International Adoption, Nitrates And Carrots, Raw Eggs – PediaCast 075
- Comments on International Adoption
- Nitrates and Carrots
- Raw Eggs
- Blocked Tear Ducts
- International Adoption Statistics (U.S. State Department)
- Nitrate Information from the AAP
- Nitrate Article from Wholesome Baby Foods
- Living with MRSA
- Raw Egg Safety (USDA)
- PediaScribe: Trick or Treat
Announcer 1: This is PediaCast.
Dr. Mike Patrick: Bandwidth for PediaCast is provided by Nationwide Children's Hospital, For Every Child
For Every Reason.
Katie: 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: Hi, everyone and Happy Friday. It is Friday November the 2nd 2007 and you've got
PediaCast number 75. Nitrates, Raw Eggs, and Tear Ducts, so a motley crew of topics to wrap up the
week. This is Dr. Mike coming to you from Birdhouse Studio and I'd like to welcome all of you to
Before we get started with our topics this week, I do have one thing to report. I was downstairs in
the studio this afternoon working on my script notes for this particular episode and my lovely wife
Karen gets home, she comes down the stairs to the basement and she has a receipt in her hand from
Walmart. And she goes on to tell me that this receipt was one she found in the yard when she pulled
up had blown into our yard and she wasn't quite sure what she should do with it. It does not have a
credit card number on it. We know that it's not our receipt because, like you know from the trash
or something, because one of the items that was on it, yes she looked, was diapers and baby formula
and we don't have any babies in the house so obviously it was not ours that had blown out.
But other than the diapers and the formula, pretty much everything else it looked like it could
have been our receipt. Now we do have a couple of other families with babies who live close by so
I'm sure it was one of them. But you know it does make you kind of wonder, you know what your
neighbors are buying at the store. I don't know there's something very sick about that, I know. But
it ended up being pop tarts, peanuts, snack cakes, fruit juice, and eggs and milk and bread, but it
was more snack foods than anything else. And Karen and I had to chuckle because it looked like it
could have been our receipt, then we stepped back and think. OK. Maybe that's why we're having
weight issues. [Laughs] So I guess our next goal is not just to exercise five days a week, but we
also have to make sure that our Walmart receipts look healthier than our neighbor's. I don't know,
have you ever done that? Have you ever checked out your neighbor's receipts from Walmart? OK I
know, sick. I tell you it's just sick. It's a good thing it's Friday.
In addition to the topics I mentioned before, we have a listener who made a comment about
international adoption, that's coming up. Also another quick note on MRSA or Methicillin-resistant
Staphylococcus Aureus, also Nitrates and carrots, raw eggs, and blocked tear ducts. That's all
coming your way.
And don't forget if there's a topic that you would like us to discuss, all you have to do is go to
Pediacast.org and click on the Contact link, you can also e-mail me at firstname.lastname@example.org. If you
do that, make sure you include where you're from so we can include that in your note when we read
it on the air. Also voice line's open for your convenience 347-404-5437 which spells KIDS.
Also 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.
can find at Pediacast.org. And with that in mind, we will be back with your questions right after
this short break.
You ever noticed how the person standing in front of you at the checkout line at the grocery store
usually has healthier line-up than you have? I don't know, it seems like if we're in the grocery
store with our snack foods, the person in front of us is skinny as a stick and has all their
yogurts and granola and everything lined up, so it's pretty embarrassing. So OK that's motivation
All right. Our first listener, this is a comment from Jonathan in the Buckeye State Ohio, just down
the road. He says, "I've been listening to your podcast for about three weeks now and I generally
enjoy it. I have a Zoology research background so I especially enjoy when you get a bit more
technical. I recently adopted a baby boy from Vietnam, I brought him home in May this yea, things
are going great. I listened with interest to your recent podcast that focused in international
adoption. I take my son to the Oak Adoptive Health Center at Akron Children's Hospital and it's
wonderful. All the staff there are really great. I did think that the doctor interviewed almost
seemed negative on international adoption even though I'm sure that's not the case, all that was
discussed were the problems that people are sure to have, at times he made it sound as if every
child adopted from overseas is tinning with problems both emotional and medical. I am well aware of
the potential medical issues and the psychological issues around international adoption such as
race, nationality, adoption itself, abandonment etcetera. But really it isn't quite as bleak as the
doctor at times made it sound, and here is a link to the actual numbers of orphans brought home to
the US. It's not quite tens of thousands as you're opening stated, but not a tiny number either.
