Vegan Diet, Napping, and Cold Sores – PediaCast 048

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News Parents Can Use

  • Lack of Contagious Yawning as a Marker for Autism
  • More States Allow Kids to Carry and Self-Administer Rescue Medicine
  • Lead Exposure – When to Get a Blood Test
  • Tips for Grocery Shopping with Kids
  • How to Pack a Healthy Lunch for School

Listener Segment

  • Vegetarian and Vegan Diet
  • Polycystic Ovaries
  • Napping and Sleeping
  • Cold Sores
  • Plastic Bottles

Research Round-up

  • Antibiotic Use Early in Life Increases Asthma Risk Later
  • Relationship of Obstructive Sleep Apnea to ADHD


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Announcer: This is PediaCast.


Dr. Mike Patrick: Hello, everyone, and welcome to this week's edition of PediaCast, a pediatric podcast for moms and dads.

This is Dr. Mike coming to you from BirdHouse Studio. I'd like to welcome everyone to the program.

It is Episode 48. We're going to talk about vegetarian diets, cold sores and sleep apnea. Plus, we'll have News Parents Can Use. And we're going to talk about lots of other things as well. So stick around.

And for those of you who are I don't know interested in seeing what BirdHouse Studio actually looks like, we are trying something new this week. We are doing the show on blogTV.

Now, obviously, none of you knew that [Laughter] so this is like a trial run.


But I will say this. If I will on the blog and the Show Notes, we'll let you know when upcoming tapings are going to be, so you can tune in to blogTV. We're on there as PediaCast Live. So you'll be able to look us up that way.

OK, some other things, we're going discuss this episode "Lack of Contagious Yawning as a Marker for Autism".

More states are allowing kids to carry self and self administer rescue medicines.

Lead exposure, when should you get a blood test? With all the talk of the toys with lead in them, some people want to know "Hey, do I get a lead test or not?" We're going to talk about.

Also tips for grocery shopping with kids and how to pack a healthy lunch for school.

Polycystic ovaries, napping and sleeping and then we had a listener with the question about plastic bottles, so we're going to discuss that as well.


And then on a research roundup, we'll wrap things up with talking about antibiotic use early in life and is there an increase risk of asthma later on, and then obstructive sleep apnea and its relationship to ADHD so all of those topics coming up in the show.

Don't forget if there's a topic that you would like us to discuss, all you have to do is go to and click on the Contact link.

You can also email and our voice line is 347-404-KIDS. That's 347-404-K-I-D-S.

So if you have a topic that you would like us to discuss, you can get a hold of us in any of those ways.

I do want to apologize that I missed last week. As you know, we were planning a trip to Chicago and we had such a good time that I just was not able to get around to getting a show out.


I do want to give a shout-out to our Chicago hosts, Mark and Mary. They did a great job showing us around the city. We visited the Brookfield Zoo, toured The Field Museum, Sun Navy Pier and spent some time on the magnificent Mayo.

If you ever get over there, Garrett's popcorn [Laughter] that is some yummy stuff. And I also wanted to mention, because this goes along with the Chicago trip, I'm not getting any paid advertising for But I do listen to quite a few Audible books.

And there was one of them that had been recommended by my father-in-law. And one of my practiced partners actually recommended as well, and since we were going to Chicago, I thought I would check it out.

It's called "The Devil in the White City" by Erik Larson. And I'm listening to the unabridged version of it. I tell you. It's a good book. It's about the Chicago world's fair in 1893 and also America's first documented serial killer.


And they kind of intertwined the stories. It's a true story. It's really fascinating, certainly not for the kids to listen to. And I'll put a link in the Show Notes to the official site at Random House.

You see, I'm not putting an Amazon ad in the Show Notes, so you can find it at Amazon or any other place that you'd like to check out books, or an

Also I wanted to mention before we get started. I did have a slip up on the directions for the Bundlo contest, so I'm going actually extend it one week, for those of you who were confused by that.

Basically, in order to enter the contest, you either can use the website Contact form at or you can email

In the last show, I had the email address wrong and I apologized for that. So and in the subject line just put "Bundlo Contest" and that way I'll know what's that about.


So we're going to extend it through the end of Friday, September 7th so entries will close at midnight on Saturday, September 8th, Eastern Daylight Time. So just make sure you get your entries in.

Now for those of you who don't know what I'm talking about. The Bundlo contest in the last four episodes prior to this one, we had guests that we interviewed. And during the interview segment of each show, there was a code word.

And the code words spelled a code, or not spelled but you basically unscramble them to make a phrase, and you just want to email me the phrase and then we're going to select three people. And they will get a lifetime subscriptions to Bundlo which is

If you're not sure what that is, it's basically an online baby book so it's a blog for your baby or child, also a photo album.


And it also has a place where you can put first steps, the first time they talked, basically the firsts in their life. So it's an online baby book. It's what it is. But you can password protect it and then share it with friends around the country. So that's pretty cool.

OK. We better get started because we have a lot to cover.

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 a specific individual.

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 don't forget. 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 and we will do it right after this short break.


[Short Break Music]


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 visit them online at

First off this week, kids with autism spectrum disorder are not susceptible to contagious yawning.

Researchers from the University of Tokyo are first to discover this link, or rather lack of a link, between contagious yawning and autism spectrum disorder.

We all know about contagious yawning, right? In fact, if by the end of this story you've yawned, then you know exactly what I'm talking about.

Contagious yawning is, if I've to share the same brain mechanism as empathy and since children with autism spectrum disorder are known to have trouble responding to the feelings of others, Dr. Atsushi Senju and his colleagues at the University of Tokyo Center for Brain and Development hypothesized that kids with autism might also exhibit an abnormal capacity for contagious yawning.

So to test this idea, 50 kids half of them with normal development and half of them with autism spectrum disorder watched two videos.


The first video showed people making non-yawning mouth movements. And as each group watched this video, observers kept track of the number of yawns among the children.

During this phase, there was no difference in the yawnry of those developing normally and those with autism spectrum disorder.

However, there was a significant difference when the groups watched the second video, which featured many people actually yawning. The group of children with autism spectrum disorder continued the yawn at their baseline rate measured during the non-yawning mouth movement video.

