Video Game Addiction and Asperger Syndrome – PediaCast 042

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  • Video Game Addiction
  • Surgeons Benefit from Video Games
  • Don't Eat Veggie Booty Snack Food
  • Safe Firearm Storage
  • Text Messaging in a Health-Care Setting
  • Cuts and Scrapes
  • Asperger Syndrome
  • Immunizations and Autism
  • Injury Prevention
  • Thumb Sucking and Pacifier Feedback
  • Automated External Defibrillators in the High School Setting
  • School Backpacks – How Much Weight Is Too Much?
  • Teletubbies are Poor Language Teachers


TIPP: The Injury Prevention Program

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Announcer: This episode of PediaCast is brought to you by Mariner Software.


Hello moms, dads, grandmoms, grandpops, aunts, uncles and anyone else who looks after a 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. It is Episode 42, say goodbye to Teletubbies, please! Also coming up in this show, video game addiction, although surgeons benefit from video games apparently. Don't eat veggie booty snack food. Boy, that sounds like good advice all around, you know. The word booty and veggie and snack and food, they just don't go all together.


Safe firearm storage, doctors resort to text messages. We'll also discuss cuts and scrapes, Asperger Syndrome, immunizations and autism, injury prevention and then we'll have some thumb sucking and pacifier feedback that relates to our last episode that we did.

And then we'll discuss automated external defibrillators in the high school setting; school backpacks, how much weight is too much; and then Teletubbies are poor language teachers. That's an interesting one. And then we'll wrap things up with some music, America The Beautiful, courtesy of the U.S. Air Force Band of the Golden West.

So this is Dr. Mike coming to you from Birdhouse Studio. I'd like to welcome everyone to the program. Obviously, we have a lot on our plate today so we'll get right into it. Don't forget, if there is a topic you would like us to discuss, all you have to do is go to and click on the Contact link. You can also visit, let us know that way. Or call the voice line at (347) 404-KIDS, that's (347) 404-K-I-D-S.


Now, I have to apologize. You may have noticed we didn't have a show last week. And I could say, well, that was because of the Fourth of July and it was a holiday week, but that wouldn't be telling the truth. We had a lot of problems. Our host where we keep our audio files basically gave us three days to get all of the audio files off of their server because we were bringing it to its knees each time that we release an episode with all of the downloads.

So we have to switch to a different hosting option. But all the files are back-up loaded. The feed directs to the proper places, so we should be in good shape, but I'll tell you, it took some time and effort and energy, particularly time to get the audio files all transferred over, but like I said, we should be in pretty good shape now.


And then, unrelated to that feed burner, which is a service that we use to help monitor how many downloads we have and basically, just to keep statistics of the program. Google recently bought them, you know like about everything else in the world. [laughter] And with Google taking over, there was a little bit of a hiccup with the software that we use to this end with the WordPress – the WordPress, what do I want to say – mechanism for putting the Show Notes out and that's where people access the feed if they're not coming in through iTunes.

And we decided not to mix well together anymore. So we had to upgrade the WordPress and then there were problems with the theme not being compatible with the new version of WordPress so then we have to update that. So basically, it was just a lot of a hassle and messing with the web. But you know, I kind of like that too. It's fun to work on the website.

And then of course, there was the distraction of the iPhone which, you know, you've probably been inundated with the news and information and opinions and reviews and all those things on the iPhone so I'll spare you that. But that was something else that kind of took up a little bit of my time. I love it, by the way.


Poison ivy, oh my goodness sakes. Last weekend, my wife Karen's brother came over to our house to help us trim some trees. I shouldn't say help, we helped him. [laughter] I don't ladders and sauce and things, just I don't know. I try to stay away from that combination. Kind of like veggie booty snack food.

Anyway, there was poison ivy and you'd think I know better, but it's not just on the plant anymore. It's now all over my skin and I'm perky itchy. I, honestly, I was seeing kids in the office this – over the last few days who came in for their poison ivy and I have to say, mine was worse than theirs. Luckily, most of it was underneath clothing. But not all of it.


Okay, one other item of business before we move on. I just want to remind you that PediaCast and PediaScribe, the blog, are both have been nominated for some awards and we would really appreciate your support so we don't look foolish in the contest and come in last or anything like that. I mean, we may not come in first, but we'd like at least a decent showing, you know.

For the Podcast awards, nominations are being accepted through July 15th and the more nominations you get, the more likely it is that you'll be put on the final ballot. If you go to, there's an icon in the side bar and that will take you to the nomination page. I think probably, we best fit into the education category. But use your own judgment and decide where we fit, then you may want to nominate some other of your favorite podcasts along the way. And again, to make it easy to get there, you just go to and click on the Podcast Awards link.

Then there's also the Bloggers Choice award. PediaCast has been nominated in the Best Podcast category and PediaScribe was nominated in the Best Parenting Blog category. So again, you could go there. There's links in the side bar of both PediaCast and PediaScribe and you can go and vote for us in the Bloggers Choice Awards as well.


And then one other important thing, we have a new contest going on over at PediaScribe. And of course, all the details will be available on the blog, so just go to or and click on the PediaScribe link.

