutes in the car, that was her nap. I mean, she was not going to lay down. She was not going to soothe no matter what we did. And so, we found that, you know –
– on the way home, we did everything in our power to keep her awake so that when we put her down, she would go to sleep. And then, of course, if she was in her bed, it's going to be much longer than a five-minute nap. So, that's something that, you know, to think about in terms of really watching to make sure that she's not – your daughter is not taking a little catnap before the big nap that maybe you weren't aware of. You know, if she's in front of the TV and she's quiet, you know –
– you look over if her eyes are closed. You may be in trouble when it comes to nap time. And then for some kids, you know, you may just have to accept the fact that they're – that they don't want a nap time. Now, in – for those kids, you know, they still probably ought to have a quiet time. And just – I just wouldn't get too upset if they're not actually sleeping during the nap time because, you know, moms do need some time to get things done during the day. And, you know, for your own brain sanity, sometimes you do need some time apart.
And so, if you have a child who would not take a nap at all, you know, it's still OK to have them in their crib for some quiet time. You can accept the fact that they're not going to sleep during nap time, but it's time that you're going to be separated from them. You can have some, you know, soft music playing in the background, some things for them to do in their bed, you know, you know that they're safe. But it's – you know, you can still get things done. Now, for some kids, if that's going to be the case, then you may be OK saying, – well, instead of it being in the crib, you know, it will be in the Pack 'n Play in the living room, they'll have some things, it's quiet time, you know, they can play with some things, but it's not crazy high stimulation time. They're in a safe place so I don't have to keep a constant eye on them. I can get some things done, but they may be, you know – if they're just crying and screaming in their crib because they want to be close to you and they weren't going to take a nap anyway, then it may be fine to say, "OK. Well, their quiet time rather than nap time is going to be in the Pack 'n Play where they can see me, but I can still get some work done.
They're not loud, you know, and they begin to accept the fact that I'm not going to pick up them up." That's one of those things again, too, where they may cry at first when they see you, but when they realize, hey, this is the time of the day when mom doesn't pick me up, you know, because – and they realize these things. You know, especially if you keep to a pattern, keep to a schedule, you know, it starts to click, but it may take a few days, you know, before that happens. And if you lose patience before those few days are up and they're crying and you pick them up, then they have learned if I cry, mom picks me up and then it's not going to stop and it's not going to go away. So, OK, we kind of talked about that with the evening. I think nap time is sort of a similar type of situation. So, let's go ahead and move on and we'll get back to segment number three our Listener Question Marathon –
– right after this break.
Welcome back to the program. This is our next question. "Dr. Mike, I am a soon to be new father. My wife is due with our first child at the end of the month and have truly enjoyed your podcast as soon – as a soon to be new parent, I feel like there's a lot of information I don't know and have found your podcast truly informative. One question my wife and I are currently struggling with is regarding the selection of a pediatrician. We have had some different recommendations from friends and family and have toured and talked to a couple of them, but I was curious if you have any helpful tips in selecting a pediatrician, things to ask, recommendations for homework, et cetera. Thank you in advance for your consideration and keep up the great work. Sincerely, Mike from Michigan." And then we also had another listener, Mary from Walnut Creek, California. She says, "Hi, Dr. Mike. My family and I recently relocated and I am currently pregnant with my second child. With our first child, we went to a pediatrician that was highly recommended by numerous friends and we were very happy with the doctor.
Since we've relocated, how do I go about finding a pediatrician that we're comfortable with since we don't have any friends that can help make the same kind of recommendation as before? We've asked school teachers and other parents at my son's preschool, but none of them seem very enthusiastic about their doctors." Oh, Great. "Parenting books often recommend interviewing several pediatricians before having a baby, but I question how realistic that is. I know doctors are often behind schedule and barely have enough time to spend with actual patients, let alone a potential one. From my experience, I also think, you don't get a good enough feel for a doctor until your child is actually sick and in need of care. So, how do I go about finding a pediatrician in a new community? Thanks." All right. Well, thanks for both the questions from both of you. And I will say it's, sort of, one of those things in pediatrics that's sort – I guess, a tradition you'd say, is that most pediatricians do a complimentary prenatal consults.
