Medicine Recalls, Eating Disorders, STDs – PediaCast 061

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Infant Cough and Cold Medicines Withdrawn from Shelves

  • Dimetapp Decongestant Plus Cough Infant Drops
  • Dimetapp Decongestant Infant Drops
  • Little Colds Decongestant Plus Cough
  • Little Colds Multi-Symptom Cold Formula
  • Pediacare Infant Drops Decongestant (containing pseudoephedrine)
  • Pediacare Infant Drops Decongestant & Cough (containing pseudoephedrine)
  • Pediacare Infant Dropper Decongestant (containing phenylephrine)
  • Pediacare Infant Dropper Long-Acting Cough
  • Robitussin Infant Cough DM Drops
  • Triaminic Infant & Toddler Thin Strips Decongestant Plus Cough
  • Tylenol Concentrated Infants' Drops Plus Cold
  • Tylenol Concentrated Infants' Drops Plus Cold & Cough


Announcer: This is PediaCast.


Welcome to PediaCast, a pediatric podcast for parents, the News Edition. And now direct from BirdHouse Studios, here's your host Dr. Mike.

Dr. Mike Patrick: Hi, everyone, and welcome to PediaCast.

It is Episode 61 for Monday, October 15, 2007 Cold Medicine, Eating Disorders and STDs.

So good morning, everyone, good Monday morning. I hope you had a good weekend. We certainly did here at Dr. Mike House [Laughter].

It was a good weekend because our Ohio State Buckeyes whether they really deserved to be number one or not, they are, in the AP poll, in the USA Today poll and the BCS poll.


Of course, we'll see how long that lasts. OK? I'm realistic here.

My daughter and I, as usual, on Saturday went to the horseshoe in Columbus and rooted on the Buckeyes. And of course, as usual, we are packed in like sardines.

Now I have to tell. I'm in the weirdo section this year. I don't know why.

But a couple of games ago, there was a woman sitting next to me and she's not a usual ticket holder. I think whoever bought the tickets next to and we're in a section that's usually season tickets and whoever bought the seats next to us must have sold them on eBay or something.

This woman, she had a stuffy nose and she takes Kleenex, reaps it in half, wads it up and sticks it up each nostril. OK, fine, except it's hanging out about two inches outside each nostril. OK, fine. I don't have to look at her. It's just a little weird. Do you know what I'm saying?


So then this Saturday, it's a different person each time, I think, whoever has the winning bid gets some that week. This guy, and again, I'm not trying to be mean but you know when someone has an overwhelming smell and you're packed in like sardines, it's not the most pleasant thing in the world.

And it wasn't BO. I couldn't quite tell what it was. He smelled like a combination of fabric softener and beans. And it started to turn my stomach a little bit. And again, I'm not trying to be rude but when you have to smell, it's like having to smell cigarette smoke for a long time. I don't understand why he smelled like fabric softener and beans.

But anyway, and then the sun was blazing down and he had his jacket all on top of his head. [Laughter] I don't know why. Again, just bunched up, just balancing on top of his head. So you really couldn't see much of his head except for the binoculars sticking out.


And they were high-powered binoculars. And he hardly ever looked at the field. He was like scanning the crowd. So I don't know. I think this is not necessarily the best thing. OK, so anyway, my little Monday morning rant complete, we probably should actually move on with the reason that you guys even downloaded this program.

It's to talk about pediatric stuff. And the lineup today, over-the-counter infant cough and cold medications are taken off of American shelves. You've probably heard this already but I figure you better hear from me, too.

Good nutrition improves learning and memory in school children. Going back to school can trigger eating disorders.

To give or not to give antidepressants in young people, we'll talk about that.

And speaking of young people, over 1 million of them in California have sexually transmitted diseases. So we'll have a story on that for you as well.

Don't forget if you have a story for us or a question or a comment, something you'd like us to talk about, or if you just wanted to give us your opinion on the show, simply go to and click on the Contact link.


You can also email or call the voice line at 347-404-KIDS. 347-404-5437.

Don't forget the information presented in PediaCast is for general educational purposes only. We do not diagnose medical conditions or formulate treatment plans for specific individuals.