Thanks and keep up the great podcast."
I checked out the link Jonathan, that you sent me and I counted up all of the adoptions in 2006 and
they totalled 20,000 from various countries and then in 2005 they totalled up to 22,00. So
technically that's tens of thousands. It's two tens which is plural, [Laughs] so I didn't really
lead you astray, it's just two tens of thousands. OK. I did put a link in the show notes, everyone
can take a look for yourself.
It's kind of interesting to see which countries are represented and they're good figures. They are
from the US State Department and it just shows a breakdown by country for the last several years
and all of the numbers. So thanks for your comments Jonathan, I do appreciate them. Some of that is
my fault because I did come up with questions that we were going to talk about and I guess that day
was a glasses-half-empty kind of day, which my wife tells me I have frequently but anyway, that's
another story. So I'll try next time we talk about international adoption which I'm sure we will at
some point in the future because it's a hot topic, I'll try to be a little more glasses-half-full
for you and my wife.
OK. Listener number two, comes from Rachel in Aston Pennsylvania. And Rachel says, "Hello, Dr.
Mike. Love your show even if you are an Ohio State fan." And then she goes on to say, "M go Blue."
Which my daughter will not appreciate me saying in the podcast, but I'm just reporting what Rachel
said. "To my question, I've been making baby food for my eight month old and she prefers the pureed
food to the jarred baby food. However she just loves carrots and I was warned not to make my own
carrots due to the high Nitrate content in them, so I've been purchasing pureed carrots for her.
Question, why are carrots susceptible to high Nitrate content? I was aware of highly processed
meats like hotdogs having high Nitrate content from the processing but not vegetables. Are there
any other vegetables that have high Nitrate content? What are the dangers of high Nitrate content
foods to the infants? How about high Nitrate foods for toddlers and preschoolers, what are those
dangers? I also have a 35 month old so I don't want to load him up on nitrates either."
OK. So let's talk about this. This is an interesting discussion. First, Nitrates are not
particularly dangerous. You heard me right, Nitrates are not particularly dangerous. They are
absorbed by the body and eliminated pretty rapidly and there really is not any bad health effect
for the most part from Nitrates at any age group. Now before you go crazy on me and say, "But I've
heard, I've heard, I've heard." What the deal is, is that there are certain bacteria in the stomach
than change Nitrates into Nitrites which can be dangerous to babies. So it's a sticking point here
and I know, you know playing with the details. But le me just say this, only in the little young
babies is this really an issue because the bacteria that convert Nitrates to Nitrites do not like
an acidic environment and yet they're living in the stomach in babies. But once babies get to be
about four to six months of age, there is more stomach acid and these bacteria at around that time
tend to go away.
So usually right around four to six months of age or so, Nitrates aren't going to be as big of an
issue because the bacteria that change the Nitrates into the dangerous Nitrites aren't going to be
there anymore. So the biggest risk from Nitrates is going to be in babies less than four months of
age. There's a small risk between four and six months of age. Maybe in a few kids there's going to
be a slight risk between six months and twelve months of age, and then once they're a year old,
really there's very, very, very little risk at all.
Now what about babies who are on acid reducers like Zantac or Prevacid, you know they have acid
reflux and they're on acid lowering drugs, then they do have a risk for a longer period of time? It
would seem to me that they would, but I don't know that for sure so I'm not going to tell you and I
couldn't find anywhere in my research that addressed that at all. So something to think about I
guess. Maybe if you have a kid on Zantac or another acid reducer, maybe you should be careful about
the Nitrates in the diet a little bit longer, but again I'm just surmising that.
What's the deal with the Nitrites?
