Pediatricians, Hives, and Sleep Apnea – PediaCast 039

Listen Now (right-click to download)


  • Slimming Down for Summer
  • Pediatricians–Are They All Board-Certified?
  • Tracheomalacia
  • Hives
  • Obstructive Sleep Apnea
  • Miscellaneous Listener Comments
  • Iron Deficiency Anemia
  • Exemptions from School Vaccines



This episode of PediaCast is brought to you by Mariner Software


Announcer: Hello moms, dads, grand moms, grand pops, 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. It's episode 39 and as always we have a full show lined up for you today. I will start things off with our News Parents Can Use segment, and we're going to talk about how you can make it a slimmer summer for your kids.


Actually some of the advice that we discuss in that segment not only applies to children but to moms and dads as well. And I'm not talking from up the pedestal, saying that you have to make it a slimmer summer because I know full well that I need to make it a slimmer summer too, so we have to work together on that. Also on the news, pediatricians, are all of them board certified? I think you'll be surprised at what we uncover in that news story, and then we'll shift in to our listener question and comment part of the show. We have a question about tracheomalacia, now I know that's a big word, and I've always try to use the simplest words possible. I mean I might tell you what the scientific name is, but still use for the layman's term. But there are some illnesses that have no layman's terms and so you really have to use the scientific term because that's the only one available.


And tracheomalacia is one of those, there's not really a simple term for it, but we're going to discuss what it is because it is fairly common and you probably have seen a baby with it and you may not have known exactly what you call it so we'll discuss that. Also a question about a strange rash which ends up being urticaria. Okay there's the scientific name again. But here's a little quiz for you, how many of you out there know what urticaria is? I'm sure that you do if we use the regular layman's term for it and we'll save that for the listener question segment and then you can see if you were right about what urticaria is. And then we're going to discuss obstructive sleep apnea, now I'm sure everybody's heard of that, that's kind of a catch 22 diagnosis. It seems more and more people are being diagnose with obstructive sleep apnea, and is that because there's more of it or are we becoming more aware of it and then diagnosing it more?


And then what's its relationship with ADHD? we'll discuss that as well. And then we do have some miscellaneous comments that listeners have made recently, and we'll talk about that as well. I also want to mention here what we're talking about listener questions. As this show has grown we've been doing it for almost a year now, next month we'll hit our 1 year anniversary, and in the beginning it was really easy to get to everyone's questions, and I'm sure that some of you have written in with questions, and you may even be a little bit frustrated because we have not been able to answer all of the questions that are out there. I have to apologize for that, there's just aren't enough hours in a day to address everyone's questions because I just get so many of them anymore. And I try to pick good variety that represents all of the age groups, babies, toddlers, children and teenagers and tried to give a good mix in.


So if your question doesn't get answered right away, it's not because it wasn't a good question, it just may not fit in with the other things that we're talking about or to give us enough varieties. I guess that's one of the problems with growing into a larger podcast that you can't really get to everyone's questions, I really do apologize for that. Okay, after the listener's segment of course we'll move on to our research round up and this week we'll going to discuss iron deficiency anemia and how it relates to intelligence testing later on in life for babies who have iron deficiency anemia so that's kind of interesting. And then we'll talk about exemptions from school vaccines and what kind of sort of backlash that people who are exempt from school vaccines or who allow their children not to get vaccines but still get to stay to give them exemption to go to school anyway, what sort of issues and problems does that cause for everybody else.


So we'll discuss that, there's a new research study that sheds some light on that topic so we'll discuss it. Don't forget if there's a topic that you would like us to discuss even though I get inundated with questions, yours still maybe a really good one and fit right into the program so please even though I'm saying, Oh we have a lot of them, please still send in questions because it does allow us to have the largest amount of variety, there's no question about that. So in order to do it you just go to and click on the Contact Link. You can also email me at, you can send a text message to or regular email message or you can record an audio file if you want. I can handle pretty much any of the audio files you can throw at me, okay maybe not like the, what is that, vogg orbis or something like that. I know your audio files out there cringing.


But you know, mp3's, .wav files, .aiff files any of those are going to be fine and you can attach it to your email, or you can call our voice line at 34-7404-KIDS, that's 347-404-K-I-D-S or 5437 if you prefer the numbers. Okay, don't forget that the information presented in PediaCast is for general 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 be sure to call your doctor and arrange a face to face interview and hands on physical examination. Also your use of this audio program is subject to the pediacast terms of use agreement which you can find at So with all those things in minds, we'll get things started and we'll be back with News Parents Can Use right after this short break.



Okay in our News Parents Can Use segment it is brought to you in conjunction with news partner Medical News Today, the largest independent health and medical news website and you can visit them online at So seven ways for kids to have a slimmer summer, and grown-ups too. This might be the first generation of children who do not outlive their parents says Dr. Amy Bohn, a family physician for the University of Michigan, Health System, the reason? Well health problems related to childhood overweight and obesity, that's the reason.


