Cystic Fibrosis, Stork Bites, and Freckles – PediaCast 037
- Cystic Fibrosis
- Stork Bites
- Eye Color
- Physical Activity and BMI in Preschoolers
- HPV Vaccination Mandates
- Prevent Child Drownings!
- Cystic Fibrosis Foundation
- Boomer Esiason Foundation
- HIV and Circumcisions
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Announcer: Hello moms, dads, grandmoms, grandpops, aunts, uncles, and anyone else who looks after kids. Welcome to this week's episode of PediaCast. Pediatric broadcast about for parents. And now, direct from the Birdhouse Studio, here's your host, Dr. Mike 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.
All right we are back in business. We have a fantastic family vacation, great time away.
But thanks for your continuous support of PediaCast by listening to episodes, visiting the website, and continuing to ask questions and offer feedback while we were gone. We had a great time. It was relaxing. And after a really busy winter in the office of seeing so much, in the way of a strep and flu. And then trying to get a weekly podcast out. And a weekly column on Disney stuff. Life is pretty hectic and so the vacation. Even though, it was kind of long it was definitely needed. But I am revived and ready to start getting the PediaCast episodes out week after week again here for good long time.
Now in addition to the vacation I have to admit I did need some time to work on a few other projects I have in the hopper. One of them is particularly exciting. And you can get involve by sharing some stories that might actually end up in print. And I'll have more details on that later on in the show. But for now, we have a lot to catch up on. So let's get right into the program.
We're going to do a traditional show this week. We have news parents can use segment and we'll get some questions from listeners. And wind things down with a research round up. So, in the news parents can use, we're going to talk about government mandate for HPV vaccines. Is that popular or not so popular?
Also, we're going to talk about swimming safety's. And since it's summer. And swimming pools around the country are opening. We're going to talk about swimming and how you can do that safely this summer. Also, in our listener segment, we have questions about seeing the dentist, cystic fibrosis, stork bites, freckles and eye color. And then we're going to wind things down with a research round up. We'll have a discussion of HIV in circumcision. Is circumcision now medically recommended because of HIV? We'll talk about that.
And also, physical activity programs for preschoolers. That's also coming up a little bit later in the show.
Don't forget, if you have a topic that you would like us to discuss, all you have to do is go to pediacast. org, and click on the contact link. You can also e-mail me at email@example.com. You can write out a question or comment. Or you can record an audio file and attach your audio file to your email. That will be fine as well. We also have a voice line. You can call 347-404-KIDS. That's 347-404-5437. That's another way to get in touch with us.
Now, don't forget the blog arm of PediaCast, is PediaScribe. It's actually Karen's PediaScribe blog. She's my lovely wife. And she took over the blog. It's been a few months ago now. But, she's running a contest over on the PediaScribe blog. I wanted to tell you about. That any comment on the blog, past or present, will get you entered into a contest. And the way this works, is for every comment you have made or make or will make. Between now and June 15th, 2007.
I mentioned the year in case you're going back to the archives. And it's 2008 right now. Well, you're a little late. But, anyway, any comment that you make will get you one entry into the contest. If you review PediaScribe on your blog. Then, that will give you two entries. So if you run a blog and you put in a word or two about PediaScribe on your blog. Then, you'll want to let us know that. And we can then follow the link and see the comment on your blog. That will get you two entries. And if you review PediaCast on your blog, and this was Karen's idea. Shows you how much she loves me. 'Cause PediaCast review, gets you three entries into the contest. And so, what do you get. Well, one winner is going to get a $20 Amazon gift certificate. The winner will be chosen at random on June 15th. Actually, probably June 16th. The contest runs through June 15th, 2007.
And, in order to get more information about that, just visit pediacast.org and click on the PediaScribe blog link for all the details. You can also go to pediascribe.com.
And with that in mind, we'll be back with "News Parents Can Use" right after this.
OK. Welcome back to the program. It is time for our "News Parents Can Use" segment. And it is brought to you in conjunction with news partner, "Medical News Today"., the largest independent health and medical news website. You can visit them online at medicalnewstoday.com. The majority of US parents are not in favor of HPV vaccine mandate. Well, debate in several state government continues to grow over school mandates for Gardasil. A vaccine recommended by the Center for Disease Control and Prevention, for girls ages 11 to 12. That is designed to provide protection against human papillomavirus or HPV.
The virus linked to cervical cancer and genital warts. The majority of US parents have already reached a decision on the issue. They do not wanted the vaccine to be mandated. According to a new report released today by the University of Michigan, Children's Hospital National Poll on children's health, only 44% of parents are in favor of the school mandate for the HPV vaccine. The report also reveals, that parents with children older than six are less likely to support an HPV vaccine mandate.
