Next Step Formulas, Type I Diabetes, Biters – PediaCast 078

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  • Next Step Formulas
  • Cold Milk and Colic
  • Type I Diabetes
  • Seizures and Brain Damage
  • Dealing with Biters



Announcer: This is PediaCast.

Dr. Mike Patrick: Bandwidth for PediaCast is provided by Nationwide Children's Hospital. For every child, for every reason.


Announcer: 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 78. Our Listener Edition for Friday, November the 9th, 2007. Cold milk, brain damage, and biters. And of course we have some other questions lined up for you as well.


Now, the observant listener will note that we didn’t have a show for a couple of days. No, I didn’t give up on PediaCast. We’re busy, really busy. And Wednesday night I took, Nicholas, my son, to an Ohio state basketball game and watched them loose. By two points to Finnley and small school in Ohio, I think it’s going to be a very long season. But anyway, we were there late and having some father son bonding time and the show just didn’t happened. And then last night I was on call and we were in this mini surge of virus so it was really busy and I didn’t get home till quite late. And so PediaCast had to take the hit. So, if you look at it this way, I’ll give you a chance to catch up. It gave me a chance to catch up a little bit on some rest.

So anyway, I’d like to welcome all of you, don’t forget if there is a topic that you would like us to discuss, it’s easy to get a hold of me. Just go to, click on the Contact Link and you can leave a message that way.


Or you can also email If you go that route, make sure you let us know where you’re from. It’s always interesting. And the voice line is open at 347-404-KIDS, which is 5437. And I know it works now because we have had callers. So, I apologize that the machine was turned off, OK. Sometimes I think I have adult ADHD, but that’s for another show. 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 to answer your questions right after this short break.



First up in our listener’s segment today is Shannon from Union Town, Pennsylvania. And Shannon says “Hi, Dr. Mike. Love the podcast. I was listening to I believe episode 73 where an optometrist listener made comment to your info on a past show about next step formulas for 9 to 24 month old. You mention this but you didn’t say what show it was in. I would love to go back and listen to that show sooner rather than later. I’ve listen to all shows, 35 to present, and I’m working on older ones one at a time. I have an 11 month old. I’m starting to wean so I would like to find it if possible. Thanks, Shannon”.


Well, Shannon, I’ll do one better for you. Let’s just go over this very quickly. Just sort of quick and dirty on my opinion on next step formulas. For the most part, very gimmick. The formula companies want you to continue being costumers and if you switched to vitamin D whole milk, then you’re supporting the dairy farmers and not the formula companies anymore. I’m just telling you the truth here. I’m not going to get any sponsors now who are in the formula business but I don’t want to lie to my listeners. There are some exceptions to that. Kids who are on soy formulas, who really have a cow milk protein allergy where they have blood in their stool or they have hives are really, really bad, eczema that you think is because of the milk and so you have them on a soy formula.


Soy milk is not as nutrient rich as cow’s milk is, in terms of the nutrients that are in it and the calories. So the soy next step formulas I think are a good choice for those kids because they’re getting something that’s a little bit more fortified than soy milk is. So that’s a little bit different. I mean there may be some kids who would benefit from the added fortification that goes into those step 2 formulas. But for your average kid, who is growing well and healthy and really doesn’t have any issues, transitioning them to formula to regular cow’s milk, vitamin D whole milk at 12 months of age is pretty much the standard. It works for quite a while, a number of years and will continue to be the recommendation, I think for most pediatricians.

So the step 2 formulas, it’s just a way for the formula companies to keep money in their pocket instead of the dairy farmers.


Now do you… Here is the thing with that, there is going to be someone you know who can say “Well, it has this, it has that”, but what they don’t tell you is having those, the extras that's in there doesn’t make a difference. Our kids are going to grow better, probably not. Again, I don’t have the any research to back that up. But I don’t think they have any research to show that’s it better. So I would save your money. The last I checked, vitamin D whole milk was still a little bit cheaper than the next step formulas. So I think in order for those to become something that's used more widespread, it’s going to have to offer a impact on parents wallets, so.