The number of overweight or obese children in the U.S has tripled since the 1960's to approximately 15% and up to 70 or 80% of these children will continue to be obese as adults says Dr. Bohn who is an Assistant Professor in the Department of Family Medicine at the U of M Medical School. As a result, children are starting to develop what we've always thought of as being more adult illnesses such as type 2 diabetes, high blood pressure, heart disease, high cholesterol, and asthma. Fortunately parents can take action now to help prevent the early onset of these diseases, and Bohn says summer is an excellent time to make some healthy lifestyle changes that will benefit kids and the entire family. Now that the warm weather has arrived Bohn offers these tips to ensure that your child has a slimmer summer.


So these are seven ways to keep your kids trim this summer. Number one, limit screen time, there is a positive co-relation between the amount of time that children spend in front of the TV, computer or video games and obesity. So it's important to limit those types of activities to less than 2 hours a day advices Bohn. By reducing time spent on sedentary activities, parents free up more time for their children to play outside and be active. Number two, make activities fun; exercise shouldn't be chores especially for children, with warm weather outside kids can do a variety of activities that involve both fun and fitness. Parents should involve children in playful activities as oppose to just doing things like puzzles and games as says Bohn and she recommends jumping ropes, swimming, skateboarding, bike riding, those sort of things as alternative to inside play.


Team sports are also a great way to promote activities, so encourage your child to join a community team such as softball, soccer, or dance as summer is a great time to get in shape for fall try-outs at school as well. In number three, involve the whole family, take turns choosing fun things to do as a group such as going on a family bike ride, visiting a zoo, or even planting a garden. Kids are more likely to want to exercise and to enjoy it if they're doing it alongside mom and dad. In addition focusing on the family as a group helps prevent overweight children from feeling embarrassed or singled out. As a parent you don't want to be critical of your child because of the concerns we see with childhood obesity and lower self-esteem says Dr. Bohn, so it's important to discuss it in the framework of the whole family being healthy and active.


Number four, stack up on healthy snacks, what you have in your kitchen influences the food choices your children make both now and later in life. Avoid buying high fats, salty or sugary snack like chips and cookies and instead try fruits and vegetables such as apples, bananas and carrots which are fun to munch on and portable. Other good snacks include yoghurt, peanut butter and celery, and whole grain crackers and cheese. Sugary soda pop and fruit flavored drinks are big contributors to obesity, so provide healthier options like bottled water or milk. You can even involve your children in the grocery shopping says Bohn. Allowing your children to choose healthy snacks that they enjoy increases the likelihood that they will eat those snacks instead of less healthy alternatives. Number five, make plans, children are often left unsupervised in the summer which makes it harder to motivate them to be active and eat properly. Bohn recommends making set plans and scheduling in some fun activities, talk to your children before the day and plan things you can do together and then talk to them at the end of the day about what you've done and what you can do tomorrow. It takes time and planning, but if you have some structure, it really helps.


Six, model good behavior, children are more likely to make healthy choices when their parents set a good example. Show them that you enjoy eating healthy food and that they will be more willing to give it a chance. Encourage young children to bike alongside as you jog and invite older ones outside to play catch. Even small things like walking to the corner store instead of driving can encourage kids to get moving. The more active and healthy you are as a parent, the more active and healthy your child would want to be. Parents being good role models can help foster good habits in their children which really help the problem of childhood obesity. And number seven, keep it up, the habits that we develop over the summer time will persist into the fall and winter months particularly if there's continuity says Bohn. If parents help their children to establish these health routines then they are most likely will continue in the future, making health a priority, it's easy in the summer, and if parents continue to make it a priority in the fall and winter children will develop healthy habits for life.


Okay, and then up to 17% of pediatricians are not certified by the American Board of Pediatrics. How well do you know your child's pediatrician? Is he or she board certified in pediatrics or has he or she ever completed special retraining in the field? Findings from a new study may prompt parents to find out if their child's physician really is who he claims to be, a board certified and specialty trained pediatrician. Study published in the June issue of The Journal of Pediatrics found that as many as 17% of physicians in a single state who claim to be pediatricians on state licensure files have never been board certified as a pediatrician by the American Board of Pediatrics, and another 12% of physicians who report to be pediatricians did not complete a medical residency training program in pediatrics.


Residency training in pediatrics and board certification by the American Board of Pediatrics distinguish the physician as having the level of expertise and knowledge to provide the best possible care for your child says the study lead author, Dr. Gary L. Freed, he continues, our findings that up to 17 % of those reporting to be pediatricians in a given state are not board certified by the American Board of Pediatrics, that should encourage more parents to find out if their child's physician really has been board certified as a pediatrician and that he or she has maintained that certification status. Re-certification is equally important because medicine is constantly changing and it has a means to keep physicians up to date on the latest medical developments. So, why are some physicians able to claim to be pediatricians without the proper training and certification? Well, Freed says many state licensing boards allows physicians to self-declare their area of expertise without verifying the information.