If you have a concern about your child's health, call your doctor and arrange a face-to-face interview and hands-on physical examination.

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

And with that in mind, we'll be back with News Parents Can Use right after this short break.

[Short Break Music]


Our News Parents Can Use edition is brought to you in conjunction with news partner, Medical News Today, the largest independent health and medical news website. You can visit them online at

Over-the-counter cough and cold medicines for infants under two years of age are being removed from the shelves of stores and drug retailers following a voluntary withdrawal by manufacturers ahead of an evaluation meeting by an advisory committee to the U.S. Food and Drug Administration set to take place later this week.

The announcement to the press was made a couple of days in Washington D.C. by the Consumer Healthcare Products Association on behalf of leading makers of over-the-counter cough and cold medicines.


The withdrawal does not apply to medication for children aged two and over, and the announcement also points out that the withdrawal is being driven by potential misuse of the products, such as giving babies too big of a dose and not by concerns about inherit product safety. Of course, they're going to say that.

President of the Consumer Healthcare Products Association, Dr. Linda Suydam said that the medicines were safe when used at the recommended dose. It's important to point out that these medicines are safe and effective when used as directed I think you can argue that point and most parents are using them appropriately. Maybe you could argue the affective part.

She went on to say the reason the makers of over-the-counter oral cough and cold medicines for infants are voluntarily withdrawn these medicines is that there had been rare patterns of misuse leading to overdose recently identified particularly in infants. And safety is the top priority.


The product manufacturers and the Consumer Healthcare Products Association have passed on recommendations to the FDA saying, the label on these products should be changed to say "Do not use in children under two years of age". At the moment the labels say "Ask a Doctor" before using in children under two.

But there's a mixed message, isn't? I mean if the problem was parents overdosing their kids then "Ask a Doctor" should be fine. But when they say "Do not use" is certainly makes you suspect a safety or efficacy problem, doesn't it?

OK, that's my opinion. I mean they're sending definitely mixed messages here. I think they're just protecting themselves because of past use.

These will be discussed by the panel meeting later this week, together with other comments and proposals made by FDA reviewers themselves.

Dr. Suydam explained that the product manufacturers are withdrawing the products out of an abundance of caution and that the vast majority of parents and caregivers safely use these medicines to help relieve their children's symptoms.


She emphasized that as all medicines it's important to read over-the-counter labels carefully and use them only as directed and always store them where children cannot reach them.

The Consumer Healthcare Products Association has announced that it will launching a major and prolonged national campaign in partnership with practitioner organizations to alert and educate parents, caregivers and health care providers about the safe use of over-the-counter medicine for children.

Now this was more telling here, if you ask me. An article in the Seattle Times questioned why the announcement was being made now as the issue has been brewing since March when Baltimore's Commissioner for Health, Dr. Joshua Sharfstein, petitioned the FDA to look into safety and effectiveness of cough and cold remedies for children age six and under.

"Pediatricians across America in the American Academy of Pediatrics also supported the move, arguing that such medicines don't work in young bodies and that they present risks not just for infants but for preschoolers, too," said the newspaper.


So there's that word "risks" [Hmm] and “don’t work… [Hmm].

Sharfstein, a pediatrician himself, said that pediatricians are taught these products don't work and may not be safe, and yet every parent gives them to their children. Their appears to be a reluctance to revert to old fashioned but potentially less risky methods, such as suctioning out infant noses or using nose drops made of salt water as suggested by Dr. Sharfstein.

In the Show Notes, we'll have a list of the products being withdrawn and also a link to pictures of the medications in question. We also have links to information about viral upper respiratory infection in young children and the use of cough and cold medications for these illnesses from the Consumer Healthcare Products Association, the Food and Drug Administration and the American Academy of Pediatrics.

So check out the Show Notes for some interesting links and the list of drugs affected.


A team of European Scientists from Unilever together with colleagues from Research Institute in Australia and Indonesia have demonstrated that nutrition can improve verbal learning and memory in school children.

