Atelctasis Vs Pneumonia – PediaCast 085

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  • Is it Atelectasis or Pneumonia?
  • What is a Hydrocele?
  • Inhaled Steroids in Winter
  • Milk Protein Allergy
  • Color Blindness




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's your host, Dr. Mike.

Dr. Mike Patrick: Hello everyone and welcome to PediaCast it is episode 85 for Wednesday, November 21st, 2007. Atelectasis, hydrocele, color blindness. Couple new words for you there I bet, but they're interesting diseases that you may not have heard of, well one of them is not really a disease, it's more of a something that happens to your lung, we'll get there, I'm jumping ahead of myself.


And of course we have some other listener questions for you as well, so we'll get to those in just a bit. As we heading to Thanks giving, I wanted to ask all of you, have you taken the time, just even 5 minutes to think about the people that you are thankful for this year? I don't want to get too philosophical, but I was thinking about this driving home the other day, I wasn't listening to any podcast or music, it's one of those drive's, or commute's when you just sort of let your brain do some free thinking, and I came to realize, it's so easy to move through life without acknowledging those who we often take for granted. I mean you know who these people are, they're people who make a real difference in our lives and ones' that we would miss most if they'd suddenly weren't there anymore. And of course for me, I'd have to be my immediate and extended family, all of my friends, co-workers, staff at the office, people who'd do little things for you here and there and you just, You know often times get chance to thank them or be thankful for them. And of course the parents who place their trust in me at the office, and the children who touch my life everyday at work.


And actually those of you out in the audience right now who meet up with me most weekdays right here on PediaCast, I'm very thankful for you too, so in the spirit of Thanksgiving, just coming up tomorrow I just want to say that I'm truly thankful for the time that all of you take to listen and interact and spread the word about PediaCast, so who are you thankful for this Thanksgiving season? Think about it please, five minutes, it's all it takes and whoever it is, have you made a conscious effort to let them know how much you appreciate them? We don't do that enough and I'm just as guilty of that as everyone else, and of course, let your kids know who you're thankful for so they can learn to appreciate that concept for themselves.


All right, so what we're going to talk about today, well, atelectasis, this is something that happens in the lung and a listener post a question, what is it? Because I saw it on a chest x-ray report of their child and how does it relate to pneumonia? So we're going to talk about that. What is a hydrocele inhaled steroids in winter time, question about milk protein allergy and then we're going to talk a little bit about color blindness.

Now don't forget if there is a topic that you would like us to discuss, if you have a question, concern, request, have a lead on an interview or great news story, any of these things, just go to the Contact Link at and let me know, or you can email, or call the voice line at 347-404-KIDS, just 5437. Okay don't forget 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, be sure to call your doctor and arrange a face to face interview and hands on physical examination. Also your use of this audio program is subject to the PediaCast Terms of Use Agreement which you can find at, and with that in mind, we will be back with answers to your questions right after this short break.



First up we have Jennifer in Tallahassee Florida, and Jennifer says, "Dear, Dr. Mike. To begin with, I have to tell you how much I love the show, it's so wonderful for a medical person to truly care enough to explain things in a way normal people can understand".


"This actually brings me to my question, my 21 month old son had a chest x-ray due to a horrible cough and troubled breathing, they told me immediately it was not pneumonia, but they just sent me a report that says atelectasis versus infiltrate in the medial segment of the right middle lobe. It goes on to say, the person writing the report would favor atelectasis, what is atelectasis? Is it common? and does it require treatment? The doctor treated my son with Zithromax and he seems fine now. The chest x-rays were very traumatic for my son, were they really necessary? I would appreciate any insight you can offer, thank you so much for all the time and care you put into PediaCast, all your listeners are so grateful".

OK. Well thank you for the question Jennifer, and this actually a good question, it's a good question because this is something that we do see on chest x-ray reports quite a bit. Let's just talk about what the report actually said.