To study the accuracy of such self-reporting systems, the study team gathered state licensure data for all active physicians in two randomly selected states in four regions of the U.S. The state selected were Ohio and Wisconsin, Texas and Mississippi, Massachusetts and Maryland and Oregon and Arizona. The state data was then matched with the American Board of Pediatrics listing of all pediatricians who have ever received board certification regardless of their medical training history. The proportion of unmatched physicians rage from 6.9% in Massachusetts to 16.8% in Maryland with the researchers finding on average 11% of physicians who claim to be pediatricians on the state licensure files not listed by the American Board of Pediatrics as ever having been board certified in Pediatrics.


The researchers then send a study to nearly 400 active physicians in all eight states who appear as pediatricians on state licensure files but have no certification record with the American Board of Pediatrics. Of the 255 physicians who responded to the survey, 61% said they had completed residency training in pediatrics. Nearly half reported they have some current board certification, and of these 53% say they were certified by a board other than the American Board of Pediatrics. Freed also notes that 12% of physicians who report to be pediatricians did not complete a pediatric residency training program. This is a reminder to parents that just because physicians claim to be pediatricians it doesn't necessarily mean that they are board certified by the American Board of Pediatrics or have ever been certified or even received the appropriate training to be designated as a specialist in the field of pediatric medicine warns Freed.


Parents have the right to have high expectations for the physicians they have entrusted with their child's care, they should feel empowered to ask physicians if they are board certified in their field of expertise he says. Parents can also go online to check a pediatrician's board certification status via the American Board of Pediatrics which is at, ABP for American Board of Pediatrics. So how do you find a pediatrician that's right for you and your child? Well parents often opt to have a pediatrician to provide care to their child, many will instead choose a family medicine practitioner to handle their child's and even the entire family's medical needs. Freed says physicians who specialize in family medicine are trained and very capable of caring for children. If a family however decides to have a pediatrician care for their child, Freed offers the following 6 tips to help guide parents in selecting a pediatrician. Number one, board certification and specialty training that demonstrate if the physician has the knowledge skill and expertise to offer the highest quality of care.


Number two, office hours, do they work for you and your family? Number three, ability to care for children with chronic diseases, is the pediatrician experience in caring for children with asthma, diabetes, those kind of things. Number four, association with a children's medical center, pediatricians who are associated with the children's hospital are able to easily refer patients for specialty care services such as rheumatology, cardiology, oncology, neurology those kind of things when needed. Number five, health care philosophy, does the pediatrician share your views? And number six, gender. As children grow from infants to adolescents they may fell less comfortable discussing their changing bodies with some of the opposite sex, so you may want to think about that as well. Now I do want to mention, in case any of you are wondering, I am board certified by the American Board of Pediatrics so you'll find me there. Alright back with listeners' right after this.



This week's episode of PediaCast is brought to you by Mariner Software, makers of Desktop Poet. Desktop Poet is fridge poetry software for the desktop of your PC or Macintosh. Desktop Poet presents you with your choice of hundreds of word tiles on the desktop which doubles as a virtual refrigerator door. You can compose imaginative pros by forming words into sentences or phrases or just take a break from the stresses of life, for your mind and doodle or brainstorm to your hearts' content.


It's poetry from the comfort of your PC or Mac. So put down the pen and paper because this is your poetry process for the 21'st century. Desktop poet takes advantage of the fact that it is on a computer to both increase the available vocabulary and decrease the number of tiles. The poetry software does this by allowing a single tile to have more than one word on it. Highlight the word, click escape and see the variations of that word available to use, want to define a word? Press the control key, select define word and you'll be taken to that specific listing at And kids also love Desktop Poet. Are you tired of shoot-them-up games that aren't necessarily suitable for your children? Well desktop poet help younger kids grasps simple word structure while the older ones can showcase their creative flare. Whether the classroom or at home, kids play with language and then the process learn. See for yourself why educators find Desktop Poet a truly educational and unique tool. And you can find Desktop Poet and other great software from this week's sponsor, Mariner software at


All right,. on to our very first listener question here. This comes from Ylan, he says "Hello. I just started listening to your podcast and I love it. Thank you for the valuable information. I have a 4 month old son who is recently diagnosed with tracheomalacia. He sounds wheezy and congested, however he doesn't seem to be bothered by it. He is a happy baby and he's thriving, my pediatrician wasn't too concerned and said he will outgrow it when he is around 12 months old. Is this a common problem among infants? Thank you, Ylan".

All right, so let's talk about a little bit of tracheomalacia. You've probably been around baby at some point or another who makes a lot of noise when they breath in, so you'll hear (gasping sound) you just hear this, we call it strider, and it is a noise when babies are breathing in kind of a high pitch squeaky noise, sounds kind of like wheeze, although to the trained ear it's a little bit different than a wheeze, we called it strider.


Now what causes this? Remember the trachea, connects the nose and mouth down to the lungs and it's composed of rings of cartilage, and basically tracheomalacia results when this rings of cartilage are kind of soft so when the child breathes in the trachea kind of collapses in on itself. I think the easiest way to think of this is think about sucking a thick milk shake through a straw, sometimes, especially when you suck too hard the straw sort of collapses in on itself and that's basically what's happening to the trachea of babies who have tracheomalacia. It's less pronounce when the infant is quiet and comfortable just like that milk shake, it's easier to drink to the straw if you do some light sips or not sips but like sucks rather than really trying to get it through the straw.