We found that minority of US parents are in favor of an HPV vaccine mandate for school entry. And that more than one quarter of parents, unequivocally disagree with HPV vaccines mandates, says Matthew M. Davis, MD, MAPP, Director of the National Poll on children's health. Part of the University of Michigan, Department of Pediatrics and Communicable Diseases. And the Child Health Evaluation in research unit in the University of Michigan, Division of General Pediatrics.
Well, states mandates that requires certain vaccinations upon school entry, have provided an effective means to prevent the spread of infectious diseases, such as mumps, measles, polio, whooping cough, and chicken pox. They have become increasingly controversial. And the HPV vaccine, which also is licensed for females ages 13 to 26. And girls as young as 9 is no exception.
In the case of the HPV vaccine, proponents of the mandate argue that state shouldn't encourage to prevent their daughters from getting cervical cancer caused by HPV infection, which is spread through sexual contacts, says Davis. Associate professor of General Pediatrics and Internal Medicine at the UM Medical School. And associate professor of Public Policy at the Gerald Harvard School of Public Policy.
Opponents however, argued that the vaccine is expensive. And that the infection can be prevented without vaccination. Although, the CDC and the American Academy of Pediatric support universal HPV vaccination for girls, ages 11 to t2, neither support school entry mandates for HPV vaccine. Still, 24 states, including the District of Columbia, have introduced bills to mandate the vaccine. In Virginia, in early 2007, passed a law requiring HPV vaccination for entry into junior high school.
But, our mandates for the HPV vaccines, parents really want for their children. To answer that question, and gain more insight and a parental opinion about new vaccines. The national poll on children's health, in collaboration with "Knowledge Networks, Incorporated", conducted a national online survey in March 2007. The survey was administered to random sample of 2,076 adults, ages 18 and older, who are a part of "Knowledge Network's" online knowledge panel.
The sample is subsequently weighted to reflect the US population figures from the US Census Bureau. About two-thirds of the sample were parents. Parents were asked if they would support a state law that requires girls to get the HPV vaccine before entering 9th grade. They also were asked if they would support a state law that would require boys and girls to get the new booster vaccines that protects against tetanus, diphtheria and whooping cough or Tdap before entering 9th grade. The survey found that 68% of parents support a mandate for the Tdap vaccine, while only 44% are in favor of a mandate for the vaccine to protect against HPV. The national poll on Children's Health also revealed that parents with children younger that six, were more likely to support a mandate for the HPV vaccine than parents with children ages 6 to 12, or ages 13 to 17.
Most notably, 85% of parents surveyed, feels that vaccines are a good way to protect their children from infectious disease, Davis says. It was parents attitude however about the safety of new vaccines that ultimately factor into their support of mandates for the HPV vaccines. While 43% of parents agree that new vaccines are safe for children. Nearly half of all parents feel neutral about the safety of new vaccines. Now, surprising, a higher proportion of parents who do not believe new vaccines are safe, are opposed to a mandate for the HPV vaccine. Compared with parents who view new vaccines as being safe. Davis also notes that nearly 70% of the survey group lives in states with HPV vaccine mandates or pending HPV vaccine mandate legislation.
Over all, he says, there were no significant differences in parents' opinions on state mandates for HPV vaccines, when comparing parents and states with mandates or pending legislation. And those in states with no mandates or pending legislation.
For the 25 states, including the District of Columbia, with existing mandates or pending legislation, 45% of parents are in favor of mandates, while 42% of parents are in favor of mandates in states that have not introduced HPV mandate legislation.
OK, moving on to our second topic in "News Parents Can Use". Emergency physician urged parents to follow 10 rules to prevent child drowning. Summer has arrived and UCLA emergency physicians would like to remind parents how to prevent drowning and water immersion injuries involving children. These unfortunate and heart wrenching events most often occur in the summer months, which are filled with water activities. In Los Angeles county, approximately, 70% of child drowning occurred during June, July and August.
According to the Los Angeles County, Department of Health Services.
Most of these tragic events occur in private backyard swimming pools. More that two-thirds of toddler aged children, who are found in pools or spas, were thought to have been else where in the house, either sleeping or playing.
"Drowning remains the leading cause accidental deaths among toddlers ages one to two" said Dr. Larry J. Baraff, Professor of Pediatrics and Emergency Medicine at the David Geffen School of Medicine at UCLA. "One of the most preventable causes of death, this tragedy can be avoided with just a few simple precautions. In the past five years, there were on an average 2,200, younger than five years old, treated in US hospital emergency departments for swimming pool submersion injuries. And 280 poor related drowning deaths per year. 90% of these deaths occurred at home. So, parents should follow this 10 basic rules to prevent a child drowning".
"Number one, never leave a child unattended or with a young sibling in a swimming pool, wading pool, bathtub or hot tub".
"Even a momentarial absence supervision may result in the drowning. And your child can drown in just two minutes. Number two, pool should be fenced and gated with self-locking gates. This includes pools located in neighborhoods, apartment complexes, family back yard, et cetera. Pools must be kept clean with no covers or rafts that might obstruct one's view of a child".