The chest x-ray report said, atelectasis versus infiltrate in the medial segment of the right middle lobe. Let's break that down into some words that you can actually understand. The medial segment of the right middle lobe, so where are we talking in the lung? Well the right lung has 3 lobes, an upper lobe, a lower lobe, and a middle lobe, and the left one actually only has 2 lobes, an upper and the lower, and then this little tiny thing called the lingula which is kind of like the middle lobe in the left lung. So the right middle lobe is the lobe we're talking about, and the medial segment, that means just the part of the right middle lobe that is closest to the mid line of the body, so if it were the lateral segment it would be toward the chest wall, toward the outside or the side of the body, but this is going to be more toward the middle of the spine where the heart is, so that's where we're looking.


Now what is it that the radiologist is seeing there? Well they think it is either atelectasis or an infiltrate. Now an infiltrate is just a fancy word that would mean some fluid there, and in kids, the most common cause of an infiltrate is going to be pneumonia. Now there are other causes for infiltrates in the lung which going to just fluid in the lung, and kids, it usually going to be puss infection. But there are other things that could do it as well, and you think of more about those in adults, but it is possible in kids, tumors, lung cancers could cause an infiltrate, also heart failure could cause an infiltrate. So I mean there are other things, but mostly we're talking pneumonia here. Now atelectasis on the other hand is basically an area of the lung that is partially collapsed. Now before you panic about what that means you have to remember that every time you take a breath, your lung partially collapses, right? I mean if your lungs are a sack filled with little tubes that are full of air, when you take a deep breath in, those tubes filled with air, but when you breath out they collapsed.


So when you look at a chest x-ray, let's talk very briefly about how x-rays work, you've got this machine that emits x-rays, they travel through the body and then land on x-ray film, and the more x-rays that get through equals more penetration of the film, to more development, more darker spots on the film, and less x-rays getting through, so this would be areas where you have bone, or muscle, those are going to have less penetration getting to the film because the body is stopping those x-rays, and so those are going to show up as lighter areas on the film. So basically when you're looking at an x-ray, you're just seeing shades of black, grays and whites and it just shows you how well the x-rays penetrated the body in that area. Now if the lung is full of air then a lot of x-rays are going to penetrate, and you're going to see a black areas where the air is, and so, if you have a lung that is fully inflated you're going to see a lot of black.


Now if you have a lung that is partially collapsed or deflated in areas, then you're going to have the air tubes kind of smoosh together because they are not expanded and filled with air, and so you're going to have sort of a more of a mass that the x-rays is going to stop the x-rays. It's going to look a little bit different on the x-rays, so you're going to basically see sort of some shadowing, and the question is, is that shadowing fluid? which in which case would be an infiltrate, or is that shadowing just area of lung that is not filled with air? And it can be difficult to tell the difference between those two, and this is why as an adult when you get a chest x-ray, they say take a great big deep breath and hold it, because they want your lungs fully expanded, but you know, you tell a 21 month old to take a deep breath and hold it, they're not going to understand what you're talking about obviously.


So you do your best to take the x-ray when they're taking a breath in, but, I mean that's pretty hard to do, so if you happen to catch them during expiration, or at some phase in the midst of expiration, or even in the midst of inspiration, you're going to have some areas of the lung that are partially collapsed, and it can look like fluid, and this is something in pediatrics that we do at a lot because parents will take their kids to an emergency department and invariably it's not at a children's' hospital, it's a community hospital where the E.R doctors see a lot less kids than they do in an emergency department of a children's hospital. And if you're an E.R doctor and you're looking at this film, and you can't decide whether it's an infiltrate or whether it's atelectasis, you're probably going to air on the side of being a more cautious because you'd rather over treat when there's not really a pneumonia there, than to say, ohh it's nothing, and not treat and then the kid gets worse, and then you're in trouble.