But basically, how it works is this. Karen is going to be giving away a Klean, that's K-L-E-A-N, Klean Bath and Body set and you can look at what their products are like and of course, we'll put a link to that in the Show Notes. But here's how it works basically. You write a story about a time in your life when your kids got you really dirty. It could be dirt, grime, pee, poop, puke, whatever and you basically describe the gory details of the story of getting really dirty. So you need a Klean Bath and Body spa kind of thing.


And you post your story on your blog by 5 o'clock on Tuesday, June 17th and if you don't have a blog, you can post your story as a comment at PediaScribe, our blog. PediaScribe will pick the top 10 stories and post a poll and then you vote for the best story between Friday, July 20th and Monday, July 23rd and so you guys will be actually picking the winner. And the person with the highest votes will win the Klean Bath and Body package. And again, there's more information on the blog.

Okay, don't forget 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 And with that in mind, we'll be back with News Parents Can Use right after this.



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. You can visit them online at

Video game addiction, given that approximately 70% to 90% of U.S. youth play video games, the American Medical Association recently called for more research on the long-term beneficial and detrimental effect of video game and internet use, as well as a review of the current video game rating system.


To spur additional study, the AMA will submit the full report and recommendations to the American Psychiatric Association and other appropriate medical specialty societies for review and consideration in conjunction with the upcoming revision of the Diagnostic and Statistical Manual of Mental Disorders. That's like the psychiatrist's bible.

While more study is needed on the addictive potential of video games, the AMA remains concerned about the behavioral health and societal effects of video game and internet over use, said Dr. Ronald Davis, the AMA President. "We urge parents to closely monitor their children's use of video games and the internet…. The AMA also calls for a review of the current video game rating system, the current rating system for video games has been in place since 1994.


Research from a variety of sources, including the U.S. Surgeon General links children's exposure to media violence with increases in aggressive and violent behavior. Concerned about the system's effectiveness in alerting parents to violence and age-appropriate content has led to attempts of both the Federal and state levels to enact regulation of video game content and to better control the sale of inappropriate video games to minors.

"We would like to see a rating system that better alerts parents to the content of the video game and recommended age of the players so they can decide whether or not their child should be playing it,… said Dr. Davis. Parents need to be more close – parents need to more closely monitor and restrict the types of video games their children are playing and buying and a clear rating system will help them to do that.

But on the other hand, video games contribute to surgical skills. A small U.S. study suggests that surgeons who played video games have better keyhole surgery skills than those who did not. This study was performed by U.S. scientist at Beth Israel Medical Center in New York and is published in the recent issue of the archives of surgery.


The researchers did a study because although anecdotal observations suggest young surgeons who played the video games were better at performing laparoscopies or keyhole surgery than those who did not, has had not been empirically investigated. Laparoscopy is a type of surgery where the surgeon has to handle small instruments and go into the patient's body via a small hole or incision, hence the term keyhole surgery.

The surgeon does the operation using a television screen to see where to move the instruments. He or she cannot look straight at the place they are operating on because it is inside the body and the keyhole is too small. The researchers found a strong link ability to play video games and performing well in keyhole surgery.

The researchers study 33 surgeons based at New York's Beth Israel Medical Center. The participants had to play three different video games for up to 25 minutes to assess their current skill and also answer questions on their past experience of playing video games.


Their surgical skills were measured during a course that took one and a half days to complete. The participants carried out a range of simulated laparoscopic and suturing procedures with their completion time in error rates were measured.

The researchers also took note of the participant's level of surgical training, number of cases of laparoscopy previously performed and the years they had been in medical practice. They then ran a cross-sectional analysis to compare participants' laparoscopic and suturing skills against video game experience and video game scores. The results show that nine young surgeons who had played the video games for at least three hours a week made 37% fewer mistakes and worked 27% faster than the 15 surgeons who had never played video games. The nine surgeons with past experience of video game playing also scored 42% higher overall on the range of surgical skill tests.


Also, the correlation between video game skills and surgical skills as measured by the simulation was stronger than either the surgeon's training or length of experience. The researchers concluded that video games could help train surgeons who perform keyhole surgery. And an invited critic that accompanies the same issue of the journal, Dr. Myriam Curet, stresses the indiscriminate video game play is not a panacea and urges the media not to distort the message in this study.

She said, "Parents still need to keep a check on their children's video gaming hours and the types of games they are playing…. And looking at the robustness of the article, she points out that it has limitations such as the small sample size.

One of the authors of the study, Dr. Douglas Gentile, did a survey in 2004 on video game playing by American teenagers and found that 90% are playing an average of nine hours each week. Excessive game playing often take the place of physical exercise and has been linked to poor performance at school and aggressive behavior.


Dr. Gentile advises parents not to view the study as supporting the notion that it's okay for children to play video games more than one hour a day because while such behavior may help with future surgical skills, all that time away from studies will not help young hopefuls gain entrance in the medical school.

Okay, and now for the story everybody's waiting for. FDA says don't eat veggie booty snack food. The U.S. Food and Drug Administration issued a recent warning telling consumers not to eat veggie booty snack food because – boy, it does roll off your tongue though. Veggie booty snack food, it could contain salmonella, a type of bacteria that causes gastrointestinal illness. Veggie booty is sold in four-ounce, one-ounce and half-ounce plastic foil bags. Plastic foil? If you have any of these products by Robert's American Gourmet, the FDA says you should throw them away.