All right, moving on. This one comes from Dawn in Grace Lake, Illinois. And Dawn says “I find your podcast a while ago through the Manic Mommies podcast and now I’m a frequent listener of PediaCast as well. Thanks for all the time you put in to making the shows so informative for parents who do not have time to research these topics on their own. I really enjoy hearing about recent research. My question has to do with the breastfeeding. While I was still nursing, my now three and a half year old daughter, I used to give her my express breast milk straight out of the fridge or cooler bag without warming it up. My thoughts behind this included the fear that if I warmed up the milk she will begin to only want to drink it warmth from the bottle. This would leave me on the car or an errand for example, looking for a place to warm a bottle if I wasn’t planning to nurse. She readily accepted both cold milk from the fridge and warm milk while nursing. However, I recently heard from a lactation consultant that giving a baby, under six months, milk or probably formula for that matter that is cold, is hard on the digestive system and can cause colic".


"If this is true, I don’t want subject my baby, that is due in April to any discomfort that I may have cause my older child by giving her cold milk for convenience sake. I’ve done a bit of my own research online, but have not found any information from a reliable professional source on this topic. I would like to add that my daughter was a colicky infant but I know from listening to your show number 38, on colic that there really isn’t a definite cause in many cases. Thanks again, Dawn”.

Well thank you, Dawn, for writing in. Cold milk does not stay cold inside the human body very long. By the time it leaves the stomach it’s warm milk, right? It’s body temperature milk. So I don’t think it’s going to be hard in the intestines. Personally, if you have a kid who is on cold milk and they’re fuzzy and you warm it and they’re not fuzzy anymore and then you give them cold milk again, and they’re fuzzy. And you warm it, and when they drink the warm milk, they’re not fuzzy.


Well, then you may have a good reason to stick with warm milk. But I doubt that will be the scene for most. They’re going to be fuzzy with milk; they’re probably going to be fuzzy whether it’s warm or cold and not the milk. So, by all means give that a try and if you or anyone out there finds that every time they give cold milk, my baby is fuzzy, but when it’s warm, let me know. Of course, it could be a personal preference kind of thing too. Maybe they just like the warm milk better and they’ve learned that if I’m fuzzy, mom will warm the milk. So that’s possible too. But keep in mind cold milk is not really going to be cold in the intestines. Once it’s in the stomach, not long at all before it warms up to body temperature.

OK. Next we have Len in Plymouth, Connecticut. And Len says, “Hi, Dr. Mike. Thank you so much for your podcast. I’ve been listening for a few months now. And I found the information you present to be both educational and entertaining. I have a question about diabetes in children. My husband and I are both Type 1 diabetics, and I was wondering what the increased risk is to my daughter now 11 months old".


"I’m also been trying to find out when and how often infants in children are screened for diabetes. I know Type 1 does typically have a sudden onset that can even occur later in life, for instance, I was diagnosed at age 20 after about a flu and my husband was diagnosed at age 33. Perhaps routine early blood testing is not particularly beneficial? Pediatrician mentioned that diabetes is rarely diagnosed before the age of 3 and was wondering why that will be the case. Thanks again for the great show. I’m a fellow Disney fan and have to tell you that my iPhone is loaded with Disney podcasts but they have been usurped. PediaCast is now the first podcast I listened to. Len”.

Well thank you, Len. And I will definitely take that as a compliment. Before we start this conversation, let’s just review very quickly for those who are not familiar with the differences between Type 1 and Type 2 diabetes.


