Lazy Eye, Toddler Beds, Batting Helmets – PediaCast 059

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  • Lazy Eye
  • Hand Washing
  • Vaginal Pain
  • Transitioning from Crib to Toddler Bed
  • Batting Helmets



Announcer 1: This is PediaCast.


Announcer 2: Welcome to PediaCast, a pediatric podcast for parents, the listener edition.& And now, direct from BirdHouse Studios, here is your host, Dr. Mike!

Dr. Mike Patrick: Hello, everyone and welcome to PediaCast.& It's episode 59 and we're doing a second listener edition in this week because I was just on vacation for a week and a half and well, we've got a little backlog of your questions and I wanted to get to those so that's what we're going to do.

It's Thursday, October 11th, 2007.& In addition to the questions, we actually have more comments than questions this week.& But there are some interesting ones and I'll have some things to say about them.& We're going to talk about lazy eye, hand washing, sacral dimples and vaginal pain, those are all comments.& And we're going to answer a question about transitioning from baby cribs to toddler beds.& How do you do that?& When do you do it?& And also batting helmet safety.


And this is what I love about PediaCast, I get to share the knowledge that I have, but some of the questions I don't know the answer and it forces me to research it and then I learn something in the process, too.& And so I'm going to tell you about that.& I really didn't have a good grasp on batting helmet safety for baseball and softball players, so we'll get that.

Don't forget if there's a question or a topic that you would like us to discuss, it's easy to get a hold of us.& All you have to do is go to and click on the Contact link.& You can also email me at or call the voice line at 347-404-KIDS.& That's 347-404-K-I-D-S.

And I do want to remind that the information presented in every episode of PediaCast is for general educational purposes only.& We do not diagnose medical conditions or formulate treatment plans for a specific individual.& If you have a concern about your child's health, be sure to call your doctor and arrange a face-to-face interview and hands-on physical examination.

Also, your use of this audio program is subject to the PediaCast Terms of Use Agreement, which you can find at &

I do want to mention before we go to a break that if you go to that's the parenting blog arm of PediaCast and of course my lovely wife, Karen, takes care of that for us, if you go there and look at today's post, she has a slide show up that shows some pictures from our family vacation.& It's not a very long slide show.& It just shows some pictures of us at Disneyland and I thought if you'd like to see what our family looks like having fun in California, just go to and there's a little slide show for you there.

OK, we will be back and we'll answer your questions and address your comments, right after this short break.

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OK.& Our first listener comment comes from Heidi in Pennsylvania and Heidi says, "Hi, Dr. Mike.& I recently commuting a long distance to work and discovered your podcast as an excellent way to feel productive during those long car trips.& I'm a first time mom of a nine-month old, an occupational therapist and a fourth year optometry student to boot (What a busy lady?).& As both a busy mother and a healthcare professional, I immediately fell in love with your podcast.& You blend the perfect amount of solid science, medical advice and thorough, easy to understand explanations.& I have found that so interesting that I am now going back in to the archives to hear as much as I can.& As an optometry student, I was thrilled to see that your second episode would be discussing amblyopia.& However, my heart sank when I heard you recommend that parents not see their family optometrist for this problem.& Optometrists are fully trained to diagnose and treat amblyopia.& To say otherwise is simply not true.& It truly broke my heart to hear you adamantly discouraging management by an OD, especially when you say the optometrist mainly just prescribe glasses and contact lenses, as I'm sure you must know the scope of optometry is much more vast.& We diagnose and treat eye diseases and disorders of the visual system.& When a referral to a specialist is indicated, such as strabismus surgery, we are capable of making the proper referral.& The following description of the role of optometry is taken from the American Optometric Association website, which is at And to quote, it says, "Optometrists examine, diagnose, treat and manage diseases, injuries and disorders of the visual system – the eye and associated structures – as well as identify related systemic conditions affecting the eye.& The website also has a thorough section explaining our education and what we do to train.& Please help me to understand why you would discredit this profession.& I have great respect for all medical doctors and I am hurt and concerned when they do not reciprocate that respect.& I love your podcast and do not want the negative statements you made to taint my overall wonderful impression.& I thank you so much for taking the time from your very busy schedule to offer this service to parents.& Thank you very much for your thoughts.& Heidi."


