Over-The-Counter Medication – PediaCast 041

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  • What Parents Should Know About Over-The-Counter Medication
  • Roller Shoes
  • Pacifier Advice
  • Teaching in the Digital Age
  • Thinking Inside the Box!



Announcer: Episode of PediaCast is brought to you buy Mariner Software.


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

Dr. Mike Patrick: Hello, everyone, and welcome to PediaCast, the 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 41, thinking inside the box. And we do have the full show lined up for you today. Although it's going to be a little bit different than what you're used to, don't worry, we'll get to our regular format again next week.


We are going to start things off with a News Parents Can Use segment. We're going to discuss the safe use of over-the-counter medications, roller shoes, some new pacifier advice that's out there and then teaching on a digital age. So that's all coming up in the news section of the program and then we'll move on to our listeners and research segments. We're going to sort of combine them together and have a little bit of discussion on medical decision-making and how doctors sort of come up with the advice that we give and how medications are sort of developed, so to speak. How we – not just medications, really, how we like to practice medicines. How we figure out what new things are out there and what advice to give and that. So anyway, it will be an interesting discussion, I hope. That's the plan. Anyway, I guess you guys will be the ultimate judge on that. And then of course next week, we'll get back to answering your questions like we usually do and presenting a couple of new research reports.


So don't tune now just because it's going to be different. Give it a chance because I think you'll find the information that I put together on the interesting side again, at least, I hope so. Don't forget, if you have a topic that you would like us to discuss, all you have to do is go to the website which, of course, is pediacast.org and click on the Contact Link and from there you'll be able to submit your questions and comments, concerns, advice, all those sorts of things.

You can also email me at pediacast@gmail.com. You can type out a text email or you can attach an audio file to your email if you are a audio-file-type person. Also, you can call the Skype line at (347) 404-KIDS, (347) 404-KIDS or 5437 and that would be fine too.

You know, I do want to – before we get into the bulk of the program here, I want to give a shout-out to a Carrie from the Babytime podcast. We had a very lengthy discussion which was wonderful. I wouldn't really call it an interview, it really was more of a discussion on pediatric topics for her show. And it's not just her show. She does that with her husband Dan, but he was a little preoccupied during our time together.


Their baby, baby Jack, was having some difficulty getting to sleep and Dan was dealing with that so Carrie and I did the discussion. And you can hear that over at the Babytime show. They're wonderful parents, wonderful people, we had a great time and you can find their show at babytimeshow.com and of course, we'll have a link to their site in the Show Notes.

Also, this past week, we kicked off the parent report. Now if you're not subscribed to the Newsletter, again you can go to pediacast.org and click on the newsletter link and you can sign up for it that way. It's not really a traditional newsletter, it's really a collection of hand-picked links that I came up with. Just sort of things – gosh, it's almost like a tumble log or you know something where I'm just putting down the things that I'm looking at through the day that I find interesting as I come across them and then putting those together into the parent report.


So it's a collection of links, sort of in the tradition of the Drudge Report, if you're familiar with that. It's really just a collection of links that I have found to be interesting and current. So if you're interested in seeing that and it's easy to get to again pediacast.org, click on the Newsletter link and subscribe. And you can always unsubscribe, you know, if you don't like it.

Also – see, all these new things. I stopped writing my weekly column and suddenly I have time to get some extra things done. The pediacast shop is now up and running. Of course, just go to pediacast.org. Look in the sidebar and you'll see a link. I did not go with Cafe Press, it's – let's say a t-shirt and other peril-type place called Printfection.


And I went with them because they had a huge collection of apparel, both in terms of different styles and different colors. Just really like their products and they have a great reviews in terms of product quality and customer service. Now, the downside to that is they are a little bit more expensive. So the baseline price of the PediaCast Merchandise is going to be a little bit higher than what you would find. Some of the other print on demand outfits.

But I guarantee, it's worth the extra few dollars in order to have such a wide selection and good quality product that gets great reviews. So if you get a chance, check it out. As I mentioned last week, there is no upcharge at my end for this because really, I'm not in this to make money on t-shirts. I'm really here to answer your questions and to be able to provide explanations of things going on in the world of pediatric medicine.


And I look at it this way too. All of these shirts have the URL on it. I mean it has pediacast.org right there on the shirt. It's an advertisement and hopefully, if you go to the shop and buy those and you know my hope is that it'll spark off conversation in you being able to spread the word about PediaCast that way.

Also, don't forget, if you haven't already checked out the PediaScribe blog, my lovely wife, Karen, puts lots and lots of work into that. Each and everyday, there's always new material on the blog. Usually, it's not medically related. It's really more just something that I think moms and dads will like. So won't you check that out.

Okay, before we get on to the news, let me remind you 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, 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 pediacast.org. So with that in mind, we will be back with News Parents Can Use and we'll do it right after this short break.


Our News Parents Can Use 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 medicalnewstoday.com.


Allergies, bee stings, rashes, bug bites and sunburn. All are synonymous with kids in summer. To help parents prepare for treating these conditions, the Consumer Health Education Center has partnered with the U.S. Food and Drug Administration, the Maternal Infant Network of the Capital Region and the Upstate New York Poison Center to create a new educational video entitled What Parents Should Know about over-the-counter medication.

The video focuses on appropriate, safe and effective over-the-counter medicine use. Now this is a great resource and I encourage everyone to take a look at the video. They also have a quiz parents can take to test your knowledge on the safe use of over-the-counter medications. And of course, we'll have a link to that in the Show Notes at pediacast.org.

Alright, roller shoes. You know, participation in after-school activities and community sports has become increasingly popular. With school out for the summer, many children are hitting the baseball, swinging the golf club or swimming to the finish line.


From softball to skateboarding, sport participation can lead to injury. For many sports, protective gear is the first step to ensure an injury-free season. Now the American Academy of Orthopedic Surgeons stresses the importance of protective gear while engaging in a particularly new phenomenon, heeling.

Heelys, also known as roller shoes or street gliders are shoes that have a wheel on the heel. This types of shoes fall into the category of inline skates which qualifies them as sports equipment. As such, they carry warnings for their use including the use of protective gears such a wrist guards and helmets to avoid injuries.

According to Dr. James Beaty, a pediatric orthopedic surgeon and president of the American Academy of Orthopedic Surgeons, physicians are in fact seeing children come in to their practices with injuries due to Heelys, mostly of a fracture-type within the hand, wrist or elbow.


For a child to maneuver in roller shoes, they merely shift their body weight backward over the heels, the wheels then engage and cause a change from walking to rolling. As these shoes are sold in a department store, parents buying them develop a false sense of security. They're like any other shoe.

But roller shoes are similar to roller blades or inline skates and protective gear should be worn at all times. If children are to heel, it should not be done while going down the hill, over a curve or in a rocky area. Injuries can be avoided if safety precautions are remembered and here are a few safety tips.