Type 1 is what we use to call juvenile onset diabetes and Type 2 was adult onset diabetes. But, it is true that there are adults who can develop Type 1 diabetes and it’s also becoming more and more true, unfortunately, that we’re seeing children particularly obese overweight children began to have Type 2 diabetes or the adult onset version. Now what happens in Type 1 diabetes is that the insulin production in the pancreas plummets. So your pancreas is not making insulin anymore. And without insulin, sugar remains in the blood stream. The glucose that can’t get into the cells where it needs. So the glucose piles up in the bloodstream and that’s why you get a high blood sugar. But the inside of the cells don’t have very much sugar, which the cells need to produce energy. And so the treatment for this is of course to provide insulin so that glucose can get from being inside the blood to inside the cells where it needs to be used.


Now, why does insulin production plummets. Well we think it’s an autoimmune type process where the pancreas is working fine at birth and at some point the immune system makes antibodies against certain parts of the pancreas and then you have a decrease in insulin production as those cells are destroyed by the immune system. And it takes some time for this process to get going. And that’s why it’s rarely seen in really young children. Now, I’ve been a PDM at relatively young pediatrician. I’ve been doing this for about 10 years now. And I’ve seen a handful of kids who were diagnosed with Type 1 diabetes before they were a year old. So, between like ten months and 12 months of age. I’ve seen maybe three or four kids like that. I’ve seen maybe somewhere between five and 10 kids who developed it sometime between age one and age three.


But the vast majority of them are going to be more kindergarten and early school age when this starts to happen. And again, because it takes some time for the immune system to destroy enough of the cells and the pancreas to make this happen.

Now, what happens with Type 2 or adult onset or now we’re seeing it more on kids, what happens here is your body is making enough insulin but the cells become less sensitive to insulin and so the body actually begins making more insulin but it still can’t do its job because the cells just aren’t responsive to it. And so again, the blood sugar glucose piles up in the blood. And you don’t get as much glucose going into the cells. And the cells need that glucose to produce energy. It seems to be that there is… We don’t understand this completely yet. But there is some mechanism by which being overweight and having a higher percentage of body fat causes the cells to become less sensitive to insulin.


So, initially the treatment with Type 2 diabetes is if it’s sort of a prediabetes. It’s diet and exercise and weight loss. And of course, there are also oral medications which increase the body’s sensitivity to the insulin and helps in that fashion.

Now, having said Type 1 versus Type 2, let’s stick with the Type 1 cause that’s what this question was about. And, is there a genetic factor at play? So, if you have two parents with Type 1 or juvenile onset diabetes, that’s insulin dependent, what are the chances that your child is going to have it. Well again, genetics does come into play if there is no parent with Type 1 diabetes, so this would be just the general population. The risk that your child will develop Type 1 diabetes is about 1 to 2 percent at some point during their life. If mom has Type 1 diabetes, then the rate goes, about double up to 2 to 4 percent risk.


If the dad has Type 1 diabetes, the risk goes up to 6 to 8 percent. And if both parents have Type 1 diabetes, then the risk goes to 10 to 25 percent. So if both parents have Type 1 diabetes, there is about a 1 in 10 to a 1 in 4 chance that your child will end up having diabetes at some point. Now the age of parental onset is important. The younger a parent is at the time of diagnosis, the greater the risk for the child also developing the disease. So, in Len’s case, both were adults when they developed type 1 diabetes. So that makes their chances a little bit less. And also, I would… I’m moving on with this. One thing that I would say is if I have a kid with both parents with Type 1 diabetes, personally, I would probably screen them every year. Cause you do want to catch this as soon as you can and with 10 to 25 percent risk is a substantial risk. So, I would probably screen them every year with the serum glucose and a hemoglobin A1C. But that’s my personal preference. It doesn’t mean if your doctor doesn’t want to do that that it’s the wrong thing to do, plus in between those yearly screenings, I would screen right away, and maybe even do glucose tolerance test if there were any signs or symptoms of diabetes such as polydipsia, which is thirsty all the time or polyuria, which is peeing frequently. Or weight loss, persistent vomiting, signs of dehydration and things like that.