It's definitely more severe when the baby is crying or breathing heavily. I wouldn't say that tracheomalacia is incredibly common, although we do see it fairly often, but it's not really rare either. I don't have specific numbers on how often it occurs, but it is something that we see in the office, I do see a baby with it, kind of at least one or two in the practice at any given time, so that one can outgrows it, another one's coming in with it, so I mean we do see it in a fair amount. Kids usually outgrow it by 18 to 24 months of age and the reason for that is that the cartilage stiffens and also the inner diameter of the airways increasing in size, so it's kind of like using a larger straw with the wider opening it's not going to be likely to collapse on itself and also if you use thicker or stiffer straw so that cartilage stiffens it's going to work a little bit better and not want to collapse on itself.


Now, severe cases are rare but they can lead to airway obstruction and so kids with very severe cases, it's a good idea to have an apnea monitor and CPR training is also useful in these cases and really rarely, rarely kid can have it so bad that they need a tracheostomy tube to maintain the airways, they have a trachea in the airway. But most cases are mild and it's simply a waiting game for it to resolve on itself, so most kids with this do not need an apnea monitor, parents would never have to perform CPR, they don't need tracheostomy tube but some cases of it can need those things. Now this is again something you diagnose at home, you have to see your doctors because there's a lot of things in the differential diagnosis, some of which that can may be serious inflammation in the airways, things like croup, tracheitis, epiglottitis, these are all things that can sort of mimic tracheomalacia.


Although usually there's more of a sudden onset and often fevers associated with those kind of things. A foreign body in the airway also is more sudden onset and that would also, you think about it more if there was the history of the age of the child or such that they may be putting something on their mouth, so if you think about a foreign body then you're going to rule that out. Structural abnormalities inside the airway can cause similar things like vocal cord paralysis, tracheal stenosis which is a genetically obtained narrowing of the trachea, hemangiomas or benign tumors of blood vessels that can impinge on the inner airways space, and then also external compression can be a problem too, there are some abnormal placement of blood vessels called a vascular ring which can push on the trachea and that could cause the similar sort of issue or tumor could do it as well.


So again there are some very serious things that could cause persistent stridor in a baby, so this is definitely something that you want to have your doctor look at because there are some things they may want to do to rule out these other possibilities. Now can you go see your doctor and they feel comfortable that it is tracheomalacia without doing special test? Sure, that's possible in some cases, it really depends on your doctor's comfort level, how often they see this, other signs and symptoms are presenting, what the family history is and all of these things, you have to take all of it into accounts, so you definitely want to see your doctor to diagnose tracheomalacia. But again most cases are mild and it's simply a waiting game, although the waiting game may last a couple of years. So you said being a parent is easy.


Okay listener question number 2. This comes from Jennifer in San Diego, and Jennifer says, " Dr. Mike, my 13 month old son recently woke up at 6:30 a.m. and when I went to change his diaper it looked like he had the chicken pox starting on the back of his legs. He wasn't complaining about it yet and everything was otherwise normal. I put a message in with his Doc, and while waiting for her to call back, my son's face started to turn red, then red blotches started up his chest wall and stomach and his ears were swelling. As each rash formed, well it looked like blisters started forming over the rash. That all happened so fast we didn't know what's going on so I called the doctor's office one more time to see if I could get through to her, and when I couldn't my husband and I headed straight out the door to the office down the street with my son. After much aggravation and being made the way over two and a half hours with the screaming baby having itching spells, the doctor finally came out to see us and told us he was having an allergic reaction to something he may have ingested. I had no idea these were hives, oops there's an urticaria word, hives".


"The doctor had to inject my son with the steroid and Benadryl to reverse the reaction immediately since his face was unrecognizable and he was covered from head to toe with very bad hives. Everything went away and he fell asleep for about the next 5 hours and when he awoke we gave him the 2nd dose of steroid and Benadryl for that day. Almost as soon as we did he started breaking out on the hives all over again, I waited 45 minutes to give the medications sometime to work before taking him to the E.R where they injected another steroid to reverse the reaction. Sorry for this being so long but my question is, how many times can one allergic reaction re-surface? we have an idea is to what he's allergic to, but we're not a 100% sure. Our referral was put in with an allergist but it may take a few weeks to get an appointment with him, any information you can shed on this would be appreciated. I just listened to your podcast on peanut allergies but I still have some questions in the meantime before meeting with an allergist. Thank you so much and keep up the awesome job you're doing with the podcast, sincerely, Jennifer".