And most of them find them in their schedule to do this. And from practice-to-practice or from doctor-to-doctor, you're going to really have some different ways that this happens. It can be a one-on-one sort of thing. This is how I personally do them because in the community where I practice, we don't have a lot of people ask to do this. I think I'd probably change the way I do it if we did have an increased number. However, I do know some pediatricians who have a patient population where this is a very common request and so they set it up. Instead of a one-on-one kind of situation, they actually have a couple of times a month when they have classes. And if you're – went in a prenatal consult, you can sign up for one of those classes and come in and talk and, you know, in sort of a lobby as a group with the doctor. Now, the way I do it, usually, the nights that I'm on call, we do have evening office hours. So, usually, the first slot in the evening when I'm on call is set up for a prenatal consults that we can take about 10, 15 minutes and answer questions.
Now, I will say that in 10 to 15 minutes, you know, you're not – it's going to be superficial. The doctor is going to be on their best behavior. Everyone is going to be smiling. Oh, congratulations. And so, you're right. You're not going to necessarily get the best sense in terms of what it's going to be like when his schedule is completely full and my kid is sick and, you know, is he going to make time to talk to me or is he going to, you know, be put out. Of course, he's going nice and smiling when you come in for the prenatal consult. So, I'll agree with you. It's probably not the best way to find out what a doctor is really like, but I still think it's a good idea to do it because you can get really some good useful information out of that meeting and we'll talk about that in a second. So, beyond the information that you get, you know, if any doctor you go to is going to seem nice when you first go, how do you find out who a good doctor is going to be?
Well, you know, one, of course, is going to be word of mouth. Now, of course, you – sounds like you've already tried that, but you, you know – you can, you know ask your friends and family, get recommendations that way. But if there's no one who likes their doctor –
– or there's no one that you know in this particular community, one place to start would be to call your local children's hospital and just find out what board certified pediatricians are in your area and who's accepting, you know, new patients in that area and you can get, sort of, a list generated that way. Another way is to ask, if you're in town and you have obstetrician that you've started to see – maybe you haven't seen them long, but, you know, most of the OB/GYNs are going to get feedback on pediatricians because when moms go back, they, you know – the OB is going to say, "Hey, how's the baby? How's things going?" You know, and so, they can get a lot of feedback about pediatricians. And I know a lot of new patients that I have seen have said, "Oh, my OB, you know, really said that you were a good pediatrician and we should come and see you."
So, you know, we definitely get some word of mouth referrals through our obstetrician colleagues so that's another place that you could ask. Now, of course, personally, you know, if I have a baby, and gee, I wonder why I would say this, but I would – if in your community there's a pediatrician available with infants, I think I would do that versus family practice. And I would try to find someone who is a board certified pediatrician because then, you know, they went through an accredited training program. They've taken the national board examinations. In pediatrics, we actually have to recertify every seven years with a written test. So, you have to keep up on current research and literature and the way things go and that – and you want a doctor who keeps up with those things so I think it is important to find someone who is board certified. Now, in terms of pediatrician versus family practice, this is not at all a crack on my family practice colleagues whatsoever, but –
I mean, the issue is this, in residency, you know, I spent three years just seeing kids and kids after kids, after kids in a very high volume children's hospital. And so, you really get exposed to just lots and lots of things and – so, then later on when you see things, you know, it clicks in your mind, oh, yeah, I saw this and, you know, it – whereas the family practice guys and gals, they're doing a couple of months of pediatrics and then a couple of months of adult medicine and then a couple of months of surgery and then a couple of months OB/GYN. And so – I mean, really, the amount of pediatrics that they see does get diluted. Now, certainly, they're going to be communities where you don't have a pediatrician and I think family practice guys and gals are going to be fine for that. But if you have a pediatrician available, I would go that route personally. Now, again, don't send me hate mail. I'm – again, I'm not saying that they're – that all family practice doctors are bad and none of them should see kids.
I'm not saying that at all. I'm just saying that, you know, if you want someone with the most experience dealing with kids, that's going to be – that's going to come from a board certified pediatrician. So, that's where I would go. Of course, you know, you're asking a board certified pediatrician, you know –
So – OK. What do you expect? Now, once you go and you see the doctor, what kind of information should you get from the prenatal visit? Now, you can go – all these baby books have a laundry list of questions that's, you know, two pages long. And you're not going to ask all those questions. I mean – because if you come and ask all those questions, you know, the doctor right away is going to sandwich –
– into a –
– into a cubby, like –
– all right. I know where this is going to go. OK.
