Ear Infections, Myspace – PediaCast 068

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  • When To Treat Ear Infections
  • Do Your Kids Supersize?
  • MySpace 411



Announcer: This is PediaCast.


Announcer: Welcome to PediaCast, a pediatric podcast for parents, The Research Edition. And now direct from Bird House Studios, here's your host Dr. Mike.


Dr. Mike Patrick: Hi everyone and welcome to PediaCast. It's episode 68 for Wednesday, October 24th 2007. Ear infections, super size and Myspace, that are going to be our 3 topics during this research episode of PediaCast. This is Dr. Mike coming to you from Bird House Studios. And I'd like to welcome everyone to the program.


Also a special welcome to those joining us on Stickam, that's Stickam.com And we are here at 7:30 on, let's see what is this? It's Wednesday. I just said it, Wednesday October the 24th. So I'd like to welcome all of you who are joining us that way too. Don't forget you have to be a member of Stickam in order to join us there and you just go to their website Stickam and you can join and then just look for PediaCast. Again we're going to try to do this most nights between 7 and 8 o'clock.


And so you can find us there. One of the thing I want to bring up here before we get in to the bulk of the program. I don't know how many of you have outdoor hot tubs. We've had one for several years and always this time of the year we start to get spiders that liked to build nest in the cover and it's like everyday a battle trying to get rid of these spiders. I know it sounds lovely trust me. People who you know are friends hopefully no one's listening who's ever been in our hot tub but it's really not so bad. I mean we take care of them. But it is, I have to say it is really a pain.


So I don't know if you can commiserate with me or not but oh well I guess we better move on to the program and I have more spiders to kill tomorrow. I just did some chemical stuff with it and saw that there were new nests and I just don't have the energy to take care of it this evening. So if anyone has any great ideas on how to stop spiders this time of the year for wanting to crawl up into the warmth and moisture of the hot tub. I would appreciate it.


Alright so what are we talking about today? We have 3 interesting research topics; When to treat your infections? There is this new idea. It's not really new. It's been around for a couple of years now of instead of treating it just giving it time to see if it goes well and so doing it before you do the antibiotic. There's also another research study we're going to talk about; Do your kids super size their food portions? And then we have the 411 couldn't resist on Myspace. We have some statistics that might surprise you.


And again they might not surprise you. Don't forget if there is a pediatric topic that you would like us to talk about, if you have a question, a comment, or a lead on a great interview, just go to PediaCast.org and click on the contact link. You can also go to pediacast@gmail.com or call the voice line at 347-404-KIDS.


Let me remind you 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 specific individuals. If you have a concern about your child's health, call your doctor and arrange a face to face interview and hands on physical examination. Also your use of this audio program is subject to the PediaCast terms of use agreement which you can find at PediaCast.org.


And with that in mind, we'll be back with our research topics. Right after this short break.



Alright welcome back to the show. You know one of the things has always been sort of a mistery to me is exactly what is the term double ear infection mean? When you hear this from parents, "Oh he was diagnosed with a double ear infection." Now my question is does that mean that there's a middle ear infection and an inner ear infection in one ear? Or is it a middle ear infection and an outer ear infection which is what we call swimmer's ear in the same ear? Or is it simply a middle ear infection in both ears? I don't know.


I supposed double is worst than single. But that's not really medical term. And I always kind of chuckle when I hear people use that. This actually talks a little bit about double ear infections although it uses, you know I'm going to assume that double means in both ears. And that's really what investigators in Texas and Israel we're looking at. Is there a difference when kids have an ear infection in one ear versus both ears? And if they have the ear infection in both ears is it you know going to be worst as it more likely than it need to be treated with an antibiotic as compared to just having it in one ear?


Now let me give you a little bit of a background here. The observation option for acute otitis media, so if you have a kid with an ear infection in the middle ear space, that's the most common kind of an ear infection that we're talking about. There is this idea especially if it's an early ear infection and the child is six months of age or older and they have mild symptoms and a fever that's less than 102 degrees, it's acceptable to give the family a prescription of an antibiotic and say you know just watch for a couple of days if the fever goes higher, or he seems worst, he's not getting better then go ahead and get the prescription filled then start the antibiotic.