So you got the Nitrates. These bacteria in the really, really young infants are going to transform
those into Nitrites, what's the problem? Nitrites, they react with hemoglobin in the red blood
cells to make a chemical called methemoglobin and then you get a condition called
methemoglobinemia, meaning that your red blood cells instead of having hemoglobin, they're mostly
methemoglobin. Now the problem with methemoglobin is that it is not a very good oxygen carrier. So
the purpose of hemoglobin remember, is to carry oxygen from the lungs and then deliver it to the
cells. So if can't do its job, then the cells are going to go without oxygen which causes what we
call cyanosis or hypoxia and then the babies get a blue color because the oxygen in the blood is
not mixing with the hemoglobin to give the blood the red color which makes babies look pink, so the
babies look blue instead because they're low on oxygen. The oxygen is not being carried in their
blood properly and we get this thing called Blue Baby Syndrome.
Also just sort of interest, the blood of these babies with the methemoglobinemia actually is about
the color of chocolate, it's like a dark brown color. If you have a baby who's sick, they're kind
of blue and you draw blood, this is one those things in the ER where the blood comes out looking
like chocolate and you can say, "Hey, I know what this is. It's methemogobinemia from Nitrites."
And then of interest the cure for this in order to convert the methemoglobin back to regular
hemoglobin is actually a chemical called Methylene Blue which is a really deep blue dye and you
give that to them through the IV and then that converts the methemoglobin back to hemoglobin.
So it's kind of a neat disease process, I mean it's not neat if it's your child who's having the
problem. But from a doctor's point of view, you know you're seeing ear infections and strep throats
and wheezing and this is something that's a little different. So that's what this is all about.
Now why carrots?
Remember the main source of Nitrates is going to be from fertilizers, from septic systems, from
decaying organic material and so that can make its way into the soil especially in farming
communities and carrots of course are in the soil and the other vegetables that are also at risk
for having a lot of Nitrate content are the green leafy vegetables that are right on the ground
like spinach and cabbage, also broccoli and beats are in that group too. But again these are going
to be most dangerous in terms of Nitrates for little babies, I mean we're talking less than six
months of age here. Something else that I think is kind of important to keep in mind is that all
carrots and all these vegetables are susceptible to Nitrates even the ones that you buy at the
grocery store that are pre-processed for babies and pureed and that sort of thing. It's just that
those carrots are screened for Nitrates and rejected if the levels are too high whereas if you make
your own carrots in the house, obviously you can't check the Nitrate level.
And at what age?
Well the American Academy of Pediatrics and lots of different sources basically say especially for
kids less than four months of age, you shouldn't give them home made cooked vegetables of any kind.
But really you shouldn't give them any solid food until they're about four months old anyway and
then you're starting with the cereals and by the time you get to the stage one and stage two baby
foods, I mean we're talking you know when they're eight or nine months old then you're fine
pureeing your own vegetables, most pediatricians would tell you and for someone in my office that's
what I would tell them as well. And in 10 years of practice I have never seen get any child get
methemoglobinemia from carrots ever, ever, ever, ever. So I really feel pretty comfortable saying
it's low risk.
If you would like to know more about Nitrates and foods, I got a couple of links for you in the
show notes. One is from the American Academy of Pediatrics, it's a phycisian's statement that they
have regarding Nitrates and foods. And then I had a really interesting Nitphysicianrate article from a place
called Wholesome Baby Foods. Now you would think that these would be kind of a green company, if
you know what I'm saying. Wholesome Baby Foods are going to be like really into organic everything
and might slant the information using sort of some scare tactics to say, "You really need to use
our products." But it wasn't like that at all, I was really impressed. And this site, the article
was very objective and gave good details and so I was very pleased with the information that I
found here. So I would check that out, it's at Wholesomebabyfood.com.
I'm not getting any kickback, we don't have any like link exchange or anything like that going on,
it's just the site that I found that I liked and their Nitrate article I thought was really fair
and balanced. See if any Fox News talent search people. See I can say fair and balance very nicely,
so if you need a medical correspondent, I'm just kidding.
Let's move on because I'm really off topic.
Jennifer in Sugar Land Texas says, "Hi, Dr. Mike. I love your podcast and listen to it while I'm
walking the kids to the park. I have recently become concerned about the outbreak of staph that has
become resistant to most antibiotics. From what I have learned the best way to prevent catching
this infection is by washing hands. I would like to know how this is transmitted, how long it stays
alive on surfaces such as playground equipment etcetera and if you can get in from swimming in a
chlorinated pool with someone who is infected. My two sons, almost 4 and 20 months are both in
swimming lessons. What else can I do to protect my children from this dangerous and deadly
In our News episode earlier this week, we touched on this a little bit and I'm not going to add too
much here. I just again want to point out that this is nothing new to us in the medical community.