So, I think the most – what's the most important questions? What's the short list? Well, you want to know, you know, what are the procedures going to be when you have the baby? Who is going to see the baby in the hospital, you know? When are you going to see him? Who – if it's a boy and you want them circumcised, who's going to do the circumcision? When do we come see you at the office for the first time?
I mean, you want to know, sort of, all the mechanics in your area. Where you – what hospital you're going to go to and the office that you're going to go? What can you expect when the baby is born? So, I think that's an important thing to know. Also, you want to know about the office hours, you know. When do they see well check ups versus sick visits, you know? In our office, we try to do well check ups in the early afternoon because we only have one waiting room. So, we try our best to schedule it. Of course, you know, it doesn't always work out very well. But we try our best to schedule well check ups first thing in the morning, sick visits later in the afternoon or – I'm sorry, later in the morning. Then we start the afternoon with some sick visits then go to some well checks and rechecks in the afternoon. So, it's hopefully after school when kids are visiting school for recheck appointments like ADHD, you know, medicine recheck kind of stuff. So, you know, in general we try to stick to that schedule. Does it always work out? No, of course not. But, you know, we do our best.
So, you – but you want to know, you know, when do you need to do well check ups versus sick visits. So, you have an idea of, you know, when you're going to be coming in. Also, do – are there weekend hours? For instance, in our practice, we have Saturday morning hours where we will do well check ups and then we also have Saturday afternoon hours where we do sick visits only. We also have Sunday morning and Sunday afternoon hours. And again, those are just for sick visits. And then we also have evening hours from 6:00 until about 10:00 at night on weekdays. And again, that's just sick visit hours. So, it's kind of like an urgent care. And the practice where I'm in, we've been doing that since the 1970s. But again, you know, there's six of us and it's only one doctor there in the evening so it works out fine, you know, plus when there are evenings – the days that I'm there in the evening, I get the morning off and the next day I have the afternoon of. So, you know, don't feel sorry for me here folks. So – but the point here is that, you know, does the practice you're going –
Do they have evening hours, if so, are those for well check ups or they're just for sick visits? You, sort of, want to know the mechanics of the office, when they're open, when you can go, also, who are you going to see. In our office, you know, we – the well check ups, we want to be with the regular doctor. But especially during flu season and the winter time for sick visits, you know, we help each other out because our schedules can just become so overwhelmed. And our on call doctor usually does not have any well check ups that day at all, it's just sick visits. So, if you do see, you know, the partners somewhat, you know, then you could – you want to know how does that work out. When would you expected to see you versus your partner, that sort of thing. Also, who handles phone calls, you know. If I call in, am I going to talk to you? Am I going to talk to a nurse? Is the nurse going to talk to you before she calls me back, you know? How does that work? Also when the office is not open and there's a medical emergency, how do you get a hold of somebody? So, you know, I think those are the most important things to get from a prenatal visit. Now, if your doctor does a one-on-one, then there's some other things –
In a group session, you probably wouldn't want to bring these things up. I mean, you could if you wanted, but it's probably not going to stick out the doctor's mind as much as if it's done on a one-to-one. And if you – if you're going to go to a doctor where they do the classes and you have some of these issues, then you may want to call in and just say, "Hey, can you make an exception and do a one-on-one kind of a prenatal consult?" You know, if there's any special social considerations for instance if – that you feel strongly about that your doctor needs to know – so, I mean, if you're Jehovah witness, do you have religious issues with certain vaccines? Really just strong feelings one way or the other about any kind of medical consideration, you know, it's nice for your doctor – potential doctor to be aware of that right up front. And also, you know, to see how they feel about that too because they, you know – if they are very against – one thing or another, then, you know, right up front that maybe you want to find someone else. Now, the other one is if there's been anything wrong with the baby before they were born up to this point.