"Number three, always secure the safety cover on your spa or hot tub. Number four, be sure all containers with liquids are emptied immediately after use. Do not leave empty containers in yards or around the house where they may accumulate water and attract young children. Number five, adults and teenagers, aged 14 and older, who supervise children should know CPR. Studies have demonstrated that nearly drowned children given quick CPR, suffered no brain damage while children not receiving such immediate treatment sustained brain damage or death".
"Number six, children should be given swimming lessons but should not be considered water safe until they are 14 years old. Number seven, keep small children out of bathrooms unless supervised by an adult or older child. Since 1973, more than 500 children have drowned in bath tubs, hot tubs, toilets and five gallon buckets. Number eight, older children and even adults, should not swim alone in the ocean or fast moving rivers. Number nine, children should wear bright colored floatation devices when boating. Number ten, don't mix alcohol, children and water".
All right, that wraps up this week's "News Parents Can Use". And we'll be back with your questions and comments right after this break.
All right, welcome back to the program. It is time for our listener's segment. Before we get to that, I would like to take a moment to tell you about this week's sponsor, Mariner Software. Now, it is important to me that I use and trust products that I recommend. And I have used one of Mariner Software products on my Mac Book from the first day I took the computer out of it's box. And I continued to use it everyday. As little gem of a program is called Mac Journal. Thanks to a new underlying blogging and podcasting architecture, journaling, as you know, it's just got a whole lot more interesting. Easily create a personal journal with Mac Journal's simple to use interface with two level security. Password protection and AES 256 encryption.
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OK, our first listener. This comes from Jason in North Carolina.
And Jason says, "Dear, Dr. Mike. I recently stumbled across your podcast, and subscribed. And is very interested in your discussion of the one your old dental check up. I've been trying to get a handle on this issue. Do you think that a one year old will cooperate for the dentist? Do you think it is a good idea for a one year old child to visit the dentist or should they wait until they are older, say three years old? Thank".
Well, thanks for the question Jason. It's a good one. The official recommendation from the American Dental Association and the American Academy of Pediatrics, is that children should start seeing a dentist soon after their first tooth erupts. Now, unfortunately in most areas, this is simply not practical because there aren't enough dentist. Especially those who have an interest in seeing children to take on that kind of load. Really, I think that the main reason that this is an issue is because there aren't enough dentist, not because of cooperation. I mean, certainly there is a way to get a one year old mouths' to open so you can take a look in there.
If you live in an area that has dedicated Pediatric Dental Specialist, then I'd recommend that you call them and ask when they'd like to start seeing children. Also, talk to you pediatrician, because here she will know what resources are available in your area and at what age the local dentist likes to start seeing patients. I know, in my area, we do not have a surplus of Pediatric Dentist. There's sort of few and far between. So, we as pediatricians provide dental exams during the well child check and counsel parents on how to take care of their baby's teeth. If we find a problem or concern, then we refer kids to a local dentist who does see babies and toddlers.
Now, at age three, that's when I usually recommend that children begin to see a dentist every six months for cleaning and a thorough oral exam. Even if we don't see specific problems at that age. So, really I think Jason that you're sort of right on both accounts. I mean, in a perfect world, one year old should be seeing a dentist. But sometimes that's hard to do based on the availability of resources in your area.
I mean, you certainly want to see your pediatrician according to all of their regular well check up guidelines. And then, your doctor can take a look at the baby's teeth. And if they find a problem, can certainly refer them on to a dental specialist. So, aged three is, in most communities where there is not a lot of dentist who see children. They usually starting at about age three is when we like to send them.
There is also the issue of the new technique of painting fluoride on baby teeth. Many pediatricians are beginning to offer this service. If yours doesn't, and you're interested in having it done, just ask your doctor if they know of any dentist in your area who are providing this service.
OK, and moving on to listener number two. This is Carolyn, who is just a little bit south of Jason. Carolyn is in Charleston, South Carolina. And Carolyn says, "Love your show. I have a four year old with cystic fibrosis and a five month old without CF. Even though I am second time mom, I love hearing the baby basics that you teach and talk about".
"With our four year old, almost every healthy child ruled and apply. So, it feels like I'm learning the basics for the first time. It's so strange to have a big healthy baby. We love it. Our niece has celiac and I loved your segment about celiac disease. Please include a similar segment about cystic fibrosis in an upcoming episode. To raise awareness and maybe help parents with undiagnosed, kids with CF. Ours presented as fairer to thrive, so it was sort of hard to miss, you know, it wasn't hard to miss, sorry. But many kids have the lungs symptoms first and go until they're two to four years old with a misdiagnoses of asthma, allergies, recurrent colds, et cetera".