It's only new to the news media. We have been seeing Methicillin-resistant Staph, the community
acquired version of it for several years and basically kids would come in and maybe they've been
seen in an urgent care or an ER in the early days of this and were diagnosed as having a spider
bite or the parents thought that it was a spider bite and then finally came in when it kept getting
bigger and basically they just have a large abscess that's filled with pus and you get some of that
pus out, culture it, the Methicillin-resistant Staph comes back and then we put them on antibiotic.
Now according to news media, this is a highly resistant strain of staph. There's actually two types
of Methicillin-resistant Staph; there's the hospital acquired and also the kind you see in nursing
homes and extended stay facilities and then there's the community acquired which is what we were
seeing out there right now and have been for several years. And the difference is that the hospital
form of it is really a different bug and is resistant to lots and lots of antibiotics, so it is a
real nuisance. But the one that we're hearing about in the news now, the community version of it,
it is resistant to Methicillin and the Penicillin group and the cousins, the staphylo sporins but,
the Sulfa antibiotics and Clindamycin still seem to be working on it very well and hopefully it
will on into the future and of course they are developing new strategies to deal with it.
I also should point out that a lot of these and we're talking about skin boils, these are abscesses
of the skin, I can't tell you how many people since these new stories have come out have come in
with other rashes; eczema, contact dermatitis, you know just really any rash and say, "Could it be
MRSA?" because they don't understand what it is that we're looking at here. Also it doesn't cause
cough, runny nose, congestion and those sort of things. The people that run into trouble with this
are ones who these wounds get big, the bacteria invade, they finally get into the blood stream and
cause what we call sepsis and that really takes a long time to happen in a person who has a normal
immune system. So if you have someone who dies from MRSA, more than likely they either neglected
to have this skin lesion taken care of in a timely manner or they had an immune system issue where
their immune system was not able to fight the infection like a normal immune system could or some
combination of those two things.
So [Knocks] knock on wood here. But we have not had any deaths in our practice tributable to
Methicillin-resistant Staph. So we talk about it being dangerous and deadly, you know it's a
nuisance but I wouldn't say that in my experience it's really been deadly or dangerous yet. And of
course we do need to take it seriously, there's no question about that and it is very good to be
knowledgeable about it and to learn about it but it's not panic time either.
In terms of the other thing that I meant to mention with these boils, a lot of times all they
really need is drainage. There have been some indication that if you get the pus out of these
things then it gets better much, much faster and possibly even without antibiotics it would go
away. We still use antibiotics, that's still the standard of care obviously in our community and
probably in our community, but the point being that the body usually can get it taken care of, if
you can get the pus out of these lesions.
In terms of where do you catch it, you know other people; so if there's someone who has it on their
skin, you can pick it up that way. It does stay alive on surfaces, usually a few days but it can be
longer if the surface environment that the bacteria is on is a hospitable one. So if it's warm and
moist, it may be able to live longer. Also there's some indication that if it's living on the
surface in some skin flakes, then it might be able to survive up to six months or more. But the
biggest reservoir for this is actually your own body and what can happen is that your nose becomes
colonized; so up inside the nasal passages with the staph bacteria. So you get it from someone
else, it gets on your skin and then it gets in your nose and starts to live there. And you know
kids, I mean they got their fingers in their nose, they're picking at it, they're rubbing at it.
Next thing you know they got the mucus on their fingers and they're scratching their skin and they
get a little open sore 'cause they've got dry skin and some eczema and the next thing you know,
it's growing in their skin.
So one strategy that we use in our office is along with the antibiotic, we also give people an
antibiotic ointment and everybody in the house puts the ointment up inside their nose, just a little
squirt of it a couple of times a day for a few days, just to try to get it out of the house
because the nasal passages are a good reservoir for this kind of bacteria.
Chlorinated swimming pools, I don't think are really a problem at all in terms of getting it from
the water because that's going to kill the bacteria pretty nicely and quickly. But if you're
swimming with someone who has one of these and your skin touches their skin then certainly it could
be an issue.