In a 12-month study of 780 children in Australia and Indonesia published in the American Journal of Clinical Nutrition, the researchers assessed the effects of adding a specific vitamin-and-mineral mix to a daily drink.

In Australia, children that received the daily drink with the added vitamin-and-mineral mix performed significantly better on mental performance tests than children in a controlled group that received the drink without added nutrients.

In Indonesia, a similar trend was observed but only in girls. This study confirms that nutrition can positively influence cognitive development in school children even in Western children who are well fed.


The scientists study 396 well-nourished children in Australia and 384 poorly nourished children in Indonesia. In each country, the children were randomly allocated to one of four groups receiving a drink with either a mix of micronutrients, such as iron, zinc, folate and Vitamins A, B6, B12, and C, or with fish oils such DHA and EPA, or with both added or with nothing added, which was the placebo or controlled group.

After 12 months, children in Australia who received the drink with the nutrient mix showed higher blood levels of these micronutrients, which means that their bodies were taking them up.

In addition, they performed significantly better on tests measuring their learning and memory capabilities compared to children in the other groups.

A similar trend was observed in Indonesia but again, only in girls. The addition of fish oil to the fortified drink did not conclusively show any additional effect on cognition.


This study adds to the mounting evidence that nutrition plays an important role in mental development. Previously, deficiencies in iron and iodine have been linked to impaired cognition, plus there's also emerging evidence that deficiencies in zinc, folate and Vitamin B12 play a role.

And more recently, fish oils have also been linked to cognitive development in children.

Most studies today have focused on deficiencies in single nutrients in young age groups. Yet the brain continues to grow and develop during childhood and adolescence. Little is known about the role of nutrition for mental development after the age of two nor have many studies looked at the effect of offering a mix of nutrients.

Until this study, there were very few randomized-controlled intervention studies assessing the impact of a multiple micronutrient intervention on cognitive function in school children.

Translation? [Laughter] This is a study showing that nutrients can make you smarter.


This study confirms that nutrition can positively influence cognitive development in kids even in those who are well fed. The researchers suggest that this finding could be relevant across the Western world.

The investigators recommend further research, of course, to investigate the exact role fish oils play in healthy school-aged children since some studies show there to be in effect and others did not.

Another research idea is the further optimization of cognitive development tests with respect to their validity and sensitivity across cultures. The scientists suggest that the smaller effects of the vitamins and minerals in Indonesian boys could be a result of a lower sensitivity of the cognitive tests in that country.

OK. Moving on, Remuda Programs for eating disorders, the nation's leading eating disorder treatment center, reports eating disorders can developed or worsen upon returning to school. The majority of eating disorders began at ages 14 and 18 when young women enter either high school or college.


Statistics show 91% of women recently surveyed on a college campus had attempted to control their weight through dieting, and 22% said they dieted often or always.

"Starting a new school can create an enormous amount of anxiety for young women," said Dr. Jennifer Lafferty, Staff Psychologist at Remuda Programs for Eating Disorders.

Going to a new school means entering a new social environment where one social status is unclear. The majority of teens today associate being fan with being attractive, popular and well liked by others.

In addition to feeding into a new social environment, academic stress at a new school can also contribute to the onset of an eating disorder. If a teen feels that she is failing to live up to either internally or externally imposed standards of academic success, she may begin to compensate by pursuing success or perfection in other areas of her life, over which she believes she has greater control, such as her weight.


"The first year of college often involves living everything that is safe and familiar, including friends, family and routines," says Lafferty.

Many teens will turn to disordered eating in an attempt to regain a sense of control, safety or comfort and some will turn into overeating and emotional eating in an effort to fill comforted or to numb out painful emotions.

Some may develop patterns of binging and purging, which often serves to alleviate build-up stress and relief from other negative emotions.

Remuda reports the risk of developing an eating disorder, particularly as high in dormitory settings. A roommate with an eating disorder often teaches other roommates or indirectly models eating disorder behaviors.

And as a result every time a boarding school or college student gets new roommates, the risk of eating disorders increases. If a student realizes that she is struggling with an eating disorder or if she feels like she is becoming too preoccupied with thoughts about food, weight or body image, she should go to her school counseling program where she can receive confidential and usually free services to address the problem.