Learn the basic skills of the sport particularly how to stop before venturing out. Be sure to wear a helmet, wrist protection and knee and elbow pads. Avoid rolling in crowded walkways. Avoid rolling in traffic and if you come to a crosswalk, make sure you obey the signals. Stay to the right side on sidewalks and don't weave in and out of the crowds.


Also, be sure to heel on smooth surfaces, keeping away from vehicular traffic and do not allow young children to heel unsupervised. Before heading out to buy wheeled shoes, keep the following in mind. You want to avoid roller shoes that put too much pressure on any area of the foot because pressure can cause blisters. Shop for the shoes and shoes of size at the end of the day when feet are at their largest and when selecting the size of the roller shoe, have your child wear the same type of sock that he or she will wear when participating in the sport.

Alright, the Foundation for the Study of Infant Deaths, which is a group at the United Kingdom announced its latest advise to parents with regard to dummies or soothers, otherwise known as binkies and pacifiers in the United States. Settling your baby to sleep with a dummy, even for naps, can reduce the risk of crib death.


If breastfeeding do not offer a dummy until your baby is one month old to ensure breastfeeding is well-established. Don't worry if the dummy falls out while your baby is asleep. Don't force your baby to take a soother if he or she doesn't want it. And never, ever co a pacifier in anything sweet.

The foundation has joined forces with the United Kingdom's leading producers of pacifiers in a two-year partnership promoting this health message. Joyce Epstein, director of the Foundation of the Study of Infant Deaths, says the partnership will spread key health messages aimed at reducing the risk of crib death and will raise much needed funds for research to help save babies lives.

This is important because despite much progress, crib death is still the biggest killer of babies over one month of age in the United Kingdom and around the world. The foundation scientific adviser, Professor George Haycock says dummy use is widespread in the U.K. and other developed countries and generates strong feelings both for and against based mainly on cultural and family tradition and custom, rather than on scientific evidence that it is beneficial or harmful.


A number of epidemiological studies have appeared in the last few years suggesting that babies who are regularly given a dummy when put down to sleep are less likely to die suddenly and unexpectedly than those who are not. To attempt to clarify the issue, the American Academy of Pediatrics set up a research group to investigate a published literature on the subject and they performed a meta-analysis of all adequately designed studies.

They found that the overall risk of seeds was halved by pacifier use and as a result of this finding, the American Academy of Pediatrics now recommends that a soother be offered every time an infant is put to sleep once breastfeeding is well-established which they estimate to be the case after about one month of age.

Professor Haycock also points out that a more recent study from California found an even greater protective effect of dummy use, but was published too late to be included in the AAP's meta-analysis.


And finally, in the News section, teaching in the digital age. Instead of thinking iPods and laptops as distractions, teachers should embrace the digital age and use technology as a classroom tool, according to a University of Missouri education professor. However, many teachers aren't sure how to do that.

A new book from the professor outlines technology-based lesson plans for social studies that cover kindergarten through 12th grade. The book covers everything from podcasting in the classroom to using digital movies to study history. "We have to prepare students for today's society and if we were not using technology in the classroom, then we are not preparing them adequately,… said Linda Bennett, editor of the book and associate professor in the MU College of Education's Department of Learning, Teaching and Curriculum.


A lesson on economics uses the simulation software Lemonade Tycoon to help students experience what it takes to run a business. Another simulation teaches history by placing students and pioneer families preparing to travel the Oregon trail in the 1800s. The students must use excel spreadsheets to pack their wagons, now that's realistic, take virtual journeys and participate in weekly online chats with other students across the nation who were taking the same virtual journey. Now it didn't sound like the virtual journey is too much like the real one, does it?

Okay, there are many tools including the internet that teachers have not considered. In the classroom, teachers can use Google Earth when teaching geography, Bennett said. Cars and now utilized GPS for navigation so it's important for students to understand satellite images. Teachers must also learn new classroom management skills because common issues now include online bullying, cheating and plagiarism and not to mention predators too.


Bennett believes that besides the usual classroom rules, we have to teach children to be good cyber citizens because there is a right and wrong way to use technology. Good advice. The recently published book called Digital Age Technology-Based K-12 Lesson Plans for Social Studies was commissioned by the National Council for the Social Studies and meets national educational technology standards. It was authored by classroom teachers across the United States and co-edited by Michael Berson, professor of Social Science Education at the University of South Florida.

So if your teacher and you know, really, all parents are teachers, or if you know a teacher or you know make a good gift, that sort of thing, digital age may prove a nice supplement for your curriculum or as I said, a nice gift. Because this is sort of a niche book, you won't find it at Amazon.com, at least not now. And it's not likely to be on the shelf at your local brick and mortar bookstore either. But you can find it online at a site called socialstudies.org and we'll include a link to it in the Show Notes.


Alright, that wraps up our News Parents Can Use. And we'll be back with a special presentation, thinking inside the box. And we'll get to that right after this.


Okay, boy, that ended a little quicker than I thought I was going to. I'd like to take a moment to tell you about this week's sponsor, Mariner Software. I've personally used one of Mariner Software products on my MacBook from the first day I took the computer out of its box. And I continue to use it everyday.


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Okay, this is going to be a little bit different. And I've really – I've really – I don't know. I put a lot of worry into this segment because you know, I've got a growing audience and we're going to do something a little different, but be assured that this is not how the program usually goes. Usually, at this point in the program, we answer some listener questions and then we go on to our research round up. But we're going to do it a little differently.

And if you're a first-time listener, please don't judge this podcast based on today's episode. It's kind of like if you visit a church and you're visiting for the first time and the sermon is about giving money. It kind of turns you off a little bit. You know and they just go on and on about how you got to give the money – it's a bad first impression for someone who is coming for the first time. And so I don't want this to be like that.


Okay, so what in the world am I talking about? Well, one of the things if you look in iTunes at the reviews, one of the things that sort of a repeated message that people put in their reviews is that I like to give both sides of an issue and that I don't inject my opinion and that's refreshing.

But you know, when you think about it, I actually do inject my opinion into things. And I get both sides of it because really, that's how a doctor goes about evaluating the kind of advice that we're going to give. I mean you have to look at both sides and you have to come up with a logical opinion on the things that you're looking at and then form a conclusion and then base your advice on that. And the conclusions really end up being the same thing as opinions. I mean if I form a conclusion about something, it really equates to my opinions.


So I do give my opinion, but I give both sides, but it's more – gosh, it's not always because I even respect both sides, to be honest with you. It's because that's part of the decision-making process in terms of integrating all of the information that we have, the core base of medical knowledge and then making some sort of recommendation based on my opinion on that, okay.

So again, this is sort of confusing and I apologize. But it's going to make sense. I got a comment on the blog from a fellow pediatrician and that let me read that to you. This comes from Dr. Clark Bartram and he says, "Dr. Mike, I think that you missed a great opportunity to discuss the use of alternative medicine on the pediatric population. I realized that you admitted not being knowledgeable on the subject few pediatricians are, but I would have appreciated a few words on the difference between homeopathic remedies and herbal therapies and the unfortunate logical fallacy that natural equates to safe and effective.