So, if you have a prenatal ultrasound that showed fluid are on the kidney or a heart problem, where they have done any blood testing and found, you know, Down Syndrome, there's a possibility of spina bifida or there's strong genetic patterns of some illness or another. You know, those are things that would be nice for the pediatrician to know about ahead of time to sort of anticipate where we go from here. So, those, I think, are, sort of, my laundry list of most important questions to get out of the prenatal visit. You know, certainly, you're going to look at these books and they're going to have a ton more – you know, how do they feel about breastfeeding? What are they going to do if it's not – if the breastfeeding is not working out? You know, and there's a whole list of things, but that's – you know, it's going to come up as you go along. You're going to find out what the doctor – how they feel about it, you know, with – if there's an issue. OK. So, let's go ahead and move on and we'll get back with our final – oh, no, actually, we have two more segments. See, I told you it was Listener Question Marathon –
– it really is. And we'll be back with more after this short break.
All right. Welcome back to the program. I told you it was a Listener Question Marathon –
– it really is and we're in the midst of it. This next one is not so much a question, but rather a comment on a previous episode. This comes from Jennifer in Milwaukee, Wisconsin. And Jennifer writes, "I just finished listening to episode number 27. I am a registered nurse with a master's degree. And I usually –
– usually, find your show incredibly informative and have felt that you've presented a well-balanced view on new research and on clinical guidelines." Oh, when they use the word "usually", you know you're in trouble. "I was therefore very surprised to hear your comments regarding cold medicine and its use with infants. I was not surprised that the deaths reported were due to high doses of pseudoephedrine and DM, et cetera because I feel that it is very difficult for the general public to read medicine labels and really understand what they are giving their children.
We all know, that there are thousands of medical errors in the hospitals every year. So, it is very realistic to expect that non medically trained parents will make mistakes with prescription and over-the-counter medications. It is important to note that these medicines do not shorten the length of the cold at all. They are strictly for symptom control and comfort, although that's in question whether they really help with that too, but – therefore I felt that it was a little cavalier to comment that there were only three deaths due to this practice using cold medications in infants. I understand the concept of cost versus benefit analysis for making decisions. But in this case, I cannot see the justification for use of these medicines in these young babies. These three deaths, while only three, were three totally preventable deaths. There was no compelling reason to use these medicines in these children and the risk is not justifiable.
I feel that this was an opportunity for you to discuss other comfort measures that can help these babies sleep and be comfortable through their colds with little to no risk, like nasal saline drops followed by bulb suctioning, increased fluid intake, cool mist humidifiers or sitting in the bathroom with a steamy shower, menthol ointment on their chest, lots of holding and rocking for comfort in sleep, and if necessary, for fever or apparent discomfort, the appropriate and much safer than cold medicine, use of Tylenol or Ibuprofen. If my baby was one of the three that died, I don't think I would feel any better about the low risk if I knew that the use of this unnecessary medication was what led to my baby's death. I do continue to really like your show and have recommended it to many friends. I just felt that I had to address this portion of your advice. Best wishes for continued success, Jennifer." Jennifer, actually, thanks for your comment.
And really, I want to thank you for mentioning the things that parents can do that are definitely safe to help babies sleep and be more comfortable through their colds with little to no risk like that nasal saline drops, the bulb syringe suctioning, increased fluid intake, cool mist humidifiers, all of those things. I really appreciate you taking the time to remind the rest of the audience about those things because my focus really was on the news report rather than the alternatives for what you can do and I probably should have included that in the discussion. So, thank you very much for calling me on that. You know, kids are a touchy subject because, you know, we all love our kids. I mean, they're small. They seem helpless. They trust us. You know, our job is to protect and nurture them. So, when we hear about anything at all that can hurt them and, you know, needless to say, kill them, you know, we react very strongly to it. But when you look at society as a whole – and again, this is a philosophical debate.
It's more of an ethic discussion really. I mean, you have to look at the big picture and even though you could say that – you know, this was three completely totally preventable deaths. First, let me say, we don't know that for sure because what – you know, the coroners in those three cases basically said we couldn't find any cause of death other than the fact that there was pseudoephedrine in the baby's body. Now, you know, are there things that could make a baby die while they are on cold medicine that weren't related to the cold medicine but that you couldn't find during the autopsy? You know, certainly, there are going to be things like that and the most – or the one that would come to my mind would be a cardiac arrhythmia. So, if you had a baby who had an electrical issue in their heart, it's going to be very hard to tell that on the autopsy because there's going to be symptoms of the kid's heart stop beating anyway, you know, because they died.