All right.& Well Heidi, I'm going to do my best to explain myself here.& I seem to get myself into trouble when I go off script and just injecting my opinions without always thinking it through.& And as most you know who have been regular listeners to the show, I sort of made the same mistake, well it wasn't really the same, but I did talk disparagingly about family practice doctors and really I shouldn't have.& And Michelle did set me straight on that and we talked about it and she actually is now involved with the show doing some rash talks which she'll be coming back soon to do measles talk, that's next up on the agenda.

But this time, actually I think this one is a little bit different.& First, I think before we talk about this, let me just remind you because we have to go all the way back to episode number two to understand what we're talking about here.& Amblyopia is also known as lazy eye and when it happens is that if the brain is getting a picture from one eye that's better than the other or if the eyes are not focused exactly on the same thing, so you get kind of a blurry picture because the eyes aren't focused.& Then what can happen is the brain starts to ignore one eye.& And if the brain does that, so that the child can see a little bit better, if the brain starts to ignore one eye that can lead to permanent eyesight loss.& It's basically, the basic, easiest explanation of this.


And one of the things that you do is you patch the good eye or you give them corrective lenses that help them to focus more on the other eye.& It kind of puts the good eye a little bit out of focus so that the brain will start paying attention to the bad eye.& Or you patch the good eye, so again, the brain has to pay attention to the eye that it was previously starting to ignore.

Again, I'm simplifying this a little bit.& But if strabismus is the cause of their eyes not looking at the same thing then you can do a surgery to help them.& Now what is strabismus?& Well it's when the eyes aren't able to focus exactly at the same point and so you shorten one muscle or another around the eye to sort of bring that eye a little bit in toward the middle or toward the outside.& Basically, they'll correct it so that the eyes are looking at the same thing again.& So you just play around with the muscles of the eye to do that.

And then if you can get them to be looking at the same point with both eyes, their eyes are focusing in again, then that can help resolve the amblyopia or help to reverse it if it's already started; although if it's too far gone, you may not be able to do that.& So hopefully, I haven't loss you with this.


And basically, in episode two I had said that my feeling is that amblyopia should be treated by a pediatric ophthalmologist rather than your neighborhood optometrist.& And actually, I'm going to stand by that recommendation.& And I have to say I don't think I discredited an entire profession in saying this, because I think the way that I practice medicine is I always, my recommendations and the things that I think about and do relate to how I feel I would want my own children to be treated.

So if I had a child at home, I would go see a pediatric ophthalmologist and even though I'm stepping on toes a little bit, I would rather say that the kids that I'm treating in my office, when I'm giving people advice, I would rather give the advice that I would want done for my own kid, whether that is politically correct or not.

And the reason I think that you're better off seeing a pediatric ophthalmologist for this is because even though optometrist may be trained to deal with amblyopia and if there's strabismus present sending them for a surgery referral, I don't think you're going to find very many optometrists who see this as often as a pediatric ophthalmologist.

And to tell you the difference, the pediatric ophthalmologist is a medical doctor that went to medical school and either has an M.D. degree or a D.O. degree.& They did an internship in general medicine and then they did an ophthalmology residency, which is going to be another three years and the internship is a year, so there's four years.& Plus, they usually do a pediatric ophthalmology fellowship and that's usually a couple of years.& We're talking six or seven years after medical school of additional training.

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An optometrist goes to optometry school and that's after college then they can start practicing after they're in school.& So there's less opportunity for practicing before you're out on your own for an optometrist as there is for a pediatric ophthalmologist.