You really could devote an entire episode to the subject of why parents turn to alternative therapies for their children…. Well you know, this message struck a chord with me because honestly, I thought that I had made that point last week. But if a fellow pediatrician didn't hear me say that, then how can I expect mom and dads out there to understand what I was talking about.

So I want to address this again and not specifically for homeopathic remedies and herbal therapies, but just in general, how it is that we come to make the recommendations that we make? I mean why is it that we go with prescription medications and sort of say stay clear of these other things? And I thought I had made that point last week, but I want to go through this again because this – it's important because this is at the core of what I'm trying to do here.


I mean parent education about what's going on with their kids and helping you understand why doctors do the things they do and to understand your child's body a little bit better, I mean that's what PediaCast is all about. And when we say that we're here to try to expand on the explanations that your doctor gives in the exam room, but doesn't have the time to go into it more, I mean the whole idea here is for you to understand why we recommend the things that we recommend.

And medicine advances through our understanding of how things work. Hey, it's not about tradition, it's not about old wives' tales that get passed down, you know, from mom to mom or from doctor to doctor even. And it's not about anecdotal reports and observations. And what I mean by that is you can't base what you do on what you see in your individual office.


You have to really look more at the whole picture and the whole base of pediatric knowledge that's out there. So when it comes to prescription medicine, I mean the whole point here is that these medications have been really well-studied. And the other ones, the homeopathic remedies and herbal-type therapies have not been studied.

There's at least not adequately and not showing statistically significant results for what they do and also not showing them to be necessarily safe and Dr. Bartram makes a good point. If you say that a medicine is a "natural…, I mean, what does that mean? All things that you put into your body in the end, you know at the end of the day, they're chemicals. They're made out of molecules which is further made out of atoms.


They interact with the body in some way, which was my point last week, and the only difference between what we call natural and what we call prescription medicines is that the prescription medicines are chemicals that have been subject to scientific studies to show that they're safe and effective, whereas the other ones have not been shown to be effective and they've not necessarily been shown to be safe either.

Now I'm not trying to scare you. They might be safe. They might be effective. We just haven't done the studies to show that's true. Now why is that important? I mean why is it important to do these studies if it seems like people take these things and are fine. I mean you don't see people dropping over dead after they've taken a specific herbal remedy, hopefully. Otherwise, then the government usually would get involved, like with efedrin.


So how is it though that we get to the point that we are studying these things? Well, I think it all has to really start with a question. And if there's something in the world that you want to do, that's – it always starts with the question. And then the next thing that happens is once you have the question, you figure out what you think the solution is going to be, you make a hypothesis based on what you think is going to happen and then you do a test to see whether it's going to work or not.

And just about every other aspect of our lives, this is really taken for granted, but it's part of the process. I mean if you're an engineer, first, you have to know a lot about the core knowledge of building a bridge. And then you have to figure out what the best kind of bridge it's going to be span one side of the bank to the other. And then you have to design it, you have to test it before you let anyone go across this, especially if it's a new sort of design.


Now as a consumer, as the person driving their car cross the bridge, you trust that the engineer has done his job. I mean, if you knew that you were going to cross this bridge and Joe Schmoe had put it together and didn't really know what he was doing, that's trouble waiting to happen. And the same thing happens in the medical field, you trust doctors because they have gone through what you need to do to learn sort of how the body works and they study the core knowledge base that has been accumulated because of studies that has been done in the past. And you trust that they're going to keep up on the latest literature and analyze it – doctors need people skills but at the heart of it, we're scientists because we have to base the things that we tell parents on knowledge as it evolves. So as science evolves and there's new studies, we have to sort of change what we do.


So basically, this is the scientific method. I mean and people who are listening to podcast, you're technologically savvy. If you're able to subscribe to a fee then you have an iPod and you're on the internet, you have high-speed access. Okay, you've heard of the scientific method. It's about making a hypothesis, testing it with the well-designed study and then seeing if it worked or didn't work. Was it true or was it not true and then adding knowledge to the base information in your field of study.

Now another study that's done better could come along and show that to be wrong. But it's an evolving process and you're learning all the time. So I think the best way to go through this is to give you some listener questions that I've had recently that we have not gone over yet. And then just sort of show you the process of how I come to giving you the recommendation or sort of my opinion.


Yeah, okay, we give both sides of it and I want to give you my opinion, but where's it come from? Because it has to come from somewhere. It's not good enough honestly, it's not good enough to say I learned in medical school because things change. I mean I went to medical school over 10 years ago. And things change and evolves. I mean think about what computers are like 10 years ago. I mean technology advances and you have to keep up with it and you have to stay current and you have to know where to look and you don't want to necessarily interpret things based on what you see on a day-to-day basis. You've got to look at the literature of all design studies.

And let me give you an example of that real quick. We have a specialist who come to our office and like yeah, we have him – I don't know, once a month or so, a drug rep will bring specialist and a pediatric field to talk to us about the latest things that are out there.


And we had a pediatric allergist in our office a while back and I remember this pediatric allergist is basically saying that in his opinion, Claritin, Zyrtec, Allegra, all of the non-drowsy antihistamine-type medications, Clarinex, were pretty much worthless that they don't do anything to help allergy symptoms and that you really need to advance to singular right from the beginning or you need to do the nasal nose sprays that are steroids so you've allergy testing and allergy shots. But the non-drowsy antihistamines basically do nothing.

And I have to chuckle a little bit because in his world, they don't do anything. But when you think about it, the only patients that this guy sees are the ones who have been problem patients for their pediatrician because their pediatrician tried Claritin, tried Allegra, tried Zyrtec, those sort of things. Maybe even tried the singular and some nose spray. Didn't get anywhere, they send it to the allergist.


So the allergist has his whole population of people that these things don't work. And so from the allergist's point of view, they don't work. So he's basing his recommendations on saying these things don't work on the population that he sees which is cute from the general population.

Now I can tell you that I see plenty of kids who have allergy symptoms and you have them do some over-the-counter Claritin and they got a lot better and they never go see the allergist. So again, just because you see something doesn't – if you're living in a forest, you see the trees, but the whole world is not made of trees and you have to go out and branch out a little bit in order to get the real answer to give good advice that is for everybody.

My wife, Karen, worked for many years in a pediatric intensive care unit that just saw surgical infants mostly with birth defects and before the birth of our first Katy, she was convinced that Katy was going to have a birth defect because she just knew it.


She was very, very worried about it because all the babies that she saw day in and day out had birth defects. So it really does sort of skew your outlook, but you have to remember to step back and not just take things for granted because that's all that you see.

Okay, so these questions that I have actually have to do with pacifiers. Now the point here if you have teenagers at home, the point with this is not the specific questions. The point here is the process. I think it's important to understand because you – this is how doctors are supposed to look into these things. And that don't always happen.