And the idea here is that if it's a mild ear infection; give the body a couple of days to take care of it and maybe save exposing your body needlessly to an antibiotic. However, knowing which children would benefit most from antibiotic therapy versus this observation approach would be helpful. And again these researchers in Texas and Israel wondered if unilateral versus bilateral infection, or one ear versus two ears made a difference.


So what they did is this, the Texas group looked at 566 children and in Israel they looked at 1026 children. All these kids ranged in age in Texas from two months to seven years. And the Israel group ranged in age from 3 months to 36 months of age. And all of them had acute otitis media or a middle ear infection. And they divided the children into two groups, those with unilateral versus those with bilateral ear infections. So you're going to have kids, one group of kids had it in one year, the other group of kids had ear infections in both ear.


And then in both groups all the kids had this procedure called Tympanocentesis. Now this is something we don't do much anymore. They did it a long time ago. And what it is, is you basically poke a needle to the eardrum and you get fluid out and culture it to see what grows. And then you look to see in what grows if there's a single organism in the culture and a large amount then you say, "Well it was a bacterial ear infection, an antibiotic was needed and this is the particular bacteria that did it so this is the particular antibiotic that's going to work the best."


If no organism grew, then they assumed that either the fluid was sterile. So there's what we would call a serous otitis or just basically having fluid behind the eardrum but it's not really an infection and of course those kids don't really need an antibiotic or they had a viral ear infection. Yes, viruses can cause ear infection and it's just like bacteria but again they're not going to respond to an antibiotic because antibiotics do not kill viruses they only kill bacteria. So on those kids' cases, also no antibiotic was needed.


Now I will mention here and this would have been sort of an interesting way to do this. This study does not look to see if you did the observation approach. Did they need the antibiotic or didn't they need the antibiotic? All they're doing here is looking at 1 ear infection versus both ears being infected and was there a bacterial agent or not. It's all that they're looking at. So what were the results? Well in the Texas group if they had ear infection one ear, 57% of them grew bacteria and if they have the ear infection in both ears then 70% of those cultures grew bacteria.


So in the one ear infected group 57% had a bacterial ear infection and in the bilateral or both ears being infected 70%. So it's difference between 57% and 70% and as it turns out this was statistically significant. So there was a difference between the two groups that the bilateral or both ears being infected was more likely to be a bacterial ear infection than the unilateral or one ear group.


Now over in Israel they looked at these kids and their results were similar. In their case the unilateral or one ear group 67% grew bacteria. And then the bilateral or both ears groups 83% grew bacteria. And this was also again statistically significant. So in both locations the bilateral group did show there's more of a chance of it being bacterial if it was in both ears. You will notice though that still even in the one ear being infected more than half in both Israel and Texas and both of those pools of patients they did have ear infection that was bacterial in over half, even when it is only one ear.


So you know how helpful this is. I'm not really sure. But there was slightly more in kids that had it in both ears. The other thing that they did is they had parents and kids fill out clinical symptom scores especially if they were old enough kids to do this. And what this was just to find out what kind of symptoms that they were having. And as it turns out the kids who had the bilateral ear infections, both ears; their clinical symptoms scores were also significantly higher. And for those of you, who are pediatric residents, family practice doctors, health care providers of any kind, you'll be interested to know that in the bilateral or both ears group the bacterium homophiles influenza, just a type of bacteria, was seen more often.


They didn't specify what type of homophiles influenza, I'm going to assume it was probably the untypable kind. And again those of you in the health care fields will know what I'm talking about when I say that. So investigators concluded that if an acute otitis media is in both ears there's a higher chance of having more severe symptoms that they will develop having more severe symptoms and that the causative agent will be bacteria.


So obviously there are plenty of times when unilateral turns out to be bacteria, so it doesn't mean again that you treat bilateral and you don't treat unilateral. Just another piece of information to consider when we decide whether to treat out right or to give the parents the prescription and have them fill it only if symptoms progress.