"Also, can you explain stork bites? How long they will stay freckles? I always thought you were born with them. When do they show up? Are genetics involved or is it all environmental? And eye color. When can you feel confident that blue will stay blue. Keep on casting. We just love listening to you. Caroline and Joey, also know as Peanut, who is four years old and Keagan, who is five months old".
OK, well let's take cystic fibrosis first. Cystic fibrosis is a genetic disorder. Basically, the defective genes is passed from the parent to the child. And it's an autosomal recessive disorder. What that means, is that the child must inherit a defective gene from each parent in order to have the disease. If they inherit the gene from only one parent, they're going to be a cystic fibrosis carrier. So, it takes two cystic fibrosis carriers. If they have a baby, then those are the ones who have a chance of having actual cystic fibrosis disease. In fact, if you remember those pun and squares from high school biology. Where you drew the little genetic squares. And had the capital, little letter. And you have to mix and match. And that's, if it's a recessive trait, then you have to have two of the little letters. Is that kind of vaguely ring a bell with some people out there?
So, if basically, if you have both parents that are CF or cystic fibrosis carriers, then there is a 25 % chance that their child will have the disease. There will be a 25% chance that they wouldn't even be a carrier. And 50% chance, that the baby will be a carrier of cystic fibrosis. It does affect all races and ethnic group. However, it is far more common in Caucasians, than any other ethnic group. One in every 20 Americans is an affected carrier. And most of these 12 million people have no idea that they are carrying a cystic fibrosis gene.
OK, so what is cystic fibrosis? Well, again, it's a genetic disease. And it causes the body to produce a thick sticky mucus. Instead of a thin slippery mucus, the mucus is thick and sticky. And this thick sticky mucus clogs the lungs, the pancreas and bile ducts. It can accumulate in the intestine and cause problems.
So, the kind of symptoms that you see are things that are going to result from having a thick sticky mucus. In the lungs, you're going to see a chronic cough and wheezing. Recurrent pneumonia, decreased oxygenation and carbon dioxide exchange. They're going to have problems exercising. They've developed an exercise intolerance because their lungs aren't working well at exchanging the gases. They could lead to collapsed lung with all of the mucus in there clogging things up. And then eventually it leads to permanent and life threatening lung damage. And this is really how it gets the name cystic fibrosis, because when you get an x-ray or look at one of these lungs after a patient dies. If they have cystic fibrosis, like on autopsy, you're going to see that there is a lot of little cyst and fibrosis or fibrous tissue in the lungs. Now the rest of the upper respiratory track is also involved. You can have chronic nasal congestion and recurring sinus infections.
Nasal polyps can result. The saliva can actually be thicker than usual and that can cause gagging, swallowing problems and feeding problems. Also, even the sweat is a little bit different. It has a higher chloride concentration in cystic fibrosis. And that causes the skin to have a really super salty taste to it. Sweat usually has a little bit of a salty taste. But, in cystic fibrosis, it's really salty. And that actually is how we, one of the ways you can diagnose cystic fibrosis. No, not by licking the skin and seeing how salty it is. But by measuring how much chloride is in the sweat. And we'll talk about that here in just a minute.
In the pancreas, the clogged ducts prevent release of digestive enzymes. So, you poor digestion and malabsorption. So, the nutrients in the intestinal tract aren't getting absorbed correctly for the body to use. And that can relate in very poor growth, fair to thrive, that sort of thing.
Also, because fats are not well digested because of this problem in the pancreas often times, stool can be really foul smelling and greasy. Because of the poor fat absorption. You can also have bowel obstruction from mucus material. And also just a general decrease ability for the intestine to sort of move things through. Because of all the mucus that is in there.
In little babies, you can have what's called, toxic mega colon, where they're not having a bowel movement for many, many days on end. And all that stuff accumulates and there is potential for life threatening perforation or a break in the intestinal wall, with all the intestinal material going into the abdominal cavity. You can have chronic diarrhea, abdominal swelling, rectal prolapse, where part of the rectum comes out through the anus. These are all things that can happen with cystic fibrosis.
Also, in the liver, the bile ducts can get clogged up with this think mucus and that can really or actually, that can cause jaundice. And there's the potential, even for liver failure in some cases.
OK. So how do you diagnose it. Well, more and more states do have a cystic fibrosis test as part of the new born screen. However, that test is not 100%. And also not all states do it. So, there is no, depending on your state, there is no guarantee that your child does get tested for cystic fibrosis. And also that test, if it comes back positive, you have to do a confirmatory test. To find out for sure. And also, just because that new born screen test is negative, if later on you suspect cystic fibrosis. There are better test that you can do. So, that's just a screening test that's done in the new born period in some states.
Sort of the definitive first test that most doctor will do if they suspect cystic fibrosis is a sweat chloride test. This is what we talked about before. Would there be an increase amount of chloride in the sweat, that makes it taste more salty. But with the sweat chloride test, basically, a special chemical is put on the skin that helps the child sweat.