Okay, well Jennifer you definitely had a big experience with urticaria or hives and basically what this is, is the immune system is hyper responding to something and that something could be a medication it could be a food, could be a virus, it could be an insect sting, could be something that the skin has come into contact with, I mean there's a lot of different things that could be. But basically the body sees whatever it is as foreign and it revs up the immune system to fight it and in doing so the immune system causes the internal release of some kind of chemicals including histamines and then this is what causes the reaction that you see. The acute treatment for hives when it's really bad like this is antihistamines to block the effect of the histamines that the body has released, also steroids because that calms down the immune system and then in severe cases which we call anaphylaxis, then we use epinephrine, and there's variety of ways you can give that if it's mostly airway related, you can give breathing treatment with epinephrine, you could also inject it under the skin or give it through an I.V.


So there's different ways that you can give it. But severe episodes of anaphylaxis are really serious allergic reaction can be life threatening especially if there's swelling in the airways, so you definitely want to seek medical attention right away just like you did. It's important to figure out again what the offending agent is so you could avoid it and the allergist will help you there with probably with skin and blood testing. You definitely want to keep antihistamines around in case it happens again so you have some Benadryl to give him, but also, wouldn't be a bad idea to have an EpiPen around as well and they do make those in the strength for babies who have severe reactions like this, so in an emergency situation where the E.R is a half hour away and that your baby is turning blue in the face, having an EpiPen on hand may help to save their life if they have anaphylactic reaction to something. And don't be afraid to head to the emergency room if you're at all worried.


You know, just because your insurance may have a clause in there that you're not allowed to go to the E.R unless your doctor tells you to, you always still have to make the best judgment on what's right for your kids and what's going to be the safest thing. I mean if your child faces swollen and you're worried, you got to get to the E.R and certainly don't wait in the waiting room 2 1/2 hours of your doctor, you got to be this quick you will, you got to go to the window and say, get me back now, you know my baby's in trouble, you definitely want to do that and don't worry about what people think of you because your baby's' life is important.

Listener number three, this comes from Stephanie in Maryland. She says, "Hello, Dr. Mike. Thanks for a great show, I just started listening about a month ago, I've heard you asking for older kid questions and I have one for you. Can you discuss sleep behavior issues on toddlers versus possible sleep apnea and is there a connection? I have a 4 year old and 2 year old, my 4 year old has always come to sleep without a problem but for about 2 months getting her to sleep has become an issue. She'll eventually go to sleep but will only sleep with the light on and at some point during the night will get up for no reason".


"She has told us, she is afraid of her room and we've told her there is nothing to be afraid of and all the shadows are from stuff in her room. She does have a tendency to snore. I know toddlers go through various stages, she's done them all but a friend of mine told me that her daughter who is the same age was diagnose with sleep apnea and was doing all the things my daughter does, we're in a process of making a doctor appointment for her, good idea, but I was wondering if you have ever heard of sleep apnea causing this issues in kids".

All right, well of course it's important to make an appointment with your doctor, you know how I feel about that, but let's use this opportunity to talk a little bit about obstructive sleep apnea. It's certainly is a common problem, I'd actually occurs in about 2% of all children, so what is it? Well obstructive sleep apnea is episodes of partial or complete upper airway obstruction which is what that leads to apnea which is when you stop breathing for short period of time.


And because there's this partial or complete upper airway obstruction, this results in gas exchange abnormalities, so you know what are the lungs for it's to get oxygen into the body and to get carbon dioxide out of the body. Well if you are not moving air in and out of the lungs, then you are going to have a problem with gas exchange, and then that's going to cause the oxygen level of the blood to drop and the carbon dioxide level in the body to rise. And this may disrupt sleep patterns when this happens. Now, obviously if this happens to the point of way too low, then you're heart is going to stop beating and you're going to die. I don't want to be that blunt about it, but in most cases with obstructive sleep apnea, in fact the vast, vast, vast majority of cases, it's intermittent, it's very brief in, the oxygen does not drop nearly to the point of any kind of danger level. It's just enough to wake you up.


Then, it may not even wake you up to the point where you're wide awake, the person who is suffering from obstructive sleep apnea may not even know that they're really waking up during the night over and over. But their body's just not able to get into a deep sleep pattern because of this partial intermittent upper airway obstruction and so that's what happens. Now let's compare that to just plain old snoring. In plain old snoring there's no apnea so you never have obstruction to the point where you briefly stop breathing, there's no gas exchange abnormalities and there's no sleep disturbance, well, at least for the person who's doing the snoring, everybody in the house asleep maybe disturbed but that's what your plugs are for. There's no sleep disturbance for the person who is snoring.


See now this is the crazy world we live in. I feel like I have to stop and say don't use your plugs like if there's infants because they could choke on them. It's kind of like, when you read the package, please open before eating. What are the symptoms then if someone who has obstructive sleep apnea? Well of course you are going to hear some snoring more than likely, but they're going to have a restless sleep, they may have day time drowsiness because they're not getting enough of the deep states of sleep during the night. Also attention problems and they can mimic ADHD and that's just from lack of uninterrupted deep sleep. So some of these kids who we think have ADHD if you correct their obstructive sleep apnea, a lot of them will do a little bit better in school. Now I will have to say how many kids have I seen in my practice who had their tonsils taken out for obstructive sleep apnea and then their ADHD went completely away, not very many.