If she doesn't know about her school's guidance program, most dorms have an RA or resident adviser who can assist her in locating resources on campus.

"The increase in eating disorders is alarming," adds Lafferty. There are several reasons why women are resorting to pathological and self-destructive means of achieving an idealized body image.

The first is that we're constantly comparing ourselves to unrealistic images and models in our culture that cause us to feel negatively about our bodies. Yup.

The discrepancy between the average woman and the typical female figure in the media has become quite wide. No pun intended.

In addition, women have increasingly become involved in competitive athletics during the past few decades. Participation in certain sports, such as track, cross countries, swimming, gymnastics and dance are associated with an increased risk of eating disorders.


Also daily life stress and pressures to succeed seem to have increased for many women over the past several decades.

If parents are concerned about their daughter, ask her to go to her college counseling office for an evaluation. And if she refuses, which she probably will, then parents may need to confront her when she comes home for the holidays.

Parents may need to let her know that she can't go back to school until a doctor and a therapist evaluate her.

Boy, talk about happy holidays, right? I'm not taking this lightly. But it's true. This is such a tough situation to deal with.

Remuda Programs for eating disorders offers Christian in-patient and residential treatment for women and girls of all phase suffering from an eating disorder. Each patient is treated by a multidisciplinary team, including a psychiatric and a primary care provider.

Registered dieticians are also involved as our master level therapists, psychologists and registered nurses.


The professional staff equips each patient with the right tools to live a healthy, productive life.

And now, I'm finished telling like a commercial for Remuda, except to say check out their website at And as always, we'll have a link to that for you in the Show Notes at

More and more children are being diagnosed with depression. However, whether or not children should be treated with antidepressants is hotly disputed. You can read a Head-to-Head where one person writes in favor, while another writes against, in this week's issue of the British Medical Journal.

Here's some of the comments you'll find from each side.

In the "Yes Camp," meaning children should be given antidepressants, argued it is wrong to deny depressed children one of the few evidence-based available treatments," so says Andrew Cotgrove, Clinical Director and Consultant in Adolescent Psychiatry at Pine Lodge Young People's Centre in Chester England.


The most controversial prescribing has been that of SSRIs or selective serotonin reuptake inhibitors for children. Nevertheless, subjective analysis of studies demonstrates a substantial benefit when compared to a placebo, for some SSRIs.

Guidelines recommend their use also for young people with depression and obsessive-compulsive disorder. Previous research has indicated that the use of SSRIs raises the risk of suicide related events. However, the risk is tiny and can be lessened even further with careful monitoring, Cotgrove writes.

Although cognitive behavioral therapy, interpersonal therapy and family therapy have some effects for young depressed patients, their effects are very small. Cotgrove explains that disturbing procedural mistakes, exclusion of evidence in the conducting and reporting of some SSRI clinical trials, have justifiably alarmed doctors and members of the public.


However, when one reviews the evidence carefully and objectively, the indications are that antidepressants have a role to play in treating young people with depression and OCD.

He concludes that young patients and their parents need to be told of the benefits and risks and be given advice and support when choosing an evidence-based treatment.

If we removed antidepressants as one of the options, we will be taking away one of the few potentially effective interventions for these disabling conditions.

Then we have the "No Camp" those who think children should not be given antidepressants. "Prescribing SSRIs for young people is dangerous, not ethically sound and poor value for money," write Sami Timimi, Consultant Child and Adolescent Psychiatrist in Lincolnshire England.

Timimi explains that as far as childhood depression is concerned, none of the SSRI studies had shown significant benefits over a placebo. Even so, national guidelines indicate that Prozac has more benefits than risks for young patients.


However, Prozac's profile is not that different from that of other SSRIs. Efficacy is small and there is a potential danger.

Timimi does acknowledge that a high placebo response makes it difficult for doctors to accept that SSRIs may be ineffective when faced with a distressed young person.

Timimi adds that a combination of fuzzy reporting it's like fuzzy math and a marketing spin have taken precedence over scientific accuracy, which have not helped the situation.