Okay, the first one is Tammy in Maryland, and you know, since I'm using your things as an example, be assured also I'll give you my outlook on your questions too. "Dear Dr. Mike, I have two boys. Gabriel is three and a half and Eli is six and a half. PediaCast has become a great resource for me and I very much appreciate the time you take on each topic.


Gabriel sucks his thumb. Since he was about two, we had been talking to him occasionally about trying not to suck his thumb without putting pressure on him. Over the summer, he completely stopped sucking his thumb on his own. Then he went back to it a few months later. We praised him a lot when he stopped. Talked about how nice his teeth look, how pretty his thumb was, but maybe the rewards were just not enough or more likely, we were in a power struggle when he started again.

After we heard your podcast about thumb sucking, we started using a sticker chart like you suggested. Gabriel is doing a great job earning his rewards and he recently got a tummy virus from his brother which turned out to be a great opportunity to talk to him about the virus – getting the virus from sucking his thumb and the thumb sucking has stopped for a week during the day. I'm concerned that the power struggle will set in again and we'll go back to square one. My question is once Gabriel stop sucking his thumb, how do you keep him from going back?…


Margaret in Michigan says, "Dear Dr. Mike, I'm a long-time listener. I love your podcast. It's the only one on my iPod that I've actually listened to all the episodes. I'm a mother of three ages 7, 3 and 20 months and I recently went back to episode 22 to review pacifier and thumb sucking because my children all have issues.

My 7-year old still sucks her thumb when she goes to sleep at night. We tried the suck thing as you suggested and I've even resorted to bribery. Nothing seems to work and I'm afraid she would be sucking her thumb when she's 20. My 3 and 20-month old both use pacifiers to go to sleep. The 3-year old strictly has bedtime use, but my 20-month old still uses it more frequently.

My 3-year old would be turning 4 soon and he and his 7-year old sister are getting prepared to give up their objects of oral fixation on his birthday. I was also planning on some reward which you suggested. I think it might work if they do it together. My worry is that my 3-year old will just take the pacifier from his younger sibling. I really don't want to take the pacifier from my 20-month old.


This is a very stressful thing for me because all of my children have always been very, very good sleepers. I am afraid to give that up especially with my youngest. I think that the other two would cope okay. My pediatrician suggested taking the pacifier from both of my kids, but I'm not sure that's the best thing for everyone. What do you think? Thank you for your wonderful podcast….

And then Deborah says, "Hi, Dr. Mike. We listened to the thumb sucking show and had a question. Our fifth child is 15 months and left the womb sucking her thumb. She is the first to do this and we find that quite adorable. She only sucks her thumb when she has a bunny which she only has when she is sleeping. It is so sweet when you take her to a room and hand her bunny, thumb goes right in and she leans to the side to be cradled.

Not surprisingly, she's a great sleeper and very easy to put to bed. After she wakes up and has her diaper changed, she throws bunny back in the crib so it appears she knows bunny's place, for now at least. As a matter of fact, if you give her bunny at other times of the day, she starts sucking her thumb and then gets a confused look and throws bunny back to bed because she relates bunny to bed.


As long as it is only a sleep time thing, we were not planning on trying to break her of thumb sucking at any point. The question you were answering related to parents that want to stop their children from thumb sucking, it also indicated that there is no medical harm from thumb sucking. So if it doesn't bother us that she sucks her thumb when she sleeps, are there benefits to helping her stop that we should be aware of….

And then Samantha in Florida says, "Hi, Dr. Mike. I'm a new listener and love your podcast. I have three-year old daughter who still has a pacifier. We've tried lots of ways to get rid of this thing to no avail. She only uses it at night, but I'm concerned about jaw and tooth damage from allowing her to have it for so long. She is a three-year old red-headed tyrant at bedtime and wants that paci. Please help us….


Okay, so using these as examples and for a more in-depth talk on pacifier and thumb sucking, episode 22 will be in the Show Notes so you can find it easily. My point here though is that this is a concern for many parents and parents want a doctor's advice on what to do. Is it safe? Is it going to be a problem?

Now the only one that really voice the concern would be Deborah who basically – although she didn't give any specifics, she just said, is there something we should be aware of? So I think that parents have in the back of their mind that thumb sucking and pacifier use is a bad thing.

I mean I get that impression because people are writing in wanting an apology for their kids still doing it. They want to know is this something to worry about? Do we have to take the thumb and pacifier out of their mouth? But they're hoping that I say, no, it's fine. Let it be.


But as a doctor, I have to go to the literature and say what do we know about thumb sucking? What do we know about pacifiers? How do we come to the decision of when to stop it and if it's good or bad? Now from a parent's point of view, you know you sort of have what's been handed down to you from popular culture that sucking, non-nutritive sucking which is what we call sucking on the thumb or sucking on the pacifier rather than on a nipple.

Does it – you know, it causes buck teeth. It can cause an overbite. It can cause oral and structural – oral structural abnormalities with the arch inside the mouth. Does it cause ear infections? Can it cause speech issues? So these are all things are going to a parent's mind because they've heard these things somewhere. In fact, I recently heard a speech pathologist on another podcast suggesting that using a pacifier too long is going to cause speech issues.


So the question becomes how do we know? How do we know if this stuff's true or not? Just because someone says it's true doesn't make it true. I mean we need to sort of rule out where these ideas came from and see if they have merit.

Well, there's really little in a way of significant research on pacifiers and thumb sucking in the medical literature and most of the stuff out there comes from the field of dentistry which is not too surprising especially when you think about the concern is is it causing mouth cavity abnormalities. Of course, the dentists are going to be very concerned about that.

So let's address this questions sort of one by one. Okay, these are the things, I think, parents are worried about. So let's go to literature and just see what we can find. So the first one would be abnormalities in the oral cavity. We'll also talk about your infections and speech as well.


Okay, so the association between digit-sucking, thumb sucking and dental abnormalities was described as early as the 1870s. And a pacifier use though became more widespread with the advent of cheap plastics. So we're talking really in about the 1960s is when the transition went from thumb sucking to giving child pacifiers, binkies, soothers, dummies, whatever you want to call them. And then someone started to think, hey is this a bad thing that we're giving them these?

So in the 1970s, there were some dental studies that were done that look at – they were cross-sectional studies. Now what does that mean? Well, a cross-sectional study just means you're going to take a bunch of kids, do a examination of their oral cavity, then determine whether there is problems or not problems, and then you're going to give the parents questionnaires and ask about their sucking habits when they were younger.


And basically, what they found was that there was an association between problems in later childhood in oral cavity and kids who had done a lot of sucking when they were younger. Now the problem though with this kind of study is that first of all the group of people that the dentist were seeing are more likely to have problems because they went to see a dentist who is a specialist on structural abnormalities.

So how many kids was normal palettes, normal mouth structures are seeing the specialist who deals with malocclusion? Not very many. So they had a much larger number of kids that they look at with a problem and that they did not have an equal number of kids without the problem. So they weren't big studies. In fact, the largest one only look at about 320 kids and they were not half normal, half not normal. They're really skewed toward being abnormal.