It may help a little bit, and there may be a small subset of kids who have obstructive sleep apnea as the only cause of ADHD, but for most kids that's more complicated than that. So how do you diagnose it? Well best way to diagnose it is with what we call a sleep study where you go to the hospital or a sleep lab and they basically put EKG machine attach to you and oxygen censors or oxygen saturation probe or monitor. It's not invasive, it just hooks on to your finger, they also will monitor your respirations to see if you have apnea or not and basically they keep a record, they watch you sleep and when you're snoring or when you're restless they see, hey. does your oxygen drop a little bit? Is your heart rate affected? So they can tell if you have gas exchange abnormalities, apnea and sleep disturbances so they can diagnose it as obstructive sleep apnea.


If you do have obstructive sleep apnea, then the first line of treatment right now for kids typically is going to be to have your tonsils adenoids taken out. And that is not a benign procedure, there's definitely risk for complications and problems when you have that done so that's why sleep study is probably good idea to diagnose it because if it's just snoring and not true obstructive sleep apnea, you don't want to put someone through a potentially hazardous surgical procedure if they're just snoring and that's it, I do think a sleep study is an important thing. Something else that can be done, this is more on the adult population and it is currently used in pediatrics, but that's a Nasal CPAP, where special nasal mask provides continuous positive airway pressure, so basically they blow air up your nose the whole time you're sleeping in order to keep everything open up. If obesity is an issue, sometimes losing weight by itself can also decrease symptoms of obstructive sleep apnea.


But if your child is snoring a lot or is restless at night or has attention problems during the day and you're concern they might have obstructive sleep apnea what do you suppose to do? We'll all say it together, go see your doctor.

Finally we have a few quick comments that I wanted to go through. This one comes from Melissa in the state of Washington. She says, "Dr. Mike I've just found pediacast not too long ago, I was listening to past episode and have to tell you thank you. I have two girls, 3 months and almost 5 years. My 5 year old has been having problems going to bed and it's gotten worse since the baby arrived. One of your past episodes had you talking about the chart you made for your daughter and the poly pockets she could earn for staying in bed, I took that idea and as Emma loves baseball turned it into a baseball game. We now play 3 strikes and you're out every night. She gets 1 strike for using the bathroom and 1 other gets her, I'm sorry, and if she gets out of bed she gets another strike. If she has the 2 strikes or fewer in the morning then she earn a sticker.


We did just as you suggested and gave her reward the first night and again earning 3 stickers. She's on now to 5 sticker, the 5 sticker prize and it's working great. My only trouble is the night she was out of bed 4 times, she knew she'd already missed her chance for a sticker and we could see her getting out of bed over and over that night. So my husband did some quick thinking instead if you get to 4 strikes you owe us a quarter for each strike". I love that idea, that is great, "so thank you", and that again came from Melissa in the state of Washington. The next one, "Hi there. Are the sleep strategies you suggested for the 18 month old in episode number 26 appropriate for my 10 1/2 month old with similar night time sleep issues. Thanks, Laura and little Selma. P.S. I am very grateful for you, for your expertise, enthusiasm, humor and dedication. My husband and I are raising our first child without family or friends close at hand as we have recently moved from California to a small town in the center of an extinct volcano in Panama".


Laura I hope you don't mind I said that, I hope you're not hiding out in the extinct volcano in Panama. I continue to be amazed though by the reach of this program. Yes the answer is yes, our discussion about sleep time issues and how to get kids to sleep to the night and how to get them to fall asleep on their own would apply to a four month old as well as in 18 month old. Generally I think you can start doing that kind of thing where you let them sleep or let them cry for longer and longer intervals during the night until they can soothe themselves. Usually you can start that between probably six to nine months of age somewhere around there. So I would encourage anyone who wants to know more information about that to tune in to episode number 26, again, because that's where you'll find all of the information.


This next one comes from the poop post at PediaScribe, and those of you who've listened for a while know that I talk about this from time to time. But the number one reason or the number one way that people find PediaCast in the blog or PediaScribe is by doing like a Google search with the word poop in it. And I usually don't include comments on the show from the blog but I could not resist including this one. This one comes from Dad EO, and he mentioned on the blog, "have you seen the Wikipoopia, not no, I didn't mean to say Wikipedia it's Wikipoopia", well I hadn't seen it so I checked it out, and let me tell you it is really funny, you've got to see it if you're at all interested in baby poop. If you have baby poop in your house, you've got to check this out, it's really funny.


It's at a site that's called, and it's this 2 guys that do a video podcast and they have some other things available at their site that's really funny. It is basically there's different kind of baby poop out there and they do their best to recreate all of the various types and since it's a video podcast, it's a little graphic. But like I said I think I was crying, I was laughing so hard at one point, it's really funny you have to check it out. And of course we'll put a link to that in the Show Notes.

That wraps up our listeners segment this week, don't forget if you have a question you'd like us to address just go to and click on the Contact Link you could also use the phone line or you can email, and you can email us with a text or attach an audio file to it which we've discussed before. We'll return with Research Round Up next.