An electrode in the collection device is able to collect sweat. And then it's analyzed for chloride. And it's a certain level or more, then you certainly suspect cystic fibrosis. You can also do a fecal fat test. Where you test the stool for how much fat is in the test. Again, 'cause there is all this malabsorption from the pancreas being clogged, and the digestive enzymes not being released. That they have increased fat in the stool and you can test for stool fat. If there is an excess amount than you suspect that cystic fibrosis is possible. For definitive diagnosis, there is a much more sophisticated blood DNA type test that can be done. Because we do know of specific DNA gene problems that you can detect in order to diagnose it.
OK, once you have the diagnosis of cystic fibrosis, what do you do? Well, referral to a Pediatric Pulmonologist who specializes in cystic fibrosis treatment is really the right way to go.
There's currently no cure for cystic fibrosis. There's many components of current treatment. And these treatment recommendations are constantly evolving as new research is done. And this is really the reason that you want to see someone who specializes in cystic fibrosis care. Because they're going more on the cutting edge of what kind of strategy is to use to provide a prolonged, as prolonged to the life span as possible. In general, antibiotics are used to treat and prevent lung infections. Bronchodilators are used to open up the airways and treat and prevent wheezing. Chest percussion therapy, we basically pound on their chest a couple of times a day. And you can do this with your hands. There's also machines that can be involved in doing it. But, that just helps to loosen the mucus and helps the mucus to come up. There is also mucus thinning medicines that can be used. Vitamin and digestive enzyme supplements. Since the pancreas is not working correctly and there is malabsorption, you are not getting many nutrients as you should.
So, we replaced vitamins and digestive enzymes in a supplement form. Caloric enhancement, especially for young children maybe necessary because of the malabsorption and decrease calories that the children are getting, and they're growing poorly. So, you want to maximize the amount of calories that they are getting. So, some adjustment in diet is important. Exercise promotes lung and heart strengthening. Which is an important thing. Of course, this is pretty obvious, second hand smoke avoidance is definitely required. Keeping yourself well hydrated, helps to loosen the mucus. Helps it will be a little bit thinner. Hand washing and excellent personal hygiene to prevent infection. And close observation to identify and deal with any potential complications that may arise. These are all important things in the treatment of cystic fibrosis.
Now, despite the best care, average life span, is currently about 37 years.
This is a big improvement compared to 20 to 30 years ago when patients where lucky to make it passed their mid 20's. And, of course, people who now, the current life span is about 37 years. But, if you have a young child with cystic fibrosis, by the time they reached their late 30's, hopefully, there will be more of a cure, genetic type cure or a more strategies that make the life span even longer that 37 years. So, there is definitely hope for the future.
Most cystic fibrosis patients continue to see their pediatric pulmonologist. And are treated in children's hospitals even into adulthood. For more information on cystic fibrosis, you can visit the cystic fibrosis foundation at cff.org, and of course there will be a link in the show notes. I didn't mention by the way in our " News Parents Can Use" segment, both of those news stories, are also will have links in the show notes to those stories as well. Sorry, I forgot to mention that.
Also, for cystic fibrosis information, there is the Boomer Esiason Foundation. Boomer Esiason was a quarterback in the NFL for the Cincinnati Bengals and a couple of other teams as well. But he had a child with cystic fibrosis. And he started the foundation to search for a cure for the disease. And you can find out more information, including a really nice reading list in book club at the Boomer Esiason Foundation which is at esiason.org. And, of course again, we'll have a link to that site in the show note as well.
OK. So, I hope I went into enough detail for you without going into detail that will sort of too science for you. But at least you have a little better understanding of what cystic fibrosis is, and how it's diagnose and treated. OK, let's move on to the other questions. These are pretty quick ones.
Stork bites, what are those? Well, they are hemangiomas on the back of the neck. Or the lower part of the scalp. You know, just right around the hair line. And basically this is where, sort of a mythology were the stork had the baby. The stork had him by the back of the neck flying around and these red marks on the back of the neck are called "stork bites". But what they really are, are hemangiomas, which is a collection of blood vessels just under the skin. They can really occur anywhere on the body. If they're on the forehead oftentimes, they're called angel kisses. Or they can be around the nose or the upper of the lip. But they can be rally anywhere in the body.
Now these collection of blood vessels usually gets darker and larger during the first year of life. So they seem to be growing and become more noticeable. But then from then from the time that the child is a year old through toddler hood and then to the early school years. they usually, gradually fade away. And by the time that their school age children, they're usually barely noticeable. Anything that increases skin blood flow, will increase your ability to see them, because they're made out of blood vessels. So you fill those blood vessels with more blood. And you're going to notice some a little bit more.