The group of children with normal development, however, exhibited a significant increase in yawning compared to their baseline when watching the yawning video.

So Dr. Senju remarked on the findings by saying, "This is the first report that a neuropsychological or psychiatric condition can selectively impair contagious yawning, while sparing spontaneous yawning."


Our study confirms the prediction of empathy theory by demonstrating the individuals with autism who show atypical development in empathy also shows selective impairment in contagious yawning.

Of course, with the mere 50 children enrolled in the study, it will be interesting to see if this relationship holds true in a larger sample size. But this kind information is important because it helps us gain a better understanding of autism.

And, of course, by deepening our understanding of autism, we'll be in a better position to help those afflicted with the disorder.

So did you yawn yet? I tell you. I must have yawned 20 times when I wrote the story.

From yawning we move to wheezing. The new school year boasts a big difference in 40 states and the District of Colombia. For the first time, students in these states will have the law on their side if they want to carry and self administer metered-dose asthma inhalers and injectable epinephrine.

In years past, little Bobby had to visit the school nurse or have the principal give mom or dad a call, if he was a life-threatening asthma or anaphylactic attack.


Most states require the medicine to have a proper label and will want a doctor's note on file in the school office.

The mothers of Asthmatics Division of the Allergy and Asthma Network, a non-profit patient advocacy and educational organization fought long and hard at the state and national levels to win over lawmakers.

Did they succeed in your state? Well, you can check out the Show Notes at for a link to the complete state-by-state rundown.

If your state is on the list and your child suffers from asthma or severe allergies, see your doctor for an updated prescription and the paperwork that your school will require.

And if your state is one of the few who doesn't allow kids to carry and self administer rescue medications, call your state representative and ask them when they plan to get with the program because a child's life may well depend on their action.

By the way, legislation is pending in New York and Pennsylvania.


So if you live in one of those two states, it's extra important to make your voice heard.

Now unless you've been living in a cave in the past few weeks, you probably know about the recall of more than a million toys made in China because of unsafe lead levels.

Well, manufacturers have lists of recalled items on their websites with directions on how to return the toys. But what if you have recalled products in your house?

Does your child need a blood test for lead? Well, according to Dr. Marcel Casavant, Medical Director of the Center Ohio Poison Center, "Any child who has eaten or repeatedly sucked on lead-contaminated objects needs a blood lead test."

Blood exposure may lead to abdominal pain, constipation, vomiting, anemia, and kidney damage. But according to Dr. Casavant, the main reason lead is such a public health concern is because lead hurts the brains of children.

In fact, most children with enough lead to hurt their brains have no symptoms.


And a blood test is the only way to make the diagnosis. This type of brain damage leads to fewer IQ points, trouble with concentration and reading, and an increased likelihood of dropping out of school early. Plus, prolonged and severe cases of lead exposure can result in high blood pressure, persistent vomiting, lethargy, and coma.

Now what if you don't have any of the recalled toys in your house?

Well, parents should still ask their child's doctor to obtain the blood lead level, if any of the following conditions apply if they live or regularly visit a home, daycare, preschool, or babysitter's home built before 1950; if they're living or regularly visiting a home or building with chipping, peeling, dusting, or chalking paint; if they're living or regularly visiting a home or building built before 1978 with renovation or remodeling ongoing, or recently performed, or planned; or if they have a friend, playmate or sibling who currently has or recently had lead poisoning; or if you're having regular contact with an individual exposed to recreational or occupational sources of lead and examples of these include but, of course, are not limited to pottery, painting, fishing, welding, and construction work.


If you are unsure of the answers to these questions or you have any other concerns regarding lead exposure in your child, be sure to call your doctor and arrange a blood test for lead.

All right, getting kids to eat their fruits and vegetables can be a challenge for any parent. However, involving children in grocery shopping is an important step in getting kids interested in fruits and vegetables.

Recently the Centers for Disease, Control and Prevention replaced the "5 A Day" program with the new "Fruits & Veggies–More Matters" campaign.

The initiative recommends that people eat more fruits and vegetables by determining individual caloric needs based on age, gender and activity level to stay healthy and prevent diseases like cancer.


"It's important for kids to start eating healthy early in life for many reasons," says Kristen Bardon, Senior Dietician in the Department of Clinical Nutrition at the University of Texas: MD Anderson Cancer Center.

One reason is to help prevent the long-term consequences of a poor diet such as obesity, diabetes, heart disease, and certain types of cancer.

Allowing your child to become involved in the grocery shopping process is a creative and fun way to help them learn more about consuming a healthy diet and keeps them entertained.

One suggestion is to have a grocery store scavenger hunt with your children. They'll discover new ways to enjoy fruits and vegetables, and you will learn what appeals to them.

Parents can have their children help with grocery lists and this teaches them the proper way to choose produce and help some learn the steps required to plan a meal.

Here are some more specific ways to involve your children while grocery shopping. Show them a picture of a fruit or vegetable and have them find that item in the store. Ask them to tell you the shape, the color or size of fruits and vegetables.


Have them count the vegetables they see in the store and encourage them to find fruits and vegetables that they have not tried before.

Kids will make good choices taking fruits and vegetables over less nutritious foods when started in an early age and given the chance.

Encourage healthy eating by creating a supportive environment and modeling the principles of healthy eating yourself.

And if you'd like to know more about the "Fruits & Veggies More Matters" campaign, which I'm sure you do, check out the link in the Show Notes.

And finally, in this week's news segment, there's a rise in the number of overweight children, right? Well, this means parents must be extra vigilant when packing school lunches.

From the first day of kindergarten to the last day of high school, kids need nutritious lunches with fruits, vegetables, grains, protein, and dairy products to maintain good eating habits that will last a lifetime.

The right foods can also improve attention span and academic performance. Elena Serrano, Nutrition Specialist for the Virginia Cooperative Extension and Assistant Professor of Human Nutrition, Foods and Exercise at Virginia Tech says, "Involve your children in picking out foods and packaging the lunch box. You'll find out what they like."


Are you hearing a team here folks? If they feel a part of the process, they're more prone to eat it.