Now the other thing is that if you've been in a pediatric ophthalmologist's waiting room, there aren't very many of them.& They're usually associated with children's hospitals and it's pretty much a mad house.& That's a disadvantage if you have to wait in a waiting room for a couple of hours and travel an hour or two to go see them in a large city.& However, the advantage that you get is a doctor who sees this disease process and all its variations and all its potential complications all day long.& They're just seeing the same thing over and over and over and over again as opposed to an optometrist who might see a few kids in a week and mostly sees adults.

Are there optometrists who see tons of kids and who maybe has a child with lazy eye in their office, five to ten of them every single day?& Well there probably are a few, but they're going to be few and far between.& Let's face it.& Most of the business that optometrist sees are people who are coming in to get refractions done to make sure their contact lenses are fitting properly and to get eye glass prescriptions.

Yes, optometrists may be qualified or they'd learned to deal with diseases of the eye, but I don't think that they are seeing significant pathology of the eye and treating it on their own as often as a medical doctor is.& Now before you get too offended about that for all of you optometrists out there, please don't be offended by that.& We all have our place.& And as a pediatrician during residency, we learned how to take care of kids with congenital heart defects, we learned how to take care of kids with severe asthma, kids who have chronic ear infections, we learned to take care of them, kids with high blood pressure.& But as a practicing pediatrician I have to know what my limitations are.


If I have a kid who has a heart murmur that I am concerned about, I'm not going to treat it on my own.& I'm going to send him to a pediatric cardiologist because that's what I would want for my own child.& If I see a kid who has constipation, we've tried this, we've tried that and I'm going to send him to the gastroenterologist.

If I have a kid with hypertension, I'm going to send him to a renal specialist.& So even though I'm qualified to take care of certain conditions, I don't because I understand that there is someone more qualified than I am who sees this day in and day out.

So I think recognizing one's limitations in referring as appropriate.& And when it comes to eye doctors this actually happened to me.& I don't think I've ever actually shared this with anyone in the listening audience, so this is a little bit personal, but I think it relates to this really well and that is I have glaucoma.& It does not affect my eyesight to the point that I'm disabled.& I just wear regular glasses, used to wear contact lenses.& And it runs in my family.

What happened is I went to see an optometrist for a routine visual exam and to get an update on a prescription for glasses or contact lenses and my eye pressures were a little bit high.& And this optometrist referred me to an ophthalmologist who specializes in glaucoma.

Now optometrists are probably trained to treat glaucoma, but honestly, when you start to get into something that's a little bit more significant and can cause blindness if it's not taken care of appropriately, I feel better seeing a medical doctor who treats glaucoma and sees glaucoma patients all the time.

And so when I was in medical school, I started using eye drops.& I had to actually have a surgery for glaucoma a couple of years ago.& And so I feel like I've been in good hands that I think is better because it's a glaucoma specialist.& This is an ophthalmologist who pretty much just sees people with glaucoma.
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And so if I had a child who had amblyopia, which can lead to blindness, I would feel better with a pediatric ophthalmologist because they see more of it.& Even though another person may be trained to do it, most optometrists do not see a lot of amblyopia and treat it compared to the amount that a pediatric ophthalmologist sees.

So I'm going to stand by that.& Really, I am not discrediting a profession.& I think optometrists have a role to play.& It's an important role and when it comes to certain processes that aren't necessarily sight robbing, it has a sight robbing potential, then I think that that's what they're there to do.

But I don't perform heart surgery.& We all have our limitations and our roles.& And that's just the way I feel about it.& And again, I apologize for offending and I hope that, Heidi, you're not too upset and you find that the other information in PediaCast is worth continuing to listen.

So I will stand by my recommendation that kids with amblyopia should see a pediatric ophthalmologist.& And again, it's not discrediting a profession.& It's simply my personal preference that comes from my past experience that I'm sharing with you.