Moving along to our Research Round Up, it is brought to you in conjunction with research partner Devon-Technologies creators of robust information retrieval software for the Macintosh platform and you can visit them online at


First up on the research segment, iron and cognition profound impact of a simple intervention, what's this all about? Investigators at the University of Michigan, Oakland University, which is also in Michigan, Hospital Nacional de Niños in San Jose, Costa Rica also participated, and this study was published in the Archives of Pediatric Adolescent Medicine. I really don't have anything against Michigan, it's just we're getting close to football season here, few months away and so I'm just gearing up for that I guess but they have a great medical school there and a great medical center and I do get a lot of information from them so I got to give credits where credits due. So the question before these researchers a previous studies had shown iron deficiency anemia during infancy and that decreases I.Q points later in life and in fact what research in the past has suggested is that there's a loss of 1.7 I.Q. points per 1 point drop in hemoglobin and basically researchers wanted to verify this finding with the more long term study.


In other words, to see does infant anemia cause decrease intelligence later in life by examining the same kids, so you've got to follow them for many, many years to see if there's a difference. Now, just some definitions here before we get started, anemia is basically in its simplest form decrease red blood cells or decrease red blood cell's ability to move oxygen around the body, so you have a decrease capacity for carrying oxygen, usually that's because of decreased red blood cells. And then the specific material that's in a red blood cell that helps to carry oxygen is hemoglobin, so by measuring hemoglobin you measure how many red blood cells there are, and you make the jump to whether there's anemia or not anemia.


Iron is important for the formation of red blood cells, so if you're iron deficient, your body can't make as many red blood cells and so you're going to have less of them and you're going to be anemic and less able to carry oxygen around the body. Okay, so what these researchers do? Well they evaluated long term follow up data on a total of 185 individuals from a middle and lower class urban community in Costa Rica, and all the babies were products of full term pregnancies, there were no premature babies in the study. And they were also free from acute or chronic medical problems that are significant, so you can't say whether intelligence may have taken a hit because of a chronic illness or because of recurrent acute infections. So these are all healthy kids basically and they were all started in the studies somewhere between 12 and 23 months of age.


And then, during the time that they started in the studies, so sometime between 12 and 23 months of age their iron status was determined by measuring blood hemoglobin as well as 3 other sort of fancy tests that look at how much iron you have in the body and can help you diagnose iron deficiency anemia. So based on this blood measurements, the children were divided into 2 groups, those with iron deficiency anemia and those with no evidence of iron deficiency anemia. Then those who had anemia from iron deficiency were treated with an iron supplement and the anemia resolved in all the children within 3 months of treatment. But we don't know is how long they've been anemic before they were seen in the study. Then researchers performed four follow up examination of these kids at ages five somewhere between 11 and 14, some were between 15 and 18 and then when they were 19 years old, so all of them were studied at each of those times and 78% of the initial kids were still available for the study at the 15, 18 and 19 year old follow up.


And then what they did to each of these follow ups, age 5, 11 to 14, 15 to 18 and then again at 19 years of age, psychologists performed some intelligence testing on them and the psychologists were blinded as to the infants or as to the persons' anemia status when they were an infant. So the psychologists did not know if any individual was which group they were in. The ones who had anemia or the ones who didn't have anemia, and they performed a several intelligence testing on them and what did they find? Well the difference between the two groups, those with iron deficiency anemia and those with a good iron status during infancy, the difference between the 2 groups average 8 to 9 I.Q points at each follow up, and there was no evidence of intelligent catch up during childhood. So their conclusion is that adequate iron intake and early screening for iron deficiency anemia during infancy is important to maximize intelligence later in life.


Research number two in our Research Round Up, exemptions to school immunization laws. This comes from Johns Hopkins Bloomberg School of Public Health, the University of Florida and Duke University and was published in the Journal of the American Medical Association. As school immunization requirements have played a major role in controlling vaccine preventable diseases in the United States, most states offer non-medical exemptions to school requirements, and some states only allows exemptions for religious reasons while other states expand a lot exemptions to include refusal to non-religious personal beliefs. There's also difference among states and how easily parents can obtain these exemptions since those who exempt have an increased risk of acquiring and transmitting disease.


The role of exemption policies may be important for otherwise vaccine preventable diseases. The researchers decided to look at differences in pertussis rates amongst states since this is a vaccine preventable disease that is currently endemic in the United States. So their objective was to determine one, if the ray of non-medical exemptions differ and have been increasing in states that offer only religious versus religious plus personal belief exemptions. Number two, if rates of non-medical exemptions differ and have been increasing in states that have easy versus medium or difficult processes for obtaining exemptions, and three, if pertussis incidence is associated with policies of granting personal belief exemptions, ease of obtaining exemptions and acceptance of parental signature as sufficient proof of compliance with school immunization requirements. So in other words, in the states that allow personal beliefs exemptions and make it easy to get, do those state have a higher incidents of pertussis?.