Ensure your children have a variety of foods in their diet, including whole grains and low-fat dairy products, also keep beverages low in sugar and high in nutrients rather than soda or juice. Place a bottle of water or container of low-fat milk in the lunch bag.

Serrano also advises not to leave out a small dessert. You can't completely skip sweets, and adding a small dessert teaches your child how to balance healthy foods and moderate unhealthier choices.

What kind of dessert? Well, how about a few animal crackers, Graham crackers or even a small piece of chocolate.

Carmen Byker, a Senior Virginia Tech majoring in Human Nutrition, Foods and Exercise, is studying the impact of eating local foods as part of an undergraduate research project.


She suggests buying fruits and vegetables for your children at a local farmer's market and explains, "This is not only a creative way for you and your child to pick out freshly picked produce but also benefits the local economy."

Local produce is a fresher. And it tastes better and is more likely to motivate your kids to eat those fruits and veggies.

Byker adds, "Kids don't have a lot of time to eat and they don't want to waste time preparing food at school."

To maximize the chance to actually eat what you've packed, you can cut, peel and slice the lunch produce in advance or buy the ready-to-eat kind like baby carrots, sliced apples, raisins, and grapes.

And here's a few more suggestions for a healthy lunch box. Cut apples and sprinkle them with lemon juice to prevent browning, add peanut butter on the side for healthy dipping. And remember, celery goes well with peanut butter, too.

Use different kinds of breads for sandwiches such as pita, bagels, rolls, or wraps instead of plain bread, but remember to stick to the whole grains, plus vegetables, soup, and a thermos on cold days is nice.


Let your children pick their favorite low-fat yogurt and add granola for a whole grain crunch, include sliced cheese for dairy paired with whole grain crackers. Other healthy desserts include trail mix, dried fruit, granola bars, fruit crisps, jello, and low fat pudding.

Also, don't forget about safety.

For younger children, be sure the sizes and shapes don't create a choking hazard. For more tips, be sure to visit which covers healthy choices for all the food groups. And as always, you can find that link in the Show Notes at

All right, that wraps up our News segment. We're going to take a short break and then we will be back with answers to your questions.

[Short Break Music]


All right, we are back with our Listener segment. And for those of you who wonder why in the world I do those interlude music things, it's really because I have to give my mouth a rest. It gets pretty dry talking.


It gives me a chance to drink some water. And I also mentioned it because now that I'm doing this on blogTV and we have people actually watching me during the interlude.

I look at the screen and can see myself there. And I realize that it is important. I definitely have to get a drink and just take a little bit of a break. I can't talk for that long of a period of time without a little breather.

So again, if you want to watch the show being recorded, you can check out blogTV. Our feed there is called PediaCast Live so you can check that out.

When? Well, it should be in the Show Notes. We'll put a little link up there a day or two ahead of time to give you the heads up of exactly when we plan on doing it.

OK, on to our Listener segment. This first question comes from Claire in Paris, France. She says, "Hello, Dr. Mike. I love podcast. I'm a university student, not a mother, but I eagerly await each new episode. I'm considering a career in medicine and I appreciate the peek-in on the life of a pediatrician which your podcast gives me."


"What is your opinion on vegetarian and vegan diets for children? Do you believe they are safe throughout childhood? You may be aware of the controversies surrounding a New York Times editorial published a few months ago."

"It denounced the vegan diet deeming it too dangerous for children. The author of the editorial was not a doctor, let alone a pediatrician. So I was interested in hearing a more official opinion. I realized there are no vegan sources of Vitamin B12, except supplements of course. But is there anything else that a vegetarian diet cannot provide for children?"

"Thank you so much for your podcast. I'd also like to thank your other listeners. Without all of their reviews, I probably would never have come across this podcast."

See, folks, I told you, didn't I? So if you have not given us a review in iTunes, those really are helpful. People read those and make their decisions on what to listen to, based on the review. So again, thanks to all of you.


OK. So let's talk about vegetarian diets. Strict vegan diets include only foods of plant origin. So this is going to include grains, vegetables, fruits, seeds, and vegetable fats. But, basically, there's not going to be any meat-derived fats and no meat of any kind.

Now, humans are omnivores, so basically our bodies and systems are made to function best with a diverse diet of plants and animals, because we are omnivores.

So if you remember from like high school biology. You've got your herbivores. You've got your carnivores. We fit in there as omnivores. So there is a risk of nutritional deficiencies associated with a vegetarian-style diet.

However, these risks can be overcome, and many kids grow up in vegan households. Nutritional deficiencies are seen in some of these kids, but they really are the exception, not the rule.


The truth is that most kids in vegan families grow and develop normally. And multiple experts have concluded independently that vegan diets can be followed safely by infants and children without compromised of nutrition or growth and actually with some notable health benefits.

Now the following issues apply to diets in the kids and also in breastfeeding moms. So, for formula-fed infants, you're going to want to use a soy formula. So obviously a milk-based formula is actually going to have a, it's an animal product so you're not going to want to use that. But a soy formula is a good alternative.

Now you want to avoid soy milk in kids who are less than 12 months because they're not going to get enough calories in that. Also, I would avoid rice milk. There's some nut-and-seed type of milks out there. You want to avoid those.


The non-dairy creamers, water-based cereal, mixtures of fruits and vegetable juice all these things basically have poor nutritional content especially for little babies who are less than 12 months old. So you want to stick with a soy formula.

Now during the first six months of life, Vitamin B12 is particularly important because, if you have a deficiency in Vitamin B12, it can lead to anemia. So vitamin supplementation for moms and babies or breastfeeding moms and babies are going to be important.

Now fortified foods that are fortified with Vitamin B12 is another option for the mom, if she's breastfeeding. But it is important that you do have extra source of Vitamin B12 especially in the first six months of life to avoid anemia.

Now the other thing is that, if you follow a vegetarian or vegan diet, you're not going to get long-chain fatty acid DHA when, switched from Similac to Similac Advance.


This is what they added to the Similac Advance.

And the theory here is, this is a long-chain fatty acid that is important for brain growth and also in the eye, the back of the eye the retina needs this in order to grow. And it comes from fish and eggs.