So, I think a lot of pneumonia in emergency department gets over called, and really, it's just atelectasis on the film. So how do you tell the difference between the 2? Well an experienced radiologist is going to be able to have a better idea of if it's fluid or if it's atelectasis or partial collapse. But I think the most important thing is to look at the clinical picture, and this is where our skills as physicians, sort of the old fashioned skills come in to play, you listen, and if you hear something that makes you concerned, and it happens to be in the same spot where you see that on the x-ray, then you're more likely to think it's a real infiltrate. So if you're listening and you hear sounds that sounds like pneumonia, and it happens to be where the radiologist saying infiltrate versus atelectasis, well its probably going to be an infiltrate if you hear something there. So atelectasis doesn't have really any noise associated with it because it's just something the lung normally is doing.


So you really have to co relate what you're seeing on the x-ray clinically, now you’re asking a couple other questions, when are chest x-rays necessary? They're necessary when the doctor who you are entrusting with the care of your child says you should get one. I don't get a ton of chest x-rays, I mean mostly we go by our clinical exam, but if you have a kid who you don't hear a pneumonia and they have this unexplained fever that's lasting for several days and you can't find any other source, certainly for those kids a chest x-ray is a good idea. You know if you have a kid who has recurrent wheezing and they'd never had a chest x-ray, it's probably not a bad idea to get one. First time wheezers, especially if they're really young, it's probably not a bad idea to make sure their heart size's normal. So, there's a lots of different clinical scenarios where you'd want to get a chest x-ray, and there's plenty of cases where you'll have one doctor who would feel more comfortable getting one and the same situation, another doctor wouldn't. I mean there's more than one way to do things and it doesn't mean that one way is right or the other.


Now I will say, if your 21 month old found getting a chest x-ray to be a traumatic experience, tough cookies. Life is full of traumatic experiences and your 21 month old will get over it. So I mean we don't want to cuddle our kids to the points that we refuse medical treatment that our doctors think is necessary because it's a traumatic experience, believe me there are many more experiences in the world of pediatric medicine that are much more traumatic than a chest x-ray. And you know for many 21 month old, just going to bed at night is a traumatic experience. All right moving on to Lissa, Lissa says, and Lissa by the way, you forgot to say where you're from, so if you do go to email route rather than to contact page, make sure you'll let us know where you're from. Lissa says "Hi, I was wondering if you could talk about a hydrocele in young boys. My son was diagnose recently with one at the age of 5, is suddenly appeared along with a heart murmur".


"A pediatric surgeon recommended a hernia surgery to repair it before he ended up with an actual hernia, without breaks of MRSA, which is methicillin-resistant staphylococcus aureus, and the risk of general anesthesia, I run to get a second opinion from a urologist. The urologist supported my decision to avoid surgery because he explained, its a same surgery whether it's done now or if he ends up with the actual hernia, am I making the right decision? I don't want my fears of putting my son into surgery that jeopardize his health at a later date, I also thought hydrocele might be an interesting topic of discussion for your show, love the podcast, Lissa".

All right Lissa well thank you, first let me say hydroceles aren't going to have anything to do with a heart murmur, so we're not going to talk about heart murmurs today. So let me just focus on hydroceles, what is it? Well in its simplest form, a hydrocele is basically fluid in the scrotum that surrounds a testicle.


Rises from a communication or a canal that goes between the abdominal cavity and the scrotum, now just to give you a little bit of background, the testicles or testis develop inside the abdomen when baby boys are still inside their mom, and then somewhere around the time of birth, maybe a little bit before birth, maybe couple weeks after birth, usually about the time of birth the testicles are descending from the abdominal cavities, so from inside where the intestines, and the kidney, and liver and all this is, it's inside that cavity and they migrate down through a canal into the scrotum and then after they get there, this canal is suppose to close. Now if it remains open the testicles can become more tractile and can go up back up into the abdominal cavity, usually they don't go all the way back in, occasionally they will.