And so, conduction problems in the heart where you have an arrhythmia are going to be hard to detect. And then the question becomes, you know, is this a baby that had SVT and no one knew about it and, you know, it progressed to death in a fairly rapid fashion. SVT is supraventricular tachycardia, which is a disease where, you know, heart starts beating really fast and you don't get a good blood output so you're not getting oxygen to the tissues. And so, you know, could it have been something like that that just did – does not show up because obviously at autopsy they can't do an EKG, they can't, you know – you just – it's really for those kids, their heart may look completely normal. So, you know, was it really those cold medicines that did it? You have to think that there were something different about those three kids if it was the cold medicine because when you consider millions and millions of doses of something and this happens to three people in a year, you know – was there something different about those kids' bodies compared to the others?
Now, you can say, "Well, even if there's that tiniest chance, I don't want to use it." But the problem with going that route is, you know, we put babies in cars, we put babies in airplanes, you know, kids get on rides at Disney World. I mean, the kid who died on Rock 'n' Roller Coaster who had the underlying heart problem – I mean, you can't say, "Well, there's a chance that every kid, you know – my kid could have some heart issue that I don't know about. We should just ban all roller coasters." You know, we're not going to ban all roller coasters just because there's a kid who didn't know that they had a heart problem and then they found out about it, you know, on the roller coaster and then they died. It – I mean, it's a terrible situation and I'm not trying to say that it's any loss of an emotional impact for the parent who loses their child. The question is, did the parent who loses their child on that way, are they – well, not going to let their other kids ride a roller coaster? Are they going to demand that their other kids all have cardio –
I'm sorry, have echocardiograms, you know, to look – to make sure that they're heart is perfectly normal. Do they all get EKGs before they're allowed to ride these things? I mean, what point – do we have to, you know, wrap our kids in plastic bubble wrap, you know, and protect them in evey single way possible. Now, again, I'm not saying that I'm diminishing what happened to these three babies at all. But there are also lots and lots of kids who do get benefit from these medicine. Now, you could say that it doesn't decrease their cough, it doesn't increase – decrease their runny nose, but I think it's pretty accepted that it does help them sleep. And if you have a child who is up crying all night long because their nose are so stuffy and they can't – they're having trouble breathing because of the stuffy nose not because of wheezing or something, but – and you're a parent and you need a good night sleep to deal with this the next day, there's something to be said for your baby child being able to sleep through the night.
Now, that doesn't mean, you know, we're giving them to a two-month old, but, you know, what about the eight-month old? Can they have some over-the-counter infant Dimetapp or Pediacare? I mean, are you going to ban all of those medicines because of this? And I, you know – my job here is not to be the gold standard advice for all of you parents out there. You know, my job is to say, "Let's look at these things critically. When someone comes out and says that we should never ever, ever give any cough and cold medicines to kids who are less than two years of age because three kids died, you know, that really robs millions of other kids from the benefit that they truly did receive from those medications.
Now, you could – you know, you could argue again that this research study show that there's no benefit, but I'm sure there's plenty of moms and dads out there who would argue it was beneficial, that they really did feel like they saw a difference. And, you know, you could probably pick apart these studies that they did to see if there really was comfort that was given from these medications. But again, I get the fact that you can't replace a child and the parents who lose one, because of these things, you feel terrible for them. But, you know, kids who die in car accidents, we don't ban cars, we don't ban airplanes, we don't even ban Disney rides. Now, you know, my argument here again is not that cold medicines are in the same league as cars and airplanes and Disney rides. My argument is just that we have to take a critical look and ask why rather than just accepting what someone, even me, says is the truth. I mean, you have to make decisions for yourself and everything that we do in life is a risk and you have to say, "Does the benefit outweigh the potential risk for a problem?"