Now moms can synthesize it from linolenic acid, which is seen in flaxseed, canola and soy bean oils, or moms can take a DHA supplement which is produced by algae. But how much do you need?

We really don't know for sure. There haven't been any good studies done to say what the amount of supplement needs to be, so that's something to keep in mind.

Now after the first six months of life, sources of additional protein are needed and this can come in the form of baby foods and also table foods, such as mashed or pureed beans, mashed tofu and soy yogurt.


Those are all good sources of protein.

After six months of age, there's also the issue of zinc. Whole grains and beans contain a chemical called phytate and phytate reduces the bioavailability of zinc. So that just means, that phytate in the diet or in the intestine decreases the intestine's ability to absorb zinc so kids who are on lots of whole grains and beans, which a lot of vegetarian kids are, have been a risk for zinc deficiency.

So what do you see with zinc deficiency? Well, you get hair loss, skin problems, delayed wound healing. So what do you do about that?

Well, we don't really know exactly how much zinc kids are supposed to get. If you do a vitamin supplement with zinc in it, is that going to be enough?


You know all I can say is that if zinc deficiency is suspected because they're hair or skin problems, then you may need to increase the amount of supplement that you're getting. But this is a difficult one because we don't know exactly, really how much zinc kids need.

Now, is there any dietary form of zinc other than vitamin supplements? Well, there are certain beans, nuts and seeds, and especially pumpkin seeds have a lot dietary zinc. Now, of course, again as I mentioned, you got to watch about choking hazards. We actually talked about that in the News segment.

But you don't want to get pumpkin seeds, the little kids who can choke on them, obviously, right? So you want to talk to your doctor especially if you feel that there could be a zinc deficiency problem.

Calcium, vitamin D and iron are other things that we get from meats and from dairy products. So if you're following a vegetarian diet, you have to make sure that your kids have a good source of calcium, vitamin D and iron.

There's also the calorie issue.


Vegan foods tend to have low bang for the buck, in terms of calories, and that can ultimately affect growth. So it is important to see all of your, or to go to the doctor to see them for all of your well checkups so they can follow along on the growth curve.

And of course, you've got to take the growth curve in light of any family tendencies because if everybody in the family is small and your kids small, but following the family pattern, then it may not be because of the diet that they're small. It might just be because of genetics.

So there have been some growth studies done comparing vegetarian kids to an index population. It's actually 404 kids in Tennessee and they looked at kids who are ages 4 months through 10 years of age. This was a cross-sectional study.

And the vegan kids where slightly smaller with regard to height and weight. And it was statistically significant that they were a little bit smaller. However, none of the vegetarian kids would qualify as being failure to thrive, so none of them were weight below 30 percentile for their age in the vegetarian group.


So they were a little bit smaller but they weren't too small. And of course, the health benefits may outweigh any growth issues. But it's still important to make sure that they're getting all of the nutrients they need.

So I guess the bottom line is we're omnivores. I mean we're designed to eat meats and plants. But a vegan diet can be safe. But you have to pay attention to proper nutrition. See your doctor regularly, follow their growth, and watch for signs of any deficiency, diseases and vitamins and minerals.

You could consider consulting with a pediatric nutritionist who takes a special interest in vegan diets. And you could call your local children's hospital, or you can try the GI or gastrointestinal department of your local children's hospital.

They may have a name of a dietician who takes a special interest in helping families with vegetarian concerns.


We have a couple of links in the Show Notes for this one. The vegan diet info from and also the vegetarian resource group those are both going to be in the Show Notes.

And by the way, if you are watching this is being taped on blogTV, I do want to mention that there's a lag behind when the show gets taped and when it actually goes live online as a podcast, not much, couple of hour's time, probably.

And so the Show Notes aren't there yet, but they will be within a couple of hours at

OK, moving on to our next Listener question. This one comes from Catherine in New York. She says, "Hi, Dr. Mike. I have a question. My dermatologist diagnosed me with polycystic ovaries and I am 15. Can you discuss that so I can understand it more?"

All right, polycystic ovaries syndrome, first let me say you're not alone. It ends up affecting as many as 1 in 10 women in the United States. And they can occur during the teenaged years but it's mostly going to be seen in young adult women.


But there are a good number of teenagers who have this problem. Basically, the ovaries are large and they end up being studded with numerous cysts. Now we know that there is a genetic tendency for this, so that in certain families, you'll see folks, kind of clustering where they'll have you know, mom who had polycystic ovary disease, grandma will, there'll be an aunt, that sort of thing.

The exact cause of it is not known. But basically what happens is because of the cysts in the ovaries, you get increased androgens steroid production. An androgen steroids result in acne, can result in facial hair, obesity, irregular menses, and also this thing called acanthosis nigricans.

And what that is, it's a fancy medical terms for darkened velvety skin on the back of the neck, under the armpits and on the inner thighs, also under the breasts.


And this is just a marker for people who have an increased androgen steroid production and it lets you know, hey something's not right here.

So if you have that, you definitely want to see your doctor. Now untreated, polycystic ovary disease can lead to type II diabetes, high blood pressure, high cholesterol, sleep apnea, and infertility.

So this is important if you have polycystic ovary disease that is treated. So how do you treat it?

Well, it's aimed primarily at reducing the effects on the body of this excess androgen production that's being made by the polycystic ovaries. So what medications are available?

You want to use acne medicines to control the acne. You can regulate menstruation with birth control pills. Reduced excess of hair growth there are medications that can do that.

And infertility is a problem so medication to increase fertility is also something that you may want to think about and you can talk to your doctor about that.


Now long-term management also includes close medical follow up and elimination of cardiovascular risks, such keeping weight and blood pressure down and also screening for type II diabetes.

And there's a wonderful detailed, complete and understandable information source from the Mayo Clinic on polycystic ovary disease and we'll put a link to that in the Show Notes for you.

OK, next we have Allen in California. Allen says, "My wife and I are having some difficulties with nap time for our four-month old.

According to the book that we have been reading "Healthy Sleep Habits Happy Child," we are supposed to put her down after two hours roughly of wakefulness. So our daughter is like a clock with this.