I do have a link in the Show Notes from the American Diabetes Association that talks all about the genetics of diabetes. It’s got some interesting facts and figures and information in there. So, we’ll put that in the Show Notes and you can take a look at that.


OK. Moving on, this comes from Sarah in Hobart, Tasmania. And Sarah says and by the way hello to all of you in Tasmania.

Sarah says “I was wondering if poorly controlled seizures can cause further brain damage and if so, what kind of seizures. If the child is having observable non-convulsive seizures such as absence, atypical absence, vocal complex partial, myoclonic seizures most of the day, could it be causing damage?”

Very good question, Sarah. And there are lots of different types of seizure. We’ve talked about generalized tonic-clonic seizures where both arms, both legs are stiff and shaking. We’ve talked about focal seizures in the past where it’s just one part of the body that’s seizing. And then you have you’re absence seizures. These are the kids who… They’re usually young children and they’re working and all of a sudden they just sort of staring into space and they’re not there for a few seconds. And then they’re back. The parents who have kids with this types, also know petit mal seizures, know what I’m talking about.


And then you have complex partial seizures which are an interesting thing. Not only is the motor areas of the brain involved, but they may have also vocal ticks that are associated with it. They may smell funny smells because the smelling center of the brain is having a seizure. And that progresses to other part of the brain and body. So they’re complex, that’s why they’re called complex partial seizures.

So, the question is if you have any of these kind of seizures, and especially if they’re frequently occurring, could they cause brain damage. Well, seizures never cause brain damage. We know that. Brain damage can cause seizures but seizures do not cause brain damage. Now, we’ll say this though, if you have a kid with frequent seizures, it can affect their development. But that’s not really brain damage. It’s just that if they’re just having seizures all the time, then they’re not having the sensory exposure that you need to have normal development.


So you do want to try to keep these kids from seizing not so much because you’re worried about brain injury but because it’s going to interfere with them being a normal child and with their development. So, that’s important.

OK. And finally, we have Rebecca in Graceville, Tennessee. And Rebecca says, “Dear, Dr. Mike. I appreciate your great show. I know you can help with me with my problem. I understand many parents have experienced this especially in a daycare or preschool setting. My 20 month old son has been bitten three time by a little girl at his learning center. From speaking with his teacher and the director of the center, the biter has been biting other children and had a biting problem last year. While visiting the center, the child bit another little boy to get a toy. I know they have tried shadowing with the child as much as possible, but we all understand that they have a lot going on. In fact, there were two other adults in the play area with the children when I was visiting and the biting occurred".


"What is your advice as a pediatrician and parent for me, a parent of a bitee. I think we may run the risk of my son turning around and biting especially since he has been bitten. Is this is correct? Please help, Rebecca”.

Well, if it’s my child that was the bitee, I would certainly put up a fuss. I mean, if there is a kid who is a known biter and he’s behavior is disrupting the rest of the class and putting other children in danger, my opinion would be that that child should be removed from the preschool. Because this is an issue. And it’s a safety issue. Now dealing with the biter, this really for anyone who is worried that their child is going to become one or if you child is one, this is how I will deal with that, and this is probably not how the parents are dealing with it for this kids with the problem is because this sort of thing usually works. What I would suggest is you basically deal with it like you would with any other bad behavior".

If they are young to the point where they don’t really understand good versus bad, I’m going to use like 18 months as sort of a cut-off there. But certainly it’s going to depend on the kid. But the younger kids, you’re really better off I think just distracting them. So if they’re being a biter, you certainly don’t want the biting to get them what they want. Because you don’t want any positive reinforcement. But at the same time, they just don’t have that cognitive ability to be able to distinguish between good and bad yet. And so probably your best bet is just to distract them, to get them involve into something else. Now, these kids that we are talking about here a little bit on the older side. And I think do understand good versus bad, right versus wrong. They’re beginning to understand that. And they have to know that biting or whatever behavior it is that you are trying to get rid of, is not acceptable. And for some reason this kid who is the biter, they are probably at home, they probably bite, they probably get what they want when they biting. They basically learned I get my way, I get the toy, I get to do whatever it is that I want whenever I bite. And so you have to definitely stop any rewards that they get when they’re biting.