Veggie booty is highly favorite by children and parents should keep a careful eye on their kids and get medical help if they show any signs of disease. Parents should also report any suspected illness linked with eating veggie booty to local health authorities.

Salmonella causes diarrhea which can be bloody, nausea, vomiting and abdominal cramps with fever. The symptom usually start when the four days after ingesting the bacteria. It's not usually life-threatening except the babies, the elderly and anyone whose immune system is weakened.

In very rare circumstances, the bacteria can get into the bloodstream and cause more severe infections of blood vessels, the heart and certain joints. Since March, doctors in 17 states have diagnosed 52 cases of salmonella linked to veggie booty. Nearly all reported cases were children under 10 and most of these are toddlers who showed symptoms of bloody diarrhea, four were admitted to hospitals.


The FDA says Robert's American Gourmet of Sea Cliff, New York and the manufacturer or contracted to make veggie booty have stopped distribution. They are recalling all potentially contaminated stock and are cooperating fully with investigators.

Veggie booty is sold in all 50 states, Canada and over the internet. Robert's American Gourmet says anyone who still has the product at home should throw it away and can contact the company for refunds or to ask for their questions.

Every year, 40,000 cases of salmonella infection are reported to authorities in the U.S. but the CDC suspects the actual number is greater because many don't visit a doctor or report milder symptoms. Salmonella infection typically arises from poor hygiene of food workers, eating raw or undercooked eggs, poultry and meat and handling certain animals like pet turtles and snakes. And the saddest thing about that news story coming to a close is that I get to say veggie booty anymore.


Few families report safe firearm storage. Few families store their firearm safely according to a pediatric researcher at Brenner Children's Hospital, part of the Wake Forest University Baptist Medical Center. Dr. Robert Durant published the results of this study in the June issue of Pediatrics.

Over 70% of families surveyed reported not storing their firearms safely in their residence. Durant said, "This concerns us a great deal because having guns in the home increases the likelihood that they will be used in a suicide or unintentional injury. It's imperative that parents understand the necessity of storing guns safely in the home. Storage patterns are most influenced by firearm-type family socialization and the age of the child….

According to Durant, the research shows the unsafe gun storage is associated with families who are raised with guns in the home. They tend to be more comfortable with guns and they're less likely to store them safely. We also found that families who had children aged two to five years and owned long guns are more likely to store guns safely than families with older children.


Our primary recommendation is that parents should remove guns from the home, Durant said. However, if parents are unwilling to do that, they should lock all guns with gun locks and store them separately from ammunition.

Firearm ownership was highest in families with two adults in the home, according to the study. Families in rural areas are more likely to own long guns and families who own long guns are more likely to leave those firearms unlocked, but they store ammunition separately from the gun. Families who own handguns were more likely to store the guns locked, but were also more likely to keep them loaded.

We are encouraging all pediatricians to talk with parents about safe gun storage practices because we want to prevent unnecessary deaths. Durant and colleagues administered the study to 3,745 parents and 96 pediatric offices in 45 states, Puerto Rico and Canada.


And finally in the news segment, doctors resort to text messaging. British physicians have discovered innovative ways of using a text messaging system to improve patient compliance with the childhood immunization schedule. The long periods between booster doses often result in children missing important jabs.

Earlier results have shown sending text message reminders to parents and guardians vastly increases appointment attendance. Stuart Hall practice IT manager from the Vale Medical Centre in South London, said his clinic was keen to look at ways of managing patient compliance in this area. We were able to put together a list of children who were overdue for their specific jab and whose parents have not responded to letters sent out previously.

Using the iPlay-Doh system, we sent targeted text messages to these parents asking them to call the clinic and book an appointment for their child's missed vaccination. The results of these text campaign was overwhelmingly positive with more than half of the parents phoning the office and making an appointment in response to the text alert.


Immunization is a means of actively protecting a child against serious disease and once children are vaccinated, their immune system can more easily fight off certain diseases. If a child misses a vaccine, they remain at risk from the disease in question. If the level of compliance decreases within a specific population, the number of children at risk for catching the disease increases and as a result, outbreaks are more likely, even among those who have been vaccinated.

Tobias Opstein, iPlay-Doh Managing Director, said, "The aim of our technology is to simplify and automate many of the processes that health care professionals are faced with. Improving patient compliance can be hugely burdensome especially when dealing with a large group of patients. iPlay-Doh's text messaging system aims to help doctors engage their patients and increased compliance in a manner that is not only cost-effective, but also personal and immediate.


Okay, that concludes our news segment. We will be back and have some questions and comments from you and that will be coming up right after this.


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Okay. First up in our listener segment this week. We have Debbie from Pennsylvania and she actually called in on the Skype line, so let's take a listen to what Debbie had to say.