But usually they just kind of hide up inside that canal, if the canal stays open or they don't do anything, now the problem with this canal being open is that if intestine migrates down into that canal you have an inguinal hernia, that's what a hernia is, it's when intestine starts to go down into this inguinal canal and the problem with that is that, it's a tight fit and if the blood supply of the intestine becomes compromised they can kill part of the intestine and that can be a life threatening issue. So that's called incarceration of the hernia. So a hernia, an inguinal hernia is just this canal that was left open, the body didn't close it like it should, and I don't have statistics on how often this happens, but it's pretty often that it doesn't close. So those kids are going to be in an increased risk of a hernia if they have the canal open, now that would not, in most circles, that would not be considered a reason to close the canal if they've never had any evidence of a hernia, because there is, as you mention, risk associated with general anesthesia.


So, and with surgical procedures in general, with bleeding and infection and that sort of things, so, if you have evidence of the canal is still open because you have testicles that tend to go up into the canal, or you have a fluid that's coming from the abdominal cavity down to the canal into the scrotum, and that's the hydrocele, then that's make you think that the canal was still open, but most doctors would say that you wouldn't do surgery for that unless they actually were getting hernias. Now again I can't call for you medical advice without seeing your child, but talk to your pediatrician about it and I think that it's commonly accepted to only do surgery when it's truly necessary to do it. Now, if you had, a hydrocele too, by the way is going to be most common after birth because that's when most of these canals are still open.


And it's kind of interesting when you see a kid with a hydrocele, basically the scrotum on one side or both sides is very large because it's filled with this fluid and it does make you wonder if they have a hernia, and so one of the ways that we use to tell the difference between just a plain hydrocele and a hernia, it's kind of interesting, you turn the light out and you get a flash light and you shine it through the scrotum, and if it's fluid you'll see a shadow of the normal sized testicle and then basically the rest of it just lights up like a nice pink color because you're just shining the light through some fluid. If they have a hernia, some intestines that's down there you're going to see a dark mass, or if they have a very enlarge swollen testicle, you can go along with mumps for instance, you're going to not see, it's going to have a different pattern when you shine the flashlight through it. You get some crazy looks from parents when you do this I can tell you that, but it is one way to tell, and I'm not telling you do that at home, don't turn the lights out and get your flashlight out and look at your baby's scrotum.


Don't say Dr. Mike told you to do that, I'm just explaining what we do in the office. Now, also in kind of like with the infiltrate in the lungs, there are other things that can cause fluid around the testicle and especially on older kids you worry about them a little bit more, a torsion of the testicle where the testicle kind of twist on itself and can cut off its blood supply that can cause a swollen scrotum. Tumors in the scrotum, testicular cancer, that can also cause fluid around the testicle as well, and viral and bacterial infections too. So that means there are other things that can cause fluid to be there and again this just point out that you really ought to have your doctor take a look at it. And then who's opinion, you know, you got a pediatric surgeon telling you do one thing and the urologist telling you to do something else, I'd say talk to your pediatrician, that's what primary care doctors are for and they maybe able to help steer you in the right direction with that.


For more information on hydrocele I found a great site at the Lucile Packard Children's Hospital at Stanford and we will have a link to that in the Show Notes. Okay moving on to listener number 3, this comes from Kristy in Boston, Massachusetts, and Kristy says, "Dear Dr. Mike, thank you for answering my asthma question in such depth and detail, I really learned a lot about my son's illness and how the medications work. I've had my parents and my husband listened to that podcast as well, I have a quick follow up question, you mention in a recent show that steroids can reduce the body's ability to fight infection, if that's the case does daily Pulmicort in the winter make a child more susceptible to cold viruses? I'm wondering, is my son's pediatrician is taking a wait and see approach to decide whether to put him on preventative Pulmicort this winter, thank you again for your great service".

Good question Kristy, inhaled steroids, remember, they're going to work at a level of the bronchial tubes, and so systemic steroids in other words, steroids that you get by mouth or through an I.V that distribute to the entire body, they're going to have a much more profound effect on the immune system in interfering with its ability to work than an inhaled steroid is going to.