Two hours after she is up, she is tired. I put her down for a nap and she falls asleep in about five minutes. Trouble is, she wakes up crying after about 30 minutes and my wife can't handle the screaming.

In trying to interpret the method, it says, "You should let your child cry for no more than one hour and that less than one hour of nap time is not considered a full nap.


And truth be told, so he is tired about one hour after she wakes up from this shortened nap. So what are we supposed to do? Should we let her cry for a full hour after she has slept for 30 minutes? Or is the entire process supposed to take one hour? Very confused. Thanks.

OK, I think the main issue here is that cookbook approaches just don't work. I mean, if a different system seems to work best for you, go for it. It usually takes a little bit of trial and error. So there's two or more kids will vouch for me here. What words with one kid is not guaranteed to work for the next.

Now I would suggest this if you haven't tried it. You can try breaking the cycle by keeping her up longer than two hours even if she seems sleepy. I mean just really try to keep her up and awake, without harming her.


But you really want to try and keep her up and the thought being that if she's worn out more, she'll sleep better and also sleep longer. And then by sleeping better and sleeping longer then the next time when she wakes up, she'll be able to go through your four hours more easily between naps.

Now this was not one of the options that you mentioned. But I think it's one worth trying and it's one that I've recommended for lots of people in the examination room, in my office. And it usually works pretty well.

So again, instead of letting him fall asleep after an hour or two, try to keep them up more like three or four hours, if you can, and then again, the fact being that they'll be more tired, more worn out and then they will sleep a little bit longer, which will make it easier for them to stay awake longer than next time.

So it's definitely going to be difficult the first time that you try to keep them up longer. There's no question about that. But you want to take their clothes off, make them a little chilly, not cold.


You do not want to harm them, like I said. But there are ways to keep infants awake a little bit longer, instead of letting them fall asleep.

The difficulty is doing that because you feel like "Oh, you know, little Bobby needs to sleep" but you really do have to try to keep them awake a little longer.

OK, this next one is anonymous. It comes from Norway where we had friends. We have Norway. It's international hour in PediaCast this week.

Our Norway listener says, "I just discovered your podcast." And as the ex-patriot woman from France noted, and this is a different one from France, "It is perfect for me, a new mom, living in Norway."

My question is this I get cold sores once or twice a year. I desperately want to spare my son from this horrible affliction. He is six months old. I tried to avoid kissing his lips but sometimes he just launches his own kisses at me.

I have not yet had an outbreak since his birth, but I'm terrified they will happen and then he'll be plagued with this burden for life.

OK, so let's talk about cold sores here.


Cold sores are caused by herpes virus. It's usually herpes simplex 1. The genital herpes are typically herpes simplex 2. So it's a herpes virus but it's not usually the one that's associated with sexually transmitted diseases. This one typically causes disease in the mouth.

Now you can have herpes simplex 2 in the mouth and you can have herpes simplex 1 in the genital region. So it's not a 100%.But typically, it's going to be herpes simplex 1 that's causing the cold sores.

Now the primary infection is usually caused by another child who has the virus and they give the virus to your child. And it basically causes loads and loads of small blisters inside the mouth and also around the lips.

So it causes a lot of discomfort. You know that it's going on when it's happening because your child is just really uncomfortable. And dehydration is possible because their mouth hurt so much.


They just aren't able to drink.

Now nearly all kids get this at one time or another during childhood and most of them do fine. A rare complication is encephalitis where they can have an infection of the brain, or they can get meningitis associated with it.

But it's very unusual and most kids who get this all these blisters in their mouth caused by the herpes virus do pretty well with it, except for possible dehydration.

Now the immune system battles the virus. But some of that virus lives on for the rest of your life and at dormant state in the cell body of a nerve. And often it's the trigeminal nerve, which is cranial nerve 5, for those keeping score [Laughter].

And basically, the immune system keeps it sequestered there. Your immune system fights it off but it doesn't kill all of it. Some of it stays alive and it stays in the cell body of a nerve.


Now if the immune system has a little hiccup, if it's fighting another viral illness or you're under a lot of stress, or anxiety, and the immune system isn't quite working like it should then that dormant virus, years later, can become active.

And then what happens is that it travels from the nerve cell body down the nerve and it causes an outbreak on or around the lips, if it was the trigeminal nerve or cranial nerve 5. Really, it can happen anywhere but that's the most common place.

And basically that outbreak that you see is a cold sore or a fever blister. And it's called that because of the scenario where often happens with another virus.

So you get a cold or a fever and your immune system is fighting off this other thing and then that herpes virus that was dormant can reactivate, go down the nerve and cause the outbreak. So that's why it's called the "cold sore" or a "fever blister".

By the way chicken pox does the same thing. It's a relative of the herpes virus. In fact, they're in the same family of viruses.


And the reactivation of all dormant chicken pox is what we call "shingles". So it's very similar to that.

Now, I do want to mention that if you are prone to cold sores, usually before the outbreak, you can have sort of an itchy or tingling or even painful sensation of the lip or the skin, just prior to the outbreak.

And there are topical and also oral antiviral medications. Those are best used during that phase before the blister actually appears when you feel the tingling or that sensation. That's the best time to use the medication.

It's pretty much worthless using antiviral medicine, either topically or by mouth, once the blister appears. But having it on hand is helpful because if you have that prodrome, you want it to get started right away.

So a lot of patients that I see, who have frequent cold sores, we'll get them a prescription for Zovirax cream.


It's topical. And they can start putting that on the skin as soon as they have that sensation to try to prevent it.

It is also possible to transmit through touch, although it's much easier to get from a kid who has the active infection because their drool is just teeming with the virus. So if they have, what we talked about before, all those blisters inside their mouth with the primary herpes infection, it's a lot easier to transmit that from one kid to another because they just have so much of the virus in their drool.

But if you have a cold sore and you're not careful and some of the virus does go inside your baby's mouth, then it is possible to transmit it from a cold sore also. But it's much easier to get from another kid who has the active infection.

So if you get one, you do have to be a little bit careful.

So thank you, Miss or Mister Norway for your anonymous question. It is appreciated.