The other thing is when you have a kid with an abnormal mouth and you give the parent a questionnaire that ask about their thumb sucking, how accurate is it going to be? I mean they want an excuse, they want a reason that their child's mouth is a mess, right? And so psycho, yeah, you know, he did suck his thumb a lot. But how much and was it significant? It's really difficult to get that out of the questionnaire especially when you're only looking at 300 kids.

So really what you need is a much larger study with a good control group that's a longitudinal study instead of a cross-sectional study. Now what does that mean? Well a longitudinal study means that you're going to take kids from the time that they're born or very young and follow them along with questionnaires so that either parents only have to remember was the kid sucking a lot yesterday or today, not five to ten years ago and so you have your observations.


And then as those same kids get to be older, you look at their oral cavities, their ear infection rates, their speech problem rates and you see if there's a difference between the kids who sucked a lot and didn't suck. I mean that's how you would design a good study to see if there's really a correlation. And can you believe that study was not published until 2005?

So we go through the 1970s, 1980s, the 1990s, and we say that sucking your thumb will cause buck teeth and the only studies that we had were from the early 1970s where kids, yeah – what, 300 kids? And relied on questionnaires asking the parents questions about sucking habits 10 years before that.

So it's not an ideal situation that come up with any really good conclusion based on the evidence. So what did they do? Still wasn't the best study that came out in 2005 but it was still a small study. They only looked at 444 kids. So you'd like to see a few thousand kids in a study, but he get what you get. So this was what they did.


They basically did, as I said, the sucking behavior questionnaire every three to six months from birth to age eight. And what they found with this is that non-nutritive sucking, so sucking on pacifiers and thumbs, beyond about 36 months of age – so beyond 3 years and then definitely up toward five to six years of age. And as you got older, if you were still doing it, then there was a larger association with a malocclusion problems. So overbites, crossbites, arched problems.

So now we're saying, okay, if you get to be 36 months of age or more or you're still sucking on something, it seems that the evidence would suggest that you're going to have a higher likelihood of malocclusion or overbites, crossbites, that sort of thing. So now we have a good study that we can say yeah, if you do it too long, there's a problem. Although you still would like to see a larger sample size, in my opinion.


Now if you ask your average dental professional, your average speech pathologist, your average pediatrician, where they get the advice from that thumb sucking causes oral problems on down the road, are they going to be able to do what I just did? Probably not. A month – now I'm not being cocky here.

Before I did the research for this particular program, could I have cited this stuff? No. But it's nice to be able to go back and look and see what's out there in the field that you're interested in and look at the information yourself and assimilate it so you can figure out, is this good thing? Is it bad thing? Are we given good advice? And in this situation, I think we're given good advice to say, you probably should really try to get your kids to not suck their thumbs, not suck a pacifier beyond three years of age based on the study.

Now because of this study, the American Academy of Pediatric Dentistry did come out with a statement and basically – and I put a link to this in the Show Notes. They said – it was a question and answer page from the American Academy of Pediatric Dentistry. And the question was when shall I worry about a sucking habit and according to American Academy of Pediatric Dentistry, and this is quote, "For most children, there's no reason to worry about a sucking habit until the permanent front teeth are ready to come in….


Now that's sort of going out on a limb because that's usually not three. I mean I don't know about your kids, but my kids didn't get their front teeth until they were school age. So the American Academy of Pediatric Dentistry – I mean this is the professional organization that would trump pediatricians in terms of child's oral health.

Their official stand is they shouldn't be doing it once their permanent front teeth are ready to come in. So consider that. Now if I'm going to take a more conservative approach, I'm going to tell parents yeah, 36 months is probably when you want to think about stopping it.

Okay. So the next one, let's talk about ear infections. This is another one of those and association between pacifier use and ear infections, is it real or is it not real? There's only two studies that have looked at this and between the two studies, they looked at about 4,000 kids. So that's nice. 4,000 kids, that's a much bigger sample size than 300 or 400.


And it did show a slightly increase risk of ear infections in kids who use pacifiers but it wasn't a very big increase in risk. In fact, the relative risk of a – if you use the pacifier was – or thumb sucking – no, I think this one was just pacifiers. Excuse me, just pacifiers.

If your kid used a pacifier, they were 1.24 times more likely to get an ear infection than if they didn't use a pacifier. So we're not talking like they were two to three times more likely. They were 1.24 times more likely. Not that impressive, really. And in fact, some experts would speculate that there's actually a reverse causality here. What that means is that if you suck a pacifier, are you 1.24 times more likely to get an ear infection or if you get an ear infection, are you 1.24 times more likely to use a pacifier?


If kids are getting frequent ear infections, they're more fuzzy. When kids are fuzzy, what do parents do? Put a pacifier in their mouth. That shuts them up. So are these kids – is it really that sucking on a pacifier makes them get ear infections more often or because they get ear infections, are they sucking on pacifiers more?

You know, you got to ask that because I mean – okay, this is small potatoes. I understand that. This is not cancer research. It's not rocket science, but how we approach things in our life to get from point A to point B, how we do that? How we come up with recommendations? It's important. It's important to understand the science behind it. And again, a 1.24 times relative risk is not that incredible.


Okay, so what about speech's use? So again, I recently heard a speech pathologist on another podcast, a very great podcast. And this is probably a very good speech pathologist, so please do not get me wrong here. This is not about slamming anyone because we all have to learn this stuff together.

Basically, the speech pathologist said that pacifier use leads to speech delay and articulation disorders in some kids and so you had to be really careful about that. And a mom basically was worried about her dentist and pediatrician were saying that there was not a concern that her child was still using pacifier, maybe was thumb sucking, but the speech pathologist was saying that it is a concern from a language perspective.

So you have a speech pathologist saying it is a concern. You have a pediatrician and a dentist saying it's not really a concern. So who do you believe? I mean who – is it a concern or is it not a concern? As a parent, you're confused.


So you have to look at okay, where are these professionals getting their information? Well, number one, he probably learned it in school. So the speech pathologist, I would assume, has learned in school that pacifiers can do this. But that's not necessarily again, just because someone teaches it, is it really based on research and founded on good research or was it just told to you because that was oral tradition, which basically is the professional version of an old wives' tale.

Or also, you could say, well, the speech pathologist sees kids with speech problems all day and it seems like every single one of them had a binky until they are three or four years old. And you can see how in your mind, that means that these things – the binky must be causing this. It's like the allergist saying Claritin, Allegra, Zyrtec don't do a thing because they never see kids where it does work.

The speech pathologist never sees kids with normal speech who had a binky until they were four or five years old. They don't see that. But that doesn't mean it doesn't exist. And it doesn't mean that the binky or thumb sucking causes the speech problem.


She said something about tongue-muscle development. Okay. Now okay, I can see that. I mean it makes sense if the kids walking around with a binky in their mouth all day, it makes sense that their speech is going to be delayed. And if they're sucking on it and their tongue is doing something different than what it needs to do to form words, it makes sense that that would cause an articulation problem.