Now, it may have a trivial effect on your immune system at the level of the lungs, but if you need it, you need it, and inhaled steroids definitely do a great job by reducing bronchial inflammation, which the inflammation of the inside of the airways is what causes the wheezing noises that we hear, so if you decrease the inflammation in the airways, then you're going to have a lot less problem with breathing. So it's one of those things that the benefit, if there's a trivial risk of an increase in viruses because you're on an inhaled steroid, I think for kids with asthma the benefit of preventing inflammation and wheezing far out ways any small risk that you have on the immune system.


But you really don't get a lot of whole body steroid exposure with inhaled steroids like you do with Prednisone, or Prednisolone, or I.V steroids, those are going to definitely zonker your immune system a lot easier and with a longer effect and more strongly than inhaled steroids. So inhaled steroids, I'm all for them for kids with asthma.

Okay listener number 4, this comes from Shawn in San Marcos, Texas, and Shawn says, "Dear Dr. Mike, first I'm a mom, my name Shawn throws people off, so I’d like to clarify, second, love the show, I found it shortly after the birth of my second child this past May, it's been useful on providing general knowledge and ideas that help me understand more aspects of my kid's development, also I like to comment since approach connected to research when it comes to making suggestions so much more comforting than some of the paranoia inducing advice thrown at me since becoming a mom. On to my question, my 5 month old daughter is diagnosed with a milk protein allergy when she was about 7 to 8 weeks old, since then she has been eating Similac Alimentum with great results.


"However, her weight has continued to drop monthly, from the 75th percentile at birth to the 10th percentile at month four, of courses is being closely monitored by our pediatrician and she has no other apparent developmental concerns. At five months her weight jumped back up to the 25th percentile which is a good sign but now that we're staring solids, she is showing less interest in the bottle and more on the food, again, this is all being closely watched by our pediatrician and I'm wondering if you can speak more about milk allergies and whether or not this relates to weight gain issues. Thanks for any information you can offer".

Okay, well again we're talking about the immune system here with the cow's milk protein allergies, and basically the immune system recognizes cows milk protein as being foreign, it makes antibodies againts the protein, and then the next time the protein is ingested, those milk proteins are attacked and that can cause a bowel inflammation, blood in the stool, it can also cause skin rashes and hives in some kids.


Now, untreated milk protein allergy, as I said leads to inflammation in the intestine and can lead the blood in the stool, and this inflammation can lead to some malabsorption so the intestine can't do its job but absorbing nutrients as well because of the inflammation that's there, so malabsorption then can lead to poor weight gain, so in the sort of a round about way, a cows milk protein allergy that is going untreated can certainly interfere with growth to some degree. Now as you mention there are plenty of alternative formulas with no cows milk protein in them, and the Similac Alimentum that your baby's on is one of them. Now these formulas do have the same caloric content, so the same concentration of calories and nutrients as cows milk formula has, so really growth should be fine after you switch. Now it does take some time for the inflammation to resolve, so once you have a kid that's been diagnose with the milk protein allergy, switching the formula, it's going to take a few weeks for the inflammation in the intestine to completely go away.


So if you have a kid with a milk protein allergy and they're having poor growth and you've address the issue, you might have to look for other causes for the poor growth. Now how many kids do we see who do not have milk protein allergy who kind of jump around a little bit on their percentiles on their growth chart? Well, lots, So you do see some kids that start out in a really large, the 75th percentile, they slowly starts to drop and they go back up a little bit and so, as you said your pediatrician is watching it carefully and that certainly what I would do as well, you also have to remember to look at the family pattern, grandma says, oh yeah your daddy, he was a huge baby, and then he thinned down, I mean if people in the family are saying, yeah my kid did too, then it's probably just your family pattern of growth because those certainly come in lots of varieties.