Debbie: Hi, Dr. Mike! This is Debbie from Pennsylvania. I was calling to see if you could chat a moment about cuts and scrapes and the proper treatment for them. I'm never sure whether I should be putting a Neosporin and a band-aid on my children's cuts or just letting them air-dry. So the band-aid versus air-dry debate is quite interesting to me right now during the summer when they're getting a bunch of cuts and scrapes on their knees. So if you could address that at one of your podcasts, that would be great. Great work! Thanks, bye.


Dr. Mike Patrick: Okay. So let's talk about cuts and scrapes. This is a pretty straightforward topic. I mean the most important thing when your child has a cut or scrape, of course, the first thing you want to do is stop the bleeding. So you want to apply pressure with a clean cloth or bandage and hold the pressure basically continuously for 20 to 30 minutes.

You don't want to keep checking as this would dislodge the clot and the bleeding may recur more easily. If the blood spurts or flows again after 20 to 30 minutes of pressure, then you want to seek medical help by calling your doctor, call in 911, head to the emergency room, that sort of thing.

Okay. Once you have the bleeding stopped, then it's time to clean the wound. You want to rinse it with clear water. Soap can irritate so you only want to use it to clean skin near the wound. Use tweezers or alcohol to remove debris that remains on skin that's near the wound. And if any debris is lodged in the wound itself, then you want to seek medical help to get that taken out.


There's no reason to use hydrogen peroxide or iodine-containing medications on the wound. If you remember the old tincture of merthiolate. Those are red stuff that your mom might have used in applicator stick to put on and boy, it burn like the Dickens. I remember it. It was terrible. And of course, I had mercury in it. So it's not used anymore. Can't even buy it. If you open up a bottle of it, the Health Department would be knocking at your door, trust me.

Okay, after you clean the wound, you're going to want to apply an antibiotic cream or ointment. Thin layer of triple antibiotic cream such as Neosporin or ointment. Of course, you want to watch for allergic reactions to these. They're uncommon, but they are possible. If you run into any problems with that, of course, call your doctor.

You want to cover the wound. Bandages keep the wound clean and may help reduce bacteria infecting the wound. After the wound has begun healing, then air exposure may actually speed the healing process.


So the important point is to cover the wound soon after it occurs, but then once healing has begun, then it's okay to keep it exposed to the air. But it is important to keep your kids from picking at it and to keep it clean. So this is one of those things where you have to just sort of use your common sense. If you have a child who picks at it a lot or you just can't keep them clean, then you want to keep it covered a little bit longer. So even though air exposure may speed the healing process, having it get infected or constantly picked at will certainly negate the benefit of leaving it exposed.

You want to change any dressings that you're using regularly. Don't let the dressing or bandage itself become wet or dirty. Change it at least once a day, but change it more often if it does get wet or dirty. If your child has sensitive skin, you can use sterile gauze and paper medical tape. You could also use a gauze roll held in place with loose fitting elastic wrap. So those are all things to think about.


Now what about stitches? Well, if the wound is deep, obviously, you're going to want to seek medical help for that. So if it has gaping edges or jagged edges or there's a fat protruding through the wound or any muscle protrusion, then of course, you're going to want to seek medical attention so they can evaluate to see if stitches need to be placed.

It is important for proper closure to take hold within a few hours after the injury itself because as long as you get it sutured up quickly, there's going to be better healing and reduced infection risk. There's also a roll for dermabond, that's the glue material so lacerations or cuts that aren't huge which you normally would just take one layer of stitches, no internal stitches can be closed pretty readily with the dermabond substance.

However, you can't use it like across joints or places where there's a high tension on both sides of the wound. I also want to avoid using it like really close to the eyes. But of course, if there's any question about any of these, you're going to want to call your doctor and let him take a look and see if stitches or dermabond are necessary.


Signs of infection with wounds, you want to call your doctor right away. If you see redness, warmth or swelling at the wound site. If there's any drainage or discharge of any color, recurrence of bleeding, increased pain at the site, fever, vomiting, any of these kind of things, you want to let your doctor know for anything else that's bothering you.

Tetanus shots are important to keep up on. We do tetanus shots when babies are two, four and six months of age. Again, around 15 months of age. Another one before kindergarten and then another one when they're 11 or 12 years old and it's every 10 years after that. If a significant wound occurs, then we consider tetanus shots if the last injection was more than five years ago and if it's a really significant wound, then you probably being seen in the emergency department. They usually will consider doing a tetanus shot regardless of the last shot day if it's a really significant dirty high-risk wound for tetanus.


I'm going to put a link in the Show Notes to a really nice first aid sheet for cuts and scrapes that came from the Mayo clinic that's available online so swing by and you can look for that, a link to that in the Show Notes.

Okay the next one is a Shawna in Georgia and Shawna says, "Dr. Mike, I love your show. Thanks for the great information you provide. My 12-year old son has Asperger's syndrome. Can you tell us more about the disorder? Thanks so much.

Okay, so let's talk a little bit about Asperger's syndrome. This is one of several autism's spectrum disorders. And this one is distinguish from others by these kids have normal cognition. That means that they basically have normal intelligence. The main issue with Asperger's syndrome is impaired social interactions along with peculiar patterns of behavior, interests and activities.