And when you have millions and millions of doses of medicine being given safely without adverse affects and you have three kids who died, is that reason enough to say that no kids should get it? And I'm not – you know, I'm not sure that it is. So, you know, I'm not saying to do it or to not do it. I'm saying you have to decide for yourself and look at the facts, and PediaCast is just to get the facts out there. And I don't have the transcript in front of me from the episode number 27, but, you know, I think I did just basically report what the statement coming out of the Centers for Disease Control was, that they were recommending not using those in kids who are less than two. You know, I certainly, you know, respect their recommendation. In a realistic world, is that going to happen? Probably not. I mean, the companies are still going to market these things for young kids and, you know, do we get, you know –
Does that make parents who are using cough and cold medicines in their 18-month old, you know, negligent parents because they're not listening to the recommendation of CDC? But when that recommendation comes from three deaths versus millions of kids who had no adverse affects, you know, is that the right recommendation? I'm not saying it is or it isn't. I'm saying you need to make that judgment in your mind and, you know – I don't want to just blindly follow the recommendation of someone who may have some ulterior motive. So, anyway, Jennifer, I really appreciate you writing in. You bring up some great points. I, in particular, want to thank you for mentioning how you can safely help babies out with their symptoms when they have cold viruses. I'm going to disagree with you a little bit on saying that we can't trust parents to look at medicines and what they're giving their kids. There's certainly more medications errors given in hospitals from people in the medicine field than there are parents who have killed their babies from overdosing cough and cold medicines because there's a lot more than three overdoses that result in deaths in hospitals.
So, anyway, again, Jennifer, thanks. I do appreciate you writing in and taking the time and I appreciate you're not throwing PediaCast out with the bath water.
All right. Let's take a quick break and then we will move on to our final segment in this listener question marathon.
OK. We're going to return with our fifth segment in our Listener Question Marathon. And our final questions is one that's not nearly as controversial. And this one comes from Shawna Smith in Winterville, Georgia. And Shawna – it's a real simple question but it's a great one. She says, "What causes cradle cap in infants and is there anything that can be done about it?" All right. Well, cradle cap is actually – the scientific name for it is seborrhea or we can say seborrhoeic dermatitis. And if you remember – gosh, it's been back several, several episodes ago, but if you're a long time listener, you'll probably remember. We talked about baby acne and that there is a type of sweat gland in baby skin that makes a, sort of, oily sweat, not a clear liquid one, but, sort of, an oil – oily fatty thicker sweat called sebum. And babies respond to mom's hormones so the female hormones during pregnancy cross to the placenta go into the babies body.
And one of the things these hormones do is they make these sweat glands make more sebum and then that leads to acne. It can lead to breast development. Baby girls can have some vaginal blood like they're having a small period. And one of the other things it does is you make more sebum. And when this happens on the scalp – remember that the skin is overturning pretty rapidly. You're making new skin cells. And so these old skin cells can sort of become cemented to the scalp in the sebum. And so the sloth skin cells don't go anywhere. They just stay on the scalp cemented down. And you see this basically as patches of a crusty scale on the scalp. All right. So, what do you do if it's mild? OK. If it's really, really mild seborrhea, well, probably nothing.
I mean if you see a little scale there and it doesn't seem to be bothering the baby. It's not itchy. It doesn't hurt at all, then really you're probably fine just leaving it alone, you know. I mean, it's something, you know, it doesn't look the best, but, you know – does it really matter? I'll probably just leave it. Now, if there's a moderate amount or the baby seems to be, you know, itching at it, it seems to be bothering him or, you know, lots of people asking questions and you just want to get rid of it because there's more there than what you can tolerate, then in order to get the actual skin cells off, you want to use, like, a little mineral oil and massage the scalp and then just a really soft brush – soft bristle brush to help get those flakes off. We used to use – we used to – I used to get the kind of brushes that you use to clean vegetables. It's like a really soft – lots and lots of little bristles brush and use that.
And it seems to work really well on baby scalp because it's soft and there's lot of those little bristles and you basically just massage the oil into the scalp and it helps to separate the crusty scale from the scalp. So, once you get the scales off, how do you prevent it from coming back? Well, there's some reason to believe that this whole process also for some kids has a yeast that's involved in the process. And so, if you use Selsun Blue shampoo, which has selenium in it, selenium is known to kill yeast and so if you kill the yeast, a lot of times, the bad seborrhea will go away. Now, the mild seborrhea is probably just what I explained before with making little bit too much sebum and the skin cells are getting cemented down. And so using the Selsun Blue is not going to be helpful in, sort of, mild to moderate cradle cap.