Never let that be gets them what they want. And then, way we’ve always handled this with our own children when they were at this age, or if they… In my practice, when I have parents who come and say my kids are doing this and that and it’s a bad behavior, this is the advice that I usually had out. And that is to basically let the kid know what the right thing and wrong thing is. So there is no question about it. And then when they do the behavior that you don’t want them to do, every single time, no exceptions, they get and immediate time out. And the time out… I think a nice place is back against the cabinets on the kitchen floor. You can set the kitchen timer. And it’s basically a minute for each year of age. So for these kids we’re talking to so a couple of minutes is a long enough time.


Now most of these young kids aren’t going to sat there. They’re going to get up and in that case, you hold them down for the two minutes. You don’t want to hurt them but an adult can hold down a two year old without bruising them and without causing them physical pain. And they get upset and they squirm around. But you basically hold them still. I wouldn’t look at them. No talking to them. Just two minutes of ignoring them and holding them there if they’re prone to getting up. And when the two minutes is over, great big hugs, I love you, that’s not acceptable behavior. OK, you might want to put it in different terms. No biting, we don’t bite. Biting is bad. And give them a big hug and let them go on. Now if immediately they bite, bang, you do it again. You do the same thing again. And there maybe days when you have to do it five or ten times or more. But I guarantee the next day you’ll do it three or four times. And the next day after that, maybe one or two times. And eventually they get the picture, that I don’t like this time out thing, I don’t like being held down, I don’t like being ignored, and so and I know that it’s going to happen every time I bite.


So now you have some negative reinforcement. But it’s not painful, it’s not abusive negative reinforcement. And it just helps them to learn that this is not an acceptable behavior. And again you can do this with your own children at home. It’s much more difficult to ask the preschool to do this and so this is why you want to be working with your kids right from the beginning to let them know what’s acceptable and what’s not acceptable because you’re going to have far less issues in preschool type settings if they are ready and conditioned for what is right and what is wrong.

But as a parent of the bitee, I’d say the biter, the parents need to get their act together or the kid should be removed from the room because the child is a safety hazard for the rest of the school. That’s my opinion.

All right, let’s go ahead and take a break and warp up the show, we’ll do it right after this.




All right, as always, thanks go out to Nationwide Children’s Hospital for providing the bandwidth sponsor. Also, Vlad over at for contributing the artwork that we have at the site and it the feed. And of course, thanks to all of you and thanks to my family. Thanks to all of you for understanding that I needed some family time for a couple of days and some office time too. Just very busy.

Also don’t forget we do have the audience survey at the website. It’s in the side bar up at the top. The audience survey is just nice. It helps us to get some demographics information. So if you haven’t done that yet, doesn’t take too long. The PediaCast shop has some t-shirts available which you can use to help spread the word about the program. We also have the poster page and of course word of mouth is always helpful.


We’re stuck at 140 reviews in iTunes and my goal is to get the 200 reviews by Christmas. So, that’s my Christmas present. 200 reviews in iTunes, please. So if you haven’t had a chance to stop by iTunes and give us a review that will be helpful. So, I hope everybody has a great weekend, and hopefully we’ll get out of full set of five shows next week. We do have a special guest next week that I’m really excited about. Dr. Bob Sears of the Sears' family of pediatrician fame. He has a new book out called “The Vaccine Book”. And he is going to swing by next week and talk to us about that book. So I’m really excited about that. So we have that to look forward to and of course, we’ll also answer some of your questions and talk about some research things. So, until Monday, this is Dr. Mike saying stay safe, stay healthy, and stay involved with your kids. So long everybody.




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