It's overall prevalence ranges from 1 and 250 to 1 and 300 kids and its more common in boys with the ratio of 4 boys affected for every 1 girl. The incidence is rising, but this is likely a result of better identification of those who are affected.

The mechanism of this likely results from an alteration during fetal brain development and particularly, in the areas of the brain that is responsible for social interactions and motor movements. But what causes this alteration in the developing brain? That's more up for debate. Most people think it's genetic factors with a combination of environmental factors thrown in. But there's a strong case for their being more of a genetic component because of this kind of observations that we see. There's unequal distribution among the sexes. Again, as I said, it's a 4:1 male predominance so you'd think that there wouldn't be that if there wasn't some sort of a genetic link associated with it.


Also, there's an increased prevalence in siblings, so it can be as high as 9% prevalence rate among siblings in some studies. And there's a really high concordance rate in identical twins. I mean if one twin has it, there's as high as 96% chance in some studies that the other twin will have it as well. So when you see that high of a concordance rate in identical twins, that also tells you that there's likely a genetic component with it. Although, you can argue that if it's environmental that the identical twins are probably exposed to the same types of environmental factors as well.

Diagnosis and criteria. This comes straight from the DSM4 and remember, we were talking about the psychiatrist bible earlier on in the news segment. That's what the DSM is. So the way that the psychiatrist diagnosed Asperger's syndrome, this is sort of the criteria that they're looking for.


You have to have an impairment and social interaction that's manifested by at least two of the following: market impairment and the use of non-verbal behaviors such as problems with eye to eye gaze, facial expression, body postures or gestures to regulate social interaction; failure to develop peer relationships appropriate for a child's developmental level; lack of spontaneous sharing of enjoyment, interest and achievements; and lack of social or emotional reciprocities. So you want to see two of those things.

Oh I'm sorry, that actually is one. So the market impairment and the use of non-verbal behaviors and those were four examples. Also failure to develop peer relationships appropriate for developmental level; lack of spontaneous sharing of enjoyment, interests and achievements and lack – or I did say this, didn't I? I'm sorry, lack of social or emotional reciprocity. I remember I said it because of the word reciprocity. It's not a word that I use everyday.


So basically of those things, you want two of all the things that I just mentioned. So that's one criteria. The next criteria is stereotypical patterns of behavior manifested by at least one of the following: preoccupation with interest that are abnormal and focused or intensity and flexible adherence to non-functional routines or rituals; repetitive motor mannerisms such as hand or finger flapping or twisting or complex whole body movements; and persistent preoccupation with parts of objects.

The next one, the disturbance has to cause clinically and significant impairment in day-to-day functions. There cannot be a significant language delay and no significant delay in cognitive development or intelligence and then you can't have criteria for another one of the autism's spectrum disorders or for schizophrenia.


So what does this mean in the real world? Basically, you're going to have a kid with normal intelligence who has impairment in relating to adults and peers. And then they may have really sort of abnormal preoccupation with things. They can have repetitive motor mannerisms or just really non-functional things, preoccupation with certain interests or are with a parts of an object and they're playing with it over and over to an abnormal degree and this things are impacting their day-to-day functions. So these would all be things that within make you worry about Asperger's Syndrome.

So once you have it, what do you do? Well, early identification and psychological intervention for the child, the parents and the entire family is important. And you basically maximize developmental and social skills, make sure that they're on an educational environment that really taps in into their strengths and is able to cope easily with their weaknesses or the younger kids play therapy and those sorts of things are going to help. There's really no known prevention since this does seems to be a genetic disorder.


So I hope that – I hope that was enough information there for you Shawna. So thanks for your question and that's something that we do see from time to time, fairly frequently. And I think it does help to sort of look at it in terms of all of the – the whole picture of what Asperger's Syndrome is because a lot of parents, you hear that terminology in just sort of a Pandora's box of what's exactly in there. What exactly makes it up. So hopefully, you know a little more about it now.

This next question comes from Mary Lou in New Jersey. She says, "Dr. Mike, I am a new listener and I really enjoy the show. My son, Andrew, is five and due for his shots. Andrew is also autistic. I cringe at the thought of putting more of those vaccines into his body. I know that no known connection has been proven between vaccines and autism and the school requires he has these shots, but I simply cannot bring myself to getting them done. Can you tell me your opinion or how I can get him into school without the vaccinations? Thank you."


Oh, Mary Lou. Mary Lou, Mary Lou. You asked for my opinion, so here we go. As you said, there's no known connection that has been proven between vaccines and autism. In fact, as we just described in our discussion of Asperger's Syndrome, which is in the spectrum of autism disorders, it makes more sense that autism is a genetic-based disease.
However, there is a proven connection between not having your child vaccinated and increased risk of developing a potentially deadly vaccine-preventable disease such as measles. There's also a proven connection between not having your child vaccinated and increased risk of spreading a vaccine-preventable disease to children who were vaccinated but whose vaccine failed to produce immune protection. Therefore, from looking at a benefit versus risk analysis, I would choose to vaccinate my child even if he or she suffers from an autism spectrum disorder.