I do have a link to a really good brochure from the Georgia Department of Human Resources. It's
called Living with MRSA. It's a PDF file and of course we'll put a link to that in the show notes.
OK. Annabeth in Wake Forest North Carolina says, "Dr. Mike, I love the show and I have a question
about raw eggs. Growing up in the 80's, my mother always let my brother and I lick the blender
beaters after she made cakes, cookies, and brownies. As far as my mother or I can remember we never
got food poisoning from Salmonella or even a tummy ache. Now I have kids but I don't let them eat
raw batter for fear of making them sick. I'm just wondering, is there a big difference in today's
food processing that make Salmonella more prevalent? Just wondering, if you could enlighten me
about this. Thanks."
You know Annabeth, I think there's always been the risk of Salmonella with raw eggs and just
recently, I mean the last 10 years I guess has become more of a public health concern. I think we
can blame, or not blame I guess, we can credit, [Laughs] it was the wrong word. You know the Ralph
Nators of the world for helping us to understand these things. I mean when you think about it, cars
were just as dangerous in the 60's and 70's but now we're much more safety conscious with air bags
and buckling up and we use safe playground materials and you know slides can be a certain height.
We've talked about this before but when I was a kid growing up in the 70's and 80's, you know
slides they seem 10 feet tall, they were metal and they were on concrete and the ground wasn't
softer back then. So I think eggs were just as dangerous, we just know the risks of what can
happen. And the fact that you never got sick with the raw eggs, either you never came in contact
with Salmonella, you were just lucky or your immune system took care of it. Maybe you had a little
diarrhea for a day or two and never really thought much of it because you didn't realize that
connection, so that's possible too.
That's really all I have to say on that topic. I do have a link to a publication from the USDA on
raw egg safety which again it was kind of interesting one I came across in my research on this. So
I share that with you in the show notes at Pediacast.org.
OK and finally to wrap up the week we have Sarah from Kansas City Missouri. She says, "Dear Dr.
Mike, thanks so much for an informative and entertaining podcast. My son is 18 months old and was
diagnosed by an Ophthalmologist as having two blocked tear ducts that prevent tears from draining
out of his eyes. The result has been constantly watery eyes as well as a handful of eye
infections. We did treat those with antibiotic eye drops. Our pediatrician told us that we will
discuss a surgical procedure to open the ducts at his 18 month well-baby check up. My first
question is, what are your thoughts on this procedure and could you talk about the use of general
anesthesia with infants and toddlers? Your comments will be greatly appreciated. Thanks again,
Sarah, generally in our area the standard of care is to deal with this a little bit before 18
months. Generally what happens is that kids, well first to understand the eye a little bit. In the
top outer portion of the eye is where the Lacrimal Gland is that makes the tears and then the tears
sweep sort of diagonally across the eye from the upper outside corner where they're made to the
lower inside corner where they drain into a duct system down into the nose. And that's why if you
cry you get a stuffy nose because those extra tears are draining into that system which then goes
into the nose.
In some babies there is a membrane that it is closed. In most kids that membrane opens up after
they're born so the tears can drain properly, but in few babies it remains closed so that the eye
is making tears but they just spill over the eye lids either on one side or both sides because that
drainage system has a membrane that's covering it. In addition to that, you can have a kid who
doesn't have a membrane covering it anymore but has some cellular debris, some gunk, some dead skin
cells that are clogging that drainage system that can basically do the same thing.
Traditionally, in the way that I was taught to deal with this about 10 years ago was that you just
watch them and if it didn't get better by the time that they were a year old, then you send them to
the Pediatric Ophthalmologist to see about having it probed in the office. Now it seems like these
days, the Pediatric Ophthalmologist that we work with, they like to see them a little bit earlier.
They would do an office probing usually at around six months of age and even if you have a bigger
kid they'll even see them for the first time at four months of age to start thinking about this.
And the balance that you're trying to do here is you want them to be big enough that the duct is
big enough that you can visualize it and open it up, probe it without damaging the surrounding
tissues. On the other hand, you don't want the kid to be so big that they're going to jerk away. So
you want the kid to big enough to do it yet small enough to be able to hold them down. I know this
this sounds terrible, it does. But it is a really quick procedure in the office to probe it and you
know in general it works pretty well.