And moving on, this one comes from Angela in Indiana. And Angela says, "Dr. Mike, thank you for your podcast. I have been catching up on past episodes while at work. I believe some time ago you mentioned the current controversy over the use of plastic bottles and the chemicals that are supposedly omitted when the bottles are heated up.

However, I didn't know if you saw the most recent study or comments that were recently released on this issue. I've included the information that I received from the Baby Bargains and Baby 411 websites. I am just curious on your thoughts on this, given this current release of information.

As a mom of two, an infant that is currently using these bottles and a three-year-old that also used these types of bottles, I am concerned.

However, I can imagine any person that hasn't been exposed to this chemical. If there was a significant risk, I would expect the FDA and other watch dog groups would be releasing warnings, et cetera.

Your thoughts would be appreciated on this. Keep up the great work. Thank you. Angela in Bloomington, Indiana.


Oh, Angela, I haven't seen any new research on the subject since we last talked about it. And at Baby Bargains and Baby 411, the results of that research, they sort of twisted a little bit. They make it sound on their websites like these plastic bottles are not safe.

But guess what? Those are the ones that are safest. Of course, you know, you do have to be a little bit careful when someone is trying to sell you something.

Basically, if you have no clue what I'm talking about here [Laughter], I would suggest that you listen to PediaCast Episode number 35. And in this week's Show Notes, we'll put a link to that so PediaCast number 35.

And we did have a long conversation about the plastic bottles, the chemical that's in there. Is that a problem?


Is it not a problem? We went into a lot of detail and discussed that in Episode 35. So I would suggest that you take a listen to that one. Again, we'll have a link in the Show Notes.

But I know I haven't heard anything new that would change my mind about the safety of plastic. Basically, the bottom line of what I said is that they're probably safe. Theoretically, there is a risk, but there's risk in everything you do in life.

I mean, there's risk when you get in a car that you're going to have a car accident and you could die. Semi truck can cross the median, hit you head on and there's nothing you could do about it, even if you have your seat belt on.

So my point is that, there's a risk involved in drinking but the benefit outweighs the risk. The benefit of getting from point A to point B in a quick fashion outweighs the risk that you're going to die in a car accident.

And I think the ease and convenience of using plastic probably outweighs any remote risk that it could be a problem. And I backed that up with research in Episode 35.


Because you know what's the alternative? Glass and there are issues with glasses as well. And again, that I also talked about that.

OK, that wraps up our Listener segment this week. We still have the research roundup coming up. And we will get to that right after this.



All right, welcome back to the program. It is time for our research roundup.

And, by the way, again, I'm going to mention it. In, we have a couple new folks listening. So I just want to remind you that, if you joined us halfway through, this is PediaCast.

We're at and you can find the podcast there. Also in iTunes in the Kids and Family Section of the iTunes directory, so you may want to check that out.

You can download the podcast and listen to it. And it's edited entirely. This is raw here, folks. [Laughter] All right.

So let's move on to our research roundup.

Antibiotic use in asthma. The title of this research study is "Increased Risk of Childhood Asthma from Antibiotic Use in Early Life".


And this was a study carried out by Canadian Investigators in Manitoba, and it was published in the Medical Journal of Chest in June of 2007.

So the question before the investigators was this previous studies have been equivocal, meaning some of them have shown a relationship and some of them showed there not to be a relationship between antibiotic use in early, and then asthma developing during childhood so some showed relationship and some don't.

So the researchers wanted to do another study to see if they could find a relationship between early antibiotic use and asthma later in life.

So they looked at 13,116 children who were born in 1995. Now children diagnosed with asthma during the first year of life were excluded. So these were kids who did not have a diagnosis of asthma, did not have any recurrent wheezing problems during the first year of life.


Now 65% of these kids did receive oral antibiotics at one point or another during the first year of life and 35% did not. So we have our two groups. Now they're of unequal size, but researchers still controlled for gender, maternal history of asthma, the number of sibling, whether they live in an urban or a rural location, and the number of health care visits that they had.

So the groups were equal with regard to those variables even though more of the kids did receive oral antibiotics during the first year of life.

And then all the kids, in both groups, were screened at age seven to see if they had a current diagnosis of asthma or if they had ever had a diagnosis of asthma, from the time that they were a year old until the time that they were seven.


And what they found was that antibiotic use during the first year of life was associated with increased risk of having developed asthma by age seven. And the results were statistically significant.

So what they found was that if you had had one to two doses of an antibiotic during the first year of life, then at age 7 you had a 1.27 times chance of having asthma than if you had not. So about 1 1/2 times and not quite, 1 1/3 times chance.

If you had had three or four doses of an antibiotic then you had 1.41 times the risk, and if you had more than four doses of an antibiotic during the first year of life, then you had a 1.74 times risk of having asthma by age seven.

So antibiotic used during the first year of life is associated by the results of this study with an increased risk of asthma by age seven.


It's not quite twice the risk but about 1 1/2 times the risk. Now this was definitely nice big sample size. You have to admit that, over 13,000 kids that they'd looked at, and they did make a good attempt to control for some of the variables.

What I question what about a paternal history of asthma? This was not considered and probably should have been.

Also, I do want to point out. This does not show a cause. It only shows an association and there is a difference. Then it really should be no surprise here. So how is it that being on an antibiotic during the first year of life could be associated with asthma later in life?

You have to remember. The thought is this. Asthma is a complex immune-mediated condition with genetic influences. So there's a genetic factor to go along with asthma. You know it doesn't run in your family.


But the immune system is also involved because your antibodies are causing the inflammation in the airways and then that leads to wheezing.

And the thought of what's going on is this. If you're on an antibiotic, again, this is a hypothesis. We don't know this for sure but the fact kind of goes like this.

If you're in an antibiotic, you're not only killing off whatever bacteria it is that's causing the ear infection or the Strep throat, or the sinus infection, or the pneumonia or whatever it is, you are also killing off the good, normal, regular bacteria that live in your body.

And then your immune system does not become conditioned to accept those bacteria. If you think about allergy shots, you're basically injecting yourself with a particular, or the doctor is injecting you or the nurse, with a particular allergen so your body gets used to it.

So inject small amounts and then you inject a small amount and a little bit of a bigger amount and a little bit of a bigger amount.