So, a fever, a warm bath. A lot of physical activity. Playing outside on a hot day. A real good meal. Sometimes, these are all things that can increase blood flow to the skin. And you're going to see a little bit more right after those things occur. Sometimes these hemangiomas can get too big and there can be problems associated with them when that happens. But that's unusual. And again, you just want to make sure you point those out to your pediatrician or your family doctor when you see him so that they can evaluate and give you good advise based on your specific child situation.
Again, for most kids these just get a little darker till they're about a year old. Then they gradually fade away. And that really nothing to worry about.
OK, what about freckles. Well, freckles are spots of increased skin pigment production. They're often genetic and related to a specific gene that is associated with increased melanin production. Which is a skin pigment. The same genes are also associated with blonde and red hair and fair complexions. So, a lot of times, those things go together. If you have someone with blonde or red hair. Or they're really fair completed. They're likely to have a lot of freckles. They can also be triggered by recurrent and significant sunlight exposure. So there are both genetic and environmental factors at play. Of course those interact, you could have two people who are exposed to the same amount of sunlight. One gets freckles, one doesn't. So, again, environment plays a role but there's also an underlying genetic role as well.
The most common on the face, shoulders, and arms. There rare in infants. They usually begin to show up in school aged children. And that's usually before puberty is when they're going to start.
OK, and then eye color. Boy, this is one I get asked a lot in the office. Basically, dark eyes, such as green, brown, hazel and gray in infants. In young infants, who are less than 6 months old. They're likely to stay that color even from birth. It's the late blue eyes that may change. As cells in the eyes begin to make pigments, as babies get a little bit older. So, they may have this real light blue color eyes. But, by the time they're a year old, the eyes starts to make more pigments. And so you start to see the green, brown, hazel or gray. If this happens, where they have the light blue and then it starts to get darker, then that usually happens between six and 12 month of age. So, if their eyes are still light blue at six months of age, they might stay that way, but there is still a chance that could change. But if it's there still light blue at one year of age, then it's a little bit more likely that they're going to stay that color.
But again, if you have a young infant with a darker color eyes. They're more likely to stay dark all along.
OK. Listener number three. Now this is an anonymous question from Oregon. And the writer says, "Dr. Mike. I love PediaCast and look forward to downloading it every week. I recently came across an article about circumcision reducing the risk of HIV infections in men by as much as 60%. I was just wondering what you thought of this. I do not have a child of my own yet, but I do have an uncircumcised stepson. My husband and I would rather not circumcised our child if and when we have a boy in the future. I know you have done a topic on circumcision in the past. But would like to hear your thoughts on this new development and if you feel this warrants having a child circumcised? Thank you for you insight".
Well, thanks of the question, Ms. Oregon. And, I would just want to say that this really specifically addresses a particular research studies. So this topic provides a nice segue into our research round up. So, I'm going to actually include the answer with our research segment. And we'll get to that right after this.
OK. Our research round up is brought to you in conjunction with research partner Devon Technologies. Creators of robust information retrieval software for the Macintosh platform. You can visit them online at devon-technologies.com. OK, up first in research round up. Male circumcision reduces the risk of HIV infection. Non-randomized epidemiological studies have suggest that uncircumcised men maybe exposed to a higher risk of infection with the HIV virus after sexual intercourse.
It has been suggested that circumcision may reduce the risk of infection by eliminating non-keratinized epithelium in the inner prepuce tissue and tissue with a high proportion of HIV target cells. The first randomized trial performed in sub Saharan, Africa, was terminated early after showing a 60% reduction in the rate of HIV infection in men after circumcisions. So, in other words, they were found there to be such a benefit to men who are circumcised at reducing the risk of HIV infection that they stopped the study and just said, "look, it's not right to recommend, there'll be a group of people who are studying that go uncircumcised because circumcision seems to offer such benefit.
Well, in the February 24th issue of "Lancet", Gray and colleagues from the Johns Hopkins University, Bloomberg School of Public Health, report the results of the second prospective randomized trial. Performed in sub Saharan, Africans to address this issue. So, they went ahead and did another study.
The cohort, consisted of 4,996 HIV negative men. Ages 15 to 49 years from the Rakai district in Uganda. All men underwent testing and counseling and were randomized to an immediate circumcision arm or a delayed circumcision arm, two years after enrollment. And there were about 2,500 men in each of these categories. One, that would get immediately circumcised. And one that they would delay for two years.
Circumcision was performed with a sleeve procedure. And all men using a dorsal penile block, so they did get anesthesia for circumcision. Patients were followed serially with re PA HIV testing. History and physical examinations for two years there after.