Okay, and then this one comes from Caroline in Cincinnati. Caroline says, "Dr. Mike, I just started listening to your podcast and I am enjoying it very much. I was scrolling through the list of previous topics and I noticed that you haven't discussed injuries from bicycling, skateboarding or inline skating.
I am currently writing my master's thesis on the topic of injury prevention and have reviewed a lot of literature stating that rates of helmet and/or safety equipment usage is low. The highest number I found was 31% of kids wearing a bike helmet. All of the other literature I've come across suggests much lower rates especially amongst skateboarders. Just something you might want to mention to your listeners. So many injuries nowadays are preventable. Thanks, and keep up the great work on your podcast. Sincerely, Caroline."


So Caroline, you definitely make a great point. We've not spent a lot of time talking about injury prevention and it is important. I'm going to try to go a little way in making this up to you by providing you with a bunch of valuable links.

These are links to something known as TIPP, T-I-P-P, also known as The Injury Prevention Program. It was designed by the American Academy of Pediatrics in the mid-1980s, and its goal was to provide pediatricians with age-appropriate injury prevention guidance. Until now, the easiest way to get in some information was a visit to your pediatrician each year, which of course you should still do.

But recently, the American Academy of Pediatrics made this program available to parents on the internet, so look for the links in the show notes. Basically, they're specific handouts with links in the Show Notes to the birth to 6 months age group, six to 12 months, 1 to 2 years, 2 to 4 years, 5-year olds, 6-year olds, 8-year olds, 10-year olds.

And then there's information sheets on bicycle helmets, bicycle safety myth and facts, getting your children to wear helmets, safe biking starts early, children as passengers on adult bikes, how to protect your home against fire, firearm injury prevention, four steps to disaster readiness when your child needs emergency medical services, lawnmower safety, poison prevention, crib safety and home playground safety. There's links in the Show Notes, it's a long Show Notes this week I know, but there are links to all those things. So if you're interested check them out and it goes through injury prevention in pretty detail for you, so be sure to check that out.

Okay, and then our next listener comment is another from the Skype line. Let's take a listen to this.
Whitney Hoffman: Hi Dr. Mike, it's Whitney Hoffman. I was just listening to your last episode about looking at the science and the studies and how that works. In particular, I was really interested that you're doing it over thumb sucking.


As you know, my older son, James, had speech and language issues. Yet out of my two children, he is the one who had no sucking habits. He did not take a pacifier ever. He didn't take – he didn't suck his thumb and he was the one who ended up with more ear infections and had a speech and language delay, somewhat secondary to all the ear infections.

On the other hand, my youngest son who is now almost nine, just over the past year, finally gave up sucking his thumbs sometimes during the night. And it was a gradual process. John, while he may have some teeth issues, his father's teeth also came in by random assignment, so we figured variations were in our future anyway. But this is a child who has had no speech or language problems at all.


So granted that's just my sample of two in my house, but I just found it very interesting that those are the things that we're supposed to have issues, like speech and language issues with thumb sucking, or having either increased or decreased infections with ear infections where it contraindicated in my sample.

Moreover, I just wanted to thank you so much for doing this because I think understanding statistics, things like standard deviations, all of those things are so important to parents when they're looking at working things and studies mean. And also what does standardized testing look like, what do all these numbers really mean when it comes right down to it, and where is your child along in this continuum. So thank you so much for doing that, and again thank you so much for PediaCast, I really love it. Thanks again, have a great summer. Bye.


Dr. Mike Patrick: Thanks for the comments Whitney, they're definitely appreciated. That was Whitney Hoffman and she does a podcast of her own. It's a really great one called the LD Podcast. So it looks at everything related to learning disabilities and disorders, and you can find her podcast at And of course we'll put a link over to that in the Show Notes.

And our finer – our finer, listen. [laughter] Our final, and it's one of the finer ones too, this is our final listener comment this week. This comes from Jason in Charlotte. And Jason says, "Dear Dr. Mike, I am a pediatric dentist. I really enjoyed your recent discussion of the scientific process, and I also liked that you used the example of non-nutritive sucking.

I seem to spend a lot of time during the office visits allaying parents' fears surrounding thumb and pacifier habits. I answer this question on a daily basis, and it sometimes seems that parents are more worried about non-nutritive sucking than the dental caries that their child has. And judging by the number of times non-nutritive sucking has been discussed in your podcast, you must be asked this question a lot also.


Like you said, I feel like I have to do the research and then distill it down for parents, but it's always difficult with all the other incorrect information out there. Here are my general recommendations for non-nutritive sucking. I do not worry about trying to stop non-nutritive sucking prior to the age of three. There is no scientific research showing that it causes any problems, and it usually just makes the child and parent frustrated.

Around three or four, when the child is more amenable to behavioral management techniques, I suggest this sock or sticker calendar method, and I was very happy to hear you mention these in your podcast coupled with positive reinforcement. Like the AAPD website states, I usually do not get worried about non-nutritive sucking until right about the time the permanent teeth erupt age five to six years old. I do not suggest getting into a power struggle with a three or four-year old over a non-nutritive sucking habit.