If you get too big, so sort of nine months to twelve months and older, then you are going to need
general anesthesia because the baby's going to be so big and there's just too big of a risk that
they'll move their head and get poked in the wrong place. So general anesthesia is typically for
these probings to open up that duct if that hasn't happened by the time that they're nine to twelve
months of age or so.
So in terms of my thoughts on this procedure, I think it has to be done because by18 months I don't
think it's going to correct itself. It sounds that there's probably a membrane issue and that's
going to have to be probed and opened up. If I saw a kid who still had that problem and I knew
that's what the problem was and the eye doctor said, "This is what I think we should do," then I
would be in agreement with that in a kid that I'm seeing in my office, medical disclaimer.
In terms of massage because you're going to come across this, one of the things that some baby
books will tell you to do is if you have a baby with this problem, is to take your finger along the
side of the nose and massage upward toward the corner of the eye, kind of like you're milking that
duct in reverse. That way if there's anything clogging the duct, it can come out. I have not had
much success with that doing anything personally. And in fact I think you do run the risk of
introducing infection with your finger, you run the risk of poking them in the eye and I really
could probably count on one hand how many parents I've had do that and then it got better pretty
quickly after they did that a few times. So I generally don't even talk about it much because in my
experience it just doesn't really work very well.
And then they've got some these extra tears around it, it's easy for some to bacteria to start to
grow in those tears and so if it's a clear drainage, you sort of leave it. If it's sort of like
sleepy in the eye and dehydrated tears like when you wake up in the morning and that's what your
baby has and you wipe it away with a warm cloth and then it's gone for a while, then that sounds
normal. But if you get the green gunk that's stringing between both eyelids and you wipe it away
and ten minutes later there's more of it there, then you've got infection on top of the blocked
tear duct drainage system issues. And then we usually either use eye ointment or eye drops
depending on the doctor's preferences and the age of the baby and that usually will take care of
the infection problem. But then remember you're just going to be back to the clear drainage or the
yellow sleepy like drainage. It's not going to make the whole problem go away. If it did, the we
would have done that from the beginning.
This is a common problem. We see it in the office quite a bit. So hopefully that helped. Again
that's blocked tear ducts.
All right. So I think we are all set, let's go ahead and take a quick break and then we'll wrap up
All right. Thanks go out to Nationwide Children's Hospital for helping us with the bandwidth this
week. Also to Vlad over at Vladstudio.com, please support him. And thanks to all of you for joining
us for another week of PediaCast.
Also thanks to my family. Karen's been really hard at work on the blog. She's entered National Blog
Posting Month, so she has a requirement now to blog every single day for the month of November. So
you can catch her at Pediascribe.com or just go to Pediacast.org and click on the blog link.
I do have a link in the show notes too, a blog post from last week that has a picture of our kids
in their Halloween costumes. I had mentioned this earlier on in the week, when at the very last
minute Katie decided she wanted to be an Antarctic researcher and my son Nicholas said, "I'll be
your penguin." And so in order to have a penguin, you got to be an Antarctic researcher because
there are no penguins in the Arctic right? You remember that? So maybe Antarctic. Anyway, my point
is that there is a picture of Katie and Nick in their costumes which were put together very quickly
on the Pediascribe blog and there will be a link in the show notes for you for that.
Also, it was off the site for a little while but it's back, the Audience Survey. If you go to
Pediacast.org and look in the side bar up toward the top right above the player there's a link for
the audience survey. And we are trying to get a lead sponsor for the program, we're in talks with
some different people and having demographics is really important. The main ones you know were age
and sex and education and income and all those demographic kind of information. This survey is a
pretty broad one and gets into your shopping preferences and all that. That's not as important,
just fill out the first few questions, if you get bored with it, you can stop. But the age and sex
and how much education you have and all those things, it does help us in securing a sponsor. So
check out the Audience Survey in the side bar.
Also reviews in iTunes, we have the poster page and of course please tell your friends and family
about the show.
All right, so everybody have a wonderful weekend. I'm going to rest voice until Monday. This is Dr.
Mike saying, "Stay safe, stay health, stay involved with your kids, and go Buckeyes."