But just because something makes sense does not make it true. And that's why research studies are important. You form your hypothesis. You say, hey, I think this is what happens. This is what makes sense to me. But now I'm going to design a study to see if it's true or not. And again, this is small potatoes. I understand that, but again, we're not talking about do we need to have pacifiers or not have pacifiers. The point here is the process. It's how you get from point A to point B when you're studying medical science.


And if your interested in your child's health, I think this is an important thing. So you know what I do, I did an extensive medline research review of pacifiers and speech. And I put in a new – I also used a PubMed, which is a database done by the government that looks at abstracts from research studies. Basically, everything that's just about ever been published. So you can read the abstracts of what the studies where in all medical disciplines.

And so I did a search. I also used this source, resource called Up To Date, which is a well respected research conglomeration of papers done by well-known professionals in their respective fields. And so I looked in all these places, did an exhaustive search and I only found one study. One! One study that looked at speech and pacifier use and thumb sucking. One! And it was a study actually in Portuguese.


So [laughter] – so it wasn't very helpful. Now there was a translation, but I don't know that I trust the translation because instead of saying that there were 130 kids in the study, it said that they studied a 130 scholars which really didn't make sense to me because in the next question – or the next sense is said that the use of questionnaire about the child's oral habit.

So apparently, these children were all scholars. But again, I think there's a translation issue. And then, the study went on to say, in the abstract that said and I quote, "An association was observed for anterior open bite and lingua (which just means tongue) interference. The same was not observed for speech disorders….


So it sounds like what it's saying is that sucking cause bite problems, like overbite, cross-bite, those things, but did not cause speech disorders. But then in the next paragraph in the conclusion, it said, "An association between the history of deleterious habits and the occurrence of lingua or tongue, interposition during swallowing was a problem, as well as a problem with speech disorders was identified.

So in the result section, they say that it was not observed. And then in the conclusion, they said it was observed. So I would hardly call this a landmark study on the facts of sucking on later speech, right? I mean it's not that great of a study in terms of – at least in terms of the interpretation or the translation. So I mean I think we need someone to read Portuguese and tell us what this thing really says.

Now despite the fact – again, speech pathology school may teach that sucking does this. And speech pathologists may say hey, I see kids who use binkies who don't talk. But that again, that doesn't make it true. Yet, in my research, I came across many speech pathology sites calling for pacifier and thumb sucking use to stop by the time kids were six to nine months of age.


In fact, the Cincinnati Ohio Speech Therapy Services site, which I'll have a link the Show Notes, basically, they had a question and answer thing and their questions said at what point should I stop allowing my child to use a binky or a pacifier?

And their answer was if you haven't introduced the pacifier to your child, I recommend you don't. If your child is taking a pacifier, we recommend removing it by six to nine months of age. Children quickly become dependent on pacifiers. They need to learn to comfort themselves instead of using a foreign device. It can also interfere with speech development, acquisition, feeding and dentition.


Okay, so they say this, but what are they basing this on? That's what I don't understand. I don't understand what they're basing it on other than they learned it. They learned it somewhere. It was in a textbook. A professor told them. And they see a lot of kids who have speech problems that have done binkies for a long time. But again, that doesn't make it true.

So what it comes down to, in my opinion – and again, please, please, please, please. I don't – this is not a slam on speech pathologists. I picked this as an example because it was recently an issue. And I got another one that's another issue that's quicker going through by doing to get to it because I don't want to just pick on the speech pathologist.

You can make the same argument for people who practice homeopathic medicine and alternative therapies. You could make the same argument for people who do herbal remedies. And again, I'm not lumping all of these people into the same category.


I'm just saying the common denominator is where are you getting your information? Where are you coming up with what you say is true, how do we know it's really true? That's the important point here. And again, this is something that is important when it comes down to critical thinking. I know I'm dwelling on this, but it's such an important core concept in science to be a scientist to understand. It really is.

I mean when you think about it, people in Christopher Columbus day thought he was crazy because he didn't think the world was flat. I mean it made sense to everyone else that the world was flat, right. But he dared to think different and then did something about it to prove it. And that I think is very commendable despite – no, okay. It wasn't just him, I realized that kind of being ego-centric in terms of the history.


But I think that whether there were other cultures that did this, that's not the point. My point is that he didn't just go with what everyone was teaching at the time. People – there were those who did not believe that the sun revolve around the earth even though that was the current thinking and the current teaching. But there were those who dared to think differently and then to try to prove it.

It made sense to everyone in the 1700 and early 1800s that diseases could be cured by putting leaches on the skin and that sucking out blood. I mean that was standard practice. That is what was taught to people to do. That was felt to be true and it carried on until someone said, hey now, wait a minute. Maybe there's these things called microorganisms. Maybe that's how we have to go about it. And this is how medicine and science advances by questioning things and then testing your hypothesis.


Another good example. In the 1960s and 1970s, kids who had in towing were almost universally put in special shoes and braces to try to make their feet go more to midline. So they weren't pointing in anymore, especially if one foot did it more than the other. And grandparents know about this because I see a lot of kids who have tibial torsion where the foot kind of points in a little bit and you have the grandparents saying he needs special shoes for that.

Because back in their day, that's what they did. That's what the medical students learned. You learned that in medical school. You learned it in residency. You did it. You practice it and it went on as the traditional – that's what you do. That was the standard of care in medicine back then. And it made sense because you put these kids in the special shoes and braces and their feet got better. So it worked. It made sense.


But then what they found is that there were groups of kids who didn't have any of that done and their feet corrected on their own too without any shoes or braces. And so they said hey, maybe it's not the shoes and braces that are making this better. Maybe just as the bone gets longer, it has a tendency to twist back towards the midline. And now we know that's true. For most – the vast majority of these kids do not need any special orthopedic intervention because for tibial torsion because it tends to correct itself.

But we didn't always know that and that wasn't always the standard teaching. So again, just because you learn it somewhere doesn't make it true and just because you see it all the time doesn't make it true. You still have to look at the research if you're going to be a professional that is giving an opinion to large groups of people. And I think with podcasting, there's this tremendous ability now for us as medical professionals to give our opinion to large groups of people, not just the few hundred in our practice. I mean I'm talking to the world right now.


And that so it becomes even more important that you are responsible with how you look at things to make sure what you're saying is true. And again, not a slam. The speech pathologist, if you're listening, who said this, I'm not picking on you. Really, I'm not. It's just looking critically at the process. That's the important thing.

Okay, one more example because I don't just want to pick on speech pathology. I also heard an obstetrician, who is also the author of a nutrition book who gave advice about what to eat when you're pregnant. And she recommended limiting fish intake during pregnancy to 12 ounces or which is the same as 350 grams per week because of the potential for mercury toxicity especially when you're looking at fish that are higher up in the food chain that eat a lot of other fish. They're going to have higher levels of mercury and so she recommended only – that basically comes out to being two servings of fish or seafood during the week during pregnancy.