On the other hand, if your pediatrician's concerned because of weight drop, it doesn't sound like you can blame calories as the issue if they're getting a lot of the Similac Alimentum and doing well with it, there probably is something else going on. But in your case it sounds like the growth is back on track, it went back up to the 25th percentile, it doesn't sound like it's anything to be too concerned about

Okay, let's move on, we have one more question, this one comes from Michelle in Portland, Oregon and Michelle says, "I think my son who just turned three might be color blind, I have an appointment with an eye doctor for a screening later this month, could you talk about color blindness and how parents might recognize it, and at what age screening should start? I do not know if any history of color blindness in my mothers' family, but we have had a few generations of small family, so it might not have shown up since my family came over from Norway in the 19th century".


Okay, so let's talk a little bit about color blindness, first of all just to give you a little bit of background with this , the normal human retina which is the back part of the eye, contains two different light sensitive cells, okay, they are the rods and the cones, you probably remember this from some biology class way back when, but just to remind you, the rods are going to be active in low light levels, and they're sensitive mostly to shades of gray, and if you just think about your night vision, you know, those were your rods in action. Now cones are going to respond more in normal daylight conditions, and there are three kinds of cones and each one is maximally sensitive to a different wave length or color of light. So you have one group of cones that are the short wave lengths and those are going to be mostly sensitive to blues, and then you're going to have medium wave length group of cones which are sensitive to yellows and greens, and then the long wave length which are going to be sensitive to the darker yellows and into the reds spectrum.


And different colors are recognized when different types of cones are stimulated to different extents, so it's kind of like mixing paints together, or mixing different color lights together, you basically the proportion of cones that are stimulated in the certain area and the degree to which each type is stimulated determines which color that you see. Okay, so what causes color blindness? Well what causes it is most usually it's a genetic mediated or inherited disorder with the photo receptors or the cones that is present at birth. Now you can have an acquired color blindness as well, from damage to the retina or the optic nerve or vision areas of the brain, so after trauma or tumors or increased pressure in the eye, that can affect color and that would be an acquired color blindness.


But what we're really talking about here which is much, much more common is going to be the genetically mediated or inherited types of color blindness. Now there are several types of inherited color blindness, and this actually gets a little bit complicated, and I don't want to inundate you with details on this, but there is couple things that sort of interesting, so I do want to go on the depth just a teach, okay. We can divide the types of color blindness into three types depending on how many systems are affected of this cone systems, so one would be monochromacy, which is failure of 2 or 3 of the cone systems, if it's all 3, then they can only see with the rods and so you get complete color blindness, which is very rare but that's something called rod monochromacy which there's just rods and no cones, so it's total absence of color discrimination, I mean everything is just in shades of gray.


Now, again this is rare disorder except, this is the whole reason I'm talking about it because I just find it kind of interesting, there is an island in the western pacific called the island of Pingelap, and in Pingelap nearly 1/3 of the island is affected with this rod monochromacy or total absence of color discrimination, and the story goes that back in the 18th century there was a big storm, typhoon type storm that devastated the island, and one of the few remaining male survivors carry the gene after this disease, and I'll let you form the remainder of the conclusion yourself about why now 1/3 of the population is affected by this, so, I think it's kind of interesting.


You can have a cone monochromacy too, were rods and cones are present but only one cone system is working, and most commonly this one is going to be the blue cones that are still working, and so these people see things in shades of gray and in blue hues but they don't see much yellow, green or red, and again this is very rare, okay this is not the typical color blindness that most of us hear about. Okay and then you have a dichromacy which is just failure of one system of cones which is also not very common, and then you have, this is the one that's really common is called anomalous trichromacy, and what this is, is all of them work, it's just that they don't work quite right, okay, really I should say, you shouldn't even put it that way, they just don't work like most people's work okay? And this are the ones where they can have problems differentiating between either blue and yellow, which is less common form, or the most common form of all is some trouble distinguishing between red and green because the two sets of cones that do, green and yellow, and red and yellow, their sensitivities are off a little bit and they just don't work like they do in everybody else.