And eventually your immune system says, "Hey, this stuff is OK. It's supposed to be here."

Well, the thought is that if you have bacteria in your body that's supposed to be there and it's not there, because you're using an antibiotic and killing everything off, then the immune system does not become conditioned to accept that bacteria.

And then, when those bacteria do come back, then your immune system says, "Hey, this bacteria is not supposed to be here," even though it is. And then it can make antibodies against those bacteria which then, the inflammation of fighting off bacteria that's always there and it's supposed to be there, can lead to inflammation, which in the airways, which then leads to asthma, or can lead to inflammation in the upper airway, which leads to allergy symptoms, or can lead to inflammation in the skin, which is eczema. And that's why eczema and allergies and asthma all kind of go hand in hand together.

So the thought is that, by killing off your normal good bacteria, it could set during the first year of life.


It could set you up to have asthma later on down the road. Now, again, you have to look at benefit versus risks.

You still have to use antibiotics when you have to use them. I mean you want to avoid them if you don't need them. And a simple ear infection does have the potential to lead to mastoiditis, which is an infection of the bone, behind the ear and then that can lead to meningitis.

It's rare but it's possible. So we have to balance the risk versus the benefit all the time. And of course, just add this possible association to your bag of knowledge. Talk to your doctor. Have your child evaluated in the context of their exact situation with your in consultation with your doctor and decide from there.

And certainly, I'm not saying don't give your child any antibiotics during the first year of life. I'm not saying that. But you definitely want to make sure there's a god reason to use them and that not overdue it.


OK. Our next study, we have one more here.

The relationship of obstructive sleep apnea to ADHD, the title of this study is "Adenotonsillectomy," which is just a fancy word, meaning you got your tonsils and your adenoids out.

Adenotonsillectomy improves sleep breathing and quality of life, but not behavior. This was a study completed by researchers in Canada and Australia and published in the Journal of Pediatrics in May of 2007.

So the question before the researchers was "Many children with obstructive sleep apnea undergo removal of tonsils and adenoids to improve breathing and sleep-related symptoms. It's also been thought, that by improving sleep in these children, daytime attention and behavior is also improved."

Researchers wanted to take a closer look at the relationship between the treatment of obstructive sleep apnea by removing tonsils and adenoids in daytime attention and behavior.


So what they did, now this was not a cross-sectional or prospective study where they like that last study we looked at, would be prospective study because they took a group of kids and then they followed those exact kids along and found what they were like when they were seven years old.

And this one, they actually did what's called a retrospective study where they looked back. So they looked back at children who were 2 to 17 years of age, who had been referred for a sleep study and then were subsequently diagnosed with obstructive sleep apnea.

Now, of the kids that they'd looked at, 86 of them went on to have their tonsils and adenoids removed. So this is our study group.

Fifty-two of them did not undergo the surgical procedure. They just left their obstructive sleep apnea there for whatever reason. Their parents decided to leave their tonsils and adenoids in. And they make up the control group.

So we have a group of kids between 100 and 200 of them, all together, and we're looking at the ones who had their tonsils out and adenoids out and the ones who didn't.


They all have obstructive sleep apnea and now we're going to ask their parents to complete a questionnaire, actually several questionnaires about changes in their child's quality of life, their quality of sleep, their quality of breathing and a revised Conners' Parent Rating Scale to assess behavior and attention.

Now the average time of these questionnaires being completed was about 3 1/2 years after they'd had their tonsils and adenoids out. Or, if they were in the control group, about 3 1/2 years after they'd had their sleep study in the control group.

And what they found is that improvements in daytime breathing, improvements in sleep breathing, improvements in the loudness of snoring and improvements in excessive daytime sleepiness, and improvements in quality of life, was all better for those who had their tonsils and adenoids out.


And it was statistically significant, meaning that the difference that you're seeing is not likely to have been there or to have happened just by chance.

So it seems that, if you have obstructive sleep apnea and it's a quality of life issue, you have an excessive daytime sleepiness because you're not breathing well at night and you're waking up frequently, then getting your tonsils and adenoids out is going be helpful.

However, there was no significant difference between the two groups with regards to rates of improved behavior, concentration, school performance, attention, and hyperactivity. So the researchers concluded that having your tonsils and adenoids out for obstructive sleep apnea improves daytime and nighttime breathing, decreases snoring loudness, improves excessive daytime sleepiness, and improved the quality of life. But it does not improve behavior, concentration, school performance, attention, or hyperactivity.


So what do I think about this study? Well, it is a relatively small sample size. The first study we looked at, it had over 13,000 kids, this one somewhere just between a 100 and 200. It's a retrospective study.

So you're asking parents to recall changes in symptoms and behaviors over the previous three- to four-year period. That's tough.

I mean it's hard to remember exactly what your kids were like three or four years ago. And also the parents knew which group they were in. I mean they knew whether their kid had their tonsils and adenoids out, or not.

And so, are just they justifying? "Oh, yeah, he did get better. You know, I put him through a surgical procedure." You'd better have gotten better. You know that sort of things.

So it's not the best study design. I think, yes. It's difficult though to ethically randomized kids to a control group for a prospective study in a case like this because you're going to say, "OK, yes, your kid has obstructive sleep apnea but we're going make him suffer. We're going to make him keep his tonsils in so we can see if his behavior is affected or not."


It's a difficult study to do prospectively. So you've got to give the researchers some credit. Really a retrospective study, looking back, is probably the only way to do this sort of thing.

Now an interesting piece I think that they left out, that they should have included in this, is how many of these kids in the study group, the ones who had their tonsils and adenoids out, how many of them, even though they did have improvement in their snoring, how many of them had complications following the surgery?

Tonsils and adenoids out is not a benign procedure. It can have complications associated with it. I have seen lots of kids have complications associated with getting their tonsils and adenoids out.

It's a very vascular area, a lot of blood vessels. You're cutting out those tonsils and adenoids. And it's by the airway so you can aspirate. It can start bleeding very easily after the child gets home.


So it's a complicated surgery. Again, I'm not saying "I'm against getting your tonsils and adenoids out." It's just one of those things you do when you have to but you don't have to and you're expecting their behavior to better. Then that's not the reason to do it.