And the year before enrollment, approximately one third of participants, reported intercourse with two or more sexual partners. 28% of patients reported inconsistent condom use, and 14% no condom use. Remarkably, over 90% of the men in both arms of the study, completed the study at last follow up. Using an intentetry analysis, the incidence of HIV infection over a period of two years was 0.66 cases per 100 person years in the surgery group, so the group that had the circumcisions. And 1.33 cases per 100 person years in the control group. The efficacy of circumcision in preventing HIV was 55%. After adjusting for sociodemographic behavioral factors and symptoms of sexually transmitted diseases. This well conducted, prospective, randomized trial is the second to show that circumcision may have the risk of HIV infection as early as two years after surgery.
The authors conclude by recommending circumcision is a public health measure to reduce the incidence of HIV infection, which is now approaching 4,000,000 infections per year.
So, what are my thoughts on this. All right, well it appears according to recent well done clinical studies that circumcision does reduce the risk of HIV transmission. Now the question becomes, does that make it a medical reason to perform this surgical procedure? Of course, we know other options reduce the risk of HIV, including condom use, a monogamous sexual relationships, and abstinence. But of course these are also things that reduce the risk of hepatitis B and HPV infection, yeah, we do recommend immunization to prevent those things. But, then again, immunizations are different from surgical procedures.
So, if a reliable HIV vaccine were to be developed, which is being worked on, would we recommend that? Well, probably. But, do we recommend routine surgery to prevent this? I think these studies will sway some parent to pursue circumcision to otherwise when they've considered it. But, you know, do we make circumcision a universal recommendation based on this studies, probably not. Of course, time will tell, and so I haven't really said what is my opinion. I still don't, you know, my personal opinion is I still don't see a medical reason to perform a circumcision in American infants. I still think it's a personal decision based on cultural values. Because of teaching of proper care of the uncircumcised penis, proper ways to protect against sexually transmitted diseases, the illness is in question may still be adequately prevented in my opinion, which is what you asked for. You know, should in other cultures and countries, should circumcision be more routinely advised, you know, possibly it should.
OK. We are going to move on to our second research study. Does physical activity in preschool lower BMI. BMI is the Body Mass Index. This was published in 2006 in the "British Medical Journal". And it was a study that was conducted by researchers at the University of Glasgow with cooperation from the Glasgow City Council Education Department. So, if you introduce physical activity programs in preschools, will it help decrease the rate of childhood obesity? That's the question that these researchers and Glasgow, Scotland were asking. So, what did they do? Well, they took a 12 month study period. And they selected 36 preschools in Glasgow, Scotland. All together, there were 545 children in these schools. And the mean age of the children were 4.2 years. So, these are preschool kids in Scotland. 545 all of them together.
Each school was then allocated to either an intervention group or a control group. Now the control group, basically was business as a usual. No change. The intervention group instituted three 30 minute physical activity session each week. they also provided parental education literature that was handed out. And bulletin boards displayed, highlighting, I'm sorry, they had bulletin board displays that highlighted the importance of increased physical activity. And then the BMI or Body Mass Index was evaluated on all children at baseline, at six months and at 12 months into the study. They also looked at home physical activity and sedentary behavior for all the children in both the intervention group and the control group. And they also did motor skills assessment batteries on bot of the group as well.
So what did they find? Well, at the end of 12 months, the intervention group kids did show significant gains in motor skill. So, when they did the motor skill assessment batteries, the kids who were in the intervention group did better and thus the difference was statistically significant compared to the control group. However, there was no difference between the two groups with regard to the amount of home physical activity they engaged in and the amount of sedentary behaviors they exhibited in the home environment. Furthermore, there was no difference in BMI or Body Mass Indexes between the two groups at six months or at 12 months.
So, the authors conclude that preschool physical activity programs do not reduce BMI or Body Mass Indexes in children. Now I include this study really for no important reason. You can bet when these researchers went in to this, they thought that this was going to show that increased activity decreased BMI. But, not all study show the result that researchers expect.
But these studies are still important because they make us think about why the study failed to show the result that we expected. So, do scrap preschool physical activity programs based on this study? Of course not. What the study shows I think is a couple of things. First, IO think, probably parental handouts and bulletin board displays aren't enough to evoke the help of parents. I mean, the fact that there was not increased physical activity, and decreased sedentary behaviors, the kids in the intervention group, I think that tells us that the parents were really getting involved in this whole thing. And a simple hand out and bulletin board displays probably aren't enough. Parents can definitely increase preschoolers physical activity at home and decrease their sedentary behaviors. But this didn't happen. So, the next is, how do we get parents more involved with the physical activity of their children?
Second, I think it shows that activity is not the only component of BMI determination. What's another? Well of course, diet. And another is going to be genetic. You can't affect genetics easily, but you can affect diet. So, I think another study which we do a better job of listening parental involvement and which also implements a dietary regimen would likely show a reduction in BMI. Now, of course, I could be wrong. You know and that's where another study comes in. You know, the next hypothesis is designing a really good program to get parents involved, daily activity and also, a dietary regimen. I think that would decrease BMI. But, you know, I can say I think it will, will it? You know, that's where you have to do another study and see. And if I'm wrong, at least you have more knowledge to add to the scientific database of what works and what doesn't work.