And this affects 7 to 10 % of of men, so it's pretty common, I mean almost 10% of the population of men is affected by red-green color blindness and again this is where the cones, the medium wave length cones which look at yellow and green, and the long wave length which look at yellow and red are not functioning properly and so it's hard to distinguish between those 2 colors. Now why in the world would it affect men more often than women to such a great extent, well the reason is because these are what we call sex link traits, they're on the X chromosome, the genes that determine this are on the X chromosome. If you remember back again from high school biology, women have 2 X chromosomes and men have 1 X chromosome and these are recessive disorders, so in order for a woman to be color blind they would have to have both recessive genes, one on each of their X's that they inherited from their mom and from their dad.


Where for men, because you have an X and a Y, you only have to have 1 copy of the defective gene which would always come from your mom, which is why the listener had asked the question and said they looked at the mom side of their family, because that's where the X comes from, the Y is coming from dad, so this is going to be more common in men because they only have to have one copy of the defective gene to have it, where women have to have two copies of the defective gene and it's going to come from mom because men always get their X chromosome from their mom. So that's the reason that you see it more often in women, okay but enough of genetics okay? This is not a genetic lesson, the next part of your question was, how do you tell if your child is color blind?


Well you can't until your child can tell you what it is that they're seeing, there's no way to look at the back of the retina and tell whether there are defects or not, there's no EEG or brain wave test, nothing like that, the only way you can tell is to have your child tell you what they're seeing. So color confusion is pretty common in toddlerhood and early childhood, I mean, always a comprehensive exam is important if you're worried about your child's eyesight, but don't think you're going to take your kid to a pediatric opthamologist when they're an infant and they're not going to be able to tell you if they're color blind or not, it just doesn't work that way. Now the classic test for color blindness is called the Ishihara test, you probably seen this before, you've done them before when you go to your eye doctor. Basically they're circles with lot's of little dots that are different colors they tell you like, okay what number do you see, and you have to be able to tell like red and green apart in order to tell what number is in all those dots.


Now most of this do use numbers and so there are adaptations that are in existence that you can use for preschool age children that'll have different shapes or may have squares, or stars, or circles, or picture of a boat, or a bulldozers or something, or they'll have a picture of boat but then above it there'll be a picture of a boat, a bulldozer, a fire truck, and something else and they basically tell the kids, hey, look at this colored ones and point at the picture you see in the color dots. So there's a way to do it but they have to be old enough that they can point out pictures and understand it and follow directions. If you like to see some examples of this, there is an optometrist in Gulf Breeze, Florida by the name of Dr. Terrace Wagner, and he has a website that does have all of these different tests for color blindness, both the traditional ones with the numbers, with the color dots and then the adopted ones for preschool kids, those are all on there as well, and of course we'll put a link to that in the Show Notes. All right we are running way over because I've just been going off on tangents right and left, so we better take a break and then we will be back to wrap up the show right after this



All right, as always thanks go out to Nationwide Children's Hospital for providing the bandwidth for this program, also Vlad over for providing the artwork for our website and feed, and of course thank you to all of you. Karen in the PediaScribe blog, she takes a trip down memory lane here recently, she takes a look back at her first 10 months working on the PediaScribe blog, it's kind of interesting to see the evolution of the blog.


It started out as a weekly column that I did before the blogsphere is really a big thing and Karen took it over and basically has done much, much, much, much, much more with it than I ever did, and really she's done a great job, and lot of people have actually found PediaCast by first finding her blogs. S0 welcome of course to all of you, and then from my stand by listeners who've been with me for a long time, I'm sure that a lot of you've gotten something or another out of her blogs. So anyway she takes a trip down memory lane and looks back at her first 10 months of blogging, and of course we have a link to that in the Show Notes. Don't forget that iTunes reviews are most helpful or standing right around 150, and again I would love to get the 200 by the New Year.


So if you haven't taken the time out, it only takes 10 minutes of that to give us a review in iTunes, we would be so appreciative. The poster page is available at the website as is the PediaCast shop, and of course thank you for always telling other parents, family and friends about PediaCast. We're going to take a couple of days of break for thanksgiving but we will be back on Monday and until then, this is Dr. Mike saying stay safe, stay healthy, and stay involve with your kids. So long everybody.


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