OK.& Next on is Suzanna and Suzanna says, "Hi, Dr. Mike.& First of all, I love, love, love the new broken up show format.& It is handy for skipping topics, for being able to go back and easily refer to topics and for being able to send links to people who might be interested in that specific topic; but who wouldn't be coaxed in to waiting through the whole show?& For myself, I'm liking being able to listen to only the news and listener sections (Check out the interviews, too.& I'm really pleased with those).& I have some comments about show 54 listener questions.& First, on hand washing.& A really good reason to wash hands is to prevent infection from viruses, for example, rotavirus.& My daughter suffered with a few bouts of rotavirus when she was younger.& Didn't that make it fun to diagnose her toddler diarrhea?& And it seem from what I read that really rigorous hand washing was one of the main ways to attempt to prevent contagion, if that's really possible.& And you can't wait until a case of rotavirus becomes apparent because everyone's been contagious for a while by then.& We find regular routine hand washing as well as trying to keep our hands away from our mouth, noses and eyes really helpful in preventing infection from everyday colds and flu.& Oh, and hand washing can also be important depending on the context in preventing contamination by allergens.& Some people are very sensitive to even very minute traces of peanut or fish oil, which my remain on a person's fingers, and then be transferred to a table top, doorknob, toy, etc.& Sacral dimple, my son has this.& In the follow-up, in his case, was to be sent to an orthopedic surgeon who put his pinky finger (Still too big, really.& Poor little guy.) up my little boy's anus.& What he felt there I don't know, but he was deemed OK.& Here is our one niggling doubt and unanswered question, we've always been curious about a comment our pediatrician, excellent but a little odd, made.& He said, "He better not become a bus driver.& Hahaha."& Implying that our son ought not to have a sit-down job.& But lots of careers involve sitting, including being a student.& Can you think of any reason he might have said this?& And why no long-term sitting?"

I have no idea.& OK?


"Vaginal pain (OK, all joking aside) really, one thing that has got to be explored when a little girl complains of vaginal pain has got to be sexual abuse, don't you think?& Did the pain stop when a certain family member was away?& That's a question I would ask.& Or maybe she's even been inserting things herself, possible.& Also, you talked about urinary tract infections, but what about a vaginal infection and it might be a good idea to clarify vagina and vulva.& It it's actually the girl's vulva that is hurting, maybe it could be that she is protruding a little.& Surgery is probably not an option at this age but maybe a panty liner would offer her more protection from outside stimuli.& I like the new fresh format.& Thanks.& Suzanna."

All right, Suzanna.& I like your way of thinking.& You're expanding on the possibilities, thinking beyond, just taking someone's answer at its face value.& You're thinking the whys, the hows and increasing the differential diagnosis that we provide on the show and really problem solving.& I love it!& Maybe you should think about medical school.


OK.& Speaking of medical school, this one comes from Peter in Arizona and Peter says, "Dr. Mike, I'm a religious listener to your show.& I'm currently finishing up my fourth year of medical school and will be starting a pediatric residency in June.& That said, I am also a relatively new parent, my son just turned two and had a question that I just can't find any good recommendation on.& My son is at that age where I have noticed he is attempting to climb out of his crib.& He hasn't actually launched himself over the side as of writing this note, but I'm concerned that the time will soon come.& My wife doesn't feel that he is ready for a big boy bed yet, but I think it might be time.& Can you discuss transition from the crib to the bed?& When to consider it?& How to accomplish it?& And what possible complications to expect?& Thanks for your time.& And this comes from Peter."

Well Peter, I would say if you're worried that a child that's two years old is going to topple out of the crib, then it's time to get him out of the crib.& Really.& I think sooner is better than later.& If you have any concern that a child's able to do that, get over the side rail and fall out, it is time.

Now the best way to do this, I think, is basically get rid of the crib, get a toddler bed.& We're talking about one of those toddler beds that's like at ground level that sit on the floor.& And I would just try to make the baby's bedroom like a big crib.& So you want a baby and toddler-proof everything like crazy — outlet covers on all of the outlets; you want to make sure there's nothing on shelves that they could pull down on themselves; that there's no electric cord dangling that they could grab a hold of.& And you really want to just make the bedroom that they're in as safe as possible, with nothing in there.& I wouldn't even put any toys in there, if it's possible, and you can have a separate toy room or a closet that latches in the bedroom as long as they haven't learned how to open latch doors then I would do that.