Now there is one factor in this whole debate, active sucking versus passive sucking. There is a study that NNS habits show that children who are active suckers cause greater malocclusion than children who are passive suckers. An active sucker is one that actively sucks on the object, i.e. making a noise or you can see the cheeks moving in and out. A passive sucker usually just places the object in his or her mouth then just holds the object in there.
I will also not pick on the speech pathologist, but I have a bone of contention with some speech pathologists in my area. I remember reading a study that concluded children with open bites due to sucking habits or other factors have temporary speech delays that do not progress past the age of seven or eight. So the bottom line for me is that yes, non-nutritive sucking can cause a temporary speech disruption but it is not a long-term problem and it is not a problem that needs intervention. I think this is much like your example of being pigeon-toed. Hope this helps….


And of course, it certainly did. So thank you, Jason, Dr. Jason I should say, the dentist, pediatric dentist in fact. And thanks for your comments and thanks for listening. And you know what, actually, that was going to be my final comment. And now I just remembered right before I started to tape this, I had to add one more. I had all the script all done and ready to go, but I had to stick this one in because it was also sort of pertinent.

This one comes from Larry. He says as a professional engineer, PhD and lifelong science nut, as well as the father of an 11-month old boy, I applaud the thinking inside the box segment of PediaCast no. 041. This is a fantastic public service above and beyond the spectacular job you do on PediaCast in general.


But I must take exception to your mention of Christopher Columbus proving that the world was round. The notion that people of the time thought the world was flat and Columbus proved them wrong is in other fabrication made popular by a book by Washington Irving centuries later and now repeatedly endlessly – repeated endlessly, I'm sorry, even in schools.

The fact is that in Columbus' time, all educated people knew the world was round and had a fairly accurate estimate of its size since the ancient Greeks. Columbus actually thought that the earth's circumference was smaller than everyone else which is why he believe he could sail from Europe to India by going West.

He was wrong, of course. Everyone would have perished on the journey if the Americas hadn't been in his way. So the Columbus story turned out after all, to be a perfect illustration of people saying things they've heard, but that turned out not to be true. Anyway, thanks again and I encourage you to take an even stronger stand in your podcasts when topics come up related to remedies that are unproven and especially those that have no plausible scientific basis. Best wishes, Larry….


That is good stuff.


Okay, moving along to our research round-up brought to you in conjunction with the research partner, Devon Technologies, creators of robust information retrieval software for the Macintosh platform and you can visit them online at


First up, automated external defibrillators in Washington State high schools. This was a study done by the Department of Family Medicine at the University of Washington in Seattle and published in the British Journal of Sports Medicine February 2007. The question before the researchers was to determine the prevalence and use of AEDs in Washington State High Schools and to examine the existing emergency preparedness for sudden cardiac arrest.

This was a cross-sectional survey that was sent to 407 high schools in Washington State and the principal at each high school basically, was invited to complete a web-based questionnaire. And on that questionnaire, they were simply asked do you have an AED or automated external defibrillator.

For those of you who don't know what that is, it basically, Eric, a set of paddles that you put on to a patient and then you just – actually, they're not really paddles, they're more sticky pads. But they analyze the heart rhythm and then they tell whether it's a shockable rhythm or not a shockable rhythm.


And then basically, anybody can operate on of these things. There's instructions when you open it up that tells you where to place the pads. You turn the machine on, it analyzes the rhythm and if it says you need to shock the patient, you pushed the button.

So they're pretty easy to use. So basically, the principles were asked, do you have this devices at your school? Where are they located? Who funds the devices if you have them? Who trains school personnel and which school personnel are trained? Do you have any coordination with emergency response agencies in your area and have you actually had to use the thing?

Okay. So what were the results of this survey? Well, 118 schools completed the survey which was only a 29% response rate. 29% of principals answered the survey. Maybe they got caught in their spam folder. I don't know, but that's pretty poor show in Washington state. Should be ashamed of yourselves. Of course, I'm not sure. It would have been much better in Ohio.


64 of the schools had at least one AED on school grounds and that came out the 54% of the schools that answered. The likelihood of AED placement increase with larger school size. 60% of AEDs were funded by donations. 27% were funded by the school district and 11% by the school or athletic department itself. 78% of coaches received AED training followed by administrators with 72%, school nurses with 70% and teachers only had 48% training rate.

Only 25% of schools coordinated the implementation of AEDs with an outside medical agency and only 6% of schools coordinated with the local emergency medical system. One school, just one reported having used an AED previously to treat sudden cardiac arrest in a basketball official who survived after a single shock. The estimated probability of AED use to treat sudden cardiac arrest was one in 154 schools per year.


So the conclusions of the study over, of course, either you're looking at a low response rate, only 29%. But of those that responded, over half of Washington State high schools have an AED on school grounds. AED used occurred in less than 1% of schools annually and was effective in the treatment of sudden cardiac arrest.

Funding of AED programs was mostly through private donations and there was little coordination with local emergency response teams, so significant improvement is needed in structuring emergency response plans and training targeted rescuers for sudden cardiac arrest in the high school setting.

So here's my question for parents out there in the PediaCast audience. Does your school have AEDs? Where are they located? Do your sports team travel with them? Who is trained to use them? And if you don't have them, what funding is available to get them?