A reason for carrying out the studies in the first place was to validate well established prescribing patterns that lead to a trend which has been hard to undo in spite of all the evidence.

This does not mean we do not reverse it. Moreover, a small but tragic number of deaths may have happened because of their use.

In the majority of childhood cases, distress is self-limiting and does not need extensive intervention. However, when an intervention is needed, psychotherapy has shown itself to be effective, Timimi concludes.


All right, gentlemen, back to your corners. We'll have no parliament style fist fights today, at least not here.

And finally, a new U.S. study suggests that in 2005 there were 1.1 million new cases of sexually transmitted infections among young Californians. These include diseases such as chlamydia, gonorrhea, syphilis, HPV and HIV and accounted for a state-wide direct medical cost exceeding $1 billion.

Published in a Californian Journal of Health Promotion, this study is the work of researchers from the Center of Research on Adolescent Health and Development at the Public Health Institute in Oakland, California.

Dr. Petra Jerman, study author and scientist at PHI said these figures constituted an epidemic of which like an iceberg only a small part is visible. The estimated number of new cases and their associated costs illustrate that the STD epidemic among California youth remains largely hidden.


Jerman and colleagues said their goal was to estimate the incidence, rate and direct medical cost of new cases of sexually transmitted infections in young people and each of California's 58 counties.

This should give policymakers and local health care providers good quality information to help prevent and control sexually transmitted infections. The authors used methods developed by the U.S. Centers for Disease Control and Prevention to estimate state-wide numbers of new incidences of eight STDs in California in 2005, among people ranging from 15 to 24 years of age.

The eight types of infection included in the study were chlamydia, gonorrhea, syphilis, genital herpes, human papillomavirus, hepatitis B, trichomonas, and HIV.

Using national estimates of the average lifetime cost per case of each type of infection, Jerman and her colleagues also worked out their direct medical cost by county to help local health authorities use information more relevant to their particular area.


To summarize, results showed that in California in 2005, there were 1.1 million estimated cases of STDs in young people. The total direct medical cost of these cases was $1.1 billion.

The estimated number of new STD cases range from a low of 82 in Alpine and Sierra counties to a high of 360,000 in Los Angeles county. The associated costs range from $38,000 to $390 million, respectively.

The most prevalent disease was HPV, human papillomavirus, with an estimated 590,000 cases in young Californians in 2005. The lowest incidence of new cases was syphilis, for which the researches estimated 380,000

In their discussion, the authors wrote that the most commonly used marker for STDs is the number of cases reported to local health authorities.


Backed by their analysis, they argued that this method underestimated their true incidence and the discrepancy is most likely due to incomplete screening of at risk populations, under reporting of infections and failure to confirm that treatments were effective.

The authors concluded that these estimates illustrate the widespread and frequently underreported incidence and costs of youth STDs in California and its counties, and provides the foundation for a comprehensive assessment of youth STD prevention needs.

So that's in California, but what about your state or your country?

Well, wherever you live, you can bet sexually transmitted diseases are out there and your kids are living in their myths. So it's important to talk about these things with your kids, not just once during the birds and bees discussion but ongoing.

So be sure to talk about abstinence, talk about condoms and talk about the real risks involved with social contact.

If you need some help talking to your kids about sex, that's OK. We have some help for you. Simply check out the Show Notes for a link to


You'll find that of course at our site

[Laughter] All right, that wraps up today's news. We'll be back to wrap up the program right after this.

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And of course, thanks go out to Medical News Today for providing our stories and also to Catherine Paddock and Christian Nordqvist; also to Vlad over at because he provides all the art work for our website and also the feed. We really appreciate that so please be sure to support him at


Also, you can get t-shirts at the PediaCast shop. You can find the link for that also at We don't make any money off the shirts. We just want you to help us spread the word about the program.

Tomorrow, I'll be joined by Dr. Dwight Powell. He is a pediatric infectious disease specialist at Nationwide Children's Hospital. We're going to talk about health issues affecting internationally adopted children, so that's coming up tomorrow.

And until then, this is Dr. Mike saying, stay safe, stay health and stay involved with your kids.

So long, everybody!

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