But if you have moderate to severe, then there could be a yeast that's involved and using the Selsun Blue shampoo may help to keep it from coming back once you get those scales off. Now, if you use Selsun Blue shampoo over-the-counter strength, there is a prescription strength as well, but for infants, over-the-counter strength is going to be just fine. You want to make sure it doesn't go in the eyes because it's not going to be anti-tear formula. They're going to be really upset at you –
– if the shampoo goes in their eyes. It's going to burn and sting and basically not be a pleasant situation. Now, you also don't need to do this everyday. You know, if you have a tendency to get moderate to severe cradle cap and is recurrent, you know, if you got the – you got the scales off and you use the Selsun Blue a couple of times a week, that's probably going to be enough to help keep it away. Now, if it's really severe, you definitely want to see your doctor. For some kids, this may be related to eczema. OK.
A sever eczema or psoriasis kind of pattern and using a steroid, either a prescription steroid cream or even an oral steroid like Orapred –
– which we talked about. I feel like a comedian. You know, you got to bring something from earlier on in the show back, you know. It's the while moment – or the while moment here in PediaCast as Orapred.
OK. Sorry, folks. But –
– you know, if you use something like that for sever eczema or seborrhea, then you want to – you got to – of course, you want to talk to your doctor about that. But if it's really inflamed and particularly, if there's a big family history of eczema and asthma, then the steroids may be helpful. And of course, it can also get infected and so you may have impetigo or a skin bacterial infection on top of that flaking and that may require either an antibiotic ointment or if it's severe, they might even need an antibiotic by mouth if they have impetigo or starting turning to a cellulitis or an infection of bacteria on top of the cradle cap.
So, that's the basic story with that, you know. It's very common. It's something that almost all babies have to some degree and if it's really mild, it doesn't seem to be causing any symptoms, you're probably best off just leaving it alone. If it's medium, you know, you can do the mineral oil and brushings and Selsun Blue shampoo. And then if it's severe, you want to see your doctor because then you got to think about the steroid medicines and see if it's infected and whether you need to do an antibiotic with that or not. OK. Also, there's a really good article on Wikipedia about cradle cap and I'm going to put a link to that in the Show Notes. I tell you, I have become really enamored with Wikipedia. It seems like pretty much everything that I've looked up on there, you get more information than you bargained for. And from what I've seen so far, most of it is – has great sources. You know, you can look in the footnotes to see where they got their information.
It's just a wonderful resource if you've not checked that out before at Wikipedia, W-I-K-I-P-E-D-I-A, wikipedia.com. OK. We're going to wrap things up with our program this week and we'll be back to do that right after this break.
All right. Well, I want to thank you for taking a time out of your busy schedules. I know parents are very busy especially with all of the things that you have to do during the day whether you're working in the home or whether you're working outside of the home.
It's – you know, it's busy being a parent. And I just want to thank you for taking the time to make PediaCast a part of your week. So, thanks, of course, to my listeners also to my family because as the, you know – the amount of time that you have to take away from your family to listen – I have to take even more time away from my family to actually make these things. So, I want to thank my family for putting up with me. Also, of course, thanks, as always, go out to Vlad over at vladstudio.com, a wonderful artist in Russia. And you can buy his prints and also free desktop images that you can put on your computer. And again, that's at vladstudio.com. Also, I want to make a quick mention, my son – I want to say, "break a leg", to him. He's in another play production. If – Again, my long time listeners will remember that he was in the world premier stage production of "Surviving the Applewhites". Well, he is also now a munchkin in the Wizard of Oz that's being put on by the Children's Hospital Pleasure Guild at the Palace Theater in the beautiful downtown Columbus, Ohio.
And before we have another episode, he'll have opening night – that set, coming up this Friday. So, I just wanted to say, "break a leg", to my son. So, Nick, "Break a leg." All right. Let's see, reminders, remember that you can contribute to the program by going to www.pediacast.org and then clicking on the contact link. You can also email us at email@example.com, attach an audio file if you like or you can call our Skype line at (347)404-KIDS, that's (347)404-K-I-D-S. Promotional materials are available on our poster page, which you can find at the website. Also reviews in iTunes are really, really, really, really, really, really helpful. So, if you have not done that, please go to iTunes and give us a review because it – the more we have, the higher we go in the ratings and the more people get exposed to the podcast.
And ultimately, the goal of this is to have enough listeners that we can get a sponsor and I can put more time into this and make it better for everyone. So, please go iTunes and give us a review. Also, you can digg our episodes each one individually at digg.com, D-I-G-G.com and there's also a link in the – at the website for you to go to Digg to do that. OK. Be sure to tell your friends, family, co-workers, and neighbors about the program so we can empower more parents to 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?