Loudness of snoring, for me, is not a reason to do it because the rest of the house can use earplugs so you don't put a kid through a surgical procedure and the risks of anesthesia, the risk for complications, just because they are allowed to snore.

However, if their quality of life is affected, if they have excess of daytime sleepiness or they're really having trouble breathing, not the parent thinks they have trouble breathing because they snore, but do they really have trouble breathing?

And that's why we do a sleep study because, if their oxygen levels dropping during the night, then it's not a safe thing for them. So you've got to get those tonsils and adenoids out. So that's why we do a sleep study more and more to diagnose, rather than just sending them first to the ear and nose doctor.


OK, so enough of our research segment there, we'll be back to wrap up the show right after this break.

[Short Break Music]


All right. I'd like to thank all of you for tuning to PediaCast this week. Also thanks to my family for allowing me to do this crazy project [Laughter] so it's not busy enough having a full time pediatric practice.

Thanks also for Vlad over at Vladstudio. And you can find him at He's a talented artist and he provides the artwork for our feed and also for the website as well. So you can find him at

Don't forget in the future episodes, if there's a topic that you would like us to discuss, it's easy to let us know what you think. Just go to and click on the Contact link. You can also email us at And I did get the email address right this time. [Laughter]

And also, you can call the voice line at 347-404-KIDS.


That's 347-404-K-I-D-S.

If you'd like to spread the word about PediaCast which, of course, I hope you do. We do have a poster page at the website at Just click on Poster and we have some promotional materials there for you.

There's some posters that you can download. Take them into your pediatrician or your family doctor and say, "Hey, look at this. Check out the show." OK. [Laughter] Maybe they'll hang up the posters in the exam room so we can help spread the word that way.

Also, you could wear a PediaCast t-shirt. You can find those at the PediaCast shop and we do have that opened. It's in the link in the side bar at

I also want to mention. I don't make any money off this t-shirts so we have them priced as low as the site will allow. They're a little bit pricier than like CafePress, but I found the quality is better.

They have lots more options so I think it's worth the extra costs. So you may want to check that out.


Of course, that also helps to spread the word by because then you're a walking billboard. Really, I should be paying you to wear the shirt but I just don't have the resources to do that. Sorry. OK. [Laughter]

And, of course, the other way that you can really help is by giving us a review in iTunes. If you have already done that and see a listener from France wouldn't even bother to listen to PediaCast except for the many positive reviews there so if you haven't taken the time to give us a review in iTunes, it would be appreciated very, very much.

Also, I want to mention the Pediascribe blog this week. Karen had a little bit of an issue. There's this place called Quechup. It's Q-U-E-C-H-U- P, something like that. I can't remember exactly. But if you go to and click on the Pediascribe blog link, she has a post about it.

But, anyway, if you've seen this social networking site springing up all over the place like LinkedIn and Facebook and MySpace and all these.


You know there's new and it seems like there's a new one every week. Well, this one, she, Karen, had an invitation and actually had several invitations. And so she joined it.

And like some of these other social network sites, it says, "Can we look in your contact group and see if any of your contacts are already members so we can link you together. And you can also have the opportunity to invite people who are in this social network because then you could invite them to join.

Well, as it turns out, she did not tell it to let anyone. She just wanted to check and see if anyone she knew was already a part of the social network program. So she did that, and as it turns out, the service went ahead and invited everyone in her list, which is like over 500 people because Gmail keeps in your contact list anyone that you have every emailed or anyone who has ever emailed you.


So if you got an invitation from Karen, please disregard it. She did her best to send out apologies and to let people know "Hey, don't sign up for this" within, probably, an hour to the invitation going out.

She sent an email to everyone saying, "Hey, I'm really sorry about this. I didn't mean for this to happen." And, in fact, she sent so many it was over 500 because that's how many that's in her contact list. She actually got locked out of Gmail for 24 hours because she had sent so many emails to apologize to everyone.

So I want to apologize for it, too. And you really want to watch out for this service called Quechup. Not ketchup like the condiment. But it's Q-U-E-C-H-EP, I think. Anyway, check out the blog and she has a post in there all about it. You'll see it there.

I also want to mention real quick. This is the post that I was going to tell you about.


It's one called "When Your Husband Is A Computer Geek". It's actually a post I'm proud of, to be honest, I mean, any blog post that talks about BlackBerrys, which my BlackBerry, by the way, has been in retirement since I got my iPhone.

But anyway, when you have a blog post that talks about BlackBerrys, Florida Mangrove Swamps and Butcherbirds all in the same post, it has to be, at least, somewhat interesting even if the title is a bit disparaging to yours truly. So you can check that out as well and there'll be a link in the Show Notes for you.

OK. We're going to wrap things up. Oh, I guess I should mention one more time.

I'm trying this new thing here. I'm actually letting you see what it looks like when we are putting the show together. And it's at The show is PediaCast Live. And if you go to, you'll find this there.

In terms of when to listen, we'll put that in the Show Notes so you can figure out exactly when you need to listen or to watch on blogTV to see us to do it live.


OK, as always, we are going to end with some featured music. And this week's featured music is brought to you by Iota Promo Net and Ray Lynch Productions.

Now when he first released this album in 1984, Ray Lynch would never have guessed that "Deep Breakfast" would become a classic of its genre. "Deep Breakfast" became the first independently released album to go Gold and then Platinum with well over 1 million copies sold and without the support of a record label.

In fact, PBS shows the single "Celestial Soda Pop" as its theme music for their show "The Seasoned Traveler". So I am going to leave you with Ray Lynch from the album "Deep Breakfast" and the track is "Celestial Soda Pop".

Now don't forget in the Show Notes, if you like the song, you can download the DRM-free.


That's right. No Digital Rights Management, let's say, free MP3 file that you can download in the Show Notes this week. And you can also purchase the remainder of the album. There'll be links in the Show Notes for that as well. Conners' Parent Rating Scale

So I will leave you with Ray Lynch in "Celestial Soda Pop" and until next time.

This is Dr. Mike saying stay safe, stay healthy and stay involved with your kids.

So long, everybody!


[End Music]

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