It's a good question, they analyze data from 1991 through 2004 as to the rates of non-medical exemptions at school entry and the incidence of pertussis for individuals aged 18 and younger. So what did they find? Well from 2001 to 2004, states that permitted personal belief exemptions had higher exemption rates than states offering only religious exemptions, so if people could do what they did, states that easily granted exemptions also had higher exemption rates compared with states with medium and difficult exemption processes, so if the state made it easy, parents did it.


Okay well here's where it gets interesting, pertussis incidence in states allowing personal belief exemptions was more than twice higher than in states that only offered religious exemptions. States with easy procedures for granting exemptions were associated with a 90% higher incidence of pertussis within the state, and states with a medium difficulty for granting exemptions were associated with the 27% higher incidence of pertussis compared to states with difficult procedures to obtain the exemptions. So the author conclude that permitting personal belief exemptions and easily granting those exemptions are associated with higher and increasing exemption rates and furthermore, state policies granting personal belief exemptions and states that easily grant those exemptions are associated with increased pertussis incidents, which is whooping cough. So the author urges states to examine their exemption policies to ensure control of pertussis and other vaccine preventable diseases.


This is one of those things where parents can make a difference because the state policies, you have to remember this is all decided at state level which would be your state legislature which is composed of a body of individuals that you elect. It's important to know how they're voting and what they're doing and what's going on in your state legislature. Now why is this important? Why should the government be involved at mandating immunizations? Well, here's another one of the issues, immunity to vaccines is not 100%. One of the ways the vaccines work is of course by making it so that you're immune within your own body to disease X, Y or Z. But another way to immunizations work is by relying on something called herd immunity, and what herd immunity is all about, I think we did discuss this way back in the early days of PediaCast, but let me mention it again, let's say that the immunization doesn't work for your child, they got the immunization but it just didn't take, they're in that small percent of kids that just didn't work for them.


Well they're still being protected by immunizations because if all the kids that they're playing with, are going to school with got immunizations and those immunizations did work, then they're not going to transmit the disease to your child who may still be able to get the disease because they're protected against it. Having a lot of kids around who are protected against a certain disease by a vaccine will also help the kids who got vaccinated, but the vaccine didn't take for them. We all have, there's definitely a benefit to every one getting immunizations because it helps protect everyone even if the immunization doesn't take in a specific individual. Now the anti-immunization helms that are out there, they squeak plenty loud. But for those of us who value vaccines have done for the public health of America, we should be squeaking too because when they're taken away, bad things can happen. All right that concludes our research round up, we'll be back.



All right, once again the information presented in every episode of PediaCast is for general 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. Your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at PediaCast is licensed under an attribution, non-commercial, no derivative works, creative comments license. For more information on this copyright license please visit and click on the creative comments link at the bottom of the page, if you're interested in using PediaCast material for a commercial project please email for details.


Okay, I have a confession to make, this is the first week I've tried this but, the episodes here lately, especially last week have just been way too long and I tend to ramble if given the opportunity, so I basically made a soundtrack that's exactly 1 hour long, and all of our breaks have been hard plugged in and so I've got a little countdown clock. Now I know one of the advantages of podcast is you can just talk on and on but sometimes I need some discipline in my life, so basically I think it's gone pretty well, there have been some delays between me ending and the interludes starting. But you just have to deal with that because I'm not really a professional yet, but we're working on it.


The breaks have been hard plugged in and actually the end of the program is hard plugged in too, so when the outro music starts, I've got to run, but I feel like I'm on like CNN or FOX news, like hey we're going to be coming up on a hard break here. All right I want to remind you that PediaScribe, the blog, Karen's PediaScribe blog, the blogging arm of PediaCast which is more on parenting and information you can use at home rather than medical, but it's a great compliment to the program and of course supporting my lovely wife is always nice. So anyway this is your last week to enter the contest. Each new comment that you make on the PediaScribe blog, enters you once into the contest. PediaScribe reviews on your site, enters you twice and PediaScribe reviews enter you twice and PediaCast reviews enter you three times and make sure you email us the links to your reviews so we can give you credit.


And then all these entries will be put into a hopper and we'll count them through the end of June 15th and then during the taping of our next episode we will draw a lucky winner to win a 20$ Amazon gift certificate and that winner will be selected at random. So make sure you go to, there's more information on that contest available for you there. By the way my wife, did have some interesting post last week, "My Husband Is a Stalker", is one that you probably should check out, kind of funny. Other titles, "Pediatric Pack Rats", "Poop Juice Review", "10 Minutes Chores", "Nickism For The Old Ages", "The Biggest Bang And A Photo Hunt Of Shoes", that's all in the PediaScribe blog, so I encourage you to check it out. Of course thanks go out to news partner, Medical News Today, research partner, Devon-Technologies and this weeks' sponsor, Mariner Software which you can find at


Website and feed artwork were brought to you by Vladstudio. So be sure to check out their website, thank of course to loyal listeners and my family. And reminder is where you go to click on the contact link to get your information or your topic I should say on the show. All right, be sure to tell your friends, family, co-workers and neighbor 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, there's our automatic music, and stay involve with your kids. So long everybody.

Leave a Reply

Your email address will not be published. Required fields are marked *