So that's her recommendation that she's telling the world in a podcast that the recommendation is two servings per week. Now I suspect that the recommendation that's in her book. I suspect that's the recommendation that she gives in the exam room and that's fine. That's a fine recommendation, but does she know, and maybe she does, that there was a huge study done. It was published in The Lancet in February 2007 and we talked about this study in Episode 38.

So I'm not going to bore you with all of the details. I'm just going to hit the highlights of the study because it was a very important study. It was done by the U.S. National Institute of Health, sponsored by the University of Illinois in Chicago and the University of Bristol in the United Kingdom and published in Lancet, a very well-respected peer-reviewed medical journal in February of 2007.


Huge sample size, they looked at 11,875 pregnant women. Huge sample size and it was a longitudinal study. They followed these same women from the time they got pregnant through their pregnance and basically, they asked them questionnaires as it was happening so they only had to think about their life in the last few days and not years and years ago. And they asked them, hey, how much seafood do you eat in? And they divided them into three groups. No seafood, up to three portions of seafood a week and then more than three portions of seafood each week.

So those are the three groups. And then they assess their child's development, their neurodevelopment at 6 months of age, 18 months of age, 30 months of age, 3 years of age, 6 years of age and 8 years of age. So we're looking at the same group, the same pregnant women, their kids looking at those same – so it's a direct one-on-one correlation of development versus how much food the mom ate in that same family and we're looking at it in 11,875 women.


I mean this is really a good study. It was very well done. And they used multiple tests to study these kids. They used – let's see, 1, 2, 3, 4, 5, 6, 7 different studies that they used to look at these kids. They used questionnaires that looked at social interactions, peer problems, hyperactivity, emotional problems, conduct disorders, Denver developmental screenings, I mean they really went all out.

They also adjusted for 28 potential confounding factors among the three groups. So in other words, they made the groups as equal as they could so that there was no difference between the three groups in terms of mean, maternal age, housing, education, child's birth weight, gestational age at delivery and how far along in pregnancy was mom, the child's sex. I mean they really made the three groups as similar as possible with the only difference being, as best they could, the difference in seafood intake. And then they looked at the children's development for each of those groups.


And basically, what they found was that the no-seafood group and the less than three portions seafood each week compared to the ones who had more than three portions of seafood a week – so the no-seafood and the less than three portions had a statistically significant increased risk for lower IQ, fine motor delay, communication delay and social developmental problems.

So the group that had more than three servings a week had higher IQs, better motor development, no communication delays, better social development. So I mean, what do you do with that? What do you with that. I mean the authors conclude that this study did not find any evidence to support the warnings of the U.S. Federal Advisory that pregnant women should limit their seafood consumption.


By contrast, maternal consumption of more than three portions of seafood per week appeared to be beneficial for a child's neurodevelopment, suggesting that advice to limit seafood consumption could actually be detrimental. The authors conclude that any benefit accrued from reduced metal mercury exposure was outweighed by the reduced intake of fatty acids essential to the developing fetal brain.

So why then is this obstetrician who wrote a book still recommending the old recommendation? I'll tell you why. Well, either she didn't know about this study. That's possible. Or she's still going with the guidelines of the government because if she says that you should have more than three portions of seafood per week and then somebody has a kid who's autistic and then they go back and sue her because she gave recommendations that were out of line with what the government is recommending.


But when do we – when do we use our heads and say, look, there was this huge study that didn't show a problem that was well done. I mean when does that became the basis of our advise rather than tradition, what's handed down just for the sake of being handed down or recommendations based on old research.

Okay, I know I'm ranting and I apologize for that. And like I said, we won't do it next week, I promise, okay. So I guess that in the end, there's lots of advise out there. And it's a confusing world for parents with the internet because you have a question in your mind, you look it up online, you find some people saying yes, some people saying no. You're going to get the whole gamut. And you have to at some point say, who am I going to trust?

And I say that you probably should trust me. No, no, I'm just teasing. [laughter] I am not perfect. Really, I'm not. And we're learning together, but you have to be open to the fact that you can learn – you can't be close-minded and say, this equals this. I mean you have to be able to open yourself up to looking at why we do things.


And I hope this has made sense to you. And again, I'm not picking on this obstetrician, I'm not picking on the speech pathologist. Has there ever been a time in my life that the advise I've given has been outdated and there's newer research to suggest something different? But yet, probably so. I don't think that's out – it's not – it doesn't make these people bad professionals. It doesn't. I think we just all need to learn to stay current with the research, to look at it with a discriminating eye and make our decisions based on what we know in science.

Now where do you go as a parent? You know, for the brave and fearless, I would suggest pubmed.gov and again, we'll put link to that in the Show Notes. Basically again, it's a service of the National Library of Medicine and the National Institutes of Health. It's just a huge public database of medical research.


The abstracts are free to read. You do have to pay to see the entire article, but honestly, most of what you need is in the abstract. I mean it tells you the study, what question it was trying to answer, what it's hypothesis was, what the methods of the study were, what were the results, what was the conclusion. I mean that's all in the abstract.

Now you could say, hey, I'm not a scientist. But the more you read these things, the more proficient you get at analyzing them. And look up words you don't know. I mean, of course, that's the beauty of the internet. If there's a word that you don't know, look it up. I mean there's no reason that we can stop learning even as adults especially when it comes to our child's health because it's hard to make decision as a parent. You want to do what's right. You want your child to be healthy. You want to make the right choices. And that's what the bottom line is. And in order to do that, the reality is you have to educate yourself.


Now in terms of sort of debunking myths that are out there, couple of sites that I really like and I've talked about one of these before snopes.com. Again, all of these things, there'll be a links in the Show Notes for you. But Snopes is a good place to – because there's a lot of myths out there and Snopes kind of addresses those with current research and current examples that's very well-done, well-researched with other sources listed. It's very nicely done.

And then there's another one called Quack Watch. That's a quackwatch.org. And that also looks at medical issues and the sort of the debunks, myths and tells you what the research really shows. And then in addition to that, there are some blogs that really focus on critical thinking using scientific principles and I have to give credit to the guy who sort of started me off on this attention to begin with, Dr. Clark Bartram. His blog is called Unintelligent Design: Tales from the Not so Normal Newborn Nursery and other Ruminations of a Skeptical Pediatrician. Got to love that title. And that his blog, we'll put a link to that in the Show Notes as well.


And then he actually gave me a list of some other blogs that he likes to read on a regular basis that also looks at science and critical thinking so if you're interested in any of these, I'll have links in the Show Notes to those as well.

Okay. So now I did promise that since I used these folks as an example, I'd go back and answer their questions. So let me go back and do that here real quick. So Tammy in Maryland basically, her issue was how do I get my two-year old – no, I'm sorry. How does she get her – see I've got to – give me just a second here. [laughter] I got to look through here again. This is Gabriel and he's three and a half. So she wants to know how to get her three and a half year old to stop. So I would say based on what I found in this latest study, even though the American Academy of Dental – of Pediatric Dentistry is saying wait until their two front teeth come in or they're adult front teeth, not wait until they come in, just right before they come in. I'm sure that Gabriel, I bet he's not even lost his two front baby teeth yet.