OK let's move on to research study number two. Children who are supersize, this is an interesting one. It was done by investigators in Nova Scotia and published in the journal of the American Dietetic Association July 2007. You know meal portion sizes have increased over the past 10 years. And this has been associated of course with increased calorie consumption and increased obesity. So investigators wanted to examine determinants and consequences of large portion sizes in kids.


In particular they wanted to know, does the frequency of eating fast food influenced a kid's idea of what their portion size ought to be and does watching TV while you eat influenced portion sizes? The investigators thought this activities might increase the preferred portion sizes for kids because these ideas make sense right? But of course in science we don't believe something just because we think it makes sense. We want the facts, just the facts ma'am.


What the researchers did in Nova Scotia is they surveyed 5,000 5th grade students and the children were shown 3D graduated food models. They looked at French fries, meats, vegetables and potato chips. And they had models, three dimensional models of each of these portions. So a portion of French fries in graduated sizes. The smallest of the models reflected current guidelines for age appropriate portion sizes and then each successive model of that food type got a little bigger, little bigger, little bigger.


And then what they did is the survey asked the kids a whole bunch of questions about their eating habits. How often they eat fast food? How often they watched TV while they eat and lots of other questions as well. And the parents of the kids were also surveyed and asked to describe their child's eating habits from the parental point of view.


OK. So what do they find? Well the results, children who ate dinner in front of the television and those who ate at fast food restaurants at least once per week were more likely to choose larger portions of French fries and potato chips. And the more meals that were consumed while watching TV and the more frequently kids ate at fast food restaurants each week resulted in greater odds of choosing large portions of fries and chips.


Children who preferred larger portions of fries and chips as it turns out 8 a mean of 243 more calories per day than those who preferred the reference portion. And children who ate fast food more than once per week and children whose parents reported unhealthy eating habits for their kids, those kids were more likely to choose smaller vegetable portions. The researchers concluded that children who eat fast food every week and who eat while watching TV are more likely to choose larger portions of unhealthy food to choose smaller portions of healthy foods and to consume more calories compared to kids who do not eat weekly fast food and who do not eat while they're watching TV.


So the take home for moms and dads here is to help your child curb obesity and to help you curb obesity. The parental type, choose fast foods less often than once each week and don't allow your kids to eat while they watch TV. These of course are the conclusions we made at the beginning of the study because they made sense right? And now we have a well designed project, research project that supports the validity of these conclusions and that's what research is all about.


OK we're going to move on. This next one, what's the 411 on Myspace. This one was published in the journal of adolescents in June of 2007. Teens as you know are in parents too, lots of people are just teens are increasingly using social networking sites. And we know that for teens there is a risk of predators stalking these sites and looking for victims. We see it on the news every week. Researchers wanted to know what type of information that teens are publishing about themselves on these sites to see if there's any risky type behavior, where someone who could figure out who they are, if it was a predator who wanted to know.


Myspace accounts for by 80% of all visits to social networking sites. So the researchers chose to use it in their study. As it turns out Myspace assigns a unique number to each profile. So researchers used a random number generator to pick profiles and they randomly selected 9,282 profiles.


I'm not sure why. Why not do 10,000? I don't know. Some people just don't like even numbers I guess. Well I mean okay it's an even number and it ends in it too. I did go to math class. But you know what I'm talking about. So they randomly selected, but I digress very badly. They selected 9,282 profiles and of these 2,423 were created by people younger than 18 years of age. So these are going to be the profiles that they focused on for the anyone who is less than 18.


What they found is that 40% of those 2,423 youth profiles were set to private and this means viewing was restricted to approved friends only and the investigators didn't try to become an approved friend. They just left those alone and you know they couldn't see them and of course that's the best case scenario.


Of the remaining 60% of youth profiles that there were 1,475 youth profiles remaining and they were pretty equally divided female to male. 54% were female and 46% were male. 8% of them had evidence of age inflation and what this means is that there was information in their profile suggesting that they were younger than their stated age. And researchers thought that maybe this was an attempt to bypass Myspace's policy of setting all profiles of those younger than 16 years of age to private automatically.