So how do you keep crawled in there?& I wouldn't close their door and lock them in alone.& But what you could do is get a baby gate that is tall enough that they can't get over it and make sure there's nothing in the room that they could pull over and stand on to get over it.& So you've basically made their bedroom into a giant Pack 'n Play.& That usually works pretty well.

Let's say they don't want to lay in the bed and they lay on the floor instead, let them do it, eventually, they'll lay on the bed again.& Kids don't mind laying on a flat surface.& So if they resist and they want to lay on the floor, I wouldn't make a big deal on that.& And again, you just want it to be safe.

In terms of possible complications, you can get a kid who wants their crib back and their crying and upset about it, but I don't think that would last more than a few days unless you give in, but they're going to forget about their crib after probably four, five days or so.& I don't see that being a problem.

But the most important thing to remember is to pick up everything, make sure there's nothing they could choke on, hurt themselves on, electrocute themselves on, anything like that.& But if you have a crib that they can get out of, you're going to have to proof the room anyway and then of course you're going to worry about head injuries and lacerations and all that sort of thing.

It's definitely I don't think that's too young at all.& In fact, there are some 18-month olds who are able to start getting out of the crib and it's time to move on to a toddler bed at that point.& I would continue to use a baby monitor in the room if you can, if you can find a way to do that without the cord daggling and all that stuff.

OK.& So I hope that answered your question, Peter, and thanks for listening.& And as you do your pediatric residency, make sure you let wherever you go know about PediaCast because we love to get pediatric residents involved and family practice residents, too.& That was for you, Michelle.


OK.& Sandy from Virginia, she says, "Hi, Dr. Mike!& I love your podcast.& I'm a relatively new listener but didn't find an answer to this question in a search of your previous shows.& My sons play baseball and one of them was hit in the side of the head by a pitch this past weekend.& Fortunately, he was wearing his helmet with a face guard and was not injured.& He shook it off and took his base.& My question is, I know that when a bicycle helmet is involved in an accident where the helmet is hit it needs to be replaced.& What determines whether a batting helmet should be replaced?& Is there a similar criteria or a recommended lifespan, X number of seasons or X number of years, for example, for batting helmets?& Thanks."& And again, that's Sandy in Virginia.

Well Sandy, I did not know the answer to this off the top of my head.& So I had to do some research and I learned a lot in the process.& It turns out that sport helmets are certified by an organization known as the NOCSAE and that stands for National Operating Committee on Standards for Athletic Equipment.

So the first thing you want to do is make sure that whatever helmet, baseball or softball helmet, that you're using, you want to look for a sticker that says it's NOCSAE certified.& There are plenty of manufacturers who make certified helmets, and I know Rawling is the company that makes the Major League Baseball helmets and they do have juvenile and junior versions of all of their helmets.& They're probably pretty pricey, but so is taking care of a head injury.& So I think it's worth having a good helmet that's going to protect your child even if it costs a little bit more money.& So you want to make sure it's NOCSAE certified and that's a starters.


Now if you're interested in what the standards are, they have certification and recertification procedures and documents at their website and we'll have a link in the Show Notes to all of these links that I'm going to talk about here.& But this organization not only certifies batting helmets for baseball and softball, they also certifies football helmets, hockey helmets, lacrosse, polo, even soccer shin guards.

They basically have all of their documents that if you wanted to set up a laboratory to certify and recertify, you could.& And actually, that's not a bad business idea when you think about it.& Of all the kids who use personal protection equipment, if you can have yourself a business that certifies and then recertifies used batting helmets, that's kind of a cool thing.& You could make some money with that for sure.& And they do have procedures and documents available.

In order to recertify, you do have to have an air gun and we'll talk about why here in just a minute.& If you go to their website and look, one thing to note in the guidelines, "to be recertified, all helmets must be completely free of defects, including no cracks anywhere on the helmet".& So I guess that's one thing you want to do if your child's hit with a pitch on the helmet, if the helmet has a crack in it and even a minute, tiny crack it would not be certified anymore.& I guess for starters, that's one thing to look at.