So according to the American Academy of Pediatric Dentistry, your fine. Let him suck his thumb. But looking at that research, probably after the age of three, you want to try to stop. So I'd still keep working at it. But it's not the end of the world if it doesn't work because according to the American Academy of Pediatric Dentistry, you're fine.

Okay, and then Margaret in Michigan. Oh yeah, Margaret was the one who wanted to know if – she got rid of the pacifiers from the house completely or still let her 20-month old do it. My opinion would be let your 20-month old do it. I mean it's a good lesson for the three-year-old. Hey, the 20-month old is still a baby. You're three now. You don't get it and you have to supervise your three-year-old enough that he's not stealing the binky. But really, three-year-olds, you don't let them out of your sight too long anyway. So you should be able to control that.


But to say, do you have to get it out of the house or not get it out of the house or probably doesn't really matter in the end. I think if your life's going to be better with the binky, keep it. I mean that would be my personal advice on that. Again, I don't like to do that very often. We talk about general topics, not specific advise for specific individuals, but I don't think there's too much liability in binky advice. I hope not anyway. Okay, never mind. Do what you want. [laughter]

Alright. And then Deborah, let's see. She wanted to know are there any medical – are there any benefits of making here stop sucking her thumb? Well, we did go through the whole gamut there so I think you have enough information to make that decision for yourself whether you think it's a good thing or a bad thing.


And then we have the three road-headed tyrant, Samantha in Florida. Samantha is not the three-year-old, but her daughter is three and still has a pacifier. So yeah, I mean it's probably time at three to start thinking about getting rid of it. I can't remember what my advice was now in that thumb sucking episode. I probably said about three. I don't remember though exactly what I said. I researched it at the time, but I don't remember coming across that particular study that I cited.

Alright. So I think we covered all of the people's issues there. So what do I have left? I think the only thing that we have left to do now is to cut to a short break because this is definitely running longer. I know I've been trying to keep this to an hour and I've done really well the last couple of weeks. In fact, I was able to added it down and make it in the right at the one-hour mark, but we're definitely going over tonight.

But again, it's because – this has been an important issue to me. It's something that I'm passionate about and I think it really is sort of the core of understanding where I'm coming from in giving you the knowledge that I have. It's not coming from what I learned in medical school. It's coming from your questions and researching it now to find out what the best answers really are.


Okay, so let's go ahead and we will take a very quick break and be back right after this.


Okay, we're back to wrap up the program. Did I get myself in too much trouble here? I just want to say please, the speech pathologist, please don't – not the one in particular the I'm talking about, just in general, as a group. Don't mug me, don't come knocking on my door. Please, please, please, please.


And if you send me a research study showing me that thumb sucking and binky sucking cause language problems, please just make sure it's a well-done study, okay. Don't give me material to critique about studies. So you want a good, big sample size. You want statistically significant results. And longitudinal studies are much better than cross-sectional studies. So keep that in mind as you do your literature and send me what I couldn't find.

Because I don't know. Maybe there's something out there. And I would tell you this. If there is, if there's some big study that shows a binky and pacifier use causes language delay and articulation disorders, I'll put it on here. You know me. I'm more than willing to let you know when I'm wrong. Because you know, we all want the truth and if there's something I'm saying that is not right, we want to correct that. So send it to me if you find a good study.


Alright. 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.

Also, your use of this audio program is subject to the PediaCast Terms of Use agreement which you can find at pediacast.org. PediaCast is licensed under an attribution non-commercial, no derivative works Creative Common's license. For more information on this copyright license, please visit pediacast.org and click on the Creative Common's link at the bottom of the page. And if you're interested in using PediaCast material for a commercial project, please email pediacast@gmail.com for details.


Thanks again, the News Partner, medical news today; our research partner, Tevin Techonologies; and this week's sponsor, Mariner Software. Website and feed artwork are brought to you by Vladstudio. Also, the artwork design on the apparel at our new PediaCast shop was also done by Vlad and so we thank him very, very much and be sure to visit his website at vladstudio.com. Very talented graphic artist.

Also, thanks to my loyal listeners because by subscribing, listening and contributing to PediaCast, you're the ones who keep this thing going. And of course, last but never, never, never least, my family. Thanks to Karen, Katy and Nick. Thanks for the time, thanks for the love and of course, your never-ending support. Then that's sweet.

Reminders, pediacast.org, click on the Contact Link if you would like to contribute to the program. You can also email pediacast@gmail.com, attached an audio file if you like or use the voice line at (347) 404-KIDS. Promotional materials are available on the poster page of the website. So just go there, you can download the PDF that has posters that you can hang on bulletin boards so we can get more parents in the know.


iTunes reviews. I'm stuck at 69 as of right now. Can you guys give me some more – I don't want to beg, I really don't. But I know that there are many, many more of you who haven't left a review than have. And iTunes reviews are just really important for propelling you to a point where more people see the programs. So there are a lot of parents out there who I really think would like PediaCast if they knew about it, but they don't know about it because it's not ranked high enough and it's going to – it gets a little bit of a higher ranking if there's more comments.

Now I know that people say that the top podcast in iTunes are just based on new subscribers, but I don't think that's exactly true because there are times when I get reviews that, then your rank goes up even though I'm looking at my feed and the subscribers are staying pretty steady. So I do think that there must be some sort of look into the reviews and also, how many stars that you have and that sort of thing.


So please, if you haven't done that, you know, I put a lot of work into this podcast as you can imagine. And leaving a review on iTunes only takes 5 minutes of your time. So please do that. Also, if you're not subscribed to the feed, if you just come and listen at the website or you download it from the website under your own digital audio player, if you have iTunes on your computer, can you please go in and subscribe through iTunes. That would be helpful even if you don't listen to it that way.

Okay, I'm not going to beg anymore. Digg.com, you can digg our episodes. Also, don't forget to read PediaScribe each and everyday and you can get to the website at pediacast.org. That's the blog done by my lovely wife, Karen, and it's really a good blog. I'm not just saying that because she's my wife. I mean really, it's well done, eclectic, large number of a topics and she's not afraid to tell you embarrassing stories about me.


The PediaCast Shop is open for your shopping pleasures. And the Parent Report should be out in the next couple of days. If you haven't subscribed to the Newsletter, go to pediacast.org, click on the Newsletter link and you can subscribe so that you start getting my handpicked collection of parent links each and every week.

Alright, so as always, we'll close the program with a reminder that you want to be sure to tell your friends, your family, your co-workers, your neighbors about the program so we can empower more parents to make great decisions regarding the health and well-being of their children.


So until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long, everybody! I hope I don't get – okay, I'm not in too much trouble, right? You still like me, right? I'm sorry if I offended anyone.


Okay, you know, if you're still listening, I just want to say [laughter] – I don't even know what I want to say. I think I'm just being goofy tonight because of the fact that that was just completely off script.

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