So it looked like about 8% of them were probably really less than 16 but lied about their age. They can't say for sure because it didn't asked these kids, "Hey." They didn't push them up into a wall or into the corner, holding their shrt by the front and said, "Tell me how old you are or I'll pull you." That was not happening. So we don't know for sure but they think that about 8% had age inflation.


9% listed their full name. 28% listed their school. 5% posted pictures of themselves in swimsuits or underwear. 18% posted information about their alcohol use. 8% posted information about tobacco use and 2% posted information about marijuana use. I guess the good news from the study is the majority of teens do not put themselves at risk by being identified by predators because they have either their profiles are set to private or they don't give their full name, they don't list their school, they don't show pictures of themselves in suggestive attire; these sort of things.


However, a sizeable minority do put themselves at risk. And so I think this is a wakeup call of sorts to parents. You really do want to discuss the concept of Internet predators with your kids. Help them understand how our predator might locate them. Let them know what types of information is safe to post and what's not to post. And now here's the thing, do you demand that they have a profile that you have access to so you can check these things out?


I mean if you have a kid who really does not want you to know that they have a Myspace profile, they're going to be able to do it. I mean they're going to be able to make up a name to figure out how to have an e-mail address that you don't know about and to do this behind your back. So I think much more important than an iron fist, "Hey, this I want access to it." And some people disagree with me with this but I think more realistically is the education of saying, "Hey this kind of thing really does happen and you've got to be careful. Make sure you're not doing this or not putting this on there." That sort of thing.


I have a 13-year old and a 10-year old at home that are not big social networking site people at all. And so for me I guess I haven't had to deal with this on a personal level so I'm sure there's parents out there who could give much better advice on exactly how to go about doing this to give them, let them know that you do trust them and yet keep them safe. And so that's an important thing and something we all should be thinking about.


Alright we're going to wrap up the research show. We haven't done one of these in a while. It's kind of fun putting together. We'll try to do more of them in the future. So let's take a quick break and then we'll come back. I want to talk to you a little bit about the Pediascribe blog which I haven't in few episodes. So we'll talk about that right after this.



Once again if you would like to participate in the program live all you have to do is to go to Stickam.com and register for a profile there. It's absolutely free. And once you're a registered member, you can look for PediaCast and add it to your favorites and then sign on and check us out. When do we do this? Most typically it's going to be between 7 and 8 o'clock Eastern Daylight Time. Which is what we're on right now. We haven't actually switched the clocks yet back but I think again it is happening soon.


Maybe next weekend, not positive about that. I probably should be. I let others worry about those kind of details. Alright so check us out. And once we get a sizeable audience, we may do some shows where we take questions live. I think that would be kind of fun and sort of interact with the audience. Right now it's just sort of an observation thing. You can hear me. You can see me. And so I guess it's sort of interactive in that way. But as we get a bigger audience, we may be even take some questions through that. So we'll see how it goes. So it's at Stickam.com.


I'd like to thank Vlad over at Vladstudio.com for providing the art work for our website. I so appreciate it. Also thanks to my family for putting up with me in doing this project. Speaking of my family, Karen, my wife runs the blog arm of PediaCast and its called Pediascribe. And she had a great post called When Exactly Do I Squeeze in Mom Time and we'll have a link to that on the show notes at PediaCast.org.


But I think a lot of moms out there can relate to this. It's basically some snap shots of her date book and it's pretty full. Anyway nothing else, that will give you something to commiserate with her. Like I need people to commiserate with me on spiders on the hot tub cover okay. She needs people to let her know she's not the only one with the busy schedule. Of course, if you can find time between your tasks to look at Pediascribe okay in to Pediascribe.com


Tomorrow if everything goes according to plan, Dr. Karen McCoy, a pediatric pulmonologist at Nationwide Children's Hospital is going to stop by to talk about vocal cord dysfunction and its confusion with asthma. So that'll be an interesting conversation and like I said if the stars align right and everything goes well, that should be here tomorrow.

So until then this is Dr. Mike saying, "Stay safe, stay healthy and stay involved with your kids." So long everybody.


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