This I just found interesting, they also had a Frequently Asked Questions page at the website of the NOCSAE and here's a couple of items from the fact, it says:

"How are baseball, softball batting helmets tested?& Being struck by a pitch or batted ball is the primary hazard to the head in baseball and softball.& Therefore, the helmet is mounted on an instrument headform, which is free to move and an air cannon is used to shoot a baseball from close range into the helmeted headform at 60 miles per hour.& Impact accelerations are measured and a severity index is calculated and compared with NOCSAE standards to determine if the helmet meets the standard."

That's pretty cool.

"How long will helmets stay in certified condition and what happens when a helmet no longer meets the standard?& Factors such as the type of helmet and the amount and intensity of usage will determine the condition of each helmet over a period of time.& It should be noted that the NOCSAE helmet standard is not a warranty, but simply a statement that a particular helmet model met the requirements of performance tests when it was manufactured or reconditioned.& In recent years, the proportion of helmets recertified annually by NAERA members (and we'll talk about what that is) as ranged between 84% to 96%.& Tests in these plants indicate that helmets which regularly undergo the reconditioning and recertification process can meet standard performance requirements for many seasons depending on the model and usage.& For football helmets, NOCSAE does recommend that the consumer adhere to a program of periodically having used helmets recertified.& Because of the difference in the amount and intensity of usage on each helmet, the consumer should use discretion regarding the frequency with which certain helmets are to be recertified."


In that, they talked about NAERA member, so what's that?& Well the NAERA is the National Athletic Equipment Reconditioning Association.& So if you are going to set up a business where you recertify helmets, then you would want to become a member of the NAERA.& And I do have a link in the Show Notes to that organization and then they also, at their website, have a list of their members so that you can try to find the place near you that does this.

I notice in some states there are several, in other states there are none, so this maybe something that if you're really interested you could ship the helmet to get it recertified.& I'm not sure what the cost of that is and how that compares to just getting a new helmet.& So I am afraid I'm kind of skirting the issue here a little bit, I realized.& But I don't want to tell you, yeah, five seasons and then you're fine.

I don't think that anyone knows for sure unless you do the recertification process as described in the documents which these NAERA members do.& I have all the links in the Show Notes if you're interested in seeing what exactly goes into the certification and recertification process and if you'd like to find a business that does this.

So OK, I want to thank everyone for your question and your comments as well.& We're running a little over.& I really didn't want any of these to be over half an hour and we're just over that.& So let's go ahead and cut to a break and then we'll be back to say goodbye.



Why do I these, the interludes, it was such a short program?& I had mentioned before it's to wet my whistle, but you know that's not the only reason.& I think that as a listener out there, we digest lots and lots of information.& And I think sometimes when you listen to my podcast, you need a little bit of music to tone the brain down afterwards.& So I'm going to keep doing it and not only that, I used to be DJ and I got to do some music.

All right, tomorrow Cat Schwartz is going to stop by and we're going to talk about tech gadgets for moms and dads.& You don't want to miss this show.& Cat Schwartz is a nationally-known tech guru who has been on the Today Show and many other places, including Howard Stern.

So we're going to welcome Cat Schwartz tomorrow, so make sure you that you tune in for that.& Thanks go out to all of you and also to Vlad over at He provides the artwork for our feed and for the website, so thanks go out to him.& Be sure to check out

Don't forget to review us in iTunes if you haven't had the chance to do that.& And don't forget also to head over to and check out the recent link, again that's the parenting blog and we do have a link to a slide show of our family pictures from Disneyland.& It's not too long.& We just picked the best ones.& I shouldn't say we.& Karen, my wife, put that all together, so she picked out the best pictures but I did take the pictures, so there.

All right, until tomorrow, this is Dr. Mike saying stay safe, stay healthy and stay involved with your kids.& So long everybody!


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