All right, that wraps up our research round up this week. And we'll be back to wrap up the show, right after this break
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OK, "Mouse Matters", that is my weekly Disney column on "The Dis", which you can find at www.info.com. And this is something that I've been doing for almost a year now. And, we're up to about 20,000 readers per month. So, I'm really happy with it. And, I love doing it really, right up there along with PediaCast. I love both of these projects. And, I'm a really Disney buff, you know, we go to Disney World a lot. Never been to Disneyland, but we have a trip plan for there this fall. I'm really excited about that. But, there is this thing in sort of Disney culture, if ever you've been to Disney World, or Disneyland, or Hong Kong Disney, or Tokyo Disney, or Disneyland Paris. There is this thing that's called, sort of a magical moment. What's a magical moment? Well, people works at Disney are, they're not called employees,. they're called cast members. Because, you know Disney is putting on a show. And even with the theme parks, when you are out and about in the theme park, you're on the stage. So, the cast members aren't just employees. They're really actors and actresses. And they're cast members.
And the magical moment is just when, a cast member sort of goes out of their way to do something they don't have to do, it surprises you. And, you know, it's just basically being nice and providing a little extra magic when you didn't expect it to happen.
Now, one of the observations that I have made in the column a couple of weeks ago, I made a point that, recently, at least at Walt Disney World, a lot of the senior employees were let go soon after 9/11. Because of decrease in attendance. And so, with the decrease people who have been there a long time, and they are sort of indoctrinated into the Disney way. And with all of these new employees that are now being hired as attendance goes back up, a lot of these newer employees aren't, really, they look at themselves as employees and not as cast members. And there is not quite as much magic as there used to be. Now, when I wrote this column, I kind of expected to get some negative feedback with some of the readers. If they don't like what I say, they're quick to let me know.
But, I really expected to get some people arguing this. And actually, sort of to my surprise, a lot of readers emailed and said, "You know we agree. They're really is not as much magic as there used to be". And then I had a person or two email me with some examples recently of some magical moments that they had that were pretty special. And it got me thinking, you know, putting a book together, a sort of a "Chicken Soup for the Soul" kind of book called "101 Magical Moment", which will be a great idea. Now, most people, kind of keep their book ideas hush hush, 'cause they don't want someone stealing the idea. But, the reason that I'm sort of publicizing this is because, this isn't the kind of book that you could just write on your own. You need stories from people. And so I put out a call in my latest column for a 101 magical moments stories. So, people who have been to a Disney theme park or the Disney studio. And if you had a magical moment with the cast member, I just wanted people to write in their stories.
And, in less than a week, in fact, say Wednesday, in about four days, I already have nearly a quarter of what I need, which really just blows me away. I mean, I thought this will take months to get 101 stories emailed to me. And I got a nice variety of stories. But I need more, you know, I still need 75% of them. So, if you have been to a Disney theme park. And if you have experienced a magical moment, and, with a cast member. And if you are a [phone rings], see I'm doing this at home, there's the telephone. If… at least I'm not on call though, so I don't get, I don't have to stop what I'm doing here unless someone else answer. Got a little podcast thing. So, in any way, if you have experienced the magical moment. If you've experienced one, you'll probably don't need any further definition of what it is. Then, you can send your story to email@example.com.
Be sure to include, you know, give me all the details of the story and be sure to include your name, your email address, your home address and your phone number. So we can satisfy all the legal folks. So, if you want your submission considered for future publication. Now, I can't guarantee that this is going to get published. If it doesn't get a published in book form, then, I do think we can find an online home to store these 101 magical moments. So, something if, you know, just a call out there. If you are a Disney buff like myself. Or if you visited Disney theme park and you've experienced a magical moment, then if you'd help me out, that will be great. And again you can fine "Mouse Matters" over at www.info.com.
All right, next week, we're going to answer questions about night terrors, lead poisoning, and colic. And of course, we're going to have "News Parents Can Use" and our research round up next week as well.
OK, as usual, thanks go out to our news partner, Medical News Today. Our research partner, Devon Technologies. And this week sponsor Mariner Software. Again, you can find them at marinersoftware.com. they're the creators of Mac Journal, one of my favorite programs. Website and feed art work, are brought to you by Vlad Studio. S be sure to visit Vlad over at vladstudio.com. Of course, thanks go out to my loyal listeners by subscribing, listening and contributing to PediaCast. You are the ones who keep this project going. Last, but certainly not lest, thanks go out to my family. Karen, for taking over the blog and just being a great wife in general. Also, Cathy and Nicholas, thanks for the time, thanks for the love, and of course your never ending support. Feel like I'd seen, the like of Oscars or something here.
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So, until next week, this is Dr. Mike, saying stay safe, stay healthy, stay involved with your kids. So long every body.
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