So as parents, of course, we need to be involved in our schools and you should definitely hold your local schools accountable and if you just think of it this way, the family of that one basketball official who was basically his life was saved because there was an AED on school grounds. If he had been officiating a basketball game at your school, would he still be alive today?

Okay, up number two in the research segment. School backpacks. How much weight is too much? This one was done by the Moore Chiropractic Wellness Center in Redding, California and was published in the journal of School Health in May of 2007. This study was also featured in the July 2007 edition of the American Academy of Pediatrics publication called Grand Rounds.


And I mentioned this because sometimes, there's a little bit of a thief between traditional medicine and chiropractic medicine. But I just wanted to mention that this was a very well-done study and of course, we want to give credit where credit is due. The question is there is debate about weight cut-offs for backpack use with some people saying that a backpack should not weigh more than 10% of a student's body weight. And others saying that it can weigh up to 15% of a student body weight.

So in these study, basically they took 531 students who were fifth through 12-graders in Northern California and the students were interviewed as to backpack use, pain associated with the use of the backpack. Frequency, site and severity of any pain, pain interference with activities and pain leading to actual medical care. Then the students were weighed and typical backpacks for that student was weighed and the weight of the backpack was determined in the form of percent of the student's body weight.


And the results were that there was a significant difference between backpacks weighing 10% versus 15% of a student's body weight. The ones that was over 10% of their body weight was more associated with upper and back end – I'm sorry, upper and mid back pain. But not so much neck pain or low back pain. There was an increased association with lost of school time, lost school sports time and greater chiropractic utilization.

So the conclusion of the authors was that the 10% cutoff is recommended along with a variety of practical methods to help schools achieve that goal for middle and high school students. And again, this is another example of parent responsibility for getting involved.

So here's a study that you can actually cite two of the school officials that routine backpack should not weigh more than 10% of a student's body weight. And of course, that's easy to figure out. Just take their body weight, multiply it by 0.10 and that's going to tell you how many pounds the backpack should be allowed to weigh.


Okay, and then finally, Teletubbies are poor language teachers. Toddlers learn their first words better from people than from Teletubbies, according to a new research at Wake Forest University. The study was published in Media Psychology. Children younger than 22 months maybe entertained by the Teletubbies but they do not learn words from the television program, said Marina Krcmar, Associate Professor of Communication at Wake Forest and Author of the study.

With the tremendous success of program such as Teletubbies that target very young children, it has become important to understand what these children are taking away from the programs. We would like to think it could work that Teletubbies and other shows can teach initial language skills, but according to Krcmar, that is just not true.


In the study, Krcmar evaluated the ability of children ages 15 to 24 months to learn new words when the words were presented as part of a Teletubbies program. She then evaluated their ability to learn the new words from an adult speaker in the same room with them. Children younger than 22 months did not accurately identify an object when taught the new word by the television program, but they were readily able to connect the word with the object when the word was presented by an adult standing in front of them.

Dr. Krcmar said during the early stages of language acquisition and for children who still have fewer than 50-word vocabularies, toddlers learn more from an adult speaker than they do from a program such as Teletubbies. The results of this study have important implications for language acquisition and indicates exposure to language via television is insufficient for teaching language to very young children. To learn new words, children must be actively engaged in the process with responsive language teachers.


We have known for years that children ages 3 and older can learn from programs like Sesame Street, but it seems television programming for children under the age of two does not help build vocabulary. The results confirm the recommendation of the American Academy of Pediatrics to avoid frequent television viewing for children under 2 years of age.

According to Krcmar, the idea that television can help teach young children their first words as the parents have dreamed, but one not supported by the research. I don't know about you, but the thought of Teletubbies teaching anything to my children – well, gosh it's not exactly a dream. In fact, if you ask me, they're pretty frightening.

I did mention before in another show, someone had asked me what I thought about TV viewing for kids less than two. Again, I just want to point out here that there maybe a role in my mind, this is my personal opinion talking. There maybe a role for limited television viewing in a kid less than two, they're not going to get much out of it.


But there is something to say about give him, mom, an hour to get some work done. Hopefully in the same room or in an adjacent room or she's got her eyes still on the child, but it seems to me that a little bit of TV watching in moderation, you shouldn't feel guilty about that in my mind.

However, you shouldn't put your kid in front of the television thinking they're going to learn to talk. I think that seems pretty obvious to all of us. But here's a study that also goes along with that. Alright, well, we will be back right after this break and we'll close out the show.



Alright, once again, we have to make the lawyers happy. The information presented in every episode of PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plan 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.

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Okay, we're going to do something that we haven't done in a while. And that is leave you with a song. And I basically came across a new way to share some music with you that is not just independent artist, but actually independent labels, so this is going to be music that you can actually purchase online at places like iTunes and so these are artists who have recording contracts with independent record labels who have allowed us to play some of their music. So this is a very exciting opportunity for us to be able to be a part of this.

And with the recent holiday in the United States, I thought our first music selection ought to be something a little patriotic so this is going to be courtesy of the U.S. Air Force Band of the Golden West, it's a jazzed up version of America the Beautiful.

So, until next time, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids. So long, everybody.

1:03:04 – 1:05:54

[Music